Engaging Professionals in Sustainable Workplace Innovation: Medical Doctors and Institutional Work

This paper investigates the role of medical professionals in the success and longevity of the implementation of workplace innovation and organizational change in the Accident and Emergency (A&E) Departments of two large public hospitals, in Australia and Canada, during the introduction of process improvement using Lean Management (LM) methodologies. We ask why and how doctors resist, influence or enable LM initiatives in healthcare. Using a qualitative methodology, we contribute to institutional work theory by unpacking the complex forms of boundary and practice work undertaken by key actors who effectively use their professional status and power to enable practice changes to be embedded. Our findings lend support to the importance of the involvement and ownership of senior doctors in the design, introduction and implementation of successful workplace innovation and organizational change. Senior doctors use their professional expertise, positional and political power at the industry, organization and workplace levels to influence strategically the use of resources designated for workplace innovation to improve efficiencies, quality of patient care and maintain their dominance. The significant organizational change achieved reflected the ownership and leadership of the workplace innovation by senior doctors in ‘hybrid roles’ who captured the rhetoric and minimized adversarialism among key stakeholders.     

Targeting lean process improvement projects for maximum financial impact

This empirical paper details a 12-month applied research project at a UK low-volume manufacturer of large vehicles. The industry problem from which this study originates was a concern over the subjective nature with which the firm’s existing lean intervention projects were being targeted (prioritised and selected). A structured literature review on this topic was unable to identify any objective decision support mechanism for doing so; one that encompassed financial as well as operational criteria. The resultant study was organised around an established seven-step action research framework. The main body of evidence was derived from extensive analysis of financial and operational data extracted from the firm’s enterprise resource planning system, along with two structured workshops that each involved multiple informants drawn from the firm’s production centres and its accountancy department. Supplementary primary research was provided in the guise of numerous unstructured interviews to validate data and from observation of shop floor practices. The main contribution of this article is identifying and addressing the gap highlighted above, by developing and testing a financially driven method for objectively targeting process improvement interventions within this large and geographically dispersed operation. This innovative method includes five new constituent techniques.     

Task analysis of healthcare delivery: A case study

Human error and medical error are highly known as contributors to patient safety [Institute of Medicine (IOM), November 1999. To err is human: building a safer health system. Available at: http://www.nap.edu/openbook/0309068371/html/11.html (accessed 05.03.07); Institute of Medicine (IOM), March 2001. Crossing the quality chasm: a new health system for the 21st century. Available at: http://www.nap.edu/openbook/0309072808/html (accessed 05.03.07); Joint Commission on Accreditation of Healthcare Organizations (JCAHO), 2007. Failure mode, effect, and criticality analysis (FMECA) worksheet. Available at: http://www.jcaho.org (accessed 24.06.07)]. A study was performed to identify the process flow affiliated with elder patients transitioning through different continuums of emergency and non-emergency care. This research is part of a larger research effort to develop and implement a web-based healthcare system that enables hospitals and nursing homes to share patient information resulting in increased knowledge of a patient's medical history, decreased errors and enhanced patient safety. Future research efforts for this study are also presented.     

Nonparametric predictive comparison of lifetime data under progressive censoring

In reliability and lifetime testing, comparison of two groups of data is a common problem. It is often attractive, or even necessary, to make a quick and efficient decision in order to save time and costs. This paper presents a nonparametric predictive inference (NPI) approach to compare two groups, say X and Y, when one (or both) is (are) progressively censored. NPI can easily be applied to different types of progressive censoring schemes. NPI is a statistical approach based on few assumptions, with inferences strongly based on data and with uncertainty quantified via lower and upper probabilities. These inferences consider the event that the lifetime of a future unit from Y is greater than the lifetime of a future unit from X.     

The wages of sweat: A social history perspective on the fight against sweatshops

The social history of the fight against sweatshops casts light on the current movement in favor of corporate social responsibility. But making the head of a chain of subcontractors responsible for seeing to the well-being of those at the end of the chain is not contemporaneous with present-day globalization and North/South relations. Since the 19th century, when the sweatshop system appeared, those who champion the workers have pointed a finger at those who, though they only exercise indirect control, profit from their exploitation. As our historical analysis emphasizes, though in other contexts the issue of poor working conditions sometimes found solutions that (partially) avoided holding the principal liable, what characterizes the anti-sweatshop movement in the context of globalization is its nearly exclusive focus on bringing pressure to bear on the contractor at the head of the chain.     

Design and implementation of a Drum-Buffer-Rope pull-system

Purpose: This paper investigates the selection, design and implementation of a Drum-Buffer-Rope (DBR) type of production pull-system in a panel fabrication plant characterised by extensive shared, batch resource resources within a low volume UK manufacturer of large vehicles. This was the second of a series of two related research projects conducted under the aegis of a Lean initiative at this case firm.

Design/methodology/approach: A purposively selected longitudinal case study conducted over 24?months and organised around a two phase research design. The initial body of evidence included a detailed map constructed by a project team of eight managers and accountants during a two day structured workshop; numerous unstructured interviews and observation of shop floor practices; document and archival analysis, and 140 photographs of the focal operation. Supplemented by extensive financial and operational data extracted from the firm’s accounting and MRP systems, including all data necessary to construct and implement bespoke capacity planning, work in progress (WIP) monitoring and simulation modelling tools. The case firm is anonymised.

Findings: The Lean manufacturing literature ignores the real-world issue of shared resources, and this gap is attributable to the concept of ‘rightsizing’ tools and equipment that is widely promoted within the Lean community. The case panel plant is characterised by extensive shared resources; many of which are also batch processes. The most appropriate pull-system method for this production environment is DBR. The detailed design of the DBR mechanism required a controlled transfer buffer of overhead conveyance capacity after the Drum because the extent of downstream process variability risked it being unable to offload panels, hence compromising throughput.

Research limitations/implications: The study is based upon a single case. This consequently has implications for the ability to generalise from the results.

Practical Implications: When the DBR pull-system design was implemented it reduced the number of panels in WIP by 60%. This equated to a 56% (18?days worth) reduction of manufacturing lead time and more than doubled the plant’s inventory turns (from 9.1 to 21.2). It also significantly improved delivery schedule adherence, with downstream jig stoppages in the Final Assembly falling from an average of six to less than one per week. The financial benefit was independently audited to equate to an annualised value of $850?K. Consequently, this project was awarded the first prize at its parent enterprise’s annual worldwide process improvement competition.

Originality/value: This paper details a novel technique that permits the routings of multiple value streams to be mapped and is useful for highlighting the identity and location of shared resources. It also contributes significantly to the literature that is available on the relationship between the Lean paradigm and the management of shared production resources, and adds to the literature on the detailed design and implementation of a DBR pull-system in a jobbing-type of environment.