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Accident and emergency (A&E) departments experience a secondary peak in patient length of stay (LoS) at around four hours, caused by the coping strategies used to meet the operational standards imposed by government. The aim of this paper is to build a discrete‐event simulation model that captures the coping strategies and more accurately reflects the processes that occur within an A&E department.

A discrete‐event simulation (DES) model was used to capture the A&E process at a UK hospital and record the LoS for each patient. Input data on 4,150 arrivals over three one‐week periods and staffing levels was obtained from hospital records, while output data were compared with the corresponding records. Expert opinion was used to generate the pathways and model the decision‐making processes.

The authors were able to replicate accurately the LoS distribution for the hospital. The model was then applied to a second configuration that had been trialled there; again, the results also reflected the experiences of the hospital.

This demonstrates that the coping strategies, such as re‐prioritising patients based on current length of time in the department, employed in A&E departments have an impact on LoS of patients and therefore need to be considered when building predictive models if confidence in the results is to be justified.

As far as the authors are aware this is the first time that these coping strategies have been included within a simulation model, and therefore the first time that the peak around the four hours has been analysed so accurately using a model.

THE study of fatigue from a physiological aspect is a field which motion study technicians have made little or no attempt to explore. Shame on their heads. The physiological simplification of motions aimed at reducing fatigue could have completely offset the notion that motion study is aimed at converting the operator into an automaton. It may well be that an elaborate motion pattern set‐up designed to simplify the work merely succeeds in setting up stresses in the worker. The superimposing of a time‐studied standard for the job may not have taken into account the adaptation of the speed of motions to the physiological limitations of the operator working at a high level performance. Very few practitioners have attempted to study motions in the factory with a view to reducing fatigue and stress as a prerequisite to studying the set‐up for increased production. Still fewer have attempted to evaluate these factors. It is about time they did.

The purpose of this paper is to analyse hospital dashboards’ visibility of information at different management levels to improve quality and performance in an acute general hospital.

Data were generated via 21 semi-structured interviews across different management levels.

All management levels had greater visibility of information, could make informed decisions, and registered performance improvement. Specifically, waiting time improved, however since introduction of hospital dashboards was work-in-progress at time of study, managers could not record improvement in terms of cost reductions, clinical effectiveness, patient safety and patient satisfaction. Different managerial levels had different visibility with top management having the greatest.

In single case studies, where only one context is used, the findings cannot be reproduced in different contexts; even though most of the results could be matched with the current literature.

The need to have balanced key performance indicators that take into account other facets of improvements, apart from time, has been emphasised. Furthermore, if middle and departmental managers have greater visibility, this would allow them to work towards a strategic fit between the departments that they manage with the rest of the hospital.

There is scant literature regarding performance dashboards’ enhancement of visibility of information at different management levels. Furthermore, according to the authors’ knowledge, no other paper has tried to identify and discuss the different levels of information, which should be visible from bedside to board namely to management, clinicians and public.

The purpose of this paper is to review the implementation of a service improvement in the UK National Health Service, relevant to the National Programme for IT in the NHS.

Case study and semi‐structured interviews, relating users' interaction with information systems to other aspects of a service improvement programme.

Information technology is a major plank of public sector service reform in general. Its impact will rely on the completeness of cultural reform and the transformation of a reactive information audience into one more proactive in seeking and making opportunities for beneficial change.

The research reported was conducted in a single setting, preliminary to an action research project. The project's aim will be to engage NHS users in a critical appreciation of their information needs, and to contribute this appreciation to the evaluation and refinement of the National Programme for IT and its products. The advantage of a situated study stems from concrete perspective and the capture of detail. These elements are readily understood by the reader, who can then assess the level of relevance to his own situation.

The intervention of a major information project ought to be synchronised in the host community with organisational development and the critical review of information needs.

Inasmuch as the NHS can be said to epitomise the social complexity of other major public sector organisations, the paper will interest readers from outside and inside the NHS. The contribution of a recipient perspective will counterbalance the tendency to “technology push” detectable in the National Programme.

Matching supply and demand in services by capacity management has a direct influence on the ability of the service delivery system to achieve service quality and resource productivity targets. Examines some propositions for the influences of capacity management on quality and resource productivity and for managing capacity. In addition to the chase and level strategies for managing capacity in services suggested by Sasser a coping strategy for capacity management is described which aims to improve the overall delivery of service quality while achieving resource productivity targets. Coping is necessary for all organizations at some time. Some research results derived from the experience of a range of service organizations indicate a less than satisfactory handling of the coping situation.

The value chain is an essential management tool for the elaboration of strategic organizational planning. However, there are few published works providing methods for the development of value chains. This research aims to present a model to develop the value chain for the public sector.

Action research was used with case study in the evaluation step.

This research presents a model for value chain development along seven steps, covering data collection planning to the formalization of final product acceptance. The model suggests executing these seven steps in three iteration levels: operational, tactical and strategic. Through case studies, six practical insights were also highlighted in this work.

Given the absence of related work, one of the limitations is the lack of comparison with other methods of value chain development in the public sector.

There are practical guides to value chain development in the public sector; however, to the best of authors’ knowledge, such guides have not been developed using research methods. In the literature, no works provide details on how value chain can be developed in the public sector. In addition, the constraints of face-to-face contacts during the COVID-19 pandemic led the research team to conduct remotely the model's development and evaluation in the case studies. The model presents elements that enable value chain development without face-to-face contact between the execution team and public institution's stakeholders.

Using the backdrop of an (apparently) extended visit to the West Indies, analogies with key concerns of internal audit are drawn. An unusual and refreshing way of exploring the main themes ‐ a discussion between Bill and Jack on tour in the islands ‐ forms the debate. Explores the concepts of control, necessary procedures, fraud and corruption, supporting systems, creativity and chaos, and building a corporate control facility.

Using the backdrop of an (apparently) extended visit to the West Indies, analogies with key concerns of internal audit are drawn. An unusual and refreshing way of exploring the main themes ‐ a discussion between Bill and Jack on tour in the islands ‐ forms the debate. Explores the concepts of control, necessary procedures, fraud and corruption, supporting systems, creativity and chaos, and building a corporate control facility.