Reducing Surgical Ward Congestion Through Improved Surgical Scheduling and Uncapacitated Simulation

High surgical bed occupancy levels often result in heightened staff stress, frequent surgical cancellations, and long surgical wait times. This congestion is in part attributable to surgical scheduling practices, which often focus on the efficient use of operating rooms but ignore resulting downstream bed utilization. This paper describes a transparent and portable approach to improve scheduling practices, which combines a Monte Carlo simulation model and a mixed integer programming (MIP) model. For a specified surgical schedule, the simulation samples from historical case records and predicts bed requirements assuming no resource constraints. The MIP model complements the simulation model by scheduling both surgeon blocks and patient types to reduce peak bed occupancies. Scheduling guidelines were developed from the optimized schedules to provide surgical planners with a simple and implementable alternative to the MIP model. This approach has been tested and delivered to planners in a health authority in British Columbia, Canada. The models have been used to propose new surgical schedules and to evaluate the impact of proposed system changes on ward congestion.     

儒家利他主义、慷慨和正义:对全球化的回应

儒家推己及人、恕者善推的外推步骤,可以视为各方差异或不同文明沟通的可行策略。外推是一种走出自我封闭、走向多元他者、从熟悉走向陌生的一种行动,可以分语言的外推、实践的外推、本体的外推三步骤为之。儒学中的恕可诠释为一无私地走出自我封闭,走向多元他者的行动。恕可用推来诠释和实践。孔子尝谓恕可终身行之。人可不断外推,从自我到家庭,从家庭到社群,从社群到国家,从国家到天下,也就是所谓全球化世界。在全球化时代,通过发扬仁、恕所预设的原初慷慨,儒学必能复兴,而原初慷慨虽超越相互性,并不否认相互性,反而能整合并成全相互性。由仁生义,由义生礼,道德的正义优先于分配的正义。当儒学强调的仁所发展的相互性,能经由恕的外推而扩张,才能真正实现正义。     

Inter-Organizational Learning and Strategic Renewal in SMEs: Extending the 4I Framework

This article explores how mature SMEs which lack internal resources access external knowledge to facilitate strategic renewal. Organizational learning, in contrast to entrepreneurial learning, recognizes that owner-managers must distribute knowledge throughout the firm to achieve competitive benefits. Three case studies demonstrate how external ‘knowledge providers’ (customers, suppliers and educational institutions) help institutionalize ‘new’ knowledge. Initially, learning from inter-organizational relationships requires owner-managers to be proactive in accessing and extending appropriate inter-organizational relationships. Second, external organizations can play an active role by ‘intertwining’ knowledge to support the development of processes, systems and routines that distribute and institutionalize learning throughout the organization. The three cases have practical implications for owner-managers and add to academic knowledge via the extension of Crossan et al's 4I model of organizational learning.     

Dual agency and fiduciary responsibilities in modern medicine

In today's complex medical world, physicians often face difficult decisions about whom they serve first--patients, corporations, insurance companies, the government, etc.     

One for All and All for One? A New Generation of Co-operatives Emerges

Business owners who traditionally organised their marketing and supply activities through co-operatives are changing their strategic orientation with increased frequency. The result is a “new generation” of co-operatives sweeping through several industries. This article examines how traditional co-operatives differ from the typical investor-owned firm and some of the motivating factors leading to the emergence of the new generation of co-operatives. These new generation co-operatives (NGCs) appear to be organisational hybrids combining aspects of investor ownership and co-operative ownership structures. The article describes differences between the traditional and new generation co-operatives with the objective of providing implications for managers who are faced with the movement toward more entrepreneurial organisations in their industries.     

Devising Context Sensitive Approaches To Change: The Example of Glaxo Wellcome

There is a growing awareness of the need for designers of organisational change to develop context sensitive approaches to implementation if change is to be successful. Existing change literature indicates that there are many aspects of an organisation’s change context that need to be considered, and a wide range of different implementation options open to those designing change. However, these contextual aspects and design options are not currently pulled together in a comprehensive manner, or in a form that makes them easily accessible to practitioners. This paper builds a framework, called the change kaleidoscope, which aims to achieve this. It illustrates the applicability of this framework in practice as an aid to managers in the development of context sensitive implementation approaches via a case study on the changes undertaken at Glaxo Wellcome UK since the early 1990s. This is an interesting case of a successful organisation that managed to change in a pro-active manner rather than in a crisis driven re-active manner. The paper concludes with the lessons for practitioners on the impact of certain contextual features and design choices during change as illustrated by the Glaxo Wellcome case, and a discussion on the use of the kaleidoscope in practice.