Search results

This paper aims to explore patient to care provider reverse exchanges to improve the care processes and service supply chain using an online feedback platform. This paper demonstrates how a better understanding of timely and unsolicited feedback (“voice of the patient as a customer”) stimulates local interventions to improve service delivery and enact the essential characteristics of highly reliable organisations (HRO).

A realist approach involving an exploratory hospital case study using user feedback from an IT patient feedback platform. The methodology included interviews, secondary data and access to thousands of patient feedback narratives.

The findings show that a systems approach to the supply chain, using real-time feedback to enact process improvement is beneficial and a fruitful source of innovation for professional services staff. The setting of the improvement focusses on a true “voice of the customer” rather than attempting to improve arbitrarily internal process efficiency has major benefits for staff and their engagement with the right interventions to support higher performance.

The findings show major positive benefits for the adaptation and constant reflection of staff on the service provided to patients. The approach provides a means of reflecting as to whether the current supply chain and service provision are fit for purpose, as well as reliable, efficient and of value to the consumer.

This study is one of a few that adopt the consumer orientation needed to fully exploit the concepts of patient-centric improvement by including dynamic feedback in the supply chain and systems approach to care.

Given the pace of industry change and the rapid diffusion of high reliability organization (HRO) approaches, lags and divergences have arisen between research and practice in healthcare. The purpose of this paper is to explore several of these theory-practice gaps and propose implications for research and practice.

Classic and cutting-edge HRO literature is applied to analyze two industry trends: delivery system integration, and the confluence of patient-as-consumer and patient-centered care.

Highly reliable integrated delivery systems will likely function very differently from classic HRO organizations. Both practitioners and researchers should address conditions such as how a system is bounded, how reliable the system should be and how interdependencies are handled. Additionally, systems should evaluate the added uncertainty and variability introduced by enhanced agency on the part of patients/families in decision making and in processes of care.

Dramatic changes in the sociotechnical environment are influencing the coupling and interactivity of system elements in healthcare. Researchers must address the maintenance of reliability across organizations and the migration of decision-making power toward patients and families.

As healthcare systems integrate, managers attempting to apply HRO principles must recognize how these systems present new and different reliability-related challenges and opportunities.

This paper provides a starting point for the advancement of research and practice in high-reliability healthcare by providing an in-depth exploration of the implications of two major industry trends.

This study demonstrates how becoming a high-reliability institution in health care is a priority, given the high-risk environment in which an error can result in harm. Literature conceptually supports the need for highly reliable health care facilities but does not show a comprehensive approach to operationalizing the concept into the daily workforce to support patients. The Veterans Health Administration closes the gap by documenting a case study that not only demonstrates specific actions and functions that create a high-reliability organization (HRO) for safety and improvement but also created a learning organization by spreading the knowledge to other facilities.

The authors instituted a methodology consisting of assessments, training and educational simulations to measure, establish and operationalize activities that identified and prevented harmful events. Visual communication boards were created to facilitate team huddles and discuss improvement ideas. Improvements were then measured and analyzed for purposeful outcomes and return on investment (ROI).

HRO can be operationalized successfully in health care systems. Measurable outcomes verified that psychological safety was achieved through the identification and participation of 3,184 process improvement projects over a five-year period, which yielded a US$2.8m ROI. Documented processes and activities were used for educational teachings, which were disseminated to other Veteran Affairs Medical Center’s through the Truman HRO Academy.

This case study is limited to one hospital in the Veterans Health Administration (VHA) network. As the VHA continues to deploy the methods outlined to other hospitals, the authors will perform incremental data collection and ongoing analysis for further validation of the HRO methods and operations. Hospitalists can adapt the methods in the case study for practical application in a health care setting outside of VHA. Although the model is rooted in health care, the methods may be adapted for use in other industries.

This case study overcomes the limitations within literature regarding operationalizing HRO by providing actual activities and demonstrations that can be implemented by other health care facilities.

The focus of this study was to analyze crisis management in a context of high-reliability organizations (HRO) evidenced in two cases of Brazilian air disasters. Aspects of human and technological natures were examined, addressing the complex sociotechnical system.

This in-depth case study addressed the two most serious air disasters on Brazilian territory. The first case involved a midair collision between Gol Flight 1907 and the Legacy jet. In the second case, TAM flight 3054 had difficulty braking when landing at the airport and crashed into a building. Data were collected from official disaster documents.

The results revealed that the management and operational activities aimed to maintain the necessary conditions that prioritize a high level of reliability. High reliability mainly involves concern over failure, reluctance to accept simplified interpretations, sensitivity to operations, commitment to resilience and detailed structure specifications.

The implications are based on alerting highly reliable organizations, emphasizing the focus on managing more reliably, resiliently and conscientiously. Changes will be required in the operations of organizations seeking to learn to manage unexpected events and respond quickly to continually improve the responsiveness of their services.

In the perspective of an intrinsic case study for crisis management in a context of HRO and disaster risk management, the originality of this study lies in its examination of the paradoxical nature of control within the systems of dangerous operations in complex organizations, as well as their contradictions in a high-reliability system.

The purpose of this paper is to describe and analyze nurses’ perceptions and evaluations of healthcare developmental work after the introduction of Lean and Six Sigma and, how nurses aspire to maintain a high reliability organization (HRO).

Nurses’ roles and the way they respond to new efficiency and quality working methods are crucial. Underlying themes were analyzed from in-depth, semi-structured interviews with (n=17) nurses at two Swedish hospitals.

The nurses perceived that Lean worked better than Six Sigma, because of its bottom-up approach, and its similarities with nurses’ well-known work qualities. Nurses coordinate patients care, collaborate in teams and take leadership roles. To maintain high reliability and to become quality developers, nurses need stable resources. However, professional’s logic collides with management’s logic. Expert knowledge (top-down approach) without nurses’ local knowledge (bottom-up approach) can lead to problems. Healthcare quality methods are standardized but must be used with flexibility. However, HROs ensue not only from method quality but also from work attitudes, commitment and continuous work-improvement.

Management can support personnel in developmental work with: continuous education, training, teamwork, knowledge sharing and cooperation. Authoritarian method structures that limit the healthcare professionals’ autonomy should be softened or abandoned.

The study uses theoretical concepts from HROs, which were developed for unexpected events, to explain the consequences of implementing Lean and Six Sigma in healthcare.

Maintaining a safe and available supply of blood requires a mindfully coordinated supply chain (SC) and is fundamental to the effective operation of health systems across the world. This study investigates how blood supply chain (BSC) actors demonstrate collective mindfulness (CM) principles in their operations and how these demonstrations lead to improvements in blood safety and availability (BSA) in different operational contexts.

Six case studies drawn from two contrasting BSCs, the UK and Indonesia, which differ in structure and regulation are investigated in this research. Qualitative data are collected and analysed using template analysis.

The cases reveal how the CM principles are demonstrated in the supply chain context in a range of operational conditions and their impact on BSA. The BSC actors in the more centralised and tightly regulated cases display more behaviours consistent with more of the CM principles over a greater range of operational conditions compared to those in the more decentralised and loosely regulated cases. As such, more improvements in BSA are found in the former compared to the latter cases.

This paper is considered the first to investigate the demonstration of CM principles at the SC as opposed to the single organisational level. It proposes an alternative approach to understanding and evaluating reliability performance using behavioural rather than statistical principles.

Purpose – To consider the ways two pre-service teachers evaluated digital information sources about climate change in order to highlight the challenges and possibilities of an instructional approach aimed at cultivating digital literacies about climate change among pre-service teachers.

Design – The qualitative research design focuses on two pre-service teachers’ written reflections and participation during class discussions across two sessions in a content literacy course. The theoretical framework that guided the analysis was civic media literacy.

Findings – Findings of this study highlight conceptions of reliability that two participants held (reliability as relative or as evidentiary support) as they worked with web sources about climate change. These conceptions reflected a denialist orientation to climate change science.

Practical Implications – This study contributes to the literature that considers the ways pre-service teachers work with websites about socioscientific topics. It highlights how an instructional model can help promote digital literacy practices that center on evaluating the reliability of websites about climate change. It also includes a companion framework called fake experts, logical fallacies, impossible expectations, cherry picking, and conspiracy theories (FLICC) that can be used to guide students to better understand techniques and practices of science denial.

This study defines service breakdowns, service breakdown prevention, and “servicide” as they relate to service-dominant logic. The study reviews relevant relevant literature on these three topics. This study categorizes real-life examples into five levels of dramatic turns toward service degradations and breakdowns that range from customer being aware but not mentioning service inadequacy to the service breakdown resulting in death of the customer or service provider. Taking initial steps in developing dramatic turn theory and improving the practice of service breakdown prevention are the major contributions of this study.

This study is a conceptual contribution that includes a dramatic turn role-playing exercise (at category 4 among five categories of dramatic turns for pedagogical/on-site enacting/practicing and training of service professionals. The study emphasizes and shows how to create and enact role-playing scenarios to increase requisite variety, provide training modules and increase skills/expertise in service enactment contexts.

Before explicit reviewing of the dramatic-turn performances, some of the participants as actors as well as audience members in role-play dramatic turns were quick to blame the customer behavior as the principal cause for the service breakdown. The study’s exposition stresses prevention of negative dramatic turns follows from experiencing and coaching a wide variety of customer and server interactions – achieving “richness” in enactments.

Research on service breakdown prevention needs to include field experiments on the efficacy of training programs for effective management of dramatic turns.

Training of service workers and service managers in experiencing/participating in dramatic turns is likely to be beneficial in reducing the severe adverse outcomes and unintended consequences of service breakdowns. Prevention, not only service failure recovery, needs to be an explicit focus in hospitality management training and assessment.

This study suggests tools and procedures to reduce the instances of the need for service breakdown recoveries.

The study calls attention and contributes a way forward in managing dramatic turns in hospitality service contexts. The study provides a nascent configurational theoretical foundation of dramatic-turn propositions. Given the severity of financial costs and loss of brand/firm reputation following the occurrence of extreme dramatic turns, a research focus on service breakdown prevention is necessary.

The purpose of this paper is to propose a contemporary reliability model for lean systems through the development of an innovative lean system reliability model (LSRM).

LSRM models the reliability of lean subsystems as a basis for determining the reliability of lean systems as a whole. Lean subsystems, in turn, consist of reliability measures for lean components. Once principal components analysis techniques are employed to determine critical subsystems, Monte Carlo simulations for lean components, subsystems, and the overall lean system are then compared with historical data to determine the adequacy of the LSRM model. If simulation results are accurate to within the researcher's objective of 2.5 per cent of historical data results, the LSRM model is determined to be a validated model.

A literature search shows limited practical methodologies to assess the reliability of lean systems.

Reliability computations involve many tedious calculations and, hence, require reliability software.

This paper defines lean system reliability, develops a conceptual model to assess the reliability of lean systems, demonstrates how to decompose a lean system into subsystems and components, and compares simulation results versus actual results to validate the LSRM model.

This paper aims to situate tourism within the wider context of temporary and permanent people movements and immigration as a form of permanent tourism with a deep gaze into tourists’ own national culture and even deeper gaze into the trappings of immigrants’ quotidian identity to define a modified identity. This paper offers, through auto-ethnography (AE) and confirmatory introspection (CI), a glimpse into the complex decision-making processes tourists, migrant workers and immigrants have to cope with to survive and thrive in a home “away” from their country of birth. The literature on the comparison between temporary mobility (tourism), nomadic migration (semi-permanent mobility) and permanent mobility (drifters, wanderers or denizen globe trotters) is sparse and unsystematic.

The use of AE and CI allows the researcher with several years of cognitive and affective information and easy access to data on the private, lived experiences of the author and closely related family. Having lived and worked in several countries, supplemented by experiences of visiting over 35 countries for varying periods, the researcher has direct access to a wealth of rich data related to tourism (one- to five-week trips to Europe, USA, South America, the Middle East, Africa, Australia and the Pacific Islands), semi-permanent mobility (one-year exchange work placement in North America) and permanent mobility (more than ten years of being immigrants to New Zealand).

The results show that tourists and immigrants are exposed to numerous decisions (varying in complexity and impact) before, during and after their travels that will impact on their acculturation, the genuineness of their experience and their willingness to modify their own identities, as well as the culture of the destinations they consume. Travelers have to overcome contextual and personal hurdles to achieve integration in a reasonable time. The way in which they tackle and overcome these hurdles will impact upon their modification of personal identity and acculturation.

This paper offers practical advice to tourists, immigrants and employers on becoming adaptable consumers, highly resilient survivors and highly reliable organizations – able to thrive in today’s global marketplace. This study helps marketers, tourism professionals and employers of migrants to understand the processes consumers go through to modify identity to effectively and timely fit into new environments.

AE- and CI-based research explores the tourist gaze and acculturation processes and discusses a two-directional model of modification of culture and identity. In addition, the paper highlights complex decision-making models tourists, nomads, globe trotters and immigrants use when considering alternative destinations and sought-after experiences.