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The purpose of this paper is to introduce a cradle to grave manifest system for medical waste in Jordan. As part of this program, medical waste classification, generation rates, and tracking in different parts of the world and in Jordan are described.

After reviewing different classification systems, the program adopted the World Health Organization definition with minor modification to be used with the proposed manifest, as it is very similar to the current bylaw regulating medical waste in Jordan. In addition, the generation rates of hazardous medical waste in 11 public hospitals and one governmental university hospital in the northern part of Jordan were calculated. These were based on the weights of these wastes that were transferred to the sole incinerator used by these hospitals over a 12-month period. These weights were obtained through interviews with personnel in charge of the medical waste incinerator.

This project has devised a manifest form to be used for medical waste transport. In addition, the generation rate was found to vary from 0.88 to 3.05 kg/bed/day based on 100 percent occupancy rates. The generation weight was found to be different for different months of the year.

Management of waste disposal and treatment, including medical waste is very important in a water poor country like Jordan. The introduction of a manifest system and the adoption of a medical classification system, in addition to the calculation of the generation rates are very important for sustainable development in the country.

The objective of this study is to systematically identify, categorize and assess the driving factors and interdependencies associated with various types of healthcare waste. The study specifically focuses on waste that has been managed or is recommended for treatment through the application of Lean Six Sigma (LSS) methodologies.

To accomplish the study’s objectives, interpretive structural modeling (ISM) was utilized. This analytical tool aided in quantifying the driving power and dependencies of each form of healthcare waste, referred to as “enablers,” as well as their related variables. As a result, these enablers were classified into four distinct categories: autonomous, dependent, linkage and drivers or independents.

In the healthcare sector, the “high cost” (HC) emerges as an autonomous variable, operating with substantial independence. Conversely, variables such as skill wastage, poor service quality and low patient satisfaction are identified as dependent variables. These are distinguished by their low driving power and high dependency. On the flip side, variables related to transportation, production, processing and defect waste manifest strong driving forces and minimal dependencies, categorizing them as independent factors. Notably, inventory waste (IW) is highlighted as a salient issue within the healthcare domain, given its propensity to engender additional forms of waste.

Employing the ISM model, along with comprehensive case study analyses, provides a detailed framework for examining the complex hierarchies of waste existing within the healthcare sector. This methodological approach equips healthcare leaders with the tools to accurately pinpoint and eliminate unnecessary expenditures, thereby optimizing operational efficiency and enhancing patient satisfaction. Of particular significance, the study calls attention to the key role of IW, which often acts as a trigger for other forms of waste in the sector, thus identifying a crucial area requiring focused intervention and improvement.

This research reveals new insights into how waste variables are structured in healthcare, offering a useful guide for managers looking to make their waste-reduction strategies more efficient. These insights are highly relevant not just for healthcare providers but also for the administrators and researchers who are helping to shape the industry. Using the classification and ranking model developed in this study, healthcare organizations can more easily spot and address common types of waste. In addition, the model serves as a useful tool for practitioners, helping them gain a deeper, more detailed understanding of how different factors are connected in efforts to reduce waste.

This paper aims to explore how the integrated thinking of a chief executive officer (CEO) impacts the management’s orchestration of the six capitals to create value in an organization.

Following a case study approach, data was gathered on two business organizations in Sri Lanka through interviews, focus group discussions and documentary analyzes. Thematic and cross-case analyzes were used in analyzing the data based on an analytical framework that was developed using systems and resource orchestration theories.

The study finds that the integrated thinking perspective of the CEO determines which capitals to embrace in the pursuit of value creation by an organization. A broader perspective on the integrated thinking of the CEO can lead to a sustainable perspective for value creation focusing on integrated corporate responsibility. On the contrary, a constrained perspective of integrated thinking can lead to a business case perspective for value creation that focuses mainly on the key areas of responsibility extended for operational efficiency. These different perspectives result in differences in value creation in organizations over time.

The capitals embraced in the integrated thinking perspective of a CEO should be translated into objectives, strategies and performance measurement and implemented at every level of the company to create value. This perspective of a CEO can be institutionalized through the adoption of accredited management systems. To foster value creation, managers should use a variety of information technology platforms and internal networks.

This is one of the first studies that explore how the perception of integrated thinking of the CEO impacts value creation in an organization through a combination of resource orchestration and systems thinking theory lenses.

This study proposes targeted modernization of the Department of Defense (DoD's) Joint Forces Ammunition Logistics information system by implementing the optimized innovative information technology open architecture design and integrating Radio Frequency Identification Device data technologies and real-time optimization and control mechanisms as the critical technology components of the solution. The innovative information technology, which pursues the focused logistics, will be deployed in 36 months at the estimated cost of $568 million in constant dollars. We estimate that the Systems, Applications, Products (SAP)-based enterprise integration solution that the Army currently pursues will cost another $1.5 billion through the year 2014; however, it is unlikely to deliver the intended technical capabilities.

Focuses on the direct and indirect impact of environmental abuse on human wellbeing. In some instances, the impact of environmental abuse on human health is not still unknown, merely being subject to scientific suspicion. This would suggest caution and the need for preventive measures to be applied. The threat to human health from environmental factors is not an isolated problem that exists on a national level. There are environmental factors that affect human health on a global level or are so widespread as to be considered global problems. Other environmental problems cross national boundaries and achieve regional importance.

Utilizing data drawn from 18 in-depth case studies the authors explore in detail the factors shaping employment in a diverse range of Irish small- and medium-sized enterprises. Existing theory in HRM is deemed inadequate in capturing the complexity of HRM in SMEs especially as it treats organizations as hermetically sealed entities. In an effort to animate the criticism directed at normative models of HRM the authors use a conceptual framework with an emergent, open systems theoretical proposition to examine the parameters, dynamics and determining factors of HRM at each of the case study companies. The results show that the notion of a normative HRM model was not coherent in terms of actual practices but rather reactive, and emergent HRM-related processes were often imposed to meet legislative requirements or to reinforce owner–manager legitimacy and control. The authors conclude that an appreciation of the interaction between structural factors both inside and outside the immediate work milieu is crucial if the heterogeneity of HRM in SMEs is to be adequately accommodated and understood.

As the 1960s drew to a close, Congress found itself grappling with an increasing array of complex technological issues that it was ill equipped to analyze and that could be the cause of costly blunders if acted upon incorrectly. To alleviate this situation, the U.S. Office of Technology Assessment (OTA) was created in 1972 under Public Law 92–484 in order to advise Congress on issues in science and technology so that relevant information would be available when pertinent legislation was being developed. Under the leadership of its director John Gibbons, OTA has earned the distinction of providing Congress, that most political of bodies, with timely and objective information without becoming mired in political skirmishes. Despite this distinction, OTA is one of the smallest government agencies, with a budget of twenty million dollars and a staff of 140. Its organization is remarkable for its simplicity. A bipartisan congressional Technology Assessment Board governs the agency overall but appoints the director who has full responsibility for running it. The nine agency divisions are organized according to scientific disciplines and report to the director with little or no intervening bureaucracy. Outside expert advice is available from the Technology Assessment Advisory Council. The result is an organization that is equally balanced politically and scientifically, that is streamlined and efficient, and that allows input from its governing members. This structure also allows great flexibility in the research and production of assessment reports. To do an assessment, OTA deploys its experts to go out and gather the information needed on the wide‐ranging topics it has been commissioned to research. The topics are chosen according to the need and interest of both houses and both political parties. Outside experts are sometimes called upon to do research but OTA exercises the final responsibility over their reports. Factual conclusions and options are presented but opinions are never given. The manner in which the information is acted upon is always left to Congress, a major reason for OTA's success.

The purpose of this study is to determine the extent to which total quality management (TQM) initiatives can improve the quality of services delivery at the medical records unit of the Korle-Bu Teaching Hospital (KBTH) to help meet the expectations and aspirations of patients and customers of the hospital.

This research adopted the survey strategy as its research design. The total study population consisted of 114 medical records staff of the KBTH. Questionnaires and personal observations were employed as the data collection instruments. The study recorded a response rate of 98 per cent. Data gathered from respondents were analysed in qualitative terms.

The overall finding of this study was that, although the medical records department of the KBTH had a fair degree of understanding on the benefits of TQM to records management service delivery, the exiting values for TQM did not meet the framework of good TQM practice, principles and standards.

Even though the subjects for the study were from the biggest hospital in Ghana, the findings of this study may not be generalised to the whole country.

The study has demonstrated the need for the medical records department of the KBTH to have and develop good TQM standards to improve the quality of services to patients and varied customers of the hospital.

The literature reviewed indicated that this study is a maiden attempt to examine how TQM initiatives including sensitivity, customer satisfaction, commitment of top management, team work, effective leadership and participatory management, people development and effective and open communication can improve the quality of medical records service delivery at the KBTH in Ghana.

The purpose of this paper is to present a case study of the implementation of Lean Six Sigma techniques through a series of student projects carried out in a hospital setting.

The five projects were carried out by teams of Masters' students taking a module on operations and quality management. The students were all staff members of the hospital. The study analysed each of the five projects under a number of headings: setting and context, approach, key success factors, benefits and lessons learnt. The projects were then examined to identify patterns among the projects.

All student projects adopted a single foundation methodology as the basis for the project, but supported this with additional techniques from the Lean Six Sigma stable. The primary methodology was Lean in the case of three projects, Six Sigma in the case of one project and mistake proofing in the case of the final project. The most commonly used supporting techniques were process mapping, seven wastes, 5S and logic tree/root cause which were each used in two of the five projects. Other techniques used were control charts, checklists and theory of constraints, which were each used by one project team. Support from top management and regular communication with stakeholders were identified as key factors for success by three of the five project teams. All of the projects, although implemented during a time period of less than three months, and by relatively novice users of Lean Six Sigma techniques, yielded practical benefit to the hospital.

This paper examines a number of Lean Six Sigma projects carried out in an Irish hospital. Students were tasked to examine and improve the efficiency and effectiveness of a clinical or/and an administrative process within the hospital. Arguably, a single module on a Master's program in healthcare leadership and organisational change is insufficient to bring about large-scale process change in a single hospital in particular, or to the Irish healthcare sector in general, but it is a start, and as these projects demonstrate it provides a set of tools, techniques and effective methods for instigating process change.

Lean Six Sigma offer a variety of methodologies and techniques for use on a process improvement project. It is vital that the project team select for use those techniques which are most appropriate to the particular context of the project. Adoption of an overall methodology (philosophy) supported by specific techniques, proved to be an effective approach.

This paper provides useful information for practitioners who are introducing the Lean Six Sigma approach into a hospital setting. The study demonstrates that relatively novice users of Lean Six Sigma can provide value to the organisation in a relatively short period of time. The paper also demonstrates that Lean Six Sigma can be used and provide benefit in a variety of settings within a hospital.

Millions around the world still cannot access safe, timely and affordable surgery. Considering access as a function of efficiency, this paper examines how the latter can be improved within the context of operating theatres. Carried out in France and Australia, this study reveals different types of waste in operating theatres and a series of successful tactics used to increase efficiency and eliminate wastefulness.

Data for this qualitative study were collected through 48 semi-structured interviews with operating theatre staff in France (n = 20) and Australia (n = 28). Transcripts were coded using a theory-driven thematic analysis to characterise sources of waste in operating theatres and the tactics used to address them.

The study confirmed the prominence of seven types of waste in operating theatres commonly found in industry and originally identified by Ohno, the initiator of lean: (1) underutilised operating rooms; (2) premature or delayed arrival of patients, staff or equipment; (3) need for large onsite storage areas and inventory costs; (4) unnecessary transportation of equipment; (5) needless staff movements; (6) over-processing and (7) quality defects. The tactics used to address each of these types of waste included multiskilling staff, levelling production and implementing just-in-time principles.

The tactics identified in this study have the potential of addressing the chronic and structurally embedded problem of waste plaguing health systems' operating theatres, and thus potentially improve access to surgical care. In a global context of resource scarcity, it is increasingly necessary for hospitals to optimise the ways in which surgery is delivered.