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To identify transitional palliative care (TPC) interventions for older adults with non-malignant chronic diseases and complex conditions.

A systematic review of the literature was conducted. CINAHL, Cochrane Library, Embase and Pubmed databases were searched for studies reporting TPC interventions for older adults, published between 2002 and 2019. The Crowe Critical Appraisal Tool was used for quality appraisal.

A total of six studies were included. Outcomes related to TPC interventions were grouped into three categories: healthcare system-related outcomes (rehospitalisation, length of stay [LOS] and emergency department [ED] visits), patient-related outcomes and family/carer important outcomes. Overall, TPC interventions were associated with lower readmission rates and LOS, improved quality of life and better decision-making concerning hospice care among families. Outcomes for ED visits were unclear.

Positive outcomes related to healthcare services (including readmissions and LOS), patients (quality of life) and families (decision-making) were reported. However, the number of studies supporting the evidence were limited.

Studies examining the effectiveness of existing care models to support transitions for those in need of palliative care are limited. This systematic literature review identified and appraised interventions aimed at improving transitions to palliative care in older adults with advanced non-malignant diseases or frailty.

Using Lean Six Sigma (LSS) implementation literature as an organising framework, the purpose of this paper is to explore the initial steps in a continuous improvement (CI) journey taken by an Irish university in order to identify the motivations, highlight key challenges and considers the capabilities required to initiate and sustain a CI programme.

This study focusses on one case organisation. A participative approach is adopted to learn from the initial steps taken in the establishment of a CI programme. Given this approach, the researchers had access to all documents and related archives associated with this initiative. Hence an iterative learning approach is adopted with the analysis of data from the first 12-month plan informing the next planning and implementation phase.

This paper provides a reflective account of why and how a university went about commencing a CI programme. The motivation to establish the CI programme not only reflects the current fiscal environment but also one characterised by a need to respond to a number of increasingly demanding stakeholders. The insights gained highlight the importance of alignment with strategy, role of specialists and use of a structured method informed by a LSS approach. Of particular note is the role of expertise, both internal and external, and within this context the interplay between a formal top-down approach and the coming together enthusiast staff, some of whom had CI experience from previous employment. A number of practical implications were identified as a result of the study including the key role of the project sponsor; the criticality of an understanding of the fundamental LSS concepts and tools and techniques by management; and the key role played by improvement specialists.

While in recent times a strong case for the application of LSS in HEIs has been made, there is a paucity of case studies based on the reflective practice in the field. This paper is novel in that it aims to address this and contribute to an emerging body of CI literature in the HEI area.

This paper aims to contribute to a developing literature on continuous improvement (CI), enabled by Lean Six Sigma (LSS), in higher education institutions (HEIs). It reports on the key learning points arising from the initial steps taken by an Irish university on its CI journey.

A case study strategy was adopted following a participatory research approach. This approach supports reflexivity and also provides access to all relevant documentation and staff within the case university. Thematic analysis was supported by data reduction and display techniques.

The introduction of a LSS approach rather than a reliance on lean alone introduced a structured methodology (DMAIC) that supported simplification of a number of administrative processes. A number of specific improvements were achieved including: Cycle time and cost reduction; customer or employee satisfaction; and rework and error reduction. The findings support the importance of the Readiness Factors as identified by Antony (2014), with particular insight into the role of senior and middle management, the impact of training and deployment of expertise.

This paper is based on an ongoing, longitudinal, empirical study of a single case study in Ireland.

This paper tracks the development of CI in a HEI in a longitudinal manner and adds to the emerging the literature in this area. The paper evaluates the role of management at various levels, analyses the use of LSS tools and techniques and evaluated the role of training and capacity building. Implications for Management are shared including: design and role of training programmes, role of champions at various organisational levels, including key functional areas and sustaining momentum.