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The purpose of this paper is to explore the nature and impact of leadership in relation to the local implementation of quality improvement interventions in health care organisations.

Using empirical data from two studies of the implementation of The Productive Ward: Releasing Time to Care™ in English hospitals, the paper explores leadership in relation to local implementation. Data were attained from in-depth interviews with senior managers, middle managers and frontline staff (n=79) in 13 NHS hospital case study sites. Framework Approach was used to explore staff views and to identify themes about leadership.

Four overall themes were identified: different leadership roles at multiple levels of the organisation, experiences of “good and bad” leadership styles, frontline staff having a sense of permission to lead change, leader's actions to spread learning and sustain improvements.

This paper offers useful perspectives in understanding informal, emergent, developmental or shared “new” leadership because it emphasises that health care structures, systems and processes influence and shape interactions between the people who work within them. The framework of leadership processes developed could guide implementing organisations to achieve leadership at multiple levels, use appropriate leadership roles, styles and behaviours at different levels and stages of implementation, value and provide support for meaningful staff empowerment, and enable leader's boundary spanning activities to spread learning and sustain improvements.

Inappropriate cardiac monitoring leads to increased hospital resource utilization and alarm fatigue, which is ultimately detrimental to patient safety. Our institution implemented a continuous cardiac monitoring (CCM) policy that focused on selective monitoring for patients based on the American Heart Association (AHA) guidelines. The primary goal of this study was to perform a three-year median follow-up review on the longitudinal impact of a selective CCM policy on usage rates, length of stay (LOS), and mortality rates across the medical center. A secondary goal was to determine the effect of smaller-scale interventions focused on reeducating the nursing population on the importance of cardiac alarms.

A system-wide policy was developed at The Ohio State University in December 2013 based on guidelines for selective CCM in all patient populations. Patients were stratified into Critical Class I, II, and III with 72 hours, 48 hours, or 36 hours of CCM, respectively. Pre- and post-implementation measures included average cardiac monitoring days (CMD), emergency department (ED) boarding rate, mortality rates, and LOS. A 12-week evaluation period was analyzed prior to, directly after, and three years after implementation.

There was an overall decrease of 53.5% CMDs directly after implementation of selective CCM. This had remained stable at the three-year follow-up with slight increase of 0.5% (p = 0.2764). Subsequent analysis by hospital type revealed that the largest and most stable reductions in CMD were in noncardiac hospitals. The cardiac hospital CMD reduction was stable for roughly one year, then dipped into a lower stable level for nine months, then returned to the previous post-implementation levels. This change coincided with a smaller intervention to further reduce CMD in the cardiac hospital. There was no significant change in mortality rates with a slight decrease of 3.1% at follow-up (p = 0.781). Furthermore, there was no significant difference in LOS with a slight increase of 1.1% on follow-up (p = 0.649). However, there was a significant increase in ED boarding rate of 7.7% (p < 0.001) likely due to other hospital factors altering boarding times.

Implementing selective CCM decreases average cardiac monitoring rate without affecting LOS or overall mortality rate. Selective cardiac monitoring is also a sustainable way to decrease overall hospital resource utilization and more appropriately focus on patient care.

Lean Six Sigma (LSS) is a continuous improvement methodology that has been adopted by several companies as a strategy to increase their competitive advantage. However, due to the misuse of LSS theory in practice, a high rate of implementation failure results. There is a need for a structured and standardised framework to describe how the LSS initiative should be implemented and sustained over time. As a result, this study aims to develop a practical, user-friendly and accurate LSS road map for a Scottish manufacturing small and medium enterprise.

The approach was to analyse existing literature on lean and Six Sigma that included road maps and critical success factors (CSFs) in order to design an in-company, quantitative survey instrument. The aim of the survey was to evaluate employees' perceptions on the importance of LSS CSFs for the successful implementation and sustainability of a continuous improvement initiative. Based on the literature and results from the data collected, an LSS reference guide - in the form of a road map - was designed to support LSS implementation and sustainability.

A customised LSS reference guide in a road map format for the Scottish SME was proposed. This road map was developed by adopting existing successful road maps from the literature into consideration and then adapting them to fulfil the company's particular perspective on CI. This study complements current literature on LSS road maps and corroborates LSS CSFs as crucial for successful LSS implementation and sustainability, regardless of the type of company and/or culture. However, a degree of importance is ascribed to the organisation's culture.

Whilst a survey was used as the data collection instrument future interviews with employees would enhance the understanding of the organisational culture and hence further improve the road map.

The authors developed a practical and strategic roadmap for a Scottish packaging small- and medium-sized enterprise (SME) which can be used by other similar SMEs. The proposed LSS road map can be replicated and/or adapted for companies in their application of LSS. The methodology by which this study's road map was designed can be used as a guide in the development of further CI road maps.

Although we have improved identification of and access to evidence-based interventions for addressing student problem behavior, teacher use of these practices remains low. In this chapter, we examine teachers’ causal attributions for student problem behavior and their implications for use of effective school-based behavioral interventions and supports. Attribution theory and research suggest that causal attributions strongly influence how individuals (e.g., teachers) perceive and respond to the problem behavior of others (e.g., students). Teacher perception regarding problem behavior and appropriate responses to it can be a significant barrier to the adoption and sustained implementation of empirically supported practices. In light of these factors, causal attribution theory and research can be used as a framework for better understanding and even changing teacher beliefs related to acceptance, implementation, and sustained use of effective behavior management practices. In this chapter, we make the case for cultivating an understanding of teachers’ causal attributions of student problem behavior and considering implications of causal attributions in future research. We explore how such research endeavors can potentially positively impact teacher implementation of effective school-based behavioral interventions and supports.

Evidence-based interventions (EBIs) for human services unfold within complicated social and organizational circumstances and are influenced by the attitudes and behaviors of diverse stakeholders situated within these environments. Coaching is commonly regarded as an effective strategy to support service providers in delivering EBIs and attaining high levels of fidelity over time. The purpose of this paper is to address a lacuna in research examining the factors influencing coaching, an important EBI support component.

The authors use the Exploration, Preparation, Implementation, and Sustainment framework to consider inner- and outer-context factors that affect coaching over time. This case study of coaching draws from a larger qualitative data set from three iterative investigations of implementation and sustainment of a home visitation program, SafeCare®. SafeCare is an EBI designed to reduce child neglect.

The authors elaborate on six major categories of findings derived from an iterative data coding and analysis process: perceptions of “good” and “bad” coaches by system sustainment status; coach as peer; in-house coaching capacity; intervention developer requirements vs other outer-context needs; outer-context support; and inner-context support.

Coaching is considered a key component for effective implementation of EBIs in public-sector systems, yet is under-studied. Understanding inner- and outer-context factors illuminates the ways they affect the capacity of coaches to support service delivery.

This paper demonstrates that coaching can accomplish more than provision of EBI fidelity support. Stakeholders characterized coaches as operating as boundary spanners who link inner and outer contexts to enable EBI implementation and sustainment.

This paper is one of seven in this volume elaborating upon different approaches to quality improvement in education. This paper aims to delineate a methodology called Implementation Science, focusing on methods to enhance the reach, adoption, use and maintenance of innovations and discoveries in diverse education contexts.

The paper presents the origins, theoretical foundations, core principles and a case study showing an application of Implementation Science in education, namely, in promoting school–community–university partnerships to enhance resilience (PROSPER).

Implementation Science is concerned with understanding and finding solutions to the causes of variation in a program’s outcomes relating to its implementation. The core phases are: initial considerations about the host context; creating an implementation structure; sustaining the structure during implementation; and improving future applications.

Few theoretical treatments and demonstration cases are currently available on commonly used models of quality improvement in other fields that might have potential value in improving education systems internationally. This paper fills this gap by elucidating one promising approach. The paper also derives value, as it permits a comparison of the Implementation Science approach with other quality improvement approaches treated in this volume.

This research aims to propose a framework to integrate Green Lean Six Sigma (GLSS) and Industry 4.0 to improve organizational sustainability.

The integration of GLSS and Industry 4.0 is proposed based on theoretical facets of the individual approaches. A generic, conceptual framework of an integrated GLSS-Industry 4.0 approach is then proposed using the application of different tools and techniques of GLSS and Industry 4.0 at different stages of the realization of a project.

Both approaches have common facets related to enablers and barriers, and the integrated application of tools and techniques of each approach supplements the common focus of both related to sustainability enhancement. The proposed, conceptual framework provides systematic guidelines from the project selection stage to the sustainment of the solution, with the enumerated application of different techniques and tools at each step of the framework.

This research is the first of its kind to propose the integration of GLSS and Industry 4.0 under the umbrella of a unified approach, including a conceptual framework of this integrated GLSS-Industry 4.0 approach.

Literature has shown that many companies fail lean implementation or is not able to sustain lean for a long time. Researchers have found that lean failures are associated with leadership, which is a key factor. However, it is not easy and a long time is needed to change the leadership, behaviour and traits. This study aims to introduce the Blue Ocean Leadership concept to address this issue.

A literature review is carried for articles related to critical success factors for Lean and Lean Six Sigma with a focus on leadership factors.

The Blue Ocean Leadership concept focuses on leaders’ acts and activities which can be changed with less effort and time. Seven categories of lean activities for leaders are identified.

Leadership is one of the many factors for the success of lean implementation. This conceptual study focuses only on leadership and it needs further field study for validation.

Blue Ocean Leadership provides lean practitioners and academicians with a new perspective for successful lean implementation.

To the best knowledge of the researcher, there is no similar study in this area. Thus, the finding can form the basis for further research for the benefit of lean communities, especially the small- or medium-sized enterprises with less cost and time.

Swanson's tri‐core model and typology of IS innovation is used to analyze Web services as IS innovation. Reconciling theoretical and practical perspectives, we develop a three‐layer nested‐stage model as a road map for studying Web services innovation. Most current Web services practice is at the first stage as IS technological process innovation (Type 1b). High compatibility, high divisibility, and high customizability are the primary characteristics of Web service (Type 1b), which originate from the innovation invention layer. Perceived communicability, perceived relative advantage, perceived complexity, and financial cost are the secondary characteristics of Web services (Type 1b), which are located at the innovation adoption layer. We propose a readiness model to illustrate the key controllable factors that influence the adoption decision of Web services (Type 1b): innovation awareness readiness, innovation‐needs fit readiness, technological skills readiness, and financial resources readiness.