Organizational change through Lean Thinking.

PubMed

Tsasis, Peter; Bruce-Barrett, Cindy

2008-08-01

In production and manufacturing plants, Lean Thinking has been used to improve processes by eliminating waste and thus enhancing efficiency. In health care, Lean Thinking has emerged as a comprehensive approach towards improving processes embedded in the diagnostic, treatment and care activities of health-care organizations with cost containment results. This paper provides a case study example where Lean Thinking is not only used to improve efficiency and cost containment, but also as an approach to effective organizational change.

Relationship-centered health care as a Lean intervention.

PubMed

Dunsford, Jennifer; Reimer, Laura E

2017-12-01

Continuous improvement efforts, recognized in much literature as Lean management techniques have been used in efforts to improve efficiency in democratic health care contexts for some time to varying degrees of success. The complexity of the health care system is magnified by the sheer number of processes and sub processes required to deliver value within a bureaucratic environment, while maintaining some level of compassionate and personalized care. There is inherent tension between what is required to be efficient and what is required to be caring and this conflict presses against Lean practice at the level of delivery.Administration and care intersect at the point of the patient's experience. In order to achieve the dual goals of improved value and lower costs, the application of Lean thinking for meaningful health care reform must acknowledge the fundamental dichotomy between the impersonal tasks required to provide health services, and human interactions. Meaningful health care reform requires an acknowledgement of this distinction, currently not recognized in literature. While administrative process improvements are necessary, they are insufficient to achieve a sustainable and caring health care system. Lean thinking must be applied differently for administrative processes and patient care encounters, because these are fundamentally different processes. In this way, Lean principles will effectively contribute to sustainable health system improvements. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The Application of Lean Thinking Principles and Kaizen Practices for the Successful Development and Implementation of the Ares I-X Flight Test Rocket and Mission

NASA Technical Reports Server (NTRS)

Askins, B. R.; Davis, S. R.; Heitzman, K. S.; Olsen, R. A.

2011-01-01

On October 28, 2009 the Ares I-X flight test rocket launched from Kennedy Space Center and flew its suborbital trajectory as designed. The mission was successfully completed as data from the test, and associated development activities were analyzed, transferred to stakeholders, and well documented. A positive lesson learned from Ares I-X was that the application of lean thinking principles and kaizen practices was very effective in streamlining development activities. Ares I-X, like other historical rocket development projects, was hampered by technical, cost, and schedule challenges and if not addressed boldly could have resulted in cancellation of the test. The mission management team conducted nine major meetings, referred to as lean events, across its elements to assess plans, procedures, processes, requirements, controls, culture, organization, use of resources, and anything that could be changed to optimize schedule or reduce risk. The preeminent aspect of the lean events was the focus on value added activities and the removal or at least reduction in non-value added activities. Trained Lean Six Sigma facilitators assisted the Ares I-X developers in conducting the lean events. They indirectly helped formulate the mission s own unique methodology for assessing schedule. A core team was selected to lead the events and report to the mission manager. Each activity leveraged specialized participants to analyze the subject matter and its related processes and then recommended alternatives and solutions. Stakeholders were the event champions. They empowered and encouraged the team to succeed. The keys to success were thorough preparation, honest dialog, small groups, adherence to the Ares I-X ground rules, and accountability through disciplined reporting and tracking of actions. This lean event formula was game-changing as demonstrated by Ares I-X. It is highly recommended as a management tool to help develop other complex systems efficiently. The key benefits for Ares I-X were obtaining unambiguous schedule margin, defining enabling options for risk reduction, and most importantly a stronger more unified team.

The Application of Lean Thinking Principles and Kaizen Practices for the Successful Development and Implementation of the Ares I-X Flight Test Rocket and Mission

NASA Technical Reports Server (NTRS)

Askins, B. R.; Davis, S. R.; Heitzman, K. S.; Olsen, R. A.

2011-01-01

On October 28, 2009 the Ares I-X flight test rocket launched from Kennedy Space Center and flew its suborbital trajectory as designed. The mission was successfully completed as data from the test, and associated development activities were analyzed, transferred to stakeholders, and well documented. Positive lessons learned from Ares I-X were that the application of lean thinking principles and kaizen practices are effective in streamlining development activities. Ares I-X, like other historical rocket development projects, was hampered by technical, cost, and schedule challenges and if not addressed boldly could have resulted in cancellation of the test. The mission management team conducted nine major meetings, referred to as lean events, across its elements to assess plans, procedures, processes, requirements, controls, culture, organization, use of resources, and anything that could be changed to optimize schedule or reduce risk. The preeminent aspect of the lean events was the focus on value added activities and the removal or at least reduction in non-value activities. Trained Lean Six Sigma facilitators assisted the Ares I-X developers in conducting the lean events. They indirectly helped formulate the mission s own unique methodology for assessing schedule. A core team was selected to lead the events and report to the mission manager. Each activity leveraged specialized participants to analyze the subject matter and its related processes and then recommended alternatives and solutions. Stakeholders were the event champions. They empowered and encouraged the team to succeed. The keys to success were thorough preparation, honest dialog, small groups, adherence to the Ares I-X ground rules, and accountability through disciplined reporting and tracking of actions. This lean event formula was game-changing as demonstrated by the success of Ares I-X. It is highly recommended as a management tool to help develop other complex systems efficiently. The key benefits for Ares I-X were obtaining unambiguous schedule margin, defining enabling options for risk reduction, and most importantly a stronger more unified team.

LEAN thinking in Finnish healthcare.

PubMed

Jorma, Tapani; Tiirinki, Hanna; Bloigu, Risto; Turkki, Leena

2016-01-01

Purpose - The purpose of this study is to evaluate how LEAN thinking is used as a management and development tool in the Finnish public healthcare system and what kind of outcomes have been achieved or expected by using it. The main focus is in managing and developing patient and treatment processes. Design/methodology/approach - A mixed-method approach incorporating the Webropol survey was used. Findings - LEAN is quite a new concept in Finnish public healthcare. It is mainly used as a development tool to seek financial savings and to improve the efficiency of patient processes, but has not yet been deeply implemented. However, the experiences from LEAN initiatives have been positive, and the methodology is already quite well-known. It can be concluded that, because of positive experiences from LEAN, the environment in Finnish healthcare is ready for the deeper implementation of LEAN. Originality/value - This paper evaluates the usage of LEAN thinking for the first time in the public healthcare system of Finland as a development tool and a management system. It highlights the implementation and achieved results of LEAN thinking when used in the healthcare environment. It also highlights the expectations for LEAN thinking in Finnish public healthcare.

Healthcare Lean.

PubMed

Long, John C

2003-01-01

Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

Lost in translation: a case-study of the travel of lean thinking in a hospital.

PubMed

Andersen, Hege; Røvik, Kjell Arne

2015-09-21

Lean thinking as a quality improvement approach is introduced in hospitals worldwide, although evidence for its impact is scarce. Lean initiatives are social, complex and context-dependent. This calls for a shift from cause-effect to conditional attributions to understand how lean works. In this study, we bring attention to the transformative power of local translation, which creates different versions of lean in different contexts, and thereby affect the evidence for lean as well as the success of lean initiatives within and among hospitals. We explored the travel of lean within a hospital in Norway by identifying local actors' perceptions of lean through their images of enablers for successful interventions. These attributions describe the characteristics of lean in use, i.e. the prevailing version of lean. Local actors' perceptions of enablers for lean interventions were collected through focus group interviews with three groups of stakeholders: managers, internal consultants and staff. A questionnaire was used to reveal the enablers relative importance. The enablers known from the literature were retrieved at the case hospital. The only exception was that external expert change agents were not believed to promote lean. In addition, the stakeholders added a number of new and supplementary enablers. Two-thirds of the most important enablers for success were novel, local ones. Among these were a problem, not method focus, a bottom-up approach, the need of internal consultants, credibility, realism and patience. The local actors told different stories about local enablers and had different images of lean depending on their hierarchical level. By comparing and analyzing the findings from the literature review, the focus groups and the survey, we deduced that the travel of lean within the hospital was affected by three principles of translation: the practical, the pragmatic, and the sceptical. Further, three logics of translation were in play: translation as a funnel, a conscious sell-in, and a wash-out. This resulted in various local versions of lean. We conclude that lean, introduced by the management, communicated by the internal consultants, and used by the staff, is transformed more than once within the hospital. Translation is part of the explanation for the lack of evidence for lean, and translation can be decisive for outcomes.

Technology integration performance assessment using lean principles in health care.

PubMed

Rico, Florentino; Yalcin, Ali; Eikman, Edward A

2015-01-01

This study assesses the impact of an automated infusion system (AIS) integration at a positron emission tomography (PET) center based on "lean thinking" principles. The authors propose a systematic measurement system that evaluates improvement in terms of the "8 wastes." This adaptation to the health care context consisted of performance measurement before and after integration of AIS in terms of time, utilization of resources, amount of materials wasted/saved, system variability, distances traveled, and worker strain. The authors' observations indicate that AIS stands to be very effective in a busy PET department, such as the one in Moffitt Cancer Center, owing to its accuracy, pace, and reliability, especially after the necessary adjustments are made to reduce or eliminate the source of errors. This integration must be accompanied by a process reengineering exercise to realize the full potential of AIS in reducing waste and improving patient care and worker satisfaction. © The Author(s) 2014.

Implementation of lean thinking: one health system's journey.

PubMed

Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Coffey, Richard J; Billi, John E

2009-08-01

Lean Thinking is a management philosophy derived from the manufacturing industry, where Toyota has long been the gold standard. Health care organizations have started to apply this approach to patient care. After initial experimentation, the University of Michigan Health System (UMHS) has adopted Lean Thinking as its uniform approach to quality improvement and is striving to become a complete Lean organization. In 2005, the senior leadership selected an initial set of projects in areas that traced the patient's journey across different care settings within our health system. Four of the projects were as follows: orthopedic surgery clinic scheduling, radiation oncology therapy, peripherally inserted central catheter (PICC) services, and coordination of care to the outpatient setting. Lean Thinking encourages service providers to focus on value as defined by the customer and the relentless elimination of waste that impedes the flow of value. A series of learning projects were conducted to test whether Lean methods would work at UMHS. The following factors were found to be key to LEAN PROJECT SUCCESS: expert guidance for initial efforts, leadership in the form of clinical champions and senior management support of the improvement work, frontline worker engagement in mapping out "current state" processes, identifying waste and designing an improved "future state," using metrics to develop and track interventions, and defining realistic project scope. As UMHS's experience applying Lean Thinking to our patient care processes has grown, so have support, enthusiasm, and expertise within the organization. UMHS's Lean Thinking system, now known as the Michigan Quality System, has emerged as the core improvement strategy.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goins, Bobby

A systems based approach will be used to evaluate the nitrogen delivery process. This approach involves principles found in Lean, Reliability, Systems Thinking, and Requirements. This unique combination of principles and thought process yields a very in depth look into the system to which it is applied. By applying a systems based approach to the nitrogen delivery process there should be improvements in cycle time, efficiency, and a reduction in the required number of personnel needed to sustain the delivery process. This will in turn reduce the amount of demurrage charges that the site incurs. In addition there should bemore » less frustration associated with the delivery process.« less

A Systems Approach to Nitrogen Delivery

DOE Office of Scientific and Technical Information (OSTI.GOV)

Goins, Bobby

A systems based approach will be used to evaluate the nitrogen delivery process. This approach involves principles found in Lean, Reliability, Systems Thinking, and Requirements. This unique combination of principles and thought process yields a very in depth look into the system to which it is applied. By applying a systems based approach to the nitrogen delivery process there should be improvements in cycle time, efficiency, and a reduction in the required number of personnel needed to sustain the delivery process. This will in turn reduce the amount of demurrage charges that the site incurs. In addition there should bemore » less frustration associated with the delivery process.« less

Lean thinking in emergency departments: concepts and tools for quality improvement.

PubMed

Bruno, Frances

2017-10-12

The lean approach is a viable framework for reducing costs and enhancing the quality of patient care in emergency departments (EDs). Reports on lean-inspired quality improvement initiatives are rapidly growing but there is little emphasis on the philosophy behind the processes, which is the essential ingredient in sustaining transformation. This article describes lean philosophy, also referred to as lean, lean thinking and lean healthcare, and its main concepts, to enrich the knowledge and vocabulary of nurses involved or interested in quality improvement in EDs. The article includes examples of lean strategies to illustrate their practical application in EDs. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

Using Lean Thinking at an otorhinolaryngology outpatient clinic to improve quality of care.

PubMed

van Leijen-Zeelenberg, Janneke E; Brunings, Jan Wouter; Houkes, Inge; van Raak, Arno J A; Ruwaard, Dirk; Vrijhoef, Hubertus J M; Kremer, Bernd

2016-04-01

Although Lean Thinking has led to considerable improvement in a variety of healthcare settings, its effects on otorhinolaryngology remain underexposed. This study reports on how the implementation of Lean Thinking at an otorhinolaryngology outpatient clinic has affected patient and provider satisfaction, waste reduction, and organizational culture. Prospective before-and-after design. The 18-month prospective before-and-after design used mixed methods for data collection and analysis. A survey was conducted to measure satisfaction among patients and providers. Semistructured interviews were conducted to evaluate the effect of Lean Thinking on waste and organizational culture. During the project, 69 issues were posted on the Lean board. Improvements were made on 36 inefficiency issues, not all concerning a specific type of waste. Employees reported considerable improvement in transportation, motion, and waiting. Patient satisfaction was high both at baseline and follow-up and did not change significantly. The effects on provider satisfaction were slight; satisfaction with autonomy and participation decreased significantly, but satisfaction with communication increased significantly. The implementation of Lean Thinking at an otorhinolaryngology outpatient clinic reduced waste and increased provider satisfaction with communication. Although patient satisfaction did not change significantly, it cannot be concluded that the intervention had no effect on perceived quality of care. Other approaches to measure patients' perceptions should be considered. NA. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

Applying lean management principles to the creation of a postpartum hemorrhage care bundle.

PubMed

Faulkner, Beth

2013-10-01

A lean management process is a set of interventions, each of which creates value for the customer. Lean management is not a new concept, but is relatively new to health care. Postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide in both developing and developed countries. We applied lean management principles as an innovative approach to improving outcomes in patients with PPH. Initial results using principles of lean management indicated significant improvements in response time and family-centered care. When applied rigorously and throughout the organization, lean principles can have a dramatic effect on productivity, cost and quality. © 2013 AWHONN.

Lean thinking in health and nursing: an integrative literature review 1

PubMed Central

Magalhães, Aline Lima Pestana; Erdmann, Alacoque Lorenzini; da Silva, Elza Lima; dos Santos, José Luís Guedes

2016-01-01

ABSTRACT Objectives: to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing. Method: an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis. Results: the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing. Conclusion: this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient. PMID:27508906

Systems Thinking, Lean Production and Action Learning

ERIC Educational Resources Information Center

Seddon, John; Caulkin, Simon

2007-01-01

Systems thinking underpins "lean" management and is best understood through action-learning as the ideas are counter-intuitive. The Toyota Production System is just that--a system; the failure to appreciate that starting-place and the advocacy of "tools" leads many to fail to grasp what is, without doubt, a significant…

Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS)

PubMed Central

Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

2016-01-01

Objectives To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Design Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. Setting North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Participants Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. Interventions NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Main outcome measures Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. Results NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014–7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. Conclusions NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency. PMID:27566629

[Lean thinking and brain-dead patient assistance in the organ donation process].

PubMed

Pestana, Aline Lima; dos Santos, José Luís Guedes; Erdmann, Rolf Hermann; da Silva, Elza Lima; Erdmann, Alacoque Lorenzini

2013-02-01

Organ donation is a complex process that challenges health system professionals and managers. This study aimed to introduce a theoretical model to organize brain-dead patient assistance and the organ donation process guided by the main lean thinking ideas, which enable production improvement through planning cycles and the development of a proper environment for successful implementation. Lean thinking may make the process of organ donation more effective and efficient and may contribute to improvements in information systematization and professional qualifications for excellence of assistance. The model is configured as a reference that is available for validation and implementation by health and nursing professionals and managers in the management of potential organ donors after brain death assistance and subsequent transplantation demands.

Proposal for a Conceptual Model for Evaluating Lean Product Development Performance: A Study of LPD Enablers in Manufacturing Companies

NASA Astrophysics Data System (ADS)

Osezua Aikhuele, Daniel; Mohd Turan, Faiz

2016-02-01

The instability in today's market and the emerging demands for mass customized products by customers, are driving companies to seek for cost effective and time efficient improvements in their production system and this have led to real pressure for the adaptation of new developmental architecture and operational parameters to remain competitive in the market. Among such developmental architecture adopted, is the integration of lean thinking in the product development process. However, due to lack of clear understanding of the lean performance and its measurements, many companies are unable to implement and fully integrate the lean principle into their product development process and without a proper performance measurement, the performance level of the organizational value stream will be unknown and the specific area of improvement as it relates to the LPD program cannot be tracked. Hence, it will result in poor decision making in the LPD implementation. This paper therefore seeks to present a conceptual model for evaluation of LPD performances by identifying and analysing the core existing LPD enabler (Chief Engineer, Cross-functional teams, Set-based engineering, Poka-yoke (mistakeproofing), Knowledge-based environment, Value-focused planning and development, Top management support, Technology, Supplier integration, Workforce commitment and Continuous improvement culture) for assessing the LPD performance.

Improvement of emergency department patient flow using lean thinking.

PubMed

Sánchez, Miquel; Suárez, Montse; Asenjo, María; Bragulat, Ernest

2018-05-01

To apply lean thinking in triage acuity level-3 patients in order to improve emergency department (ED) throughtput and waiting time. A prospective interventional study. An ED of a tertiary care hospital. Triage acuity level-3 patients. To apply lean techniques such as value stream mapping, workplace organization, reduction of wastes and standardization by the frontline staff. Two periods were compared: (i) pre-lean: April-September, 2015; and (ii) post-lean: April-September, 2016. Variables included: median process time (time from beginning of nurse preparation to the end of nurse finalization after doctor disposition) of both discharged and transferred to observation patients; median length of stay; median waiting time; left without being seen, 72-h revisit and mortality rates, and daily number of visits. There was no additional staff or bed after lean implementation. Despite an increment in the daily number of visits (+8.3%, P < 0.001), significant reductions in process time of discharged (182 vs 160 min, P < 0.001) and transferred to observation (186 vs 176 min, P < 0.001) patients, in length of stay (389 vs 329 min, P < 0.001), and in waiting time (71 vs 48 min, P < 0.001) were achieved after lean implementation. No significant differences were registered in left without being seen rate (5.23% vs 4.95%), 72-h revisit rate (3.41% vs 3.93%), and mortality rate (0.23% vs 0.15%). Lean thinking is a methodology that can improve triage acuity level-3 patient flow in the ED, resulting in better throughput along with reduced waiting time.

Keynote: Beyond Budgeting in a Lean and Agile World

NASA Astrophysics Data System (ADS)

Bogsnes, Bjarte

We suggest that we need a fundamentally different philosophy and a concept for how organisations are led and managed. We believe that it is time to challenge the traditional management myths. The main goal of Beyond Budgeting is not get rid of budgets. The budget must go, but it is more the budgeting mindset we need to get rid of, because it represents the old thinking that needs to be changed. Based on the works of The Beyond Budgeting Round Table, we review a set of 12 principles for a new style of contemporary leadership and management.

Use of a service evaluation and lean thinking transformation to redesign an NHS 111 refer to community Pharmacy for Emergency Repeat Medication Supply Service (PERMSS).

PubMed

Nazar, Hamde; Nazar, Zachariah; Simpson, Jill; Yeung, Andre; Whittlesea, Cate

2016-08-26

To demonstrate the contribution of community pharmacy from NHS 111 referrals out of hours (OOH) for emergency supply repeat medication requests via presentation of service activity, community pharmacist feedback and lean thinking transformation. Descriptive service evaluation using routine service activity data over the pilot period; survey of community pharmacists, and service redesign through lean thinking transformation. North East of England NHS 111 provider and accredited community pharmacies across the North East of England. Patients calling the North East of England NHS 111 provider during OOH with emergency repeat medication supply requests. NHS 111 referral to community pharmacies for assessment and if appropriate, supply of emergency repeat medication. Number of emergency repeat medication supply referrals, completion rates, reasons for rejections, time of request, reason for access, medication(s), pharmaceutical advice and services provided. Secondary outcomes were community pharmacist feedback and lean thinking transformation of the patient pathway. NHS 111 referred 1468 patients to 114 community pharmacies (15/12/2014-7/4/2015). Most patients presented on Saturdays, with increased activity over national holidays. Community pharmacists completed 951 (64.8%) referrals providing 2297 medications; 412 were high risk. The most common reason for rejecting referrals was no medication in stock. Community pharmacists were positive about the provision of this service. The lean thinking transformation reduced the number of non-added value steps, waits and bottlenecks in the patient pathway. NHS 111 can redirect callers OOH from urgent and emergency care services to community pharmacy for management of emergency repeat medication supply. Existing IT and community pharmacy regulations allowed patients to receive a medication supply and pharmaceutical advice. Community pharmacists supported integration into the NHS OOH services. Adopting lean thinking provided a structured framework to evaluate and redesign the service with the aim to improve effectiveness and efficiency. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Lean thinking transformation of the unsedated upper gastrointestinal endoscopy pathway improves efficiency and is associated with high levels of patient satisfaction.

PubMed

Hydes, Theresa; Hansi, Navjyot; Trebble, Timothy M

2012-01-01

Upper gastrointestinal (UGI) endoscopy is a routine healthcare procedure with a defined patient pathway. The objective of this study was to redesign this pathway for unsedated patients using lean thinking transformation to focus on patient-derived value-adding steps, remove waste and create a more efficient process. This was to form the basis of a pathway template that was transferrable to other endoscopy units. A literature search of patient expectations for UGI endoscopy identified patient-derived value. A value stream map was created of the current pathway. The minimum and maximum time per step, bottlenecks and staff-staff interactions were recorded. This information was used for service transformation using lean thinking. A patient pathway template was created and implemented into a secondary unit. Questionnaire studies were performed to assess patient satisfaction. In the primary unit the patient pathway reduced from 19 to 11 steps with a reduction in the maximum lead time from 375 to 80 min following lean thinking transformation. The minimum value/lead time ratio increased from 24% to 49%. The patient pathway was redesigned as a 'cellular' system with minimised patient and staff travelling distances, waiting times, paperwork and handoffs. Nursing staff requirements reduced by 25%. Patient-prioritised aspects of care were emphasised with increased patient-endoscopist interaction time. The template was successfully introduced into a second unit with an overall positive patient satisfaction rating of 95%. Lean thinking transformation of the unsedated UGI endoscopy pathway results in reduced waiting times, reduced staffing requirements and improved patient flow and can form the basis of a pathway template which may be successfully transferred into alternative endoscopy environments with high levels of patient satisfaction.

Application of a mathematical model for ergonomics in lean manufacturing.

PubMed

Botti, Lucia; Mora, Cristina; Regattieri, Alberto

2017-10-01

The data presented in this article are related to the research article "Integrating ergonomics and lean manufacturing principles in a hybrid assembly line" (Botti et al., 2017) [1]. The results refer to the application of the mathematical model for the design of lean processes in hybrid assembly lines, meeting both the lean principles and the ergonomic requirements for safe assembly work. Data show that the success of a lean strategy is possible when ergonomics of workers is a parameter of the assembly process design.

The promise of Lean in health care.

PubMed

Toussaint, John S; Berry, Leonard L

2013-01-01

An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Lean Principles and Defense Information Technology Acquisition: An Investigation of the Determinants of Successful Application

ERIC Educational Resources Information Center

Haley, M.

2013-01-01

The purpose of this study was to investigate whether or not there have been successful applications of lean manufacturing principles in highly variable defense IT environments. Specifically, the study assessed if implementation of the lean philosophies by a defense organization yielded repeatable, predictable results in software release schedules…

Getting 'Lean': hardwiring process excellence into Northeast Health.

PubMed

Brown, Tricia; Duthe, Robert

2009-01-01

Many healthcare organizations are turning to the "Lean" Toyota Production System as a means to hardwire process excellence into their organizations. Northeast Health, an integrated delivery system in New York's capital region, introduced the Lean concept into its culture in 2004. After four years, the organization is beginning to see its staff hardwire Lean thinking into day-to-day behaviors. This paper focuses on the approach used by Northeast Health to introduce Lean concepts into its culture, challenges faced, lessons learned and the factors critical to success.

Florida hospital saves 5.3 M dollars by adopting principles of lean manufacturing.

PubMed

2005-01-01

Florida hospital saves 5.3M dollars by adopting principles of lean manufacturing. Surgery cancellations have been slashed from 13% of cases to less than 3%, while emergency department admissions have increased by 20%. Those are just two of the results of a quality improvement project at Lee Memorial Health System in Fort Myers, FL, that focused on using the principles of lean manufacturing to improve patient flow in the five-hospital system

[Lean logistics management in healthcare: a case study].

PubMed

Aguilar-Escobar, V G; Garrido-Vega, P

2013-01-01

To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

Applying Lean: Implementation of a Rapid Triage and Treatment System

PubMed Central

Murrell, Karen L.; Offerman, Steven R.; Kauffman, Mark B.

2011-01-01

Objective: Emergency department (ED) crowding creates issues with patient satisfaction, long wait times and leaving the ED without being seen by a doctor (LWBS). Our objective was to evaluate how applying Lean principles to develop a Rapid Triage and Treatment (RTT) system affected ED metrics in our community hospital. Methods: Using Lean principles, we made ED process improvements that led to the RTT system. Using this system, patients undergo a rapid triage with low-acuity patients seen and treated by a physician in the triage area. No changes in staffing, physical space or hospital resources occurred during the study period. We then performed a retrospective, observational study comparing hospital electronic medical record data six months before and six months after implementation of the RTT system. Results: ED census was 30,981 in the six months prior to RTT and 33,926 after. Ambulance arrivals, ED patient acuity and hospital admission rates were unchanged throughout the study periods. Mean ED length of stay was longer in the period before RTT (4.2 hours, 95% confidence interval [CI] = 4.2–4.3; standard deviation [SD] = 3.9) than after (3.6 hours, 95% CI = 3.6–3.7; SD = 3.7). Mean ED arrival to physician start time was 62.2 minutes (95% CI = 61.5–63.0; SD = 58.9) prior to RTT and 41.9 minutes (95% CI = 41.5–42.4; SD = 30.9) after. The LWBS rate for the six months prior to RTT was 4.5% (95% CI = 3.1–5.5) and 1.5% (95% CI = 0.6–1.8) after RTT initiation. Conclusion: Our experience shows that changes in ED processes using Lean thinking and available resources can improve efficiency. In this community hospital ED, use of an RTT system decreased patient wait times and LWBS rates. PMID:21691524

An Exploration of Healthcare Inventory and Lean Management in Minimizing Medical Supply Waste in Healthcare Organizations

ERIC Educational Resources Information Center

Hicks, Rodney

2013-01-01

The purpose of this study was to understand how lean thinking and inventory management technology minimize expired medical supply waste in healthcare organizations. This study was guided by Toyota's theory of lean and Mintzberg's theory of management development to explain why the problem of medical supply waste exists. Government…

Lean Manufacturing Principles Improving the Targeting Process

DTIC Science & Technology

2012-06-08

author has familiarity with Lean manufacturing principles. Third, Lean methods have been used in different industries and have proven adaptable to the...92 The case study also demonstrates the multi organizational application of VSM, JIT and the 5S method ...new members not knowing the process, this will serve as a start point for the developing of understanding. Within the Food industry we observed “the

Applying Lean principles and Kaizen rapid improvement events in public health practice.

PubMed

Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

Applying lean principles to continuous renal replacement therapy processes.

PubMed

Benfield, C Brett; Brummond, Philip; Lucarotti, Andrew; Villarreal, Maria; Goodwin, Adam; Wonnacott, Rob; Talley, Cheryl; Heung, Michael

2015-02-01

The application of lean principles to continuous renal replacement therapy (CRRT) processes in an academic medical center is described. A manual audit over six consecutive weeks revealed that 133 5-L bags of CRRT solution were discarded after being dispensed from pharmacy but before clinical use. Lean principles were used to examine the workflow for CRRT preparation and develop and implement an intervention. An educational program was developed to encourage and enhance direct communication between nursing and pharmacy about changes in a patient's condition or CRRT order. It was through this education program that the reordering workflow shifted from nurses to pharmacy technicians. The primary outcome was the number of CRRT solution bags delivered in the preintervention and postintervention periods. Nurses and pharmacy technicians were surveyed to determine their satisfaction with the workflow change. After implementation of lean principles, the mean number of CRRT solution bags dispensed per day of CRRT decreased substantially. Respondents' overall satisfaction with the CRRT solution preparation process increased during the postintervention period, and the satisfaction scores for each individual component of the workflow after implementation of lean principles. The decreased solution waste resulted in projected annual cost savings exceeding $70,000 in product alone. The use of lean principles to identify medication waste in the CRRT workflow and implementation of an intervention to shift the workload from intensive care unit nurses to pharmacy technicians led to reduced CRRT solution waste, improved efficiency of CRRT workflow, and increased satisfaction among staff. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

The positive impact of simultaneous implementation of the BD FocalPoint GS Imaging System and lean principles on the operation of gynecologic cytology.

PubMed

Wong, Rebecca; Levi, Angelique W; Harigopal, Malini; Schofield, Kevin; Chhieng, David C

2012-02-01

Our cytology laboratory, like many others, is under pressure to improve quality and provide test results faster while decreasing costs. We sought to address these issues by introducing new technology and lean principles. To determine the combined impact of the FocalPoint Guided Screener (GS) Imaging System (BD Diagnostics-TriPath, Burlington, North Carolina) and lean manufacturing principles on the turnaround time (TAT) and productivity of the gynecologic cytology operation. We established a baseline measure of the TAT for Papanicolaou tests. We then compared that to the performance after implementing the FocalPoint GS Imaging System and lean principles. The latter included value-stream mapping, workflow modification, and a first in-first out policy. The mean (SD) TAT for Papanicolaou tests before and after the implementation of FocalPoint GS Imaging System and lean principles was 4.38 (1.28) days and 3.20 (1.32) days, respectively. This represented a 27% improvement in the average TAT, which was statistically significant (P < .001). In addition, the productivity of staff improved 17%, as evidenced by the increase in slides screened from 8.85/h to 10.38/h. The false-negative fraction decreased from 1.4% to 0.9%, representing a 36% improvement. In our laboratory, the implementation of FocalPoint GS Imaging System in conjunction with lean principles resulted in a significant decrease in the average TAT for Papanicolaou tests and a substantial increase in the productivity of cytotechnologists while maintaining the diagnostic quality of gynecologic cytology.

Lean thinking in hospitals: is there a cure for the absence of evidence? A systematic review of reviews

PubMed Central

Andersen, Hege; Røvik, Kjell Arne; Ingebrigtsen, Tor

2014-01-01

Objective Lean interventions aim to improve quality of healthcare by reducing waste and facilitate flow in work processes. There is conflicting evidence on the outcomes of lean thinking, with quantitative and qualitative studies often contradicting each other. We suggest that reviewing the literature within the approach of a new contextual framework can deepen our understanding of lean as a quality-improvement method. This article theorises the concept of context by establishing a two-dimensional conceptual framework acknowledging lean as complex social interventions, deployed in different organisational dimensions and domains. The specific aim of the study was to identify factors facilitating intended outcomes from lean interventions, and to understand when and how different facilitators contribute. Design A two-dimensional conceptual framework was developed by combining Shortell's Dimensions of capability with Walshes’ Domains of an intervention. We then conducted a systematic review of lean review articles concerning hospitals, published in the period 2000–2012. The identified lean facilitators were categorised according to the intervention domains and dimensions of capability provided by the framework. Results We provide a framework emphasising context by relating facilitators to domains and dimensions of capability. 23 factors enabling a successful lean intervention in hospitals were identified in the systematic review, where management and a supportive culture, training, accurate data, physicians and team involvement were most frequent. Conclusions In the absence of evidence, the two-dimensional framework, incorporating the context, may prove useful for future research on variation in outcomes from lean interventions. Findings from the review suggest that characteristics and local application of lean, in addition to strategic and cultural capability, should be given further attention in healthcare quality improvement. PMID:24435890

Using Toyota's A3 Thinking for Analyzing MBA Business Cases

ERIC Educational Resources Information Center

Anderson, Joe S.; Morgan, James N.; Williams, Susan K.

2011-01-01

A3 Thinking is fundamental to Toyota's benchmark management philosophy and to their lean production system. It is used to solve problems, gain agreement, mentor team members, and lead organizational improvements. A structured problem-solving approach, A3 Thinking builds improvement opportunities through experience. We used "The Toyota…

The human side of lean teams.

PubMed

Wackerbarth, Sarah B; Strawser-Srinath, Jamie R; Conigliaro, Joseph C

2015-05-01

Organizations use lean principles to increase quality and decrease costs. Lean projects require an understanding of systems-wide processes and utilize interdisciplinary teams. Most lean tools are straightforward, and the biggest barrier to successful implementation is often development of the team aspect of the lean approach. The purpose of this article is to share challenges experienced by a lean team charged with improving a hospital discharge process. Reflection on the experience provides an opportunity to highlight lessons from The Team Handbook by Peter Scholtes and colleagues. To improve the likelihood that process improvement initiatives, including lean projects, will be successful, organizations should consider providing training in organizational change principles and team building. The authors' lean team learned these lessons the hard way. Despite the challenges, the team successfully implemented changes throughout the organization that have had a positive impact. Training to understand the psychology of change might have decreased the resistance faced in implementing these changes. © 2014 by the American College of Medical Quality.

The Power of ROFO Principle Together with Companywide Training in Executing Lean Production Strategy

ERIC Educational Resources Information Center

Goh, Ah Bee; Chakpitak, Nopasit; Sureephong, Pradorn

2015-01-01

This paper reports the findings of the case study conducted at Schaffner Thailand (ST) factory regarding the application of the ROFO principle coupled with companywide training on the execution of Lean Production (LP) strategy. The case study was motivated by 3 main objectives: 1) to examine the effectiveness of the ROFO principle and companywide…

Study on lean thinking among MSMEs in the Machine tool sector in India

NASA Astrophysics Data System (ADS)

Priyaadarshini, R. G.; Sathish Kumar, V. R.; Aishwarya Rajlakshmi, S.

2018-02-01

In the era of stiff competition and customer expectations, manufacturing organizations across the world are struggling hard to minimize their costs and maximise their performance. Micro, Small and Medium enterprises (MSMEs), who are dependent on large corporate for business and support have a tall task of keeping pace quality in processes and output. They are in the constant vigil to adopt new systems and practices so that they can minimise their cost and maximize the productivity. This study has been conducted in the machine tool sector of Coimbatore, India; which houses more than 9000 companies and offers employment to over one lakh employees. They have a tremendous pressure to use scientific processes to increase their product quality and productivity. While Lean manufacturing has been the thrust to improve the competitiveness among MSMEs in India, this study has attempted to understand their attitude towards lean management and understand the extent to which companies practice lean tools and practices. It has been found that most of the organizations in the study possess a culture of lean thinking and possess the support of top management and employees also towards the initiative. It is also seen that the organizations that incorporated lean in their daily operations have been able to scale up their productivity.

Lean Production as an Innovative Approach to Construction

NASA Astrophysics Data System (ADS)

Spišáková, Marcela; Kozlovská, Mária

2013-06-01

Lean production presents a new approach to the construction management which has enabled enterprises to attain very high levels of efficiency, competitiveness and flexibility in production systems. Nowadays, a number of industrial processes are managed in accordance with these advanced management principles [1]. The principles of lean production are applied within the integrated design and delivery solutions (IDDS) and prefabricated construction. IDDS uses collaborative work processes and enhanced skills, with integrated data, information, and knowledge management to minimize structural and process inefficiencies and to enhance the value delivered during design, build, and operation, and across projects. Prefabrication presents a one of opportunities for construction methods, which allows the compliance with principles of sustainable design, provides the potential benefits such as faster construction, fewer housing defects, reduction in energy use and waste and elimination of environmental and safety risks. This paper presents the lean production within the IDDS and its potential in the modern prefabrication. There is created a field providing of benefits of lean production in construction industry.

Application of Hands-On Simulation Games to Improve Classroom Experience

ERIC Educational Resources Information Center

Hamzeh, Farook; Theokaris, Christina; Rouhana, Carel; Abbas, Yara

2017-01-01

While many construction companies claim substantial productivity and profit gains when applying lean construction principles, it remains a challenge to teach these principles in a classroom. Lean construction emphasises collaborative processes and integrated delivery practices. Consequently, new teaching methods that nurture such values should…

Lean Thinking in Libraries: A Case Study on Improving Shelving Turnaround

ERIC Educational Resources Information Center

Kress, Nancy J.

2007-01-01

The University of Chicago's Joseph Regenstein Library Bookstacks Department has used process mapping and continuous improvement to successfully improve its overall operations. The most recent efforts focus on Lean manufacturing, an initiative centered on eliminating waste in manufacturing processes. The conversion of the Bookstacks Department from…

Lean and Agile: An Epistemological Reflection

ERIC Educational Resources Information Center

Browaeys, Marie-Joelle; Fisser, Sandra

2012-01-01

Purpose: The aim of the paper is to contribute to the discussion of treating the concepts of lean and agile in isolation or combination by presenting an alternative view from complexity thinking on these concepts, considering an epistemological approach to this topic. Design/methodology/approach: The paper adopts an epistemological approach, using…

Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

PubMed

Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

2017-12-01

UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

Building Lean Supply Chain and Manufacturing Skills through an Interactive Case Study

ERIC Educational Resources Information Center

Ozelkan, Ertunga C.; Teng, S. Gary; Johnson, Thomas; Benson, Tom; Nestvogel, Dean

2007-01-01

With the ongoing global pressure to cut costs and focus on quality, many companies have been implementing "lean manufacturing" concepts to survive in the competitive marketplace. Thus it is imperative that engineering and business graduates are equipped with the lean principles, and are ready to take ownership of lean initiatives as they enter the…

Lean Production as Promoter of Thinkers to Achieve Companies' Agility

ERIC Educational Resources Information Center

Alves, Anabela C.; Dinis-Carvalho, Jose; Sousa, Rui M.

2012-01-01

Purpose: This paper aims to explore the lean production paradigm as promoter of workers' creativity and thinking potential, and recognize this human potential as a fundamental asset for companies' growth and success, being a major factor to face the disturbing and unpredictable needs of current markets, providing companies with the necessary…

Study on HOPE Management Mode of Coal Enterprises Based on Systematic Thinking

NASA Astrophysics Data System (ADS)

Zhaoran, Zhang; Tianzhu, Zhang; Wenjing, Tong

2018-02-01

The extensive management mode of coal enterprises is no longer applicable to the demand of enterprise development under the new economic situation. Combined with the characteristics of coal mine production, based on the system of thinking, integration of lean, people, comprehensive, job management theory, formed HOPE management model, including a core system and three support systems and 18 elements. There are three stages in the development and implementation of this model. To 6S site management for the initial stage to job process reengineering for the intermediate stage to post value process control for the advanced stage. The successful implementation of HOPE model in coal enterprises needs comprehensive control from five aspects: lean culture construction, flattening organizational structure, cost control system, performance appraisal system and lean information management platform. HOPE model can be implemented smoothly and make “win-win” between enterprises and employees.

Lean consumption.

PubMed

Womack, James P; Jones, Daniel T

2005-03-01

During the past 20 years, the real price of most consumer goods has fallen worldwide, the variety of goods and the range of sales channels offering them have continued to grow, and product quality has steadily improved. So why is consumption often so frustrating? It doesn't have to be--and shouldn't be--the authors say. They argue that it's time to apply lean thinking to the processes of consumption--to give consumers the full value they want from goods and services with the greatest efficiency and the least pain. Companies may think they save time and money by off-loading work to the consumer but, in fact, the opposite is true. By streamlining their systems for providing goods and services, and by making it easier for customers to buy and use those products and services, a growing number of companies are actually lowering costs while saving everyone time. In the process, these businesses are learning more about their customers, strengthening consumer loyalty, and attracting new customers who are defecting from less user-friendly competitors. The challenge lies with the retailers, service providers, manufacturers, and suppliers that are not used to looking at total cost from the standpoint of the consumer and even less accustomed to working with customers to optimize the consumption process. Lean consumption requires a fundamental shift in the way companies think about the relationship between provision and consumption, and the role their customers play in these processes. It also requires consumers to change the nature of their relationships with the companies they patronize. Lean production has clearly triumphed over similar obstacles in recent years to become the dominant global manufacturing model. Lean consumption, its logical companion, can't be far behind.

Antecedents and characteristics of lean thinking implementation in a Swedish hospital: a case study.

PubMed

Ulhassan, Waqar; Sandahl, Christer; Westerlund, Hugo; Henriksson, Peter; Bennermo, Marie; von Thiele Schwarz, Ulrica; Thor, Johan

2013-01-01

Despite the reported success of Lean in health care settings, it is unclear why and how organizations adopt Lean and how Lean transforms work design and, in turn, affects employees' work. This study investigated a cardiology department's journey to adopt and adapt Lean. The investigation was focused on the rationale and evolution of the Lean adoption to illuminate how a department with a long quality improvement history arrived at the decision to introduce Lean, and how Lean influenced employees' daily work. This is an explanatory single case study based on semistructured interviews, nonparticipant observations, and document studies. Guided by a Lean model, we undertook manifest content analysis of the data. We found that previous improvement efforts may facilitate the introduction of Lean but may be less important when forecasting whether Lean will be sustained over time. Contextual factors seemed to influence both what Lean tools were implemented and how well the changes were sustained. For example, adoption of Lean varied with the degree to which staff saw a need for change. Work redesign and teamwork were found helpful to improve patient care whereas problem solving was found helpful in keeping the staff engaged and sustaining the results over time.

Improving Business School Courses by Applying Lean Principles and Practices

ERIC Educational Resources Information Center

Emiliani, M. L.

2004-01-01

Describes the application of lean principles and practices to the design and delivery of a graduate business course on leadership taken by part-time working professional students in a classroom setting. The principal objectives were to improve consistency between what was taught in the course and how the course was taught, eliminate waste, improve…

Lean management-the journey from toyota to healthcare.

PubMed

Teich, Sorin T; Faddoul, Fady F

2013-04-01

The evolution of production systems is tightly linked to the story of Toyota Motor Company (TMC) that has its roots around 1918. The term "lean" was coined in 1990 following the exploration of the Toyota model that led to the "transference" thesis sustaining the concept that manufacturing problems and technologies are universal problems faced by management and that these concepts can be emulated in non-Japanese enterprises. Lean is a multi-faceted concept and requires organizations to exert effort along several dimensions simultaneously; some consider a successful implementation either achieving major strategic components of lean, implementing practices to support operational aspects, or providing evidence that the improvements are sustainable in the long term. The article explores challenges and opportunities faced by organizations that intend incorporating lean management principles and presents the specific context of the healthcare industry. Finally, the concepts of "essential few" and customer value are illustrated through a simple example of process change following lean principles, which was implemented in a dental school in the United States.

[Improving a hospital's supply chain through lean management].

PubMed

Aguilar-Escobar, V G; Garrido-Vega, P; Godino-Gallego, N

2013-01-01

Supply management is an area where hospitals have significant opportunities for improvement. The main objective of this paper has been to analyze how the application of Lean principles can improve logistics costs and user satisfaction. In connection with satisfaction, it also aimed to examine which aspects of the service define it and check for differences between different groups of users. The results of an experience to reorganize the hospital logistic system based on some Lean principles have been studied. This is therefore a case study, which combine different methods of data collection. The logistics cost calculation was carried out using the full costing method. To measure satisfaction of healthcare personnel, the internal logistics service users, an anonymous survey was conducted. Processing of the data obtained from the survey have included exploratory analysis, factor analysis and ANOVAs. The data have showed an improvement in logistics management after the implementation of Lean principles. Logistics costs were reduced and the satisfaction level of the internal users with the new logistics system was increased. Some differences in the degree of satisfaction by different groups of users were also detected, although they did not seem to distinguish between different aspects of logistic service. The analyzed experience shows the applicability and suitability of Lean principles to improve logistics operational costs and increase user satisfaction. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

Utilization of lean management principles in the ambulatory clinic setting.

PubMed

Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

2009-03-01

The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

PubMed Central

Matt, Dominik T.

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. PMID:29065578

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals.

PubMed

Arcidiacono, Gabriele; Matt, Dominik T; Rauch, Erwin

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system.

Axiomatic Design of a Framework for the Comprehensive Optimization of Patient Flows in Hospitals

PubMed

Arcidiacono, Gabriele; Matt, Dominik T.; Rauch, Erwin

2017-01-01

Lean Management and Six Sigma are nowadays applied not only to the manufacturing industry but also to service industry and public administration. The manifold variables affecting the Health Care system minimize the effect of a narrow Lean intervention. Therefore, this paper aims to discuss a comprehensive, system-based approach to achieve a factual holistic optimization of patient flows. This paper debates the efficacy of Lean principles applied to the optimization of patient flows and related activities, structures, and resources, developing a theoretical framework based on the principles of the Axiomatic Design. The demand for patient-oriented and efficient health services leads to use these methodologies to improve hospital processes. In the framework, patients with similar characteristics are clustered in families to achieve homogeneous flows through the value stream. An optimization checklist is outlined as the result of the mapping between Functional Requirements and Design Parameters, with the right sequence of the steps to optimize the patient flow according to the principles of Axiomatic Design. The Axiomatic Design-based top-down implementation of Health Care evidence, according to Lean principles, results in a holistic optimization of hospital patient flows, by reducing the complexity of the system. © 2017 Gabriele Arcidiacono et al.

Operationalising the Lean principles in maternity service design using 3P methodology

PubMed Central

Smith, Iain

2016-01-01

The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as “wrap around care” in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements. PMID:27933146

Operationalising the Lean principles in maternity service design using 3P methodology.

PubMed

Smith, Iain

2016-01-01

The last half century has seen significant changes to Maternity services in England. Though rates of maternal and infant mortality have fallen to very low levels, this has been achieved largely through hospital admission. It has been argued that maternity services may have become over-medicalised and service users have expressed a preference for more personalised care. NHS England's national strategy sets out a vision for a modern maternity service that continues to deliver safe care whilst also adopting the principles of personalisation. Therefore, there is a need to develop maternity services that balance safety with personal choice. To address this challenge, a maternity unit in North East England considered improving their service through refurbishment or building new facilities. Using a design process known as the production preparation process (or 3P), the Lean principles of understanding user value, mapping value-streams, creating flow, developing pull processes and continuous improvement were applied to the design of a new maternity department. Multiple stakeholders were engaged in the design through participation in a time-out (3P) workshop in which an innovative pathway and facility for maternity services were co-designed. The team created a hybrid model that they described as "wrap around care" in which the Lean concept of pull was applied to create a service and facility design in which expectant mothers were put at the centre of care with clinicians, skills, equipment and supplies drawn towards them in line with acuity changes as needed. Applying the Lean principles using the 3P method helped stakeholders to create an innovative design in line with the aspirations and objectives of the National Maternity Review. The case provides a practical example of stakeholders applying the Lean principles to maternity services and demonstrates the potential applicability of the Lean 3P approach to design healthcare services in line with policy requirements.

Efficient Project Delivery Using Lean Principles - An Indian Case Study

NASA Astrophysics Data System (ADS)

Kovvuri, P. Ramachandra Reddy; Sawhney, Anil; Ahuja, Ritu; Sreekumar, Aiswarya

2016-03-01

Construction industry in India is growing at a rapid pace. Along with this growth, the industry is facing numerous challenges that are making delivery of projects inefficient. Experts believe that capacity constraints in the industry need to be addressed immediately. Government has recommended `introduction of efficient technologies and modern management techniques' to increase the productivity of the industry. In this context, lean principles can act as a lever to make project delivery more efficient and provide the much needed impetus to the Indian construction sector. Around the globe lean principles are showing positive results on the projects. Project teams are reporting improvements in construction time, cost and quality along with softer benefits of enhanced collaboration, coordination and trust in project teams. Can adoption of lean principles provide similar benefits in the Indian construction sector? This research was conducted to answer this question. Using an action research approach a key lean construction tool called Last Planner System (LPS) was tested on a large Indian construction project. The work described in this work investigates the improvements achieved in project delivery by adopting LPS in Indian construction sector. Comparison in pre- and post-implementation data demonstrates increase in the certainty of work-flow and improves schedule compliance. This is measured through a simple LPS metric called percent plan complete. Explicit improvements in schedule performance are seen during 8 week LPS implementation along with implicit improvements in coordination, collaboration and trust in the project team. This work reports the findings of LPS implementation on the case study project outlining the barriers and drivers to adoption, strategies needed to ensure successful implementation and roadmap for implementation. Based on the findings the authors envision that lean construction can make project delivery more efficient in India.

Evaluating Lean in healthcare.

PubMed

Burgess, Nicola; Radnor, Zoe

2013-01-01

The purpose of this paper is to present findings relating to how Lean is implemented in English hospitals. Lean implementation snapshots in English hospitals were conducted by content analysing all annual reports and web sites over two time periods, giving a thorough analysis of Lean's status in English healthcare. The article identifies divergent approaches to Lean implementation in English hospitals. These approaches are classified into a typology to facilitate an evaluation of how Lean is implemented. The findings suggest that implementation tends to be isolated rather than system-wide. A second dataset conveys Lean implementation trajectory across the time period. These data signal Lean's increasing use by English hospitals and shows progression towards an increasingly systemic approach. Data were collected using content analysis methods, which relies on how "Lean" methods were articulated within the annual report and/or on the organisation's web site, which indicates approaches taken by hospital staff implementing Lean. This research is the first to examine more closely "how" Lean is implemented in English hospitals. The emergent typology could prove relevant to other public sector organizations and service organisations more generally. The research also presents a first step to understanding Lean thinking in the English NHS. This article empirically analyses Lean implementation in English hospitals. It identifies divergent approaches that allow inferences about how far Lean is implemented in an organisation. Data represent a baseline for further analysis so that Lean implementation can be tracked.

Real-Time Culture Change Improves Lean Success: Sequenced Culture Change Gets Failing Grades.

PubMed

Kusy, Mitchell; Diamond, Marty; Vrchota, Scott

2015-01-01

Success with the Lean management system is rooted in a culture of stakeholder engagement and commitment. Unfortunately, many leaders view Lean as an "add-on" tool instead of one that requires a new way of thinking and approaching culture. This article addresses the "why, how, and what" to promote a Lean culture that works. We present a five-phased approach grounded in evidence-based practices of real-time culture change. We further help healthcare leaders understand the differences between traditional "sequenced" approaches to culture change and "real-time" methods--and why these real-time practices are more sustainable and ultimately more successful than traditional culture change methods.

A Simulation of Lean Manufacturing: The Lean Lemonade Tycoon 2

ERIC Educational Resources Information Center

Ncube, Lisa B.

2010-01-01

This article discusses the functions and effectiveness of games and simulations in the learning processes, in particular as an experiential learning methodology. The application of the game Lemonade Tycoon in the development of lean manufacturing concepts is described. This article addresses the use of the game to teach the principles of lean…

Interlacing Mission, Strategic Planning, and Vision to Lean: Powerful DNA for Change

ERIC Educational Resources Information Center

Arnold, Alison; Flumerfelt, Shannon

2012-01-01

The authors' purpose for this article is to describe a K-12 public school district's journey to internalize and actualize its mission, strategic planning and vision as one coherent engagement using Lean principles and tools. Lean jointly comprises an organizational philosophy and management toolkit prominent in private, government, and nonprofit…

Benchmarking performance measurement and lean manufacturing in the rough mill

Treesearch

Dan Cumbo; D. Earl Kline; Matthew S. Bumgardner

2006-01-01

Lean manufacturing represents a set of tools and a stepwise strategy for achieving smooth, predictable product flow, maximum product flexibility, and minimum system waste. While lean manufacturing principles have been successfully applied to some components of the secondary wood products value stream (e.g., moulding, turning, assembly, and finishing), the rough mill is...

Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

PubMed

Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

2010-01-01

In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

Lean thinking in health and nursing: an integrative literature review.

PubMed

Magalhães, Aline Lima Pestana; Erdmann, Alacoque Lorenzini; Silva, Elza Lima da; Santos, José Luís Guedes Dos

2016-08-08

to demonstrate the scientific knowledge developed on lean thinking in health, highlighting the impact and contributions in health care and nursing. an integrative literature review in the PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS and SciELO electronic library databases, from 2006 to 2014, with syntax keywords for each data base, in which 47 articles were selected for analysis. the categories were developed from the quality triad proposed by Donabedian: structure, process and outcome. Lean thinking is on the rise in health surveys, particularly internationally, especially in the USA and UK, improving the structure, process and outcome of care and management actions. However, it is an emerging theme in nursing. this study showed that the use of lean thinking in the context of health has a transforming effect on care and organizational aspects, promoting advantages in terms of quality, safety and efficiency of health care and nursing focused on the patient. evidenciar o conhecimento científico desenvolvido sobre pensamento Lean na área da saúde, destacando o impacto e as contribuições no cuidado em saúde e enfermagem. revisão integrativa da literatura a partir das bases de dados PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS e na biblioteca eletrônica SciELO, de 2006 a 2014, com sintaxe de palavras-chaves para cada base, selecionados 47 artigos para análise. as categorias foram elaboradas a partir da tríade de qualidade proposta por Donabedian: estrutura, processo e resultado. O pensamento Lean está em ascensão nas pesquisas sobre saúde, principalmente no âmbito internacional, com destaque para os Estados Unidos e Reino Unido, melhorando a estrutura, o processo e o resultado a partir das ações assistenciais e gerenciais. Porém, é uma temática incipiente na enfermagem. por meio desse estudo observou-se que a utilização do pensamento Lean, no contexto da saúde, tem um efeito transformador nos aspectos assistenciais e organizacionais, promovendo vantagens em termos de qualidade, segurança e eficiência dos cuidados de saúde e enfermagem com foco no paciente. evidenciar el conocimiento científico desarrollado sobre el pensamiento Lean en el área de la salud (destacando el impacto y las contribuciones en el cuidado de la salud) y en la enfermería. revisión integradora de la literatura a partir de las bases de datos PubMed, CINAHL, Scopus, Web of Science, Emerald, LILACS y en la biblioteca electrónica SciELO, de 2006 a 2014, con sintaxis de palabras clave para cada base; fueron seleccionados 47 artículos para análisis. las categorías fueron elaboradas a partir de la tríade de calidad propuesta por Donabedian: estructura, proceso y resultado. El pensamiento Lean está en ascensión en las investigaciones sobre salud, principalmente en el ámbito internacional, con destaque para los Estados Unidos y Reino Unido, mejorando la estructura, el proceso y el resultado a partir de acciones asistenciales y administrativas. Sin embargo, es una temática incipiente en la enfermería. por medio de ese estudio se observó que la utilización del pensamiento Lean, en el contexto de la salud, tiene un efecto transformador en los aspectos asistenciales y organizacionales, promoviendo ventajas en términos de calidad, seguridad y eficiencia de los cuidados de salud y enfermería con enfoque en el paciente.

Educating Adults: A Matter of Balance.

ERIC Educational Resources Information Center

Tice, Elizabeth T.

1997-01-01

In the conceptual debate over the appropriate methods for adult learning, both those who think learning only occurs at the feet of the master and those who think that adults should be totally self-directed are right to an extent. A balance is needed, considering the age, leaning style, and desired outcomes of the student. (JOW)

Restructuring of the Diabetes Day Centre: a pilot lean project in a tertiary referral centre in the West of Ireland.

PubMed

McDermott, A M; Kidd, P; Gately, M; Casey, R; Burke, H; O'Donnell, P; Kirrane, F; Dinneen, S F; O'Brien, T

2013-08-01

Diabetes is a chronic disease amenable to management in the community and outpatient setting. The increasing incidence of diabetes places outpatient endocrinology services under pressure to provide a quality service in a timely manner. Our aim was to apply lean thinking to the diabetes clinic in a tertiary referral centre in the West of Ireland to improve flow, as reflected in reduced patient journey times. The project lasted 6 months, from January to June 2011. An introductory seminar on lean thinking was arranged to inform and motivate the Diabetes Day Centre staff. Two 'rapid improvement events' took place. Value stream mapping (VSM) was the predominant lean tool employed. Patient journeys were mapped and quantified (minutes) using timesheets allocated to each step in the process at baseline, and following intervention. Data were analysed using Minitab V.16.0. VSM allowed the value-adding and problem-causing steps in the patient journey through the diabetes clinic process to be identified and addressed. Total patient journey time through the clinic was significantly reduced from 118 (± 38.02) min to 58 (± 18.30) min (p<0.001). This project reflects the successful application of VSM as a lean tool in a pilot study at our institution as evidenced by improved patient flow and a significant reduction in patient journey time through the clinic. Through the incorporation of Lean into the ethos of the hospital, we have the potential to deliver excellent care in a safe environment and in an efficient manner, while benefiting the patient, employees and tax-payer.

Lean Management—The Journey from Toyota to Healthcare

PubMed Central

Teich, Sorin T.; Faddoul, Fady F.

2013-01-01

The evolution of production systems is tightly linked to the story of Toyota Motor Company (TMC) that has its roots around 1918. The term “lean” was coined in 1990 following the exploration of the Toyota model that led to the “transference” thesis sustaining the concept that manufacturing problems and technologies are universal problems faced by management and that these concepts can be emulated in non-Japanese enterprises. Lean is a multi-faceted concept and requires organizations to exert effort along several dimensions simultaneously; some consider a successful implementation either achieving major strategic components of lean, implementing practices to support operational aspects, or providing evidence that the improvements are sustainable in the long term. The article explores challenges and opportunities faced by organizations that intend incorporating lean management principles and presents the specific context of the healthcare industry. Finally, the concepts of “essential few” and customer value are illustrated through a simple example of process change following lean principles, which was implemented in a dental school in the United States. PMID:23908857

Lean Management Systems in Radiology: Elements for Success.

PubMed

Schultz, Stacy R; Ruter, Royce L; Tibor, Laura C

2016-01-01

This article is a review of the literature on Lean and Lean Management Systems and how they have been implemented in healthcare organizations and particularly in radiology departments. The review focuses on the elements required for a successful implementation of Lean by applying the principles of a Lean Management System instead of a Lean tools-only approach. This review shares the successes and failures from healthcare organizations' efforts to improve the quality and safety of the services they provide. There are a limited number of healthcare organizations in the literature who have shared their experiences and additional research is necessary to determine whether a Lean Management System is a viable alternative to the current management structure in healthcare.

Teaching Lean Six Sigma within a Supply Chain Context: The Airplane Supply Chain Simulation

ERIC Educational Resources Information Center

Ellis, Scott C.; Goldsby, Thomas J.; Bailey, Ana M.; Oh, Jae-Young

2014-01-01

Lean six sigma is a management methodology that firms can employ to achieve substantial improvement in supply chain performance. However, few pedagogical exercises facilitate students' use of a comprehensive set of lean six sigma principles within a supply chain context. We describe the Airplane Supply Chain Simulation that helps students…

Improving Autopsy Report Turnaround Times by Implementing Lean Management Principles.

PubMed

Cromwell, Susan; Chiasson, David A; Cassidy, Debra; Somers, Gino R

2018-01-01

The autopsy is an integral part of the service of a large academic pathology department. Timely reporting is central to providing good service and is beneficial for many stakeholders, including the families, the clinical team, the hospital, and the wider community. The current study aimed to improve hospital-consented autopsy reporting times (turnaround time, TAT) by using lean principles modified for a healthcare setting, with an aim of signing out 90% of autopsies in 90 days. An audit of current and historical TATs was performed, and a working group incorporating administrative, technical, and professional staff constructed a value stream map documenting the steps involved in constructing an autopsy report. Two areas of delay were noted: examination of the microscopy and time taken to sign-out the report after the weekly autopsy conference. Several measures were implemented to address these delays, including visual tracking using a whiteboard and individualized tracking sheets, weekly whiteboard huddles, and timelier scheduling of clinicopathologic conference rounds. All measures resulted in an improvement of TATs. In the 30 months prior to the institution of lean, 37% of autopsies (53/144) were signed out in 90 days, with a wide variation in reporting times. In the 30 months following the institution of lean, this improved to 74% (136/185) ( P < .0001, Fisher exact test), with a marked reduction in variability. Further, the time from autopsy to presentation at weekly clinicopathological rounds was also reduced (median: 73 days prior to lean; 63 days post-lean). The application of lean principles to autopsy sign-out workflow can significantly improve TATs and reduce variability, without changing staffing levels or significantly altering scheduling structure.

Using lean principles to improve outpatient adult infusion clinic chemotherapy preparation turnaround times.

PubMed

Lamm, Matthew H; Eckel, Stephen; Daniels, Rowell; Amerine, Lindsey B

2015-07-01

The workflow and chemotherapy preparation turnaround times at an adult infusion clinic were evaluated to identify opportunities to optimize workflow and efficiency. A three-phase study using Lean Six Sigma methodology was conducted. In phase 1, chemotherapy turnaround times in the adult infusion clinic were examined one year after the interim goal of a 45-minute turnaround time was established. Phase 2 implemented various experiments including a five-day Kaizen event, using lean principles in an effort to decrease chemotherapy preparation turnaround times in a controlled setting. Phase 3 included the implementation of process-improvement strategies identified during the Kaizen event, coupled with a final refinement of operational processes. In phase 1, the mean turnaround time for all chemotherapy preparations decreased from 60 to 44 minutes, and a mean of 52 orders for adult outpatient chemotherapy infusions was received each day. After installing new processes, the mean turnaround time had improved to 37 minutes for each chemotherapy preparation in phase 2. In phase 3, the mean turnaround time decreased from 37 to 26 minutes. The overall mean turnaround time was reduced by 26 minutes, representing a 57% decrease in turnaround times in 19 months through the elimination of waste and the implementation of lean principles. This reduction was accomplished through increased efficiencies in the workplace, with no addition of human resources. Implementation of Lean Six Sigma principles improved workflow and efficiency at an adult infusion clinic and reduced the overall chemotherapy turnaround times from 60 to 26 minutes. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Improving preanalytic processes using the principles of lean production (Toyota Production System).

PubMed

Persoon, Thomas J; Zaleski, Sue; Frerichs, Janice

2006-01-01

The basic technologies used in preanalytic processes for chemistry tests have been mature for a long time, and improvements in preanalytic processes have lagged behind improvements in analytic and postanalytic processes. We describe our successful efforts to improve chemistry test turnaround time from a central laboratory by improving preanalytic processes, using existing resources and the principles of lean production. Our goal is to report 80% of chemistry tests in less than 1 hour and to no longer recognize a distinction between expedited and routine testing. We used principles of lean production (the Toyota Production System) to redesign preanalytic processes. The redesigned preanalytic process has fewer steps and uses 1-piece flow to move blood samples through the accessioning, centrifugation, and aliquoting processes. Median preanalytic processing time was reduced from 29 to 19 minutes, and the laboratory met the goal of reporting 80% of chemistry results in less than 1 hour for 11 consecutive months.

Application of hands-on simulation games to improve classroom experience

NASA Astrophysics Data System (ADS)

Hamzeh, Farook; Theokaris, Christina; Rouhana, Carel; Abbas, Yara

2017-09-01

While many construction companies claim substantial productivity and profit gains when applying lean construction principles, it remains a challenge to teach these principles in a classroom. Lean construction emphasises collaborative processes and integrated delivery practices. Consequently, new teaching methods that nurture such values should form the basis of lean construction education. One of the proposed methods is 'hands-on team simulation games' which can be employed to replicate various real-life processes, projects, or systems for the purpose of teaching, analysing, and understanding. This study aims at assessing this simulation games and understanding their impact on students' learning and satisfaction. Surveys and tests are administered to assess changes in student's perception of their learning styles and their understanding of key lean construction concepts. Results show a positive student reaction to hands-on simulation games, provide pedagogical insights, and highlight suggestions for improvement.

NO{sub x}-abatement potential of lean-premixed GT combustors

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sattelmayer, T.; Polifke, W.; Winkler, D.

1998-01-01

The influence of the structure of perfectly premixed flames on NO{sub x} formation is investigated theoretically. Since a network of reaction kinetics modules and model flames is used for this purpose, the results obtained are independent of specific burner geometries. Calculations are presented for a mixture temperature of 630 K, an adiabatic flame temperature of 1840 K, and 1 and 15 bars combustor pressure. In particular, the following effects are studied separately from each other: molecular diffusion of temperature and species, flame strain, local quench in highly strained flames and subsequent reignition, turbulent diffusion (no preferential diffusion), and small scalemore » mixing (stirring) in the flame front. Either no relevant influence or an increase in NO{sub x} burners is to avoid excessive turbulent stirring in the flame front. Turbulent flames that exhibit locally and instantaneously near laminar structures (flamelets) appear to be optimal. Using the same methodology, the scope of the investigation is extended to lean-lean staging, since a higher NO{sub x}-abatement potential can be expected in principle. As long as the chemical reactions of the second stage take place in the boundary between the fresh mixture of the second stage and the combustion products from upstream, no advantage can be expected from lean-lean staging. Only if the preliminary burner exhibits much poorer mixing than the second stage can lean-lean staging be beneficial. In contrast, if full mixing between the two stages prior to afterburning can be achieved (lean-mix-lean technique), the combustor outlet temperature can in principle be increased somewhat without NO penalty.« less

Lean health care: what can hospitals learn from a world-class automaker?

PubMed

Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Billi, John E

2006-05-01

With health care costs continuing to rise, a variety of process improvement methodologies have been proposed to address the reported inefficiencies in health care delivery. Lean production is one such method. The management philosophy and tools of lean production come from the manufacturing industry, where they were pioneered by Toyota Motor Corporation, which is viewed as the leader in utilizing these performance improvement methods. Lean has already enjoyed tremendous success in improving quality and efficiency in both the manufacturing and the service sector industries. Health care systems have just begun to utilize lean methods, with reports of improvements just beginning to appear in the literature. We describe some of the basic philosophy and principles of lean production methods and how these concepts can be applied in the health care environment. We describe some of the early success stories and ongoing endeavors of lean production in various health care organizations. We believe the hospital is an ideal setting for use of the lean production method, which could significantly affect how health care is delivered to patients. We conclude by discussing some of the potential challenges in introducing and implementing lean production methods in the health care environment. Lean production is a novel approach to delivering high-quality and efficient care to patients, and we believe that the health care sector can anticipate the same high level of success that the manufacturing and service industries have achieved using this approach. Hospitalists are primed to take action in delivering care of greater quality with more efficiency by applying these new principles in the hospital setting. (c) 2006 Society of Hospital Medicine.

Lean management systems: creating a culture of continuous quality improvement.

PubMed

Clark, David M; Silvester, Kate; Knowles, Simon

2013-08-01

This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

The Finnish healthcare services lean management.

PubMed

Hihnala, Susanna; Kettunen, Lilja; Suhonen, Marjo; Tiirinki, Hanna

2018-02-05

Purpose The purpose of this paper is to discuss health services managers' experiences of management in a special health-care unit and development efforts from the point of view of the Lean method. Additionally, the aim is to deepen the knowledge of the managers' work and nature of the Lean method development processes in the workplace. The research focuses on those aspects and results of Lean method that are currently being used in health-care environments. Design/methodology/approach These data were collected through a number of thematic interviews. The participants were nurse managers ( n = 7) and medical managers ( n = 7) who applied Lean management in their work at the University Hospital in the Northern Ostrobothnia Health Care District. The data were analysed with a qualitative content analysis. Findings A common set of values in specialized health-care services, development of activities and challenges for management in the use of the Lean manager development model to improve personal management skills. Practical implications Managers in specialized health-care services can develop and systematically manage with the help of the Lean method. This emphasizes assumptions, from the point of view of management, about systems development when the organization uses the Lean method. The research outcomes originate from specialized health-care settings in Finland in which the Lean method and its associated management principles have been implemented and applied to the delivery of health care. Originality/value The study shows that the research results and in-depth knowledge on Lean method principles can be applied to health-care management and development processes. The research also describes health services managers' experiences of using the Lean method. In the future, these results can be used to improve Lean management skills, identify personal professional competencies and develop skills required in development processes. Also, the research findings can be used in the training of health services managers in the health-care industry worldwide and to help them survive the pressure to change repeatedly.

Lean Manufacturing Improves Emergency Department Throughput and Patient Satisfaction.

PubMed

Kane, Marlena; Chui, Kristen; Rimicci, Janet; Callagy, Patrice; Hereford, James; Shen, Sam; Norris, Robert; Pickham, David

2015-09-01

A multidisciplinary team led by nursing leadership and physicians developed a plan to meet increasing demand and improve the patient experience in the ED without expanding the department's current resources. The approach included Lean tools and engaged frontline staff and physicians. Applying Lean management principles resulted in quicker service, improved patient satisfaction, increased capacity, and reduced resource utilization. Incorporating continuous daily management is necessary for sustainment of continuous improvement activities.

Effective management of patients with acute ischemic stroke based on lean production on thrombolytic flow optimization.

PubMed

Liang, Zhuoyuan; Ren, Lijie; Wang, Ting; Hu, Huoyou; Li, Weiping; Wang, Yaping; Liu, Dehong; Lie, Yi

2016-12-01

The efficacy of thrombolytic therapy for acute ischemic stroke (AIS) decreases when the administration of tissue plasminogen activator (tPA) is delayed. Derived from Toyota Production System, lean production aims to create top-quality products with high-efficiency procedures, a concept that easily applies to emergency medicine. In this study, we aimed to determine whether applying lean principles to flow optimization could hasten the initiation of thrombolysis. A multidisciplinary team (Stroke Team) was organized to implement an ongoing, continuous loop of lean production that contained the following steps: decomposition, recognition, intervention, reengineering and assessment. The door-to-needle time (DNT) and the percentage of patients with DNT ≤ 60 min before and after the adoption of lean principles were used to evaluate the efficiency of our flow optimization. Thirteen patients with AIS in the pre-lean period and 43 patients with AIS in the lean period (23 in lean period I and 20 patients in lean period II) were consecutively enrolled in our study. After flow optimization, we reduced DNT from 90 to 47 min (p < 0.001 ¤ ). In addition, the percentage of patients treated ≤60 min after hospital arrival increased from 38.46 to 75.0 % (p = 0.015 ¤ ). Adjusted analysis of covariance confirmed a significant influence of optimization on delay of tPA administration (p < 0.001). The patients were more likely to have a good prognosis (mRS ≤ 2 at 90 days) after the flow optimization (30.77-75.00 %, p = 0.012 ¤ ). Our study may offer an effective approach for optimizing the thrombolytic flow in the management of AIS.

Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature.

PubMed

Aij, Kjeld Harald; Rapsaniotis, Sofia

2017-01-01

As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone's leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations.

Experimenting "Learn by Doing" and "Learn by Failing"

ERIC Educational Resources Information Center

Pozzi, Rossella; Noè, Carlo; Rossi, Tommaso

2015-01-01

According to the literature, in recent years, developing experiential learning has fulfilled the requirement of a deep understanding of lean philosophy by engineering students, demonstrating the advantages and disadvantages of some of the key principles of lean manufacturing. On the other hand, the literature evidences how some kinds of game-based…

Lean Six Sigma Implementation for Military Logistics to Improve Readiness

DTIC Science & Technology

2007-04-30

mistake-proofing ( poka - yoke ). Lean, as a management philosophy, is also very focused on creating a better workplace through the Toyota principle...Techniques • Pull System • Visual Control • Mistake proofing ( poka yoke ) • Equipment Changeover 37 Pull System • Issuance of an RFI engine would “trigger

A New Lean Paradigm in Higher Education: A Case Study

ERIC Educational Resources Information Center

Doman, Mark S.

2011-01-01

Purpose: This case study aims to demonstrate that lean principles and practices utilized in industry can be successfully applied to improve higher education administrative processes through an innovative and engaging learning experience involving undergraduate students. Design/methodology/approach: This is a first-hand account by the instructor of…

Lean principles and defense information technology acquisition: An investigation of the determinants of successful application

NASA Astrophysics Data System (ADS)

Haley, M.

The purpose of this study was to investigate whether or not there have been successful applications of lean manufacturing principles in highly variable defense IT environments. Specifically, the study assessed if implementation of the lean philosophies by a defense organization yielded repeatable, predictable results in software release schedules reductions. Additionally, the study set out to determine what potential critical success factors (CSF's) were documented in the secondary data captured for each release, and extracted the variables used in the decision making for acceptability of fielding. In evaluating lean applicability to the high variability environment of USAF IT acquisitions, the research was conducted using non-experimental quantitative methods of archival secondary data. The sample for this case study was compiled from a USAF office that had implemented these techniques in pre-development, development and testing, and fielding phases. Based on the research data, acquisitionists and lean practitioners are inherently interconnected. Therefore, an understanding that critical success factors (CSFs) are integral to successful lean application in DoD IT acquisitions is crucial. Through a combination of synergistic alignments, plyometric CSFs were discovered to maximize the effects of each single CSF to produce rapid results in defense IT acquisitions. These include: (1) Enterprise Incorporation, (2) Team Trust, (3) Transformational Leadership, (4) Recursive Improvement, (5) Integrated Synergy, (6) Customer-Centric Culture and (7) Heuristic Communication.

Solving Homeland Security’s Wicked Problems: A Design Thinking Approach

DTIC Science & Technology

2015-09-01

spur solutions. This thesis provides a framework for how S&T can incorporate design- thinking principles that are working well in other domains to...to spur solutions. This thesis provides a framework for how S&T can incorporate design-thinking principles that are working well in other domains to...Galbraith’s Star Model was used to analyze how DHS S&T, MindLab, and DARPA apply design-thinking principles to inform the framework to apply and

Experimenting `learn by doing' and `learn by failing'

NASA Astrophysics Data System (ADS)

Pozzi, Rossella; Noè, Carlo; Rossi, Tommaso

2015-01-01

According to the literature, in recent years, developing experiential learning has fulfilled the requirement of a deep understanding of lean philosophy by engineering students, demonstrating the advantages and disadvantages of some of the key principles of lean manufacturing. On the other hand, the literature evidences how some kinds of game-based experiential learning overlook daily difficulties, which play a central role in manufacturing systems. To fill the need of a game overcoming such lack of vision, an innovative game direct in-field, named Kart Factory, has been developed. Actual production shifts are simulated, while keeping all the elements peculiar to a real production set (i.e. complexity, effort, safety). The working environment is a real pedal car assembly department, the products to be assembled have relevant size and weight (i.e. up to 35 kg approximately), and the provided tools are real production equipment (e.g. keys, screwdrivers, trans-pallets, etc.). Due to the need to maximise the impact on students, a labour-intensive process characterises the production department. The whole training process is based on three educational principles: Experience Value Principle, Error Value Principle, and Team Value Principle. As the 'learn by doing' and 'learn by failing' are favoured, the theory follows the practice, while crating the willingness to 'do' instead of just designing or planning. The gathered data prove the Kart Factory's effectiveness in reaching a good knowledge of lean concepts, notwithstanding the students' initial knowledge level.

What Is Lean Management in Health Care? Development of an Operational Definition for a Cochrane Systematic Review.

PubMed

Rotter, Thomas; Plishka, Christopher; Lawal, Adegboyega; Harrison, Liz; Sari, Nazmi; Goodridge, Donna; Flynn, Rachel; Chan, James; Fiander, Michelle; Poksinska, Bonnie; Willoughby, Keith; Kinsman, Leigh

2018-01-01

Industrial improvement approaches such as Lean management are increasingly being adopted in health care. Synthesis is necessary to ensure these approaches are evidence based and requires operationalization of concepts to ensure all relevant studies are included. This article outlines the process utilized to develop an operational definition of Lean in health care. The literature search, screening, data extraction, and data synthesis processes followed the recommendations outlined by the Cochrane Collaboration. Development of the operational definition utilized the methods prescribed by Kinsman et al. and Wieland et al. This involved extracting characteristics of Lean, synthesizing similar components to establish an operational definition, applying this definition, and updating the definition to address shortcomings. We identified two defining characteristics of Lean health-care management: (1) Lean philosophy, consisting of Lean principles and continuous improvement, and (2) Lean activities, which include Lean assessment activities and Lean improvement activities. The resulting operational definition requires that an organization or subunit of an organization had integrated Lean philosophy into the organization's mandate, guidelines, or policies and utilized at least one Lean assessment activity or Lean improvement activity. This operational definition of Lean management in health care will act as an objective screening criterion for our systematic review. To our knowledge, this is the first evidence-based operational definition of Lean management in health care.

Teaching Workflow Analysis and Lean Thinking via Simulation: A Formative Evaluation

PubMed Central

Campbell, Robert James; Gantt, Laura; Congdon, Tamara

2009-01-01

This article presents the rationale for the design and development of a video simulation used to teach lean thinking and workflow analysis to health services and health information management students enrolled in a course on the management of health information. The discussion includes a description of the design process, a brief history of the use of simulation in healthcare, and an explanation of how video simulation can be used to generate experiential learning environments. Based on the results of a survey given to 75 students as part of a formative evaluation, the video simulation was judged effective because it allowed students to visualize a real-world process (concrete experience), contemplate the scenes depicted in the video along with the concepts presented in class in a risk-free environment (reflection), develop hypotheses about why problems occurred in the workflow process (abstract conceptualization), and develop solutions to redesign a selected process (active experimentation). PMID:19412533

Redesigning care at the Flinders Medical Centre: clinical process redesign using "lean thinking".

PubMed

Ben-Tovim, David I; Bassham, Jane E; Bennett, Denise M; Dougherty, Melissa L; Martin, Margaret A; O'Neill, Susan J; Sincock, Jackie L; Szwarcbord, Michael G

2008-03-17

*The Flinders Medical Centre (FMC) Redesigning Care program began in November 2003; it is a hospital-wide process improvement program applying an approach called "lean thinking" (developed in the manufacturing sector) to health care. *To date, the FMC has involved hundreds of staff from all areas of the hospital in a wide variety of process redesign activities. *The initial focus of the program was on improving the flow of patients through the emergency department, but the program quickly spread to involve the redesign of managing medical and surgical patients throughout the hospital, and to improving major support services. *The program has fallen into three main phases, each of which is described in this article: "getting the knowledge"; "stabilising high-volume flows"; and "standardising and sustaining". *Results to date show that the Redesigning Care program has enabled the hospital to provide safer and more accessible care during a period of growth in demand.

Lean Six Sigma Belt Certification Goals and Standing in TACOM Life Cycle Management Command

DTIC Science & Technology

2010-12-01

goes up must come down, what’s hot eventually cools off” ( Schonberger , 2008, p. 1). Industry was tiring of just-in-time and total quality control by...placard ( Schonberger , 2008). In the next paragraphs, we will explore the concept of Lean Six Sigma by looking at the histories and principles behind...20_1- 10_.pdf Schonberger , R. (2008). Best Practices in Lean Six Sigma Process Improvement, A Deeper Look. New Jersey: John Wiley & Sons, Inc

Applying the Principles of Lean Production to Gastrointestinal Biopsy Handling: From the Factory Floor to the Anatomic Pathology Laboratory.

PubMed

Sugianto, Jessica Z; Stewart, Brian; Ambruzs, Josephine M; Arista, Amanda; Park, Jason Y; Cope-Yokoyama, Sandy; Luu, Hung S

2015-01-01

To implement Lean principles to accommodate expanding volumes of gastrointestinal biopsies and to improve laboratory processes overall. Our continuous improvement (kaizen) project analyzed the current state for gastrointestinal biopsy handling using value-stream mapping for specimens obtained at a 487-bed tertiary care pediatric hospital in Dallas, Texas. We identified non-value-added time within the workflow process, from receipt of the specimen in the histology laboratory to the delivery of slides and paperwork to the pathologist. To eliminate non-value-added steps, we implemented the changes depicted in a revised-state value-stream map. Current-state value-stream mapping identified a total specimen processing time of 507 minutes, of which 358 minutes were non-value-added. This translated to a process cycle efficiency of 29%. Implementation of a revised-state value stream resulted in a total process time reduction to 238 minutes, of which 89 minutes were non-value-added, and an improved process cycle efficiency of 63%. Lean production principles of continuous improvement and waste elimination can be successfully implemented within the clinical laboratory.

Ten principles for thinking about the future: a primer for environmental professionals

Treesearch

David N. Bengston

2017-01-01

Every decision we make is about the future, but most of us are never taught how to think critically about it. This guide addresses this issue by identifying and reviewing 10 principles for thinking about the future, along with related strategies for improving environmental foresight. The principles and strategies are drawn from the transdisciplinary field of futures...

A healthcare Lean Six Sigma System for postanesthesia care unit workflow improvement.

PubMed

Kuo, Alex Mu-Hsing; Borycki, Elizabeth; Kushniruk, Andre; Lee, Te-Shu

2011-01-01

The aim of this article is to propose a new model called Healthcare Lean Six Sigma System that integrates Lean and Six Sigma methodologies to improve workflow in a postanesthesia care unit. The methodology of the proposed model is fully described. A postanesthesia care unit case study is also used to demonstrate the benefits of using the Healthcare Lean Six Sigma System model by combining Lean and Six Sigma methodologies together. The new model bridges the service gaps between health care providers and patients, balances the requirements of health care managers, and delivers health care services to patients by taking the benefits of the Lean speed and Six Sigma high-quality principles. The full benefits of the new model will be realized when applied at both strategic and operational levels. For further research, we will examine how the proposed model is used in different real-world case studies.

Lean manufacturing: A better way for enhancement in productivity

NASA Astrophysics Data System (ADS)

Kumar Ahir, Pankaj; Kumar Yadav, Lalit; Singh Chandrawat, Saurabh

2012-03-01

Productivity is the impact of peoples working together. Machines are merely an extended way of collective imagination and energy. Lean Manufacturing is the most used method for continues improvement of business. Organization management philosophy focusing on the reduction of wastage to improve overall customer value. "Lean" operating principles began in manufacturing environments and are known by a variety of synonyms; Lean Manufacturing, Lean Production, Toyota Production System, etc. It is commonly believed that Lean started in Japan "The notable activities in keeping the price of Ford products low is the steady restriction of the production cycle. The longer an article is in the process of manufacture and the more it is moved about, the greater is its ultimate cost." "A systematic approach to identifying and eliminating waste through continuous improvement, flowing the product at the pull of the customer in pursuit of perfection."

Lean principles to optimize instrument utilization for spine surgery in an academic medical center: an opportunity to standardize, cut costs, and build a culture of improvement.

PubMed

Lunardini, David; Arington, Richard; Canacari, Elena G; Gamboa, Kelly; Wagner, Katiri; McGuire, Kevin J

2014-09-15

Case study OBJECTIVE.: To optimize the utilization of operating room instruments for orthopedic and neurosurgical spine cases in an urban level 1 academic medical center through application of Lean principles. Process improvement systems such as Lean have been adapted to health care and offer an opportunity for frank assessment of surgical routines to increase efficiency and enhance value. The goal has been to safely reduce the financial burden to the health care system without compromising care and if possible reallocate these resources or gains in efficiency to further improve the value to the patient. The investigators identified instruments as a source of waste in the operating room and proposed a Lean process assessment. The instruments and the instrument processing workflow were described. An audit documented the utilization of each instrument by orthopedic surgeons and neurosurgeons through observation of spine cases. The data were then presented to the stakeholders, including surgeons, the perioperative director, and representatives from nursing, central processing, and the surgical technicians. Of the 38 cases audited, only 89 (58%) of the instruments were used at least once. On the basis of the data and stakeholder consensus, 63 (41%) of the instruments were removed, resulting in a weight reduction of 17.5 lb and consolidation of 2 instrument sets into 1. Projected cost savings were approximately $41,000 annually. Although new instruments were purchased to standardize sets, the return on investment was estimated to be 2 years. Inefficient surgical routines may comprise significant resource waste in an institution. Process assessment is an important tool in decreasing health care costs, with objectivity provided by Lean or similar principles, and essential impetus to change provided by stakeholders. 4.

Workplace ergonomics in lean production environments: A literature review.

PubMed

Arezes, Pedro M; Dinis-Carvalho, José; Alves, Anabela Carvalho

2015-01-01

Lean Production Systems (LPS) have become very popular among manufacturing industries, services and large commercial areas. A LPS must develop and consider a set of work features to bring compatibility with workplace ergonomics, namely at a muscular, cognitive and emotional demands level. Identify the most relevant impacts of the adoption of LPS from the ergonomics point of view and summarizes some possible drawbacks for workplace ergonomics due to a flawed application of the LPS. The impacts identified are focused in four dimensions: work pace, intensity and load; worker motivation, satisfaction and stress; autonomy and participation; and health outcome. This paper also discusses the influence that the work organization model has on workplace ergonomics and on the waste elimination previewed by LPS. Literature review focused LPS and its impact on occupational ergonomics conditions, as well as on the Health and Safety of workers. The main focus of this research is on LPS implementations in industrial environments and mainly in manufacturing industry workplaces. This is followed by a discussion including the authors' experience (and previous research). From the reviewed literature it seems that there is no consensus on how Lean principles affect the workplace ergonomics since most authors found positive (advantages) and negative (disadvantages) impacts. The negative impacts or disadvantages of LPS implementations reviewed may result from the misunderstanding of the Lean principles. Possibly, they also happen due to partial Lean implementations (when only one or two tools were implemented) that may be effective in a specific work context but not suitable to all possible situations as the principles of LPS should not lead, by definition, to any of the reported drawbacks in terms of workplace ergonomics.

Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature

PubMed Central

Aij, Kjeld Harald; Rapsaniotis, Sofia

2017-01-01

As health care organizations face pressures to improve quality and efficiency while reducing costs, leaders are adopting management techniques and tools used in manufacturing and other industries, especially Lean. Successful Lean leaders appear to use a coaching leadership style that shares underlying principles with servant leadership. There is little information about specific similarities and differences between Lean and servant leaderships. We systematically reviewed the literature on Lean leadership, servant leadership, and health care and performed a comparative analysis of attributes using Russell and Stone’s leadership framework. We found significant overlap between the two leadership styles, although there were notable differences in origins, philosophy, characteristics and behaviors, and tools. We conclude that both Lean and servant leaderships are promising models that can contribute to the delivery of patient-centered, high-value care. Servant leadership may provide the means to engage and develop employees to become successful Lean leaders in health care organizations. PMID:29355240

How much of Toyota's philosophy is embedded in health care at the organisational level? A review.

PubMed

Antierens, Alain; Beeckman, Dimitri; Verhaeghe, Sofie; Myny, Dries; Van Hecke, Ann

2018-05-01

Identify which of Toyota's principles are reported in health care institutions at the organisational level and to identify the type of reported outcomes related to the effectiveness of lean production reported in these studies. No scientific research has been conducted to determine which of Toyota's principles are embedded in health care systems. This knowledge is needed to perform targeted adjustments in health care. Sixty studies were identified for the final analysis. Some Toyota Way principles appear more deeply embedded in health care institutions than others are. Not all principles of Toyota's philosophy and production system were embedded in the studies in this review. The type of reported outcomes at the organisational level was diverse. This literature review increases our knowledge about how many (and which) of the Toyota Way principles are embedded in health care. This knowledge may support reflection by nursing managers about how the full range of lean management principles could be embedded at the managerial and/or operational level. © 2018 John Wiley & Sons Ltd.

Organisational readiness and Lean Thinking implementation: findings from three emergency department case studies in New Zealand.

PubMed

Rees, Gareth H

2014-01-01

This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand's healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site's case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Virtual modelling of components of a production system as the tool of lean engineering

NASA Astrophysics Data System (ADS)

Monica, Z.

2015-11-01

Between the most effective techniques of manufacturing management is considered the Lean Engineering. The term “lean engineering” was created by Japanese manufacturers. The high efficiency of this method resulted in a meaningful growth in concern in the philosophy of Lean among European companies, and consequently the use of its European markets. Lean philosophy is an approach to manufacturing to minimize the use of all resources, including time. These are resources that are used in the company for a variety of activities. This implies, first identify and then eliminate activities which does not generate added value in the field of design, manufacturing, supply chain management, and customer relations. The producers of these principles not only employ teams multi-professional employees at all levels of the organization, but also use a more automated machines to produce large quantities of products with a high degree of diversity. Lean Engineering is to use a number of principles and practical guidelines that allow you to reduce costs by eliminating absolute extravagance, and also simplification of all manufacturing processes and maintenance. Nowadays it could be applied the powerful engineering programs to realize the concept of Lean Engineering. They could be described using the term CAD/CAM/CAE. They consist of completely different packages for both the design of elements, as well process design. Their common feature is generally considered with their application area. They are used for computer programs assisting the design, development and manufacturing phases of a manufacturing process. The idea of the presented work is to use the Siemens NX software for aiding the process of Lean Engineering system creating. The investigated system is a robotized workcell. In the NX system are created the components of the designed workcell such as machine tools, as industrial robot, as conveyors and buffers. The system let to functionally link these components to simulate the work process and to introduce the rules of Lean Engineering. The purpose is also to determine the rules of Lean designing in such advanced design and simulation environments.

Addressing the medicinal chemistry bottleneck: a lean approach to centralized purification.

PubMed

Weller, Harold N; Nirschl, David S; Paulson, James L; Hoffman, Steven L; Bullock, William H

2012-09-10

The use of standardized lean manufacturing principles to improve drug discovery productivity is often thought to be at odds with fostering innovation. This manuscript describes how selective implementation of a lean optimized process, in this case centralized purification for medicinal chemistry, can improve operational productivity and increase scientist time available for innovation. A description of the centralized purification process is provided along with both operational and impact (productivity) metrics, which indicate lower cost, higher output, and presumably more free time for innovation as a result of the process changes described.

A Value Analysis of Lean Processes in Target Value Design and Integrated Project Delivery.

PubMed

Nanda, Upali; K Rybkowski, Zofia; Pati, Sipra; Nejati, Adeleh

2017-04-01

To investigate what key stakeholders consider to be the advantages and the opportunities for improvement in using lean thinking and tools in the integrated project delivery (IPD) process. A detailed literature review was followed by case study of a Lean-IPD project. Interviews with members of the project leadership team, focus groups with the integrated team as well as the design team, and an online survey of all stakeholders were conducted. Statistical analysis and thematic content analysis were used to analyze the data, followed by a plus-delta analysis. (1) Learning is a large, implicit benefit of Lean-IPD that is not currently captured by any success metric; (2) the cardboard mock-up was the most successful lean strategy; (3) although a collaborative project, the level of influence of different stakeholder groups was perceived to be different by different stakeholders; (4) overall, Lean-IPD was rated as better than traditional design-bid-build methods; and (5) opportunities for improvement reported were increase in accurate cost estimating, more efficient use of time, perception of imbalance of control/influence, and need for facilitation (which represents different points of view). While lean tools and an IPD method are preferred to traditional design-bid-build methods, the perception of different stakeholders varies and more work needs to be done to allow a truly shared decision-making model. Learning was identified as one of the biggest advantages.

Visual-Spatial Thinking in Hypertexts.

ERIC Educational Resources Information Center

Johnson-Sheehan, Richard; Baehr, Craig

2001-01-01

Explores what it means to think visually and spatially in hypertexts and how users react and maneuver in real and virtual three-dimensional spaces. Offers four principles of visual thinking that can be applied when developing hypertexts. Applies these principles to actual hypertexts, demonstrating how selectivity, fixation, depth discernment, and…

Succesful Lean Manufacturing Implementation: Internal Key Influencing Factors

NASA Astrophysics Data System (ADS)

Virginia, Iuga; Claudiu, Kifor

2015-09-01

Manufacturing sectors and companies all over the world are successfully implementing lean principles within their processes. Nowadays, lean has become an indispensable part of global players. Companies worldwide need to be aware of multiple factors which weigh heavily on the success or failure of lean implementation. This paper focuses on giving a brief and structured overview over the fundamental organizational factors which play a substantial role for the lean manufacturing (LM) implementation process. The study below focuses on internal factors which are indispensable for a successful LM implementation within organizations. It is imperative that these internal factors are known, recognized and taken into consideration during the whole LM implementation process. Ignoring their influence on the process's implementation may lead to endangering the expected results or to making the process more difficult which could result in much higher human resource consumption.

Adoption of Lean Principles in a High-Volume Molecular Diagnostic Microbiology Laboratory

PubMed Central

Mitchell, P. Shawn; Mandrekar, Jayawant N.

2014-01-01

Clinical laboratories are constantly facing challenges to do more with less, enhance quality, improve test turnaround time, and reduce operational expenses. Experience with adopting and applying lean concepts and tools used extensively in the manufacturing industry is described for a high-volume clinical molecular microbiology laboratory, illustrating how operational success and benefits can be achieved. PMID:24829247

Lean systems approaches to health technology assessment: a patient-focused alternative to cost-effectiveness analysis.

PubMed

Bridges, John F P

2006-12-01

Many countries now use health technology assessment (HTA) to review new and emerging technologies, especially with regard to reimbursement, pricing and/or clinical guidelines. One of the common, but not universal, features of these systems is the use of economic evaluation, normally cost-effectiveness analysis (CEA), to confirm that new technologies offer value for money. Many have criticised these systems as primarily being concerned with cost containment, rather than advancing the interests of patients or innovators. This paper calls into question the underlying principles of CEA by arguing that value in the healthcare system may in fact be unconstrained. It is suggested that 'lean management principles' can be used not only to trim waste from the health system, but as a method of creating real incentives for innovation and value creation. Following the lean paradigm, this value must be defined purely from the patients' perspective, and the entire health system needs to work towards the creation of such value. This paper offers as a practical example a lean approach to HTA, arguing that such an approach would lead to better incentives for innovation in health, as well as more patient-friendly outcomes in the long run.

Improving animal research facility operations through the application of lean principles.

PubMed

Khan, Nabeel; Umrysh, Brian M

2008-06-01

Animal research is a vital component of US research and well-functioning animal research facilities are critical both to the research itself and to the housing and feeding of the animals. The Office of Animal Care (OAC) at Seattle Children's Hospital Research Institute realized it had to improve the efficiency and safety of its animal research facility (ARF) to prepare for expansion and to advance the Institute's mission. The main areas for improvement concerned excessive turnaround time to process animal housing and feeding equipment; the movement and flow of equipment and inventory; and personnel safety. To address these problems, management held two process improvement workshops to educate employees about lean principles. In this article we discuss the application of these principles and corresponding methods to advance Children's Research Institute's mission of preventing, treating, and eliminating childhood diseases.

Managing a Special Library. Parts I and II.

ERIC Educational Resources Information Center

Labovitz, Judy; Swanigan, Meryl

1985-01-01

Various concepts from "In Search of Excellence" are described in context of authors' personal styles. Discussions address thinking in terms of options, using statistics, learning value of corporate politics, a bias toward action, productivity through people, the "lean-machine" concept, staying close to client, entrepreneurship…

STEPS: lean thinking, theory of constraints and identifying bottlenecks in an emergency department.

PubMed

Ryan, A; Hunter, K; Cunningham, K; Williams, J; O'Shea, H; Rooney, P; Hickey, F

2013-04-01

This study aimed to identify the bottlenecks in patients' journeys through an emergency department (ED). For each stage of the patient journey, the average times were compared between two groups divided according to the four hour time frame and disproportionate delays were identified using a significance test These bottlenecks were evaluated with reference to a lean thinking value-stream map and the five focusing steps of the theory of constraints. A total of 434 (72.5%) ED patients were tracked over one week. Logistic regression showed that patients who had radiological tests, blood tests or who were admitted were 4.4, 4.1 and 7.7 times more likely, respectively, to stay over four hours in the ED than those who didn't The stages that were significantly delayed were the time spent waiting for radiology (p = 0.001), waiting for the in-patient team (p = 0.004), waiting for a bed (p < 0.001) and ED doctor turnaround time (p < 0.001).

The challenges of lean manufacturing implementation in kitting assembly

NASA Astrophysics Data System (ADS)

Fansuri, A. F. H.; Rose, A. N. M.; Nik Mohamed, N. M. Z.; Ahmad, H.

2017-10-01

Literature studies shows that lean manufacturing goes way back with the original founder Eli Whitney in year 1799. The main purpose of lean manufacturing is to identify and eliminate waste in production. The application of lean manufacturing can be carried out in any industrial processes with regards to the understanding of lean principles, theories and practices. Kitting is one of the important aspects in a successful production. The continuous supply of materials from store to production has to be systematic and able to achieve lean standard for it to be successful. The objective of this paper is to review the implementation of lean manufacturing in kitting assembly. Previous papers show that, the implementation of lean manufacturing in kitting assembly may be beneficial to the organization such as reduce in space occupancy, part shortages, lead time and manpower. Based on previous research, some industries may tend to change between kitting and line stocking which are due to lack of understanding when implementing kitting and causes longer lead time and materials overflow in store. With a proper understanding on what to kit, where to kit, how to kit, why to kit and who kits the material with a standardised process flow may ensure the success of kitting.

From Toyota to the bedside: nurses can lead the lean way in health care reform.

PubMed

Johnson, Joyce E; Smith, Amy L; Mastro, Kari A

2012-01-01

The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.

Readiness factors for lean implementation in healthcare settings--a literature review.

PubMed

Al-Balushi, S; Sohal, A S; Singh, P J; Al Hajri, A; Al Farsi, Y M; Al Abri, R

2014-01-01

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature. A comprehensive review of literature focussing on lean and lean healthcare was conducted. Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings. The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study. The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed. To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

Physician strives to create lean, clean health care machine. Studies of manufacturing processes may one day help make your practice more efficient.

PubMed

Hill, D

2001-01-01

Elisabeth Hager, MD, MMM, CPE, is teaming up with scientists and industrialists to teach physicians how to apply principles of lean, total-quality manufacturing to their practices. She believes innovation and efficiencies can help doctors resurrect their profession's image and their control over it--and perhaps even reinvent American health care.

Futuring for Future Ready Librarians

ERIC Educational Resources Information Center

Figueroa, Miguel A.

2018-01-01

Futurists and foresight professionals offer several guiding principles for thinking about the future. These principles can help people to think about the future and become more powerful players in shaping the preferred futures they want for themselves and their communities. The principles also fit in well as strategies to support the Future Ready…

Car Assembly Line Efficiency Improvement by Lean Principle

NASA Astrophysics Data System (ADS)

Sawassalung, Suwalee; Chutima, Parames

2017-06-01

This research aimed to increase the efficiency of actual working time to compare to design standard time ratio (DSTR) as per analysing process of Lean System of the assembly line in a car manufacturer in Thailand. Currently, the case study factory and its group of factories, which have many branches all over the world, have competed with each other on quality, delivered time and production cost. The production cost which can reduce without affecting quality and acceptable by clients is the manpower cost. The index of competition is DSTR. The factory now has DSTR of 6.13 and DSTR of the assembly department is 4.24 which is very high comparing to other departments. The low DSTR indicates that the factory has good quality. The ways to solve the problem are to apply the following tools, i.e. Lean principle, Value Stream Mapping (VSM), Waste Analysis and ECRS. After implementing the above tools, the results showed that DSTR decreased from 4.24 to 4.06 or 4.25%.

Applying Lean/Toyota production system principles to improve phlebotomy patient satisfaction and workflow.

PubMed

Melanson, Stacy E F; Goonan, Ellen M; Lobo, Margaret M; Baum, Jonathan M; Paredes, José D; Santos, Katherine S; Gustafson, Michael L; Tanasijevic, Milenko J

2009-12-01

Our goals were to improve the overall patient experience and optimize the blood collection process in outpatient phlebotomy using Lean principles. Elimination of non-value-added steps and modifications to operational processes resulted in increased capacity to handle workload during peak times without adding staff. The result was a reduction of average patient wait time from 21 to 5 minutes, with the goal of drawing blood samples within 10 minutes of arrival at the phlebotomy station met for 90% of patients. In addition, patient satisfaction increased noticeably as assessed by a 5-question survey. The results have been sustained for 10 months with staff continuing to make process improvements.

Integration of human factors principles in LARG organizations--a conceptual model.

PubMed

Figueira, Sara; Machado, V Cruz; Nunes, Isabel L

2012-01-01

Nowadays many companies are undergoing organizational transformations in order to meet the changing market demands. Thus, in order to become more competitive, supply chains (SC) are adopting new management paradigms to improve SC performance: lean, agile, resilient and green (LARG paradigms). The implementation of new production paradigms demands particular care with the issues related with Human Factors to avoid health and safety problems to workers and losses to companies. Thus, the successful introduction of these new production paradigms depends among others on a Human Factors oriented approach. This work presents a conceptual framework that allows integrating ergonomic and safety design principles during the different implementation phases of lean, agile, resilient and green practices.

Experiences of leaders in the implementation of Lean in a teaching hospital—barriers and facilitators in clinical practices: a qualitative study

PubMed Central

Aij, Kjeld Harald; Simons, Frederique Elisabeth; Widdershoven, Guy A M; Visse, Merel

2013-01-01

Objectives To date, experiences of leaders in the implementation of Lean after a Lean Training Programme have not been systematically investigated within teaching hospitals. Existing studies have identified barriers and facilitators only from an improvement programme perspective and have not considered the experiences of leaders themselves. This study aims to bridge this gap. Design Semistructured, indepth interviews. Setting One of largest teaching hospitals in the Netherlands. Participants 31 medical, surgical and nursing professionals with an average of 19.2 years of supervisory experience. All professionals were appointed to a Lean Training Programme and were directly involved in the implementation of Lean. Results The evidence obtained in this study shows that, from the perspectives of participants, leadership management support, a continuous learning environment and cross-departmental cooperation play a significant role in successful Lean implementation. The results suggest that a Lean Training Programme contributed to positive outcomes in personal and professional skills that were evident during the first 4 months after programme completion. Conclusions Implementing Lean in a teaching hospital setting is a challenge because of the ambiguous and complex environment of a highly professionalised organisation. The study found that leadership management support and a continuous learning environment are important facilitators of Lean implementation. To increase the successful outcomes of leadership actions, training should be supplemented with actions to remove perceived barriers. This requires the involvement of all professionals, the crossing of departmental boundaries and a focus on meaning-making processes rather than simply ‘implementing’ facts. Therefore, this research suggests that programme participants, such as staff members and leaders, can mutually explore the meanings of Lean thinking and working for their own contexts. By entering this shared learning process (eg, learning on the job) the ownership of Lean implementation could also increase. PMID:24171938

The Henry Ford Production System: LEAN Process Redesign Improves Service in the Molecular Diagnostic Laboratory

PubMed Central

Cankovic, Milena; Varney, Ruan C.; Whiteley, Lisa; Brown, Ron; D'Angelo, Rita; Chitale, Dhananjay; Zarbo, Richard J.

2009-01-01

Accurate and timely molecular test results play an important role in patient management; consequently, there is a customer expectation of short testing turnaround times. Baseline data analysis revealed that the greatest challenge to timely result generation occurred in the preanalytic phase of specimen collection and transport. Here, we describe our efforts to improve molecular testing turnaround times by focusing primarily on redesign of preanalytic processes using the principles of LEAN production. Our goal was to complete greater than 90% of the molecular tests in less than 3 days. The project required cooperation from different laboratory disciplines as well as individuals outside of the laboratory. The redesigned processes involved defining and standardizing the protocols and approaching blood and tissue specimens as analytes for molecular testing. The LEAN process resulted in fewer steps, approaching the ideal of a one-piece flow for specimens through collection/retrieval, transport, and different aspects of the testing process. The outcome of introducing the LEAN process has been a 44% reduction in molecular test turnaround time for tissue specimens, from an average of 2.7 to 1.5 days. In addition, extending LEAN work principles to the clinician suppliers has resulted in a markedly increased number of properly collected and shipped blood specimens (from 50 to 87%). These continuous quality improvements were accomplished by empowered workers in a blame-free environment and are now being sustained with minimal management involvement. PMID:19661386

Applying Lean Six Sigma to improve medication management.

PubMed

Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health care managers who plan to apply Lean Six Sigma techniques in their organizations to improve the quality of care for their patients.

Strategic Assessment of Lean Six Sigma Practicality in the Turkish Army

DTIC Science & Technology

2015-12-01

quo is not responding to the current problem that the organization should create a need to overcome resistance and mobilize commitment. The second...we think this factor has a small effect on LSS aplication in an organization since questions in this factor focus on individual employees’ perceptions

The Relative Merits of Lean, Enriched, and Empowered Offices: An Experimental Examination of the Impact of Workspace Management Strategies on Well-Being and Productivity

ERIC Educational Resources Information Center

Knight, Craig; Haslam, S. Alexander

2010-01-01

Principles of lean management encourage managers to exert tight control over office space and the people within it. Alternative, design-led approaches promote the value of offices that are enriched, particularly by plants and art. On the basis of a social identity perspective, we argue that both of these approaches may compromise organizational…

Adoption of lean principles in a high-volume molecular diagnostic microbiology laboratory.

PubMed

Mitchell, P Shawn; Mandrekar, Jayawant N; Yao, Joseph D C

2014-07-01

Clinical laboratories are constantly facing challenges to do more with less, enhance quality, improve test turnaround time, and reduce operational expenses. Experience with adopting and applying lean concepts and tools used extensively in the manufacturing industry is described for a high-volume clinical molecular microbiology laboratory, illustrating how operational success and benefits can be achieved. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Using lean manufacturing principles to evaluate wait times for HIV-positive patients in an urban clinic in Kenya.

PubMed

Monroe-Wise, Aliza; Reisner, Elizabeth; Sherr, Kenneth; Ojakaa, David; Mbau, Lilian; Kisia, Paul; Muhula, Samuel; Farquhar, Carey

2017-12-01

As human immunodeficiency virus (HIV) treatment programs expand in Africa, delivery systems must be strengthened to support patient retention. Clinic characteristics may affect retention, but a relationship between clinic flow and attrition is not established. This project characterized HIV patient experience and flow in an urban Kenyan clinic to understand how these may affect retention. We used Toyota's lean manufacturing principles to guide data collection and analysis. Clinic flow was evaluated using value stream mapping and time and motion techniques. Clinic register data were analyzed. Two focus group discussions were held to characterize HIV patient experience. Results were shared with clinic staff. Wait times in the clinic were highly variable. We identified four main barriers to patient flow: inconsistent patient arrivals, inconsistent staffing, filing system defects, and serving patients out of order. Focus group participants explained how clinic operations affected their ability to engage in care. Clinic staff were eager to discuss the problems identified and identified numerous low-cost potential solutions. Lean manufacturing methodologies can guide efficiency interventions in low-resource healthcare settings. Using lean techniques, we identified bottlenecks to clinic flow and low-cost solutions to improve wait times. Improving flow may result in increased patient satisfaction and retention.

Lean in healthcare from employees' perspectives.

PubMed

Drotz, Erik; Poksinska, Bozena

2014-01-01

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

Management strategies to effect change in intensive care units: lessons from the world of business. Part II. Quality-improvement strategies.

PubMed

Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

2014-03-01

The success of quality-improvement projects relies heavily on both project design and the metrics chosen to assess change. In Part II of this three-part American Thoracic Society Seminars series, we begin by describing methods for determining which data to collect, tools for data presentation, and strategies for data dissemination. As Avedis Donabedian detailed a half century ago, defining metrics in healthcare can be challenging; algorithmic determination of the best type of metric (outcome, process, or structure) can help intensive care unit (ICU) managers begin this process. Choosing appropriate graphical data displays (e.g., run charts) can prompt discussions about and promote quality improvement. Similarly, dashboards/scorecards are useful in presenting performance improvement data either publicly or privately in a visually appealing manner. To have compelling data to show, ICU managers must plan quality-improvement projects well. The second portion of this review details four quality-improvement tools-checklists, Six Sigma methodology, lean thinking, and Kaizen. Checklists have become commonplace in many ICUs to improve care quality; thinking about how to maximize their effectiveness is now of prime importance. Six Sigma methodology, lean thinking, and Kaizen are techniques that use multidisciplinary teams to organize thinking about process improvement, formalize change strategies, actualize initiatives, and measure progress. None originated within healthcare, but each has been used in the hospital environment with success. To conclude this part of the series, we demonstrate how to use these tools through an example of improving the timely administration of antibiotics to patients with sepsis.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency.

PubMed

Lin, Sandra Y; Gavney, Dean; Ishman, Stacey L; Cady-Reh, Julie

2013-11-01

To apply Lean Sigma, a quality-improvement strategy supported by tactical tools to eliminate waste and reduce variation, to improve efficiency of patient flow in a large tertiary otolaryngology clinic. The project goals were to decrease overall lead time from patient arrival to start of interaction with care provider, improve on-time starts of patient visits, and decrease excess staff/patient motion. Prospective observational study. Patient flow was mapped through the clinic, including preregistration processes. A time-stamp observation study was performed on 188 patient visits over 5 days. Using Lean Sigma principles, time stamps were analyzed to identify patient flow constraints and areas for potential interventions. Interventions were evaluated and adjusted based on feedback from shareholders: removal of bottlenecks in clinic flow, elimination of non-value added registration staff tasks, and alignment of staff hours to accommodate times of high patient census. A postintervention time observation study of 141 patients was performed 5 months later. Patient lead time from clinic arrival to exam start time decreased by 12.2% on average (P = .042). On-time starts for patient exams improved by 34% (χ(2) = 16.091, P < .001). Excess patient motion was reduced by 74 feet per patient, which represents a 34% reduction in motion per visit. Use of Lean Sigma principles in a large tertiary otolaryngology clinic led to decreased patient wait time and significant improvements in on-time patient exam start time. Process mapping, engagement of leadership and staff, and elimination of non-value added steps or processes were key to improvement. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

Three Approaches to Space Systems Acquisitions and their Application to the Defense Department’s Weather Satellite Program

DTIC Science & Technology

2012-03-01

by Toyota in the manufacturing world, such as just-in-time, kaizen , one-piece flow, jidoka, and heijunka. These techniques helped spawn the “lean...relentless reflection (hansei) and continuous improvement ( kaizen ) Similar to Principle 2, this principle shares similarity with space program

Implementing "lean" principles to improve the efficiency of the endoscopy department of a community hospital: a case study.

PubMed

Laing, Karen; Baumgartner, Katherine

2005-01-01

Many endoscopy units are looking for ways to improve their efficiency without increasing the number of staff, purchasing additional equipment, or making the patients feel as if they have been rushed through the care process. To accomplish this, a few hospitals have looked to other industries for help. Recently, "lean" methods and tools from the manufacturing industry, have been applied successfully in health care systems, and have proven to be an effective way to eliminate waste and redundancy in workplace processes. The "lean" method and tools in service organizations focuses on providing the most efficient and effective flow of service and products. This article will describe the journey of one endoscopy department within a community hospital to illustrate application of "lean" methods and tools and results.

Lean Forward and Listen: poetry as a mode of understanding in medicine.

PubMed

Andrews, Angela

2015-01-01

Many claims have been made over recent years for the use of poetry (and, more broadly, literature) in the curriculum of medical students. Most often, poetry is put forward as having the potential to humanize medicine by promoting, for example, empathy, ethical sensitivity, and an appreciation for diverging interpretations. While these endpoints are all important, this essay uses the experience of a junior doctor undertaking a degree in creative writing to consider how the poetic way of seeing and thinking differs from clinical thinking, and why that might matter. In particular, the author considers the importance in medicine of the capacity to not know, as well as the possibilities for a deeper understanding of patients offered by thinking in terms of poetic voice.

Does Lean healthcare improve patient satisfaction? A mixed-method investigation into primary care.

PubMed

Poksinska, Bozena Bonnie; Fialkowska-Filipek, Malgorzata; Engström, Jon

2017-02-01

Lean healthcare is claimed to contribute to improved patient satisfaction, but there is limited evidence to support this notion. This study investigates how primary-care centres working with Lean define and improve value from the patient's perspective, and how the application of Lean healthcare influences patient satisfaction. This paper contains two qualitative case studies and a quantitative study based on results from the Swedish National Patient Survey. Through the case studies, we investigated how primary-care organisations realised the principle of defining and improving value from the patient's perspective. In the quantitative study, we compared results from the patient satisfaction survey for 23 primary-care centres working with Lean with a control group of 23 care centres not working with Lean. We also analysed changes in patient satisfaction over time. Our case studies reveal that Lean healthcare implementations primarily target efficiency and little attention is paid to the patient's perspective. The quantitative study shows no significantly better results in patient satisfaction for primary-care centres working with Lean healthcare compared with those not working with Lean. Further, care centres working with Lean show no significant improvements in patient satisfaction over time. Lean healthcare implementations seem to have a limited impact on improving patient satisfaction. Care providers need to pay more attention to integrating the patient's perspective in the application of Lean healthcare. Value needs to be defined and value streams need to be improved based on both the knowledge and clinical expertise of care providers, and the preferences and needs of patients. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Increasing Therapist Productivity: Using Lean Principles in the Rehabilitation Department of an Academic Medical Center.

PubMed

Johnson, Diana; Snedeker, Kristie; Swoboda, Michael; Zalieckas, Cheryl; Dorsey, Rachel; Nohe, Cassandra; Smith, Paige; Roche, Renuka

The Department of Rehabilitation Services, within the University of Maryland Medical Center's 650-bed academic medical center, was experiencing difficulty in meeting productivity standards. Therapists in the outpatient division believed they were not spending enough time performing billable patient care activities. Therapists in the inpatient division had difficulty keeping pace with the volume of incoming referrals. Collectively, these issues caused dissatisfaction among referral sources and frustration among the staff within the rehabilitation department. The department undertook a phased approach to address these issues that included examining the evidence, using Lean process improvement principles, and employing transformational leadership strategies to drive improvements in productivity and efficiency. The lessons learned support the importance of having meaningful metrics appropriate for the patient population served, the use of Lean as an effective tool for improving productivity in rehabilitation departments, the impact of engaging staff at the grassroots level, and the importance of having commitment from leaders. The study findings have implications for not only rehabilitation and hospital leadership, but CEOs and managers of any business who need to eliminate waste or increase staff productivity.

Comprehensive Study on Wastages of Supply Chain Information Sharing in Automotive Industries

NASA Astrophysics Data System (ADS)

Sendhil Kumar, R.; Pugazhendhi, S.; Muralidharan, C.; Murali, S.

2017-03-01

A supply chain is a very extensive concept, which encompasses many problems and features when it comes to controlling. Now a day’s lean concept is a very common method to several areas, such as service sectors and manufacturing. Applying the lean concept to supply chain management is a very popular study part, it has attracted many industrial practices and researchers with different applications. Information sharing and technology remain one of the key factors of integrating the supply chain members. Current scenario the competition is no longer between the competing companies, but it happens between the supply chains. So the efficiency of the supply chain is very important. And the effective sharing of information can enhance the supply chain efficiency through minimizing the inventories and Information sharing can increase supply chain efficiency by reducing inventories and stabilizing the production. This paper describes and discusses about the seven deadly wastes of supply chain information with the comparative principle of Toyota production system (TPS) principle approach. How the TPS can be applied to supply chain information sharing And lean tool of 5S concept possibility improve the information sharing.

Practice paper of the academy of nutrition and dietetics: principles of productivity in food and nutrition services: applications in the 21st century health care reform era.

PubMed

Gregoire, Mary B; Theis, Monica L

2015-07-01

Food and nutrition services, along with the health care organizations they serve, are becoming increasingly complex. These complexities are driven by sometimes conflicting (if not polarizing) human, department, organization, and environment factors and will require that managers shift how they think about and approach productivity in the context of the greater good of the organization and, perhaps, even society. Traditional, single-factor approaches to productivity measurements, while still valuable in the context of departmental trend analysis, are of limited value when assessing departmental performance in the context of an organization's goals and values. As health care continues to change and new models of care are introduced, food and nutrition services managers will need to consider innovative approaches to improve productivity that are consistent with their individual health care organization's vision and mission. Use of process improvement tools such as Lean and Six Sigma as strategies for evaluating and improving food and nutrition services efficiency should be considered. Copyright © 2015 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.

True retention of nutrients on cooking of Australian retail lamb cuts of differing carcass classification characteristics.

PubMed

Kosulwat, Somkiat; Greenfield, Heather; Buckle, Kenneth A

2003-12-01

The true retention of nutrients (proximate principles and cholesterol) on cooking of three retail cuts from lambs classified by weight, sex and fatness score was investigated. Fat retentions of the total cut and of the lean portion of lamb legs and mid-loin chops were not affected by carcass fatness, weight and sex or their interactions, however, the fat retention of the total cut and of the lean portion of forequarter chops was affected by fat score, with forequarter chops from fat score 1 retaining more fat than did chops of carcasses of higher fat score. Overall, fat was lost by all cuts (total cut) on cooking, with only 70-80% of fat being retained, but fat content of lean only increased on cooking (retention >100%), indicating the passage of fat into the lean portion from the external fat cover during the cooking process. Carcass factors and their interactions had little or no effect on the protein, water and ash retentions of the total cut or the lean portions of the three cuts. Cholesterol retention by the lean portion of three cooked lamb cuts was not affected by any carcass factors or their interactions. Cholesterol retentions were ∼99% for total cuts and tended to be ∼102% for the lean portions.

Developing weighted criteria to evaluate lean reverse logistics through analytical network process

NASA Astrophysics Data System (ADS)

Zagloel, Teuku Yuri M.; Hakim, Inaki Maulida; Krisnawardhani, Rike Adyartie

2017-11-01

Reverse logistics is a part of supply chain that bring materials from consumers back to manufacturer in order to gain added value or do a proper disposal. Nowadays, most companies are still facing several problems on reverse logistics implementation which leads to high waste along reverse logistics processes. In order to overcome this problem, Madsen [Framework for Reverse Lean Logistics to Enable Green Manufacturing, Eco Design 2009: 6th International Symposium on Environmentally Conscious Design and Inverse Manufacturing, Sapporo, 2009] has developed a lean reverse logistics framework as a step to eliminate waste by implementing lean on reverse logistics. However, the resulted framework sets aside criteria used to evaluate its performance. This research aims to determine weighted criteria that can be used as a base on reverse logistics evaluation by considering lean principles. The resulted criteria will ensure reverse logistics are kept off from waste, thus implemented efficiently. Analytical Network Process (ANP) is used in this research to determine the weighted criteria. The result shows that criteria used for evaluation lean reverse logistics are Innovation and Learning (35%), Economic (30%), Process Flow Management (14%), Customer Relationship Management (13%), Environment (6%), and Social (2%).

Development of an interprofessional lean facilitator assessment scale.

PubMed

Bravo-Sanchez, Cindy; Dorazio, Vincent; Denmark, Robert; Heuer, Albert J; Parrott, J Scott

2018-05-01

High reliability is important for optimising quality and safety in healthcare organisations. Reliability efforts include interprofessional collaborative practice (IPCP) and Lean quality/process improvement strategies, which require skilful facilitation. Currently, no validated Lean facilitator assessment tool for interprofessional collaboration exists. This article describes the development and pilot evaluation of such a tool; the Interprofessional Lean Facilitator Assessment Scale (ILFAS), which measures both technical and 'soft' skills, which have not been measured in other instruments. The ILFAS was developed using methodologies and principles from Lean/Shingo, IPCP, metacognition research and Bloom's Taxonomy of Learning Domains. A panel of experts confirmed the initial face validity of the instrument. Researchers independently assessed five facilitators, during six Lean sessions. Analysis included quantitative evaluation of rater agreement. Overall inter-rater agreement of the assessment of facilitator performance was high (92%), and discrepancies in the agreement statistics were analysed. Face and content validity were further established, and usability was evaluated, through primary stakeholder post-pilot feedback, uncovering minor concerns, leading to tool revision. The ILFAS appears comprehensive in the assessment of facilitator knowledge, skills, abilities, and may be useful in the discrimination between facilitators of different skill levels. Further study is needed to explore instrument performance and validity.

Motivating Language and Empathic Leadership Drives Aircraft Readiness

DTIC Science & Technology

2017-03-01

4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188) Washington, DC 20503. 1. AGENCY USE ONLY (Leave blank...language theory, empathic leadership, caring leader, leadership- management exchange (LMX), high quality connections, unit support, organizational justice...critical thinking, Marine Aviation Logistics, Marine Air Group, Marine Aircraft Wing, supply chain management , Squadron, AIRSPEED, lean-six-sigma

The Effects of Cognitive Style and Media Richness on Commitment to Telework and Virtual Teams.

ERIC Educational Resources Information Center

Workman, Michael; Kahnweiler, William; Bommer, William

2003-01-01

Sternberg's Thinking Style Inventory and the Organizational Commitment Questionnaire were completed by 261 of 552 teleworkers in virtual teams. Cognitive styles and types of media (rich/lean) were associated with commitment to telework and to the team. Results have implications for staff development and the design of telework. (Contains 74…

Implementing NICU critical thinking programs: one unit's experience.

PubMed

Zimmerman, Denise; Pilcher, Jobeth

2008-01-01

Critical thinking is the hallmark of today's nursing practice environment. Nowhere is this more critical than in the high-tech environment of the NICU. Despite the importance of critical thinking in nursing practice, there is limited information on the process of teaching new NICU nurses to think critically. Based on the principles of adult education, orientation and continuing education for NICU nurses should be goal directed, build on the learner's prior experience, and build in opportunities for active participation, reflection, and experiential learning. This article reviews the principles of adult education and their application to the process of teaching critical thinking in the NICU. One unit's experience of critical thinking education is used to provide concrete examples of how NICU education can be transformed from a traditional didactic methodology to a more dynamic experiential approach.

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal

PubMed Central

Naidoo, Logandran

2016-01-01

Background Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. Aim The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. Setting The study was conducted at the Catherine Booth Hospital (CBH) – a rural district hospital in KwaZulu-Natal, South Africa. Methods This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. Results All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). Conclusion The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators. PMID:27543283

Consistency of maternal cognitions and principles across the first five months following preterm and term deliveries

PubMed Central

Winstanley, A.; Sperotto, R.G.; Putnick, D.L.; Cherian, S.; Bornstein, M.H.; Gattis, M.

2014-01-01

The aims of this study were to examine and compare the development of parenting cognitions and principles in mothers following preterm and term deliveries. Parenting cognitions about child development, including thinking that is restricted to single causes and single outcomes (categorical thinking) and thinking that takes into account multiple perspectives (perspectivist thinking), have been shown to relate to child outcomes. Parenting principles about using routines (structure) or infant cues (attunement) to guide daily caregiving have been shown to relate to caregiving practices. We investigated the continuity and stability of parenting cognitions and principles in the days following birth to 5 months postpartum for mothers of infants born term and preterm. All parenting cognitions were stable across time. Categorical thinking increased at a group level across time in mothers of preterm, but not term, infants. Perspectivist thinking increased at a group level for first-time mothers (regardless of birth status) and tended to be lower in mothers of preterm infants. Structure at birth did not predict later structure (and so was unstable) in mothers of preterm, but not term, infants and neither group changed in mean level across time. Attunement was consistent across time in both groups of mothers. These results indicate that prematurity has multiple, diverse effects on parenting beliefs, which may in turn influence maternal behavior and child outcomes. PMID:25459794

Lean methodology in health care.

PubMed

Kimsey, Diane B

2010-07-01

Lean production is a process management philosophy that examines organizational processes from a customer perspective with the goal of limiting the use of resources to those processes that create value for the end customer. Lean manufacturing emphasizes increasing efficiency, decreasing waste, and using methods to decide what matters rather than accepting preexisting practices. A rapid improvement team at Lehigh Valley Health Network, Allentown, Pennsylvania, implemented a plan, do, check, act cycle to determine problems in the central sterile processing department, test solutions, and document improved processes. By using A3 thinking, a consensus building process that graphically depicts the current state, the target state, and the gaps between the two, the team worked to improve efficiency and safety, and to decrease costs. Use of this methodology has increased teamwork, created user-friendly work areas and processes, changed management styles and expectations, increased staff empowerment and involvement, and streamlined the supply chain within the perioperative area. Copyright (c) 2010 AORN, Inc. Published by Elsevier Inc. All rights reserved.

[Bioethics of principles].

PubMed

Pérez-Soba Díez del Corral, Juan José

2008-01-01

Bioethics emerges about the tecnological problems of acting in human life. Emerges also the problem of the moral limits determination, because they seem exterior of this practice. The Bioethics of Principles, take his rationality of the teleological thinking, and the autonomism. These divergence manifest the epistemological fragility and the great difficulty of hmoralñ thinking. This is evident in the determination of autonomy's principle, it has not the ethical content of Kant's propose. We need a new ethic rationality with a new refelxion of new Principles whose emerges of the basic ethic experiences.

On the Concrete Nature of Human Thinking: Content and Context in Analogical Transfer.

ERIC Educational Resources Information Center

Reeves, Lauretta M.; Weisberg, Robert W.

1993-01-01

Asserts that the development of abstract knowledge and critical thinking skills has been extolled as a primary goal of education. Reviews research in problem solving and other educational endeavors. Maintains that learning abstract solution principles is enhanced when instruction is accompanied by examples illustrating those principles. (ACM)

Set Partitions and the Multiplication Principle

ERIC Educational Resources Information Center

Lockwood, Elise; Caughman, John S., IV

2016-01-01

To further understand student thinking in the context of combinatorial enumeration, we examine student work on a problem involving set partitions. In this context, we note some key features of the multiplication principle that were often not attended to by students. We also share a productive way of thinking that emerged for several students who…

Systems Thinking : Ancient Maya's Evolution of Consciousness and Contemporary Systems Thinking

NASA Astrophysics Data System (ADS)

Jere Lazanski, Tadeja

2010-11-01

Systems thinking as a modern approach for problem solving was revived after WWII even though it had been an ancient philosophy. We can track systems thinking back to antiquity. Making a distinction from Western rationalist traditions of philosophy, C. West Churchman often identified with the I Ching as a systems approach sharing a frame of reference similar to pre-Socratic philosophy and Heraclitus. In this paper, we will compare the evolutionary system of consciousness, which was presented in the Tun calendar of Mayan Indians and contemporary systems theory and systems thinking, which is nothing else but highly evolved human consciousness in society. We will present Mayan calendar systems to contemporary systems thinking principles and explain the answer to the Ackoff's judgment on four hundred years of analytical thinking as the dominant mode of society. We will use the methods of historical comparison and a method of a systems approach. We will point out the big picture and Mayan divine plan as main systems principles. The Mayan numerical system and long count units has been proven as one of the most accurate systems for describing the present and future of the civilization in which we have all evolved. We will also explain the Mayan nine-level pyramids system that represents the evolutionary system, i.e. the consciousness, which in our time shows the actual level of human consciousness. Deriving from all described, we will show the main systems principles, discussed by contemporary systems authors and Mayan systems principles, which differ only in one expression—they named "the big picture" as "the divine plan". The final results can be perfectly applied to the society we live in. Seeing the world from the big picture point of view is reaching a level of awareness, in which linear thinking is replaced by systems thinking. The Mayans explained that the civilization would achieve the system of conscious co-creation. We can claim that linear thinking guides us to a limited consciousness, whereas systems thinking opens the possibilities of conscious co-creation for the benefits of sustainable society and future of the planet.

Visual Thinking Routines: A Mixed Methods Approach Applied to Student Teachers at the American University in Dubai

ERIC Educational Resources Information Center

Gholam, Alain

2017-01-01

Visual thinking routines are principles based on several theories, approaches, and strategies. Such routines promote thinking skills, call for collaboration and sharing of ideas, and above all, make thinking and learning visible. Visual thinking routines were implemented in the teaching methodology graduate course at the American University in…

Improving the layout of recycling centres by use of lean production principles.

PubMed

Sundin, Erik; Björkman, Mats; Eklund, Mats; Eklund, Jörgen; Engkvist, Inga-Lill

2011-06-01

There has been increased focus on recycling in Sweden during recent years. This focus can be attributed to external environmental factors such as tougher legislation, but also to the potential gains for raw materials suppliers. Recycling centres are important components in the Swedish total recycling system. Recycling centres are manned facilities for waste collection where visitors can bring, sort and discard worn products as well as large-sized, hazardous, and electrical waste. The aim of this paper was to identify and describe the main flows and layout types at Swedish recycling centres. The aim was also to adapt and apply production theory for designing and managing recycling centre operations. More specifically, this means using lean production principles to help develop guidelines for recycling centre design and efficient control. Empirical data for this research was primarily collected through interviews and questionnaires among both visitors and employees at 16 Swedish recycling centres. Furthermore, adapted observation protocols have been used in order to explore visitor activities. There was also close collaboration with a local recycling centre company, which shared their layout experiences with the researchers in this project. The recycling centres studied had a variety of problems such as queues of visitors, overloading of material and improper sorting. The study shows that in order to decrease the problems, the recycling centres should be designed and managed according to lean production principles, i.e. through choosing more suitable layout choices with visible and linear flows, providing better visitor information, and providing suitable technical equipment. Improvements can be achieved through proper planning of the layout and control of the flow of vehicles, with the result of increased efficiency and capacity, shorter visits, and cleaner waste fractions. The benefits of a lean production mindset include increased visitor capacity, waste flexibility, improved sorting quality, shorter time for visits and improved working conditions. Copyright © 2011 Elsevier Ltd. All rights reserved.

Modelling Lean and Green Supply Chain

NASA Astrophysics Data System (ADS)

Duarte, Susana Carla Vieira Lino Medina

The success of an organization depends on the effective control of its supply chain. It is important to recognize new opportunities for organization and its supply chain. In the last few years the approach to lean, agile, resilient and green supply chain paradigms has been addressed in the scientific literature. Research in this field shows that the integration of these concepts revealed some contradictions among so many paradigms. This thesis is mainly focused on the lean and green approaches. Thirteen different management frameworks, embodied in awards, standards and tools were studied to understand if they could contribute for the modelling process of a lean and green approach. The study reveals a number of categories that are common in most management frameworks, providing adequate conditions for a lean and green supply chain transformation. A conceptual framework for the evaluation of a lean and green organization`s supply chain was proposed. The framework considers six key criteria, namely, leadership, people, strategic planning, stakeholders, processes and results. It was proposed an assessment method considering a criteria score for each criterion. The purpose is to understand how lean and green supply chain can be compatible, using principles, practices, techniques or tools (i.e. elements) that support both, a lean and a green approach, in all key criteria. A case study in the automotive upstream supply chain was performed to understand more deeply if the elements proposed for the conceptual framework could be implemented in a real-scenario. Based on the conceptual framework and the case study, a roadmap to achieve a lean-green transformation is presented. The proposed roadmap revealed its contribution to the understanding on how and when an organization`s supply chain should apply the lean and green elements. This study is relevant to practice, as it may assist managers in the adoption of a lean and green supply chain approach, giving insights for the implementation of a hybrid supply chain.

A Hybrid Fuzzy Model for Lean Product Development Performance Measurement

NASA Astrophysics Data System (ADS)

Osezua Aikhuele, Daniel; Mohd Turan, Faiz

2016-02-01

In the effort for manufacturing companies to meet up with the emerging consumer demands for mass customized products, many are turning to the application of lean in their product development process, and this is gradually moving from being a competitive advantage to a necessity. However, due to lack of clear understanding of the lean performance measurements, many of these companies are unable to implement and fully integrated the lean principle into their product development process. Extensive literature shows that only few studies have focus systematically on the lean product development performance (LPDP) evaluation. In order to fill this gap, the study therefore proposed a novel hybrid model based on Fuzzy Reasoning Approach (FRA), and the extension of Fuzzy-AHP and Fuzzy-TOPSIS methods for the assessment of the LPDP. Unlike the existing methods, the model considers the importance weight of each of the decision makers (Experts) since the performance criteria/attributes are required to be rated, and these experts have different level of expertise. The rating is done using a new fuzzy Likert rating scale (membership-scale) which is designed such that it can address problems resulting from information lost/distortion due to closed-form scaling and the ordinal nature of the existing Likert scale.

Making Thinking Audible and Visible via Cooperative Learning

ERIC Educational Resources Information Center

Jacobs, George M.; Wang, Aili; Li, Xishuang; Xie, Yongye

2008-01-01

This chapter begins with a section that describes cooperative learning and explains eight cooperative learning principles. The second section looks briefly at why making thinking audible and visible enriches students' thinking. Making thinking audible means that teachers and students speak out what is going through their minds as they do a task,…

The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research

PubMed Central

Schweikhart, Sharon A.; Dembe, Allard E

2010-01-01

Background Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside of the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma to improve the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the NIH Roadmap for Biomedical Research and the NIH Clinical and Translational Science Award (CTSA) program. Methods This article presents a description of the main principles, practices, and methodologies used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Results Examples are provided of Lean and Six Sigma applications that are being planned at a current CTSA site, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particularly translational research phases. Conclusions Lean and Six Sigma process improvement methodologies are well suited to help achieve NIH’s goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice. PMID:19730130

The applicability of Lean and Six Sigma techniques to clinical and translational research.

PubMed

Schweikhart, Sharon A; Dembe, Allard E

2009-10-01

Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma in improving the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the National Institutes of Health (NIH) Roadmap for Medical Research and the NIH's Clinical and Translational Science Award program. This article presents a description of the main principles, practices, and methods used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Examples of Lean and Six Sigma applications that are being planned at a current Clinical and Translational Science Award site are provided, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particular translational research phases. Lean and Six Sigma process improvement methods are well suited to help achieve NIH's goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice.

The Development of Media Activities by Undergraduate Students in Order to Promote Agricultural Tourism Community Enterprise According to the Principles of Social Service Learning and Community-Based Leaning

ERIC Educational Resources Information Center

Thamwipat, Kuntida; Princhankol, Pornpapatsorn; Yampinij, Sakesun; Meejaleurn, Sopon

2018-01-01

This research was aimed to develop media activities by undergraduate students to promote agricultural tourism community enterprise according to the principles of social service learning and community-based learning, 2) to evaluate the quality of such media activities, 3) to measure the income of the community after the development of media…

Self-assessment, reflection on practice and critical thinking in nursing students.

PubMed

Siles-González, José; Solano-Ruiz, Carmen

2016-10-01

In accordance with the principles of the European Higher Education Area, the aim of this study was to contribute to the implementation of self-assessment through the application of reflection on learning and critical thinking. The theoretical framework employed was Habermas's critical theory and emancipatory interest as a preliminary step to generate educational transformations. The methodological contribution is the design a student self-assessment document that promotes reflection on action and critical thinking. The development of assessment through peer evaluation and other intermediate solutions until achieving self-assessment entails a shift in the educational and scientific paradigm, but also involves the implementation in practice of democratic and ethical principles, values and premises in society. Self-assessment is a novel concept for students, and obliges them to reinterpret their role. Due to the diversity of students' principles, values, motivations, interests and aspirations, this reinterpretation of their role can have a positive outcome, stimulating an active and critical attitude towards group work and self-assessment; or, on the contrary, can generate a stance characterised by disinterest, passivity and lack of critical thinking. The forms of assessment adopted in a given educational system reflect ways of thinking related to ideologies, values, ethical principles and educational paradigms: in order to render implementation of effective self-assessment feasible, it is necessary to undertake structural and regulatory reforms. Students have little experience of reflection on practice or critical thinking. Massification and cultural and structural factors determine the form of assessment. In this context, it would seem advisable to move towards self-assessment gradually and cautiously. Copyright © 2016 Elsevier Ltd. All rights reserved.

Lean and leadership practices: development of an initial realist program theory.

PubMed

Goodridge, Donna; Westhorp, Gill; Rotter, Thomas; Dobson, Roy; Bath, Brenna

2015-09-07

Lean as a management system has been increasingly adopted in health care settings in an effort to enhance quality, capacity and safety, while simultaneously containing or reducing costs. The Ministry of Health in the province of Saskatchewan, Canada has made a multi-million dollar investment in Lean initiatives to create "better health, better value, better care, and better teams", affording a unique opportunity to advance our understanding of the way in which Lean philosophy, principles and tools work in health care. In order to address the questions, "What changes in leadership practices are associated with the implementation of Lean?" and "When leadership practices change, how do the changed practices contribute to subsequent outcomes?", we used a qualitative, multi-stage approach to work towards developing an initial realist program theory. We describe the implications of realist assumptions for evaluation of this Lean initiative. Formal theories including Normalization Process Theory, Theories of Double Loop and Organization Leaning and the Theory of Cognitive Dissonance help understand this initial rough program theory. Data collection included: key informant consultation; a stakeholder workshop; documentary review; 26 audiotaped and transcribed interviews with health region personnel; and team discussions. A set of seven initial hypotheses regarding the manner in which Lean changes leadership practices were developed from our data. We hypothesized that Lean, as implemented in this particular setting, changes leadership practices in the following ways. Lean: a) aligns the aims and objectives of health regions; b) authorizes attention and resources to quality improvement and change management c) provides an integrated set of tools for particular tasks; d) changes leaders' attitudes or beliefs about appropriate leadership and management styles and behaviors; e) demands increased levels of expertise, accountability and commitment from leaders; f) measures and uses data effectively to identify actual and relevant local problems and the root causes of those problems; and g) creates or supports a 'learning organization' culture. This study has generated initial hypotheses and realist program theory that can form the basis for future evaluation of Lean initiatives. Developing leadership capacity and culture is theorized to be a necessary precursor to other systemic and observable changes arising from Lean initiatives.

Instructional Design Models and Teacher Thinking: Toward a New Conceptual Model for Research and Development.

ERIC Educational Resources Information Center

Moallem, Mahnaz; Earle, Rodney S.

1998-01-01

In an effort to connect current research findings on teacher thinking with components of instructional design models and principles, this article discusses a new contextual model for thinking about teaching and considers the implications of the model for instructional development of research in instructional design and teacher thinking. (Author)

Impact of Lean on patient cycle and waiting times at a rural district hospital in KwaZulu-Natal.

PubMed

Naidoo, Logandran; Mahomed, Ozayr H

2016-07-26

Prolonged waiting time is a source of patient dissatisfaction with health care and is negatively associated with patient satisfaction. Prolonged waiting times in many district hospitals result in many dissatisfied patients, overworked and frustrated staff, and poor quality of care because of the perceived increased workload. The aim of the study was to determine the impact of Lean principles techniques, and tools on the operational efficiency in the outpatient department (OPD) of a rural district hospital. The study was conducted at the Catherine Booth Hospital (CBH) - a rural district hospital in KwaZulu-Natal, South Africa. This was an action research study with pre-, intermediate-, and post-implementation assessments. Cycle and waiting times were measured by direct observation on two occasions before, approximately two-weekly during, and on two occasions after Lean implementation. A standardised data collection tool was completed by the researcher at each of the six key service nodes in the OPD to capture the waiting times and cycle times. All six service nodes showed a reduction in cycle times and waiting times between the baseline assessment and post-Lean implementation measurement. Significant reduction was achieved in cycle times (27%; p < 0.05) and waiting times (from 11.93 to 10 min; p = 0.03) at the Investigations node. Although the target reduction was not achieved for the Consulting Room node, there was a significant reduction in waiting times from 80.95 to 74.43 min, (p < 0.001). The average efficiency increased from 16.35% (baseline) to 20.13% (post-intervention). The application of Lean principles, tools and techniques provides hospital managers with an evidence-based management approach to resolving problems and improving quality indicators.

Lean Mission Operations Systems Design - Using Agile and Lean Development Principles for Mission Operations Design and Development

NASA Technical Reports Server (NTRS)

Trimble, Jay Phillip

2014-01-01

The Resource Prospector Mission seeks to rove the lunar surface with an in-situ resource utilization payload in search of volatiles at a polar region. The mission operations system (MOS) will need to perform the short-duration mission while taking advantage of the near real time control that the short one-way light time to the Moon provides. To maximize our use of limited resources for the design and development of the MOS we are utilizing agile and lean methods derived from our previous experience with applying these methods to software. By using methods such as "say it then sim it" we will spend less time in meetings and more time focused on the one outcome that counts - the effective utilization of our assets on the Moon to meet mission objectives.

The lean service machine.

PubMed

Swank, Cynthia Karen

2003-10-01

Jefferson Pilot Financial, a life insurance and annuities firm, like many U.S. service companies at the end of the 1990s was looking for new ways to grow. Its top managers recognized that JPF needed to differentiate itself in the eyes of its customers, the independent life-insurance advisers who sell and service policies. To establish itself as these advisers' preferred partner, it set out to reduce the turnaround time on policy applications, simplify the submission process, and reduce errors. JPF's managers looked to the "lean production" practices that U.S. manufacturers adopted in response to competition from Japanese companies. Lean production is built around the concept of continuous-flow processing--a departure from traditional production systems, in which large batches are processed at each step. JPF appointed a "lean team" to reengineer its New Business unit's operations, beginning with the creation of a "model cell"--a fully functioning microcosm of JPF's entire process. This approach allowed managers to experiment and smooth out the kinks while working toward an optimal design. The team applied lean-manufacturing practices, including placing linked processes near one another, balancing employees' workloads, posting performance results, and measuring performance and productivity from the customer's perspective. Customer-focused metrics helped erode the employees' "My work is all that matters" mind-set. The results were so impressive that JPF is rolling out similar systems across many of its operations. To convince employees of the value of lean production, the lean team introduced a simulation in which teams compete to build the best paper airplane based on invented customer specifications. This game drives home lean production's basic principles, establishing a foundation for deep and far-reaching changes in the production system.

An Expert Teacher's Thinking and Teaching and Instructional Design Models and Principles: An Ethnographic Study.

ERIC Educational Resources Information Center

Moallem, Mahnaz

1998-01-01

Examines an expert teacher's thinking and teaching processes in order to link them to instructional-design procedures. Findings suggest that there were fundamental differences between the teacher's thinking and teaching processes and microinstructional design models. (Author/AEF)

Eye on the Gemba: Using Student-Created Videos and the Revised Bloom's Taxonomy to Teach Lean Management

ERIC Educational Resources Information Center

Marley, Kathryn A.

2014-01-01

Developing exercises that lead students to use higher order thinking skills is a challenge for faculty in any discipline. An excellent way to approach this problem is to use the Revised Bloom's Taxonomy as a guide. In the taxonomy, the highest level of learning is to create. The author describes an assignment that builds on the use of…

Katherine Young, P.E. | NREL

Science.gov Websites

) Water rights and resources engineering Database planning and development Research Interests Collection lean principles to streamline exploration and drilling and reduce error/risk Research, development and Groundwater modeling Quantitative methods in water resource engineering Water resource engineering and

Analysis of creative mathematic thinking ability in problem based learning model based on self-regulation learning

NASA Astrophysics Data System (ADS)

Munahefi, D. N.; Waluya, S. B.; Rochmad

2018-03-01

The purpose of this research identified the effectiveness of Problem Based Learning (PBL) models based on Self Regulation Leaning (SRL) on the ability of mathematical creative thinking and analyzed the ability of mathematical creative thinking of high school students in solving mathematical problems. The population of this study was students of grade X SMA N 3 Klaten. The research method used in this research was sequential explanatory. Quantitative stages with simple random sampling technique, where two classes were selected randomly as experimental class was taught with the PBL model based on SRL and control class was taught with expository model. The selection of samples at the qualitative stage was non-probability sampling technique in which each selected 3 students were high, medium, and low academic levels. PBL model with SRL approach effectived to students’ mathematical creative thinking ability. The ability of mathematical creative thinking of low academic level students with PBL model approach of SRL were achieving the aspect of fluency and flexibility. Students of academic level were achieving fluency and flexibility aspects well. But the originality of students at the academic level was not yet well structured. Students of high academic level could reach the aspect of originality.

Walking the Talk: Putting Constructivist Thinking into Practice in Classrooms.

ERIC Educational Resources Information Center

Riley, Maureen Keohane; And Others

1993-01-01

The constructivist approach of the Teacher as Composer project used analog experiences that replicate thinking and social demands. Classroom constraints, inservice limitations, and teacher mindsets impeded its application. Personal narratives and principles of children's thinking helped bridge the gap between theory and practice. (SK)

Elimination of waste: creation of a successful Lean colonoscopy program at an academic medical center.

PubMed

Damle, Aneel; Andrew, Nathan; Kaur, Shubjeet; Orquiola, Alan; Alavi, Karim; Steele, Scott R; Maykel, Justin

2016-07-01

Lean processes involve streamlining methods and maximizing efficiency. Well established in the manufacturing industry, they are increasingly being applied to health care. The objective of this study was to determine feasibility and effectiveness of applying Lean principles to an academic medical center colonoscopy unit. Lean process improvement involved training endoscopy personnel, observing patients, mapping the value stream, analyzing patient flow, designing and implementing new processes, and finally re-observing the process. Our primary endpoint was total colonoscopy time (minutes from check-in to discharge) with secondary endpoints of individual segment times and unit colonoscopy capacity. A total of 217 patients were included (November 2013-May 2014), with 107 pre-Lean and 110 post-Lean intervention. Pre-Lean total colonoscopy time was 134 min. After implementation of the Lean process, mean colonoscopy time decreased by 10 % to 121 min (p = 0.01). The three steps of the process affected by the Lean intervention (time to achieve adequate sedation, time to recovery, and time to discharge) decreased from 3.7 to 2.4 min (p < 0.01), 4.0 to 3.4 min (p = 0.09), and 41.2 to 35.4 min (p = 0.05), respectively. Overall, unit capacity of colonoscopies increased from 39.6 per day to 43.6. Post-Lean patient satisfaction surveys demonstrated an average score of 4.5/5.0 (n = 73) regarding waiting time, 4.9/5.0 (n = 60) regarding how favorably this experienced compared to prior colonoscopy experiences, and 4.9/5.0 (n = 74) regarding professionalism of staff. One hundred percentage of respondents (n = 69) stated they would recommend our institution to a friend for colonoscopy. With no additional utilization of resources, a single Lean process improvement cycle increased productivity and capacity of our colonoscopy unit. We expect this to result in increased patient access and revenue while maintaining patient satisfaction. We believe these results are widely generalizable to other colonoscopy units as well as other process-based interventions in health care.

Using LEAN principles to improve quality, patient safety, and workflow in histology and anatomic pathology.

PubMed

Serrano, Leo; Hegge, Pamela; Sato, Brendon; Richmond, Barbara; Stahnke, Lennis

2010-05-01

Histology and anatomic pathology have historically been slow to accept many of the process changes that have been widely accepted in the clinical laboratory. In this article, we describe the application of the Toyota Production System (LEAN) to histology and anatomic pathology as implemented at the Avera McKennan Hospital laboratory. Avera McKennan is the flagship hospital of the Avera Health System, a faith based, not for profit healthcare system based in South Dakota. Comprised of 235 hospitals, clinics, and physicians, with over 12,000 employees, Avera Health is one of the largest healthcare systems in the region. Beginning in 2004, Avera McKennan's laboratory began its "LEAN journey" and in the intervening years has expanded it throughout all areas of the laboratory. Following the example set by the laboratory, many other areas of the hospital have joined in the LEAN Process Improvement journey. In January 2009, the Avera McKennan Laboratory became the first hospital laboratory in the US to achieve the CAP ISO-15189 accreditation in both clinical and anatomic pathology.

Implementation of a 'lean' cytopathology service: towards routine same-day reporting.

PubMed

Hewer, Ekkehard; Hammer, Caroline; Fricke-Vetsch, Daniela; Baumann, Cinzia; Perren, Aurel; Schmitt, Anja M

2018-05-01

To systematically assess the effects of a Lean management intervention in an academic cytopathology service. We monitored outcomes including specimen turnaround times during stepwise implementation of a lean cytopathology workflow for gynaecological and non-gynaecological cytology. The intervention resulted in a major reduction of turnaround times for both gynaecological (3rd quartile 4.1 vs 2.3 working days) and non-gynaecological cytology (3rd quartile 1.9 vs. 1.2 working days). Introduction of fully electronic reporting had additional effect over continuous staining of slides alone. The rate of non-gynaecological specimens reported the same day increased from 4.5% to 56.5% of specimens received before noon. Lean management principles provide a useful framework for organization of a cytopathology workflow. Stepwise implementation beginning with a simplified gynaecological cytology workflow allowed involved staff to monitor the effects of individual changes and allowed for a smooth transition. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Using Lean principles to manage throughput on an inpatient rehabilitation unit.

PubMed

Chiodo, Anthony; Wilke, Ruste; Bakshi, Rishi; Craig, Anita; Duwe, Doug; Hurvitz, Edward

2012-11-01

Performance improvement is a mainstay of operations management and maintenance of certification. In this study at a University Hospital inpatient rehabilitation unit, Lean management techniques were used to manage throughput of patients into and out of the inpatient rehabilitation unit. At the start of this process, the average admission time to the rehabilitation unit was 5:00 p.m., with a median time of 3:30 p.m., and no patients received therapy on the day of admission. Within 8 mos, the mean admission time was 1:22 p.m., 50% of the patients were on the rehabilitation unit by 1:00 p.m., and more than 70% of all patients received therapy on the day of admission. Negative variance from this performance was evaluated, the identification of inefficient discharges holding up admissions as a problem was identified, and a Lean workshop was initiated. Once this problem was tackled, the prime objective of 70% of patients receiving therapy on the date of admission was consistently met. Lean management tools are effective in improving throughput on an inpatient rehabilitation unit.

A Cross-Disciplinary Partnership to Improve Manufacturing Education.

ERIC Educational Resources Information Center

Stephens, Matthew P.; Kraebber, Henry W.

1998-01-01

An exemplary university/business partnership involved the development of a training program to enhance workplace productivity for a relatively small manufacturing facility. The objectives were to educate the work force in the principles of workplace organization and lean manufacturing practices. (Author/JOW)

Critical Thinking, Autonomy and Practical Reason

ERIC Educational Resources Information Center

Cuypers, Stefaan E.

2004-01-01

This article points out an internal tension, or even conflict, in the conceptual foundations of Harvey Siegel's conception of critical thinking. Siegel justifies critical thinking, or critically rational autonomy, as an educational ideal first and foremost by an appeal to the Kantian principle of respect for persons. It is made explicit that this…

Agile: From Software to Mission Systems

NASA Technical Reports Server (NTRS)

Trimble, Jay; Shirley, Mark; Hobart, Sarah

2017-01-01

To maximize efficiency and flexibility in Mission Operations System (MOS) design, we are evolving principles from agile and lean methods for software, to the complete mission system. This allows for reduced operational risk at reduced cost, and achieves a more effective design through early integration of operations into mission system engineering and flight system design. The core principles are assessment of capability through demonstration, risk reduction through targeted experiments, early test and deployment, and maturation of processes and tools through use.

Quality initiatives: lean approach to improving performance and efficiency in a radiology department.

PubMed

Kruskal, Jonathan B; Reedy, Allen; Pascal, Laurie; Rosen, Max P; Boiselle, Phillip M

2012-01-01

Many hospital radiology departments are adopting "lean" methods developed in automobile manufacturing to improve operational efficiency, eliminate waste, and optimize the value of their services. The lean approach, which emphasizes process analysis, has particular relevance to radiology departments, which depend on a smooth flow of patients and uninterrupted equipment function for efficient operation. However, the application of lean methods to isolated problems is not likely to improve overall efficiency or to produce a sustained improvement. Instead, the authors recommend a gradual but continuous and comprehensive "lean transformation" of work philosophy and workplace culture. Fundamental principles that must consistently be put into action to achieve such a transformation include equal involvement of and equal respect for all staff members, elimination of waste, standardization of work processes, improvement of flow in all processes, use of visual cues to communicate and inform, and use of specific tools to perform targeted data collection and analysis and to implement and guide change. Many categories of lean tools are available to facilitate these tasks: value stream mapping for visualizing the current state of a process and identifying activities that add no value; root cause analysis for determining the fundamental cause of a problem; team charters for planning, guiding, and communicating about change in a specific process; management dashboards for monitoring real-time developments; and a balanced scorecard for strategic oversight and planning in the areas of finance, customer service, internal operations, and staff development. © RSNA, 2012.

Thinking about Air and Space Power in 2025: Five Guiding Principles

DTIC Science & Technology

2012-06-01

conflicts show the need for thinking about this principle in the design as well as the use of platforms. Any such analysis neces- sitates drawing on all...space and the commonplace employment of medium- and high - altitude drones. The self-deployment of drones and their integra- tion into air traffic will...technical advances will lead to the de- velopment of stratospheric drones ( high - altitude platforms), adding the benefits of increased persistence

Modern Management Principles Come to the Dental School.

PubMed

Wataha, John C; Mouradian, Wendy E; Slayton, Rebecca L; Sorensen, John A; Berg, Joel H

2016-04-01

The University of Washington School of Dentistry may be the first dental school in the nation to apply lean process management principles as a primary tool to re-engineer its operations and curriculum to produce the dentist of the future. The efficiencies realized through re-engineering will better enable the school to remain competitive and viable as a national leader of dental education. Several task forces conducted rigorous value stream analyses in a highly collaborative environment led by the dean of the school. The four areas undergoing evaluation and re-engineering were organizational infrastructure, organizational processes, curriculum, and clinic operations. The new educational model was derived by thoroughly analyzing the current state of dental education in order to design and achieve the closest possible ideal state. As well, the school's goal was to create a lean, sustainable operational model. This model aims to ensure continued excellence in restorative dental instruction and to serve as a blueprint for other public dental schools seeking financial stability in this era of shrinking state support and rising costs.

Pathways to lean software development: An analysis of effective methods of change

NASA Astrophysics Data System (ADS)

Hanson, Richard D.

This qualitative Delphi study explored the challenges that exist in delivering software on time, within budget, and with the original scope identified. The literature review identified many attempts over the past several decades to reform the methods used to develop software. These attempts found that the classical waterfall method, which is firmly entrenched in American business today was to blame for this difficulty (Chatterjee, 2010). Each of these proponents of new methods sought to remove waste, lighten out the process, and implement lean principles in software development. Through this study, the experts evaluated the barriers to effective development principles and defined leadership qualities necessary to overcome these barriers. The barriers identified were issues of resistance to change, risk and reward issues, and management buy-in. Thirty experts in software development from several Fortune 500 companies across the United States explored each of these issues in detail. The conclusion reached by these experts was that visionary leadership is necessary to overcome these challenges.

A practical guide to applying lean tools and management principles to health care improvement projects.

PubMed

Simon, Ross W; Canacari, Elena G

2012-01-01

Manufacturing organizations have used Lean management principles for years to help eliminate waste, streamline processes, and cut costs. This pragmatic approach to structured problem solving can be applied to health care process improvement projects. Health care leaders can use a step-by-step approach to document processes and then identify problems and opportunities for improvement using a value stream process map. Leaders can help a team identify problems and root causes and consider additional problems associated with methods, materials, manpower, machinery, and the environment by using a cause-and-effect diagram. The team then can organize the problems identified into logical groups and prioritize the groups by impact and difficulty. Leaders must manage action items carefully to instill a sense of accountability in those tasked to complete the work. Finally, the team leaders must ensure that a plan is in place to hold the gains. Copyright © 2012 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Integrating Complexity Thinking with Teacher Education Practices: A Collective yet Unpredictable Endeavour in Physical Education?

ERIC Educational Resources Information Center

Jess, Mike; Atencio, Matthew; Carse, Nicola

2018-01-01

While complexity thinking features increasingly in the education and physical education literature, there remains a paucity of research presenting evidence of the influence that complexity principles have on learning. We further advocate that more work with complexity thinking is required to investigate how teacher educators engage with key…

Critical Thinking Handbook: High School. A Guide for Redesigning Instruction.

ERIC Educational Resources Information Center

Paul, Richard; And Others

This handbook, designed to help high school teachers remodel their lesson plans, has one basic objective: to demonstrate that it is possible and practical to integrate instruction for critical thinking into the teaching of all subjects. The handbook discusses the concept of critical thinking and the principles that underlie it and shows how…

An "Infusion" Approach to Critical Thinking: Moore on the Critical Thinking Debate

ERIC Educational Resources Information Center

Davies, W. Martin

2006-01-01

This paper argues that general skills and the varieties of subject-specific discourse are both important for teaching, learning and practising critical thinking. The former is important because it outlines the principles of good reasoning "simpliciter" (what constitutes sound reasoning patterns, invalid inferences, and so on). The latter is…

Following Alice: Theories of Critical Thinking and Reflective Practice in Action at Postgraduate Level

ERIC Educational Resources Information Center

Swanwick, Ruth; Kitchen, Ruth; Jarvis, Joy; McCracken, Wendy; O'Neil, Rachel; Powers, Steve

2014-01-01

This paper presents a flexible framework of principles for teaching critical thinking and reflective practice skills at the postgraduate level. It reports on a collaborative project between four UK institutions providing postgraduate programmes in deaf education. Through a critical review of current theories of critical thinking and reflective…

Critical Thinking Theory to Practice: Using the Expert's Thought Process as Guide for Learning and Assessment.

PubMed

Marshall, Teresa A; Marchini, Leonardo; Cowen, Howard; Hartshorn, Jennifer E; Holloway, Julie A; Straub-Morarend, Cheryl L; Gratton, David; Solow, Catherine M; Colangelo, Nicholas; Johnsen, David C

2017-08-01

Critical thinking skills are essential for the successful dentist, yet few explicit skillsets in critical thinking have been developed and published in peer-reviewed literature. The aims of this article are to 1) offer an assessable critical thinking teaching model with the expert's thought process as the outcome, learning guide, and assessment instrument and 2) offer three critical thinking skillsets following this model: for geriatric risk assessment, technology decision making, and situation analysis/reflections. For the objective component, the student demonstrates delivery of each step in the thought process. For the subjective component, the student is judged to have grasped the principles as applied to the patient or case. This article describes the framework and the results of pilot tests in which students in one year at this school used the model in the three areas, earning scores of 90% or above on the assessments. The model was thus judged to be successful for students to demonstrate critical thinking skillsets in the course settings. Students consistently delivered each step of the thought process and were nearly as consistent in grasping the principles behind each step. As more critical thinking skillsets are implemented, a reinforcing network develops.

Managing a Public Library. Parts I and II.

ERIC Educational Resources Information Center

Aronoff, Carol; Cart, Michael

1985-01-01

Discusses factors that contribute to Santa Monica Public Library's excellence, including supportive city government and citizenry, city council, library board, lean top management, and the basic management team. Specific management principles and techniques, public relations, and measures of service at Beverly Hills Public Library are also…

Cost and efficiency lead to increased value for the patient and bottom line for the practice.

PubMed

Dahl, Owen J

2009-01-01

Understanding how much it costs to provide a service is a basic premise of any business. In addition, healthcare is in need of improved processes to provide and increase value to the patient. This can be accomplished by the application of principles called Six Sigma and Lean Management. Today's medical practice leader must be aware of the costs of doing business and be able to apply proven management principles to the processes involved in providing patient care.

Energy deficiency, menstrual disturbances, and low bone mass: what do exercising Australian women know about the female athlete triad?

PubMed

Miller, Stephanie M; Kukuljan, Sonja; Turner, Anne I Turner; van der Pligt, Paige; Ducher, Gaele

2012-04-01

Prevention of the female athlete triad is essential to protect female athletes' health. The aim of this study was to investigate the knowledge, attitudes, and behaviors of regularly exercising adult women in Australia toward eating patterns, menstrual cycles, and bone health. A total of 191 female exercisers, age 18-40 yr, engaging in ≥2 hr/wk of strenuous activity, completed a survey. After 11 surveys were excluded (due to incomplete answers), the 180 participants were categorized into lean-build sports (n = 82; running/athletics, triathlon, swimming, cycling, dancing, rowing), non-lean-build sports (n = 94; basketball, netball, soccer, hockey, volleyball, tennis, trampoline, squash, Australian football), or gym/fitness activities (n = 4). Mean (± SD) training volume was 9.0 ± 5.5 hr/wk, with participants competing from local up to international level. Only 10% of respondents could name the 3 components of the female athlete triad. Regardless of reported history of stress fracture, 45% of the respondents did not think that amenorrhea (absence of menses for ≥3 months) could affect bone health, and 22% of those involved in lean-build sports would do nothing if experiencing amenorrhea (vs. 3.2% in non-lean-build sports, p = .005). Lean-build sports, history of amenorrhea, and history of stress fracture were all significantly associated with not taking action in the presence of amenorrhea (all p < .005). Few active Australian women are aware of the detrimental effects of menstrual dysfunction on bone health. Education programs are needed to prevent the female athlete triad and ensure that appropriate actions are taken by athletes when experiencing amenorrhea.

Achieving Success via Multi-Model Process Improvement

DTIC Science & Technology

2007-03-01

Mellon University page 19 Lean Tactics: Kaizen Events Kaizen - Make people’s jobs easier by taking them apart, studying them, and making improvements...KAI” - take apart and make anew • “ZEN” - think, make good the actions of others, do good deeds and help others Kaizen tips (VAL, M&A, QPM, CAR...business - Requires firm understanding of the “before” state - “Just do it” Projects - Kaizen event with rollout plan • required use of Six Sigma

Redesigning emergency department patient flows: application of Lean Thinking to health care.

PubMed

King, Diane L; Ben-Tovim, David I; Bassham, Jane

2006-08-01

To describe in some detail the methods used and outcome of an application of concepts from Lean Thinking in establishing streams for patient flows in a teaching general hospital ED. Detailed understanding was gained through process mapping with staff followed by the identification of value streams (those patients likely to be discharged from the ED, those who were likely to be admitted) and the implementation of a process of seeing those patients that minimized complex queuing in the ED. Streaming had a significant impact on waiting times and total durations of stay in the ED. There was a general flattening of the waiting time across all groups. A slight increase in wait for Triage categories 2 and 3 patients was offset by reductions in wait for Triage category 4 patients. All groups of patients spent significantly less overall time in the department and the average number of patients in the ED at any time decreased. There was a significant reduction in number of patients who do not wait and a slight decrease in access block. The streaming of patients into groups of patients cared for by a specific team of doctors and nurses, and the minimizing of complex queues in this ED by altering the practices in relation to the function of the Australasian Triage Scale improved patient flow, thereby decreasing potential for overcrowding.

Developing Critical Thinking in E-Learning Environment: Kuwait University as a Case Study

ERIC Educational Resources Information Center

Al-Fadhli, Salah; Khalfan, Abdulwahed

2009-01-01

This article investigated the impact of using e-learning models' with the principles of constructivism to enhance the critical thinking skills of students in higher education institutions. The study examines the effectiveness of e-learning model in enhancing critical thinking of students at university level. This effectiveness is measured by a…

DOE Office of Scientific and Technical Information (OSTI.GOV)

Smith, Jeff

This report discusses the UHSP monitoring program, a radioactive material accounting process and its purpose. The systematic approach to implementing Lean principles, determining key requirements, root causes of variation and disruption that interfere with program efficiency and effectiveness. Preexisting issues within the UHSP are modeled to illustrate the impact that they have on the large and extensive systems.

Expressing the sense of the House of Representatives that the Federal Government should incorporate the principles of the Lean Six Sigma management strategy.

THOMAS, 112th Congress

Rep. Schweikert, David [R-AZ-5

2011-09-22

House - 10/03/2011 Referred to the Subcommittee on Federal Workforce, U.S. Postal Service, and Labor Policy. (All Actions) Tracker: This bill has the status IntroducedHere are the steps for Status of Legislation:

E3 Success Story - Making an Investment in the Company: C.U.E.

EPA Pesticide Factsheets

C.U.E. in Mount Hope, West Virginia, makes molded and cast parts.An array of opportunities were found by WVMEP to implement lean production principles in areas such as mistake proofing, kanban systems, rapid exchange of dies, 5S, and value stream mapping.

Single service point: it's all in the design.

PubMed

Bradigan, Pamela S; Rodman, Ruey L

2008-01-01

"Design thinking" principles from a leading design firm, IDEO, were key elements in the planning process for a one-desk service model, the ASK Desk, at the John A. Prior Health Sciences Library. The library administration and staff employed the methodology to enhance customer experiences, meet technology challenges, and compete in a changing education environment. The most recent renovations demonstrate how the principles were applied. The concept of "continuous design thinking" is important in the library's daily operations to serve customers most effectively.

Water Rocket Seen from Educational Point of View

NASA Astrophysics Data System (ADS)

Takemae, Toshiaki

The water rocket can be easily made of familiar materials. The water rocket flies well beyond expectations. Water rockets are widely used in educational activities for youngsters. The water rocket activities are interesting and educational for people of all ages. I will divide the contents of the water rocket activity into 3 steps and introduce representative examples in each step. I have considered the aim and the effect of each step. The 1st Step is the experience stage. The purpose of this step is to give a lot of children pleasure. In the 1st step, children are encouraged to have curiosity. It is important that the child enjoys the water rocket activity. It gets the children to think that they want to fly a water rocket. It is important to encourage children to have fun during the 1st step so that they will want to continue to the 2nd step. The 2nd Step is the research stage. The water rocket includes elements which show the children various physical phenomena. Through the water rocket activity, the child leans about real rockets. The children also learn the method of scientific experiments. Each child leans and experiences a scientific way of considering things. The water rocket is the optimal research subject for the club activities of school children. The 3rd Step is the creative stage. The child understands the principle of the mechanism. Then, the child improves a water rocket. To realize a variety of ideas, the child continues to repeat these activities in a variety of ways. In this way, the child gains a wide variety of experiences while advancing towards their goal. By using the water rocket as an educational tool we can teach children about many subjects and phenomena, many of which can be seen in daily life.

It's not maths; it's science: exploring thinking dispositions, learning thresholds and mindfulness in science learning

NASA Astrophysics Data System (ADS)

Quinnell, R.; Thompson, R.; LeBard, R. J.

2013-09-01

Developing quantitative skills, or being academically numerate, is part of the curriculum agenda in science teaching and learning. For many of our students, being asked to 'do maths' as part of 'doing science' leads to disengagement from learning. Notions of 'I can't do maths' speak of a rigidity of mind, a 'standoff', forming a barrier to learning in science that needs to be addressed if we, as science educators, are to offer solutions to the so-called 'maths problem' and to support students as they move from being novice to expert. Moving from novice to expert is complex and we lean on several theoretical frameworks (thinking dispositions, threshold concepts and mindfulness in learning) to characterize this pathway in science, with a focus on quantitative skills. Fluid thinking and application of numeracy skills are required to manipulate experimental data sets and are integral to our science practice; we need to stop students from seeing them as optional 'maths' or 'statistics' tasks within our discipline. Being explicit about the ways those in the discipline think, how quantitative data is processed, and allowing places for students to address their skills (including their confidence) offer some ways forward.

Thinking inside the Box Constrained Creativity and New Technology

ERIC Educational Resources Information Center

Gill, Bradley

2012-01-01

Thinking outside of the box is a standard cliche for creativity. Yet an awareness of the boxed nature of new media can empower young students to think creatively about design. This article is a reflection of one teacher who led a group of young students in a series of lessons based on basic design principles related to technology. It is based on…

The Brazilian Air Force Uniform Distribution Process: Using Lean Thinking, Statistical Process Control and Theory of Constraints to Address Improvement Opportunities

DTIC Science & Technology

2015-03-26

universal definition” (Evans & Lindsay, 1996). Heizer and Render (2010) argue that several definitions of this term are user-based, meaning, that quality...for example, really good ice cream has high butterfat levels.” ( Heizer & Render , 2010). Garvin, in his Competing in Eight Dimensions of Quality...Montgomery, 2005). As for definition purposes, the concept adopted by this research was provided by Heizer and Render (2010), for whom Statistical Process

The relative benefits of green versus lean office space: three field experiments.

PubMed

Nieuwenhuis, Marlon; Knight, Craig; Postmes, Tom; Haslam, S Alexander

2014-09-01

Principles of lean office management increasingly call for space to be stripped of extraneous decorations so that it can flexibly accommodate changing numbers of people and different office functions within the same area. Yet this practice is at odds with evidence that office workers' quality of life can be enriched by office landscaping that involves the use of plants that have no formal work-related function. To examine the impact of these competing approaches, 3 field experiments were conducted in large commercial offices in The Netherlands and the U.K. These examined the impact of lean and "green" offices on subjective perceptions of air quality, concentration, and workplace satisfaction as well as objective measures of productivity. Two studies were longitudinal, examining effects of interventions over subsequent weeks and months. In all 3 experiments enhanced outcomes were observed when offices were enriched by plants. Implications for theory and practice are discussed. PsycINFO Database Record (c) 2014 APA, all rights reserved.

The joint use of resilience engineering and lean production for work system design: A study in healthcare.

PubMed

Rosso, Caroline Brum; Saurin, Tarcisio Abreu

2018-09-01

Although lean production (LP) has been increasingly adopted in healthcare systems, its benefits often fall short of expectations. This might be partially due to the failure of lean to account for the complexity of healthcare. This paper discusses the joint use of principles of LP and resilience engineering (RE), which is an approach for system design inspired by complexity science. Thus, a framework for supporting the design of socio-technical systems, which combines insights from LP and RE, was developed and tested in a system involving a patient flow from an emergency department to an intensive care unit. Based on this empirical study, as well as on extant theory, eight design propositions that support the framework application were developed. Both the framework and its corresponding propositions can contribute to the design of socio-technical systems that are at the same time safe and efficient. Copyright © 2018 Elsevier Ltd. All rights reserved.

NPITxt, a 21st-Century Reporting System: Engaging Residents in a Lean-Inspired Process.

PubMed

Raja, Pushpa V; Davis, Michael C; Bales, Alicia; Afsarmanesh, Nasim

2015-05-01

Operational waste, or workflow processes that do not add value, is a frustrating but nonetheless largely tolerated barrier to efficiency and morale for medical trainees. In this article, the authors tested a novel reporting system using several submission formats (text messaging, e-mail, Web form, mobile application) to allow residents to report various types of operational waste in real time. This system informally promoted "lean" principles of waste identification and continuous improvement. In all, 154 issues were submitted between March 30, 2011, and June 30, 2012, and categorized as closely as possible into lean categories of operational waste; 131 issues were completely addressed with the requested outcome partially or fully implemented or with successful clarification of existing policies. A real-time, voluntary reporting system can effectively capture trainee observations of waste in health care and training processes, give trainees a voice in a hierarchical system, and lead to meaningful operations improvement. © 2014 by the American College of Medical Quality.

The heuristic-analytic theory of reasoning: extension and evaluation.

PubMed

Evans, Jonathan St B T

2006-06-01

An extensively revised heuristic-analytic theory of reasoning is presented incorporating three principles of hypothetical thinking. The theory assumes that reasoning and judgment are facilitated by the formation of epistemic mental models that are generated one at a time (singularity principle) by preconscious heuristic processes that contextualize problems in such a way as to maximize relevance to current goals (relevance principle). Analytic processes evaluate these models but tend to accept them unless there is good reason to reject them (satisficing principle). At a minimum, analytic processing of models is required so as to generate inferences or judgments relevant to the task instructions, but more active intervention may result in modification or replacement of default models generated by the heuristic system. Evidence for this theory is provided by a review of a wide range of literature on thinking and reasoning.

Microscopic Description of Le Chatelier's Principle

ERIC Educational Resources Information Center

Novak, Igor

2005-01-01

A simple approach that "demystifies" Le Chatelier's principle (LCP) and simulates students to think about fundamental physical background behind the well-known principles is presented. The approach uses microscopic descriptors of matter like energy levels and populations and does not require any assumption about the fixed amount of substance being…

Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy

PubMed

Inauen, Alice; Rettke, Horst; Fridrich, Annemarie; Spirig, Rebecca; Bauer, Georg F

2017-01-01

Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.

78 FR 70090 - Request for Public Comments on the UN Committee on World Food Security Principles for Responsible...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-11-22

...- governmental and civil society organizations, think tanks, educational institutions, private sector companies... process to develop voluntary, non-binding international principles for responsible investment in...

Supporting Productive Struggle with Communication Moves

ERIC Educational Resources Information Center

Freeburn, Ben; Arbaugh, Fran

2017-01-01

"Principles to Actions: Ensuring Mathematical Success for All" (NCTM 2014, p. 10) contains eight research-informed teaching practices that have been shown to support students' mathematical thinking and learning. Two teaching practices highlighted herein are "to elicit and use evidence of students' thinking" and "support…

How Visual Management for Continuous Improvement Might Guide and Affect Hospital Staff: A Case Study.

PubMed

Ulhassan, Waqar; von Thiele Schwarz, Ulrica; Westerlund, Hugo; Sandahl, Christer; Thor, Johan

2015-01-01

Visual management (VM) tools such as whiteboards, often employed in Lean thinking applications, are intended to be helpful in improving work processes in different industries including health care. It remains unclear, however, how VM is actually applied in health care Lean interventions and how it might influence the clinical staff. We therefore examined how Lean-inspired VM using whiteboards for continuous improvement efforts related to the hospital staff's work and collaboration. Within a case study design, we combined semistructured interviews, nonparticipant observations, and photography on 2 cardiology wards. The fate of VM differed between the 2 wards; in one, it was well received by the staff and enhanced continuous improvement efforts, whereas in the other ward, it was not perceived to fit in the work flow or to make enough sense in order to be sustained. Visual management may enable the staff and managers to allow communication across time and facilitate teamwork by enabling the inclusion of team members who are not present simultaneously; however, its adoption and value seem contingent on finding a good fit with the local context. A combination of continuous improvement and VM may be helpful in keeping the staff engaged in the change process in the long run.

Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol).

PubMed

Lawal, Adegboyega K; Rotter, Thomas; Kinsman, Leigh; Sari, Nazmi; Harrison, Liz; Jeffery, Cathy; Kutz, Mareike; Khan, Mohammad F; Flynn, Rachel

2014-09-19

Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer's needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case-control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. PROSPERO CRD42014008853.

Lean management in health care: definition, concepts, methodology and effects reported (systematic review protocol)

PubMed Central

2014-01-01

Background Lean is a set of operating philosophies and methods that help create a maximum value for patients by reducing waste and waits. It emphasizes the consideration of the customer’s needs, employee involvement and continuous improvement. Research on the application and implementation of lean principles in health care has been limited. Methods This is a protocol for a systematic review, following the Cochrane Effective Practice and Organisation of Care (EPOC) methodology. The review aims to document, catalogue and synthesize the existing literature on the effects of lean implementation in health care settings especially the potential effects on professional practice and health care outcomes. We have developed a Medline keyword search strategy, and this focused strategy will be translated into other databases. All search strategies will be provided in the review. The method proposed by the Cochrane EPOC group regarding randomized study designs, non-randomised controlled trials controlled before and after studies and interrupted time series will be followed. In addition, we will also include cohort, case–control studies, and relevant non-comparative publications such as case reports. We will categorize and analyse the review findings according to the study design employed, the study quality (low- versus high-quality studies) and the reported types of implementation in the primary studies. We will present the results of studies in a tabular form. Discussion Overall, the systematic review aims to identify, assess and synthesize the evidence to underpin the implementation of lean activities in health care settings as defined in this protocol. As a result, the review will provide an evidence base for the effectiveness of lean and implementation methodologies reported in health care. Systematic review registration PROSPERO CRD42014008853 PMID:25238974

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

PubMed

Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

2016-10-01

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Ergonomics and Kaizen as strategies for competitiveness: a theoretical and practical in an automotive industry.

PubMed

Vieira, Leandro; Balbinotti, Giles; Varasquin, Adriano; Gontijo, Leila

2012-01-01

With increased international competitiveness in the automotive industry, came the concern of the companies save costs and lower production costs. For this purpose many ways are designed to reduce costs and waste of raw materials and reduce activities that do not aggregate value to manufacturing processes. In the early XVII appears the manufacturing system, which processes were hard with little concern for the health and safety of employees and conditions of the workplace. After the advent of the production system called lean manufacturing, a new paradigm in terms of production system capable of providing high levels of productivity and quality. It is based on waste elimination that occur during the production process. After began a new way of thinking, creating a culture of continuous improvement and lean process with no waste and reducing costs, without neglecting the welfare worker and improving the conditions of their work environment. This paper presents a reflection on the application of ergonomics in a lean production system of an automotive industry, using methodology based on the Kaizen (Continuous Improvement) to gain performance and improving the conditions of the workplace, also will be presented with positive and negative points in using this methodology in relation to ergonomics. The research will be conducted by collecting data 'in loco' and interviews with workers. Some studies show that in companies that are lean system and using the methodology of Kaizen, the results of product quality, levels of absenteeism and accidents are better than those obtained in companies that do not apply the same concept.

The Thinking Parent: Understanding and Guiding Your Child.

ERIC Educational Resources Information Center

Stokes, Anne

Noting that the principles of good child rearing that apply to very young children are the foundation of the principles that deal with older children, this book translates those early foundational principles and applies them to the kindergarten through grade six child. The material uses a common sense approach that acknowledges the uniqueness of…

How Sociological Leaders Teach: Some Key Principles

ERIC Educational Resources Information Center

Persell, Caroline Hodges; Pfeiffer, Kathryn M.; Syed, Ali

2008-01-01

This paper arose from a larger study designed to explore what leaders in the field of sociology think are the most important goals and principles for students to understand after taking a college-level introductory course and how they teach those principles. A population of scholarly leaders in sociology was defined by various forms of peer…

A Framework for Thinking about Informal Statistical Inference

ERIC Educational Resources Information Center

Makar, Katie; Rubin, Andee

2009-01-01

Informal inferential reasoning has shown some promise in developing students' deeper understanding of statistical processes. This paper presents a framework to think about three key principles of informal inference--generalizations "beyond the data," probabilistic language, and data as evidence. The authors use primary school classroom…

Intersections of Critical Systems Thinking and Community Based Participatory Research: A Learning Organization Example with the Autistic Community

PubMed Central

Raymaker, Dora M

2016-01-01

Critical systems thinking (CST) and community based participatory research (CBPR) are distinct approaches to inquiry which share a primary commitment to holism and human emancipation, as well as common grounding in critical theory and emancipatory and pragmatic philosophy. This paper explores their intersections and complements on a historical, philosophical, and theoretical level, and then proposes a hybrid approach achieved by applying CBPR's principles and considerations for operationalizing emancipatory practice to traditional systems thinking frameworks and practices. This hybrid approach is illustrated in practice with examples drawn from of the implementation of the learning organization model in an action research setting with the Autistic community. Our experience of being able to actively attend to, and continuously equalize, power relations within an organizational framework that otherwise has great potential for reinforcing power inequity suggests CBPR's principles and considerations for operationalizing emancipatory practice could be useful in CST settings, and CST's vocabulary, methods, and clarity around systems thinking concepts could be valuable to CBPR practioners. PMID:27833398

Intersections of Critical Systems Thinking and Community Based Participatory Research: A Learning Organization Example with the Autistic Community.

PubMed

Raymaker, Dora M

2016-10-01

Critical systems thinking (CST) and community based participatory research (CBPR) are distinct approaches to inquiry which share a primary commitment to holism and human emancipation, as well as common grounding in critical theory and emancipatory and pragmatic philosophy. This paper explores their intersections and complements on a historical, philosophical, and theoretical level, and then proposes a hybrid approach achieved by applying CBPR's principles and considerations for operationalizing emancipatory practice to traditional systems thinking frameworks and practices. This hybrid approach is illustrated in practice with examples drawn from of the implementation of the learning organization model in an action research setting with the Autistic community. Our experience of being able to actively attend to, and continuously equalize, power relations within an organizational framework that otherwise has great potential for reinforcing power inequity suggests CBPR's principles and considerations for operationalizing emancipatory practice could be useful in CST settings, and CST's vocabulary, methods, and clarity around systems thinking concepts could be valuable to CBPR practioners.

Critical Thinking Handbook: 6th-9th Grades. A Guide for Remodelling Lesson Plans in Language Arts, Social Studies, & Science.

ERIC Educational Resources Information Center

Paul, Richard; And Others

This handbook designed for teachers of sixth through ninth grades, has two objectives: (1) to make the concept of critical thinking and the principles that underlie it clear; and (2) to show how critical thinking can be taught in language arts, social studies, and science. The introduction presents the reader with the concepts of critical thinking…

Integrating Systems Thinking Into Nursing Education.

PubMed

Phillips, Janet M; Stalter, Ann M

2016-09-01

A critical need exists for nursing leadership in current complex health care settings. Systems thinking can be incorporated into nursing education at all levels by using evidence-based principles in education. Teaching tips are provided using a systems awareness model to guide nurse educators in the assessment and integration of systems thinking and engaging learners in interprofessional education and practice. J Contin Educ Nurs. 2016;47(9):395-397. Copyright 2016, SLACK Incorporated.

Three contextual frameworks for siblingships: nonlinear thinking, disposition, and phallocentrism.

PubMed

Lament, Claudia

2013-01-01

This discussion of Juliet Mitchell's paper "Siblings: Thinking Theory" places her work within the context of three frameworks: nonlinear thinking, disposition, and phallocentrism. The nonlinear dimension of the developmental process demonstrates how the sibling experience is not static, but rather is subject to a natural transmogrification toward new adaptive forms and meanings that occur over the sequential progress of organizational growth. Secondly, dispositional variables tend to be overlooked in their role in how brothers and sisters engage one another, titrate closeness and separateness, and creatively live out their love, admiration, hate, envy, and rivalry with each other. Sensitivities in dispositional leanings, such as special empathic qualities, may even serve to mitigate sibling turbulence. Lastly, the phallocentricity in Western societies privileges an implicitly male perspective that envisions sibling relationships in terms of threatening competitors, as the common linguistic phrase sibling rivalry suggests. This inflection in culture disregards more-expanding qualities in object relationships and aim-giving strategies that are exchanged in sibling play. These variables are not the sole contributors to the sibling experience, but a sampling of influences both from within and outside the child that affect that experience.

Northwestern University School of Speech: A History.

ERIC Educational Resources Information Center

Rein, Lynn Miller

This book presents a concise history of the first 100 years of development of the school of speech at Northwestern University (Illinois). Following an introduction that provides an overview of the school, the first chapter focuses on both the efforts of Robert McLean Cumnock to found a school of oratory on the principles of elocution and the…

Residential Care: Back to First Principles.

ERIC Educational Resources Information Center

Burns, David A.

Residential care must be redefined, free from jargon and rhetoric. Over the past 20 years, the social welfare approach, which encompasses the medical model, has dominated legislative and practical thinking about residential care. This theoretical thinking reached its culmination in the concept of the therapeutic community. The therapeutic…

Development of a fast, lean and agile direct pelletization process using experimental design techniques.

PubMed

Politis, Stavros N; Rekkas, Dimitrios M

2017-04-01

A novel hot melt direct pelletization method was developed, characterized and optimized, using statistical thinking and experimental design tools. Mixtures of carnauba wax (CW) and HPMC K100M were spheronized using melted gelucire 50-13 as a binding material (BM). Experimentation was performed sequentially; a fractional factorial design was set up initially to screen the factors affecting the process, namely spray rate, quantity of BM, rotor speed, type of rotor disk, lubricant-glidant presence, additional spheronization time, powder feeding rate and quantity. From the eight factors assessed, three were further studied during process optimization (spray rate, quantity of BM and powder feeding rate), at different ratios of the solid mixture of CW and HPMC K100M. The study demonstrated that the novel hot melt process is fast, efficient, reproducible and predictable. Therefore, it can be adopted in a lean and agile manufacturing setting for the production of flexible pellet dosage forms with various release rates easily customized between immediate and modified delivery.

Using Innovative Methodologies From Technology and Manufacturing Companies to Reduce Heart Failure Readmissions.

PubMed

Johnson, Amber E; Winner, Laura; Simmons, Tanya; Eid, Shaker M; Hody, Robert; Sampedro, Angel; Augustine, Sharon; Sylvester, Carol; Parakh, Kapil

2016-05-01

Heart failure (HF) patients have high 30-day readmission rates with high costs and poor quality of life. This study investigated the impact of a framework blending Lean Sigma, design thinking, and Lean Startup on 30-day all-cause readmissions among HF patients. This was a prospective study in an academic hospital in Baltimore, Maryland. Thirty-day all-cause readmission was assessed using the hospital's electronic medical record. The baseline readmission rate for HF was 28.4% in 2010 with 690 discharges. The framework was developed and interventions implemented in the second half of 2011. The impact of the interventions was evaluated through 2012. The rate declined to 18.9% among 703 discharges (P < .01). There was no significant change for non-HF readmissions. This study concluded that methodologies from technology and manufacturing companies can reduce 30-day readmissions in HF, demonstrating the potential of this innovations framework to improve chronic disease care. © The Author(s) 2014.

Evaluation of Mean Platelet Volume values in lean women with polycystic ovary syndrome.

PubMed

Silfeler, Dilek Benk; Kurt, Raziye Keskin; Yengil, Erhan; Un, Burak; Arica, Secil; Baloglu, Ali

2014-05-01

Mean Platelet Volume (MPV) is an important indicator of platelet activation. It is known that MPV increases in patients with coronory artery disease, diabetes mellitus, atherosclerosis and Polycystic ovary syndrome (PCOS). Our aim was to measure the MPV in lean patients with polycystic ovary syndrome. The present study was designed to examine the platelet function by measuring MPV in non-obese women with PCOS. A total of 50 outpatients with PCOS were included. The control group consisted of 50 healthy subjects. Serum platelet, MPV, and white blood cell (WBC) levels were compared and evaluated retrospectively in all participants. These values were compared by statistical analysis. There were no statistically significant difference in between groups regarding MPV (p═0.357), WBC (p═0,414) and platelet (p═0,666). There are studies implying MPV increase in PCOS patients, in our patients MPV levels did not correlate with PCOS except for patients with obesity. We think that PCOS itself has no effect on MPV levels and obesity changes MPV levels.

Theoretical Cognitive Principles Observed in the Social Studies Classroom

ERIC Educational Resources Information Center

Walker, Juan; Langan, Elise; Kemp, Andrew; Pagnotti, John; Russell, William

2016-01-01

Pre-service elementary social studies teachers in the south eastern United States participated in a mixed methods study to determine the degree to which they utilized critical thinking skills. Insight Assessments administered analysis of their reflections, critical thinking skills, and dispositions test. The researchers developed a post survey for…

Fostering Critical Thinking in the Classroom

ERIC Educational Resources Information Center

Sahamid, Husniah

2014-01-01

The ability to cite reasons, to justify claims and give support to arguments is seen as primary characteristics of a critical thinker. This paper discusses how the "Elements of Reasoning" is employed with Socratic Questioning to develop critical thinking in the language classroom. The principles that guide the questioning are laid out…

Think Exit at Entry

ERIC Educational Resources Information Center

O'Rourke, Tom; Satterfield, Coy E.

2005-01-01

This paper describes the "Think Exit at Entry" program that has become the guiding principle for the Georgia Department of Juvenile Justice (DJJ). The Georgia DJJ believes that the transition process begins the day the youth enters the system and continues well after release from the institution. Literature points the need for transition…

The Curriculum Innovation Canvas: A Design Thinking Framework for the Engaged Educational Entrepreneur

ERIC Educational Resources Information Center

Willness, Chelsea; Bruni-Bossio, Vince

2017-01-01

Integrating literature on entrepreneurial business models and community-based experiential learning, we propose a new framework to advance the practice of curriculum innovation. Grounded in principles of design thinking, the curriculum innovation canvas provides a human-centered, collaborative, and holistic platform for instructors, curriculum…

Teachers' Perceptions of Examining Students' Thinking: Changing Mathematics Instructional Practice

ERIC Educational Resources Information Center

Anderson-Pence, Katie L.

2015-01-01

This paper seeks to illuminate teachers' perceptions of the challenges and benefits of systematically examining students' thinking as part of a professional development program in elementary mathematics education. Using a framework of models of conceptual change and principles of discomfort, three elementary teachers' perceptions of their…

SPELT (Strategies Program for Effective Learning/Thinking): A Description and Analysis of Instructional Procedures.

ERIC Educational Resources Information Center

Peat, D.; And Others

1989-01-01

Describes an instructional model, Strategies Program for Effective Learning/Thinking (SPELT), that was developed to translate cognitive psychological theory and research into a practical instructional program. The extent to which SPELT conforms to current instructional design principles is examined, and macro versus micro instructional sequencing…

2014 Summer Series - Harold (Sonny) White - Eaglework Laboratories: Advanced Propulsion

NASA Image and Video Library

2014-08-12

Human space exploration is currently still in Low Earth Orbit. Although this is much further in the future, we still can ask what would it eventually take for humans to explore the outer solar system? How hard is interstellar flight? We will open with a brief discussion on the types of things we have been thinking about for the next endeavor for human space exploration, and then lean forward and discuss a couple of advanced propulsion concepts that may one day be useful for helping us reach the stars.

Cognitive factors affecting student understanding of geologic time

NASA Astrophysics Data System (ADS)

Dodick, Jeff; Orion, Nir

2003-04-01

A critical element of the earth sciences is reconstructing geological structures and systems that have developed over time. A survey of the science education literature shows that there has been little attention given to this concept. In this study, we present a model, based on Montagnero's ([1996]) model of diachronic thinking, which describes how students reconstruct geological transformations over time. For geology, three schemes of diachronic thinking are relevant: 1. Transformation, which is a principle of change; in geology it is understood through actualistic thinking (the idea that present proceeses can be used to model the past). 2. Temporal organization, which defines the sequential order of a transformation; in geology it is based on the three-dimensional relationship among strata. 3. Interstage linkage, which is the connections between successive stages of a transformation; in geology it is based on both actualism and causal reasoning. Three specialized instruments were designed to determine the factors which influence reconstructive thinking: (a) the GeoTAT which tests diachronic thinking skills, (b) the TST which tests the relationship between spatial thinking and temporal thinking, and (c) the SFT which tests the influence of dimensional factors on temporal awareness. Based on the model constructed in this study we define the critical factors influencing reconstructive thinking: (a) the transformation scheme which influences the other diachronic schemes, (b) knowledge of geological processes, and (c) extracognitive factors. Among the students tested, there was a significant difference between Grade 9-12 students and Grade 7-8 students in their ability to reconstruct geological phenomena using diachronic thinking. This suggests that somewhere between Grades 7 and 8 it is possible to start teaching some of the logical principles used in geology to reconstruct geological structures.

The relative merits of lean, enriched, and empowered offices: an experimental examination of the impact of workspace management strategies on well-being and productivity.

PubMed

Knight, Craig; Haslam, S Alexander

2010-06-01

Principles of lean management encourage managers to exert tight control over office space and the people within it. Alternative, design-led approaches promote the value of offices that are enriched, particularly by plants and art. On the basis of a social identity perspective, we argue that both of these approaches may compromise organizational outcomes by disempowering workers and failing to give them input into the design of their office space. This hypothesis is tested in two experiments (ns = 112, 47). The first was conducted in an interior office in a psychology department, the second in a commercial city office. In 4 independent conditions we examine the impact of space management strategies in which the office is either (a) lean, (b) decorated by the experimenter (with plants and art), (c) self-decorated, or (d) self-decorated and then redecorated by the experimenter. We examine the impact of these conditions on organizational identification, well-being, and various forms of productivity (attention to detail, information processing, information management, and organizational citizenship). In both experiments, superior outcomes are observed when offices are decorated rather than lean. However, further improvements in well-being and productivity are observed when workers have input into office decoration. Moreover, these effects are attenuated if this input is overridden. Implications for theory and practice are discussed. In particular, findings point to the need to question assumptions about the merits of lean office space management that have been dominant throughout the last century. PsycINFO Database Record (c) 2010 APA, all rights reserved.

Lean techniques for the improvement of patients’ flow in emergency department

PubMed Central

Chan, HY; Lo, SM; Lee, LLY; Lo, WYL; Yu, WC; Wu, YF; Ho, ST; Yeung, RSD; Chan, JTS

2014-01-01

BACKGROUND: Emergency departments (EDs) face problems with overcrowding, access block, cost containment, and increasing demand from patients. In order to resolve these problems, there is rising interest to an approach called “lean” management. This study aims to (1) evaluate the current patient flow in ED, (2) to identify and eliminate the non-valued added process, and (3) to modify the existing process. METHODS: It was a quantitative, pre- and post-lean design study with a series of lean management work implemented to improve the admission and blood result waiting time. These included structured re-design process, priority admission triage (PAT) program, enhanced communication with medical department, and use of new high sensitivity troponin-T (hsTnT) blood test. Triage waiting time, consultation waiting time, blood result time, admission waiting time, total processing time and ED length of stay were compared. RESULTS: Among all the processes carried out in ED, the most time consuming processes were to wait for an admission bed (38.24 minutes; SD 66.35) and blood testing result (mean 52.73 minutes, SD 24.03). The triage waiting time and end waiting time for consultation were significantly decreased. The admission waiting time of emergency medical ward (EMW) was significantly decreased from 54.76 minutes to 24.45 minutes after implementation of PAT program (P<0.05). CONCLUSION: The application of lean management can improve the patient flow in ED. Acquiescence to the principle of lean is crucial to enhance high quality emergency care and patient satisfaction. PMID:25215143

The Participative Design of an Endoscopy Facility using Lean 3P

PubMed Central

Smith, Iain

2016-01-01

In the UK, bowel cancer is the second largest cancer killer. Diagnosing people earlier can save lives but demand for endoscopies is increasing and this can put pressure on waiting times. To address this challenge, an endoscopy unit in North East England decided to improve their facilities to increase capacity and create environments that improve the experience of users. This presented a significant opportunity for step change improvement but also a problem in terms of creating designs that meet user requirements whilst addressing structural or space constraints. The Lean design process known as ‘3P' (standing for the production preparation process) was utilised as a participative design strategy to engage stakeholders in the design of the new department. This involved a time-out workshop (or 3P event) in which Lean and participative design tools were utilised to create an innovative design based on ‘point of delivery' (POD) principles. The team created a design that demonstrated an increase in treatment room capacity by 25% and bed capacity by 70% whilst reducing travel distance for patients by 25.8% and staff by 27.1%. This was achieved with an increase in available space of only 13%. The Lean 3P method provided a structured approach for corporate and clinical staff to work together with patient representatives as cross-functional teams. This participative approach facilitated communication and learning between stakeholders about care processes and personal preferences. Lean 3P therefore appears to be a promising approach to improving the healthcare facilities design process to meet user requirements. PMID:27493744

The LEAN Payload Integration Process

NASA Technical Reports Server (NTRS)

Jordan, Lee P.; Young, Yancy; Rice, Amanda

2011-01-01

It is recognized that payload development and integration with the International Space Station (ISS) can be complex. This streamlined integration approach is a first step toward simplifying payload integration; making it easier to fly payloads on ISS, thereby increasing feasibility and interest for more research and commercial organizations to sponsor ISS payloads and take advantage of the ISS as a National Laboratory asset. The streamlined integration approach was addressed from the perspective of highly likely initial payload types to evolve from the National Lab Pathfinder program. Payloads to be accommodated by the Expedite the Processing of Experiments for Space Station (EXPRESS) Racks and Microgravity Sciences Glovebox (MSG) pressurized facilities have been addressed. It is hoped that the streamlined principles applied to these types of payloads will be analyzed and implemented in the future for other host facilities as well as unpressurized payloads to be accommodated by the EXPRESS Logistics Carrier (ELC). Further, a payload does not have to be classified as a National Lab payload in order to be processed according to the lean payload integration process; any payload that meets certain criteria can follow the lean payload integration process.

An improved tree height measurement technique tested on mature southern pines

Treesearch

Don C. Bragg

2008-01-01

Virtually all techniques for tree height determination follow one of two principles: similar triangles or the tangent method. Most people apply the latter approach, which uses the tangents of the angles to the top and bottom and a true horizontal distance to the subject tree. However, few adjust this method for ground slope, tree lean, crown shape, and crown...

An Agile Methodology for Implementing Service-Oriented Architecture in Small and Medium Sized Organizations

ERIC Educational Resources Information Center

Laidlaw, Gregory

2013-01-01

The purpose of this study is to evaluate the use of Lean/Agile principles, using action research to develop and deploy new technology for Small and Medium sized enterprises. The research case was conducted at the Lapeer County Sheriff's Department and involves the initial deployment of a Service Oriented Architecture to alleviate the data…

Sustainability as a Design Principle for Composition: Situational Creativity as a Habit of Mind

ERIC Educational Resources Information Center

Newcomb, Matthew

2012-01-01

Design is a rhetorical activity that requires creative thinking in response to difficult situations. That creative work ultimately builds new relationships and new contexts. Sustainable design can become an approach to composition that alters ways of thinking about writing situations, keeping ethical and contextual factors in focus, and…

The Construction of a Square through Multiple Approaches to Foster Learners' Mathematical Thinking

ERIC Educational Resources Information Center

Reyes-Rodriguez, Aaron; Santos-Trigo, Manuel; Barrera-Mora, Fernando

2017-01-01

The task of constructing a square is used to argue that looking for and pursuing several solution routes is a powerful principle to identify and analyse properties of mathematical objects, to understand problem statements and to engage in mathematical thinking activities. Developing mathematical understanding requires that students delve into…

Establishing an Atmosphere for Critical Thinking in the Online Classroom

ERIC Educational Resources Information Center

Steadman, Ronald G.

2015-01-01

Metacognition and critical thinking are crucial elements in the educational process. The following article examines the use of a quiz/poll classroom assessment technique (CAT) in a 100-level Christian worldview classroom (CWV-101) designed to stimulate student engagement with the course principles in a self-reflective and non-threating…

Taking Math Beyond Counting in Preschool: Thinking About the Same Object, Different State!

ERIC Educational Resources Information Center

Chafel, Judith A.; Olmsted, Judith

In order to help preschool children understand mathematical principles, five different learning activities designed to help them think about physical transformation or change are described. Introductory remarks focus on Piaget's concept of transformation and on various strategies teachers can use to help children consider changes in the state of…

Operation ARA: A Computerized Learning Game that Teaches Critical Thinking and Scientific Reasoning

ERIC Educational Resources Information Center

Halpern, Diane F.; Millis, Keith; Graesser, Arthur C.; Butler, Heather; Forsyth, Carol; Cai, Zhiqiang

2012-01-01

Operation ARA (Acquiring Research Acumen) is a computerized learning game that teaches critical thinking and scientific reasoning. It is a valuable learning tool that utilizes principles from the science of learning and serious computer games. Students learn the skills of scientific reasoning by engaging in interactive dialogs with avatars. They…

Systematic Design of a Learning Environment for Domain-Specific and Domain-General Critical Thinking Skills

ERIC Educational Resources Information Center

Tiruneh, Dawit Tibebu; Weldeslassie, Ataklti G.; Kassa, Abrham; Tefera, Zinaye; De Cock, Mieke; Elen, Jan

2016-01-01

Identifying effective instructional approaches that stimulate students' critical thinking (CT) has been the focus of a large body of empirical research. However, there is little agreement on the instructional principles and procedures that are theoretically sound and empirically valid to developing both domain-specific and domain-general CT…

Organizing for the Future Requires the Non-Aristotelian Lens of a Dragonfly.

ERIC Educational Resources Information Center

Collins, Marla Del

To organize for the future requires non-Aristotelian thinking...a multifaceted wide-angle lens revealing hidden information. A multifaceted lens includes at least three general systems of evaluation, all of which promote complex thinking. The three systems are general semantics, postmodern feminist philosophy, and the unifying principle of…

Who Done It? Connecting Murder Mysteries to the Communication Classroom

ERIC Educational Resources Information Center

Macchi, Stacey; Ridle, Cynthia

2012-01-01

It is important for students to understand various communication principles and be able to apply them in a variety of settings using critical thinking skills. Students must learn how to think critically, which includes the ability to apply, connect, analyze, and evaluate information. Teachers, instructors, and professors who are able to integrate…

Visual Literacy and Visual Thinking.

ERIC Educational Resources Information Center

Hortin, John A.

It is proposed that visual literacy be defined as the ability to understand (read) and use (write) images and to think and learn in terms of images. This definition includes three basic principles: (1) visuals are a language and thus analogous to verbal language; (2) a visually literate person should be able to understand (read) images and use…

Teaching Moral Education: Principles of Instruction.

ERIC Educational Resources Information Center

Doris, Dennis A.

1978-01-01

A nonindoctrinating, sound theoretical and practical base upon which to develop the teaching of moral education relies on several principles: discussion of moral conflict situations; knowledge of the student's stage of moral development; guidance of developmental matches; encouragement of role taking; and focus on rational thinking. (JMF)

Education within Sustainable Development: Critical Thinking Formation on ESL Class

NASA Astrophysics Data System (ADS)

Pevneva, Inna; Gavrishina, Olga; Smirnova, Anna; Rozhneva, Elena; Yakimova, Nataliya

2017-11-01

The article is devoted to consideration of the critical thinking formation in course of foreign language teaching within the education for sustainable development as a crucial skill of perspective employee and a future leader of Russian employment market. The necessity to include the component of problem education and critical thinking methodology in course of the foreign language class is justified along with analysis of the basic principles of critical thinking and certain strategies that can be implied in class. This model targets communicative language competences of students as well as critical thinking due to interconnection of various types of cognitive activities in class. The role in personality development of the students is considered along with the formation and enhancing of critical thinking skills within the modern personality-oriented approach.

FIST at 5: Looking Back, Looking Ahead

DTIC Science & Technology

2011-05-01

Innovative Problem Solving ( TRIZ ) is a master’s class in design, with a strong em- phasis on simplicity and speed. Altshuller’s TRIZ contradiction matrix...and 40 principles are powerful, elegant, and efficient. They should be required reading across the acquisition com- munity (learn more at triz ...shortcuts. As with any tool, expertise comes from practice. Truly mastering Agile, Lean, TRIZ , or MOSA requires concentrated study, experimentation, and

Thinking on the Margin: A Classroom Experiment

ERIC Educational Resources Information Center

Bangs, Joann

2009-01-01

One of the most important concepts being taught in principles classes is the idea of "thinking on the margin." It can also be one of the most difficult to get across. One of the most telling examples, according to this author, comes in trying to get students to learn the profit maximizing condition for perfectly competitive firms. She…

How Scientists Use Critical-Thinking Skills: Isolating Both Total RNA and Protein Using the Same Small Organ

ERIC Educational Resources Information Center

Porta, Angela R.; Dhawan, Puneet

2006-01-01

Undergraduate biology programs are currently undergoing reform to involve students in biomedical research. Engaging students in more active, hands-on experiments allows students to discover scientific principles for themselves, and to develop techniques of critical thinking and problem solving. This models the world of real scientific research,…

Development and Validation of Instruments to Measure Learning of Expert-Like Thinking

ERIC Educational Resources Information Center

Adams, Wendy K.; Wieman, Carl E.

2011-01-01

This paper describes the process for creating and validating an assessment test that measures the effectiveness of instruction by probing how well that instruction causes students in a class to think like experts about specific areas of science. The design principles and process are laid out and it is shown how these align with professional…

Documenting Critical Thinking in a Capstone Course: Moving Students toward a Professional Disposition

ERIC Educational Resources Information Center

Kiener, Michael; Ahuna, Kelly H.; Tinnesz, Christine Gray

2014-01-01

This study describes a university capstone course designed to increase student critical thinking skills and preparation for the workforce. Principles of action research and qualitative methods were used to focus on how pedagogical choices of the instructor would influence student learning in these areas. Through extensive use of case studies,…

The Role of Visual Thinking in Writing the News Story

ERIC Educational Resources Information Center

Choo, Suzanne

2010-01-01

In this article, the author begins with a proposition asking what if visual thinking were privileged in the English classroom and then proceeds to elaborate on a curriculum grounded on three principles: (1) sense and perception as starting points; (2) meta-conceptual links between visual and verbal texts; and (3) the art of visualization in…

Who Is the Real Owner? Or How a Simple Pepsi-Cola Story Can Help Students Build Critical Thinking Skills

ERIC Educational Resources Information Center

Galetcaia, Tatiana; Thiessen, Loreena

2010-01-01

Besides language competence, international students must develop a systematic approach to processing information and follow up with co-construction of the knowledge acquired. Critical thinking is a crucial principle commonly required in North American universities for evaluating academic texts. This practice may present certain difficulties for…

Understanding the Equals Sign as a Gateway to Algebraic Thinking

ERIC Educational Resources Information Center

Matthews, Percival G.; Rittle-Johnson, Bethany; Taylor, Roger S.; McEldoon, Katherine L.

2010-01-01

In this study, the authors wanted to examine whether success on items testing basic equivalence knowledge, such as the meaning of the equal sign and ability to solve problems such as 3 + 5 = 4 + _, predicted success on items testing more advanced algebraic thinking (i.e. principles of equality and solving equations that use letter variables). This…

Linking Past to Present to Create an Image of the Child

ERIC Educational Resources Information Center

Hughes, Eileen

2007-01-01

Principles of the Reggio Emilia approach are a catalyst for thinking about practices in early childhood education. Teachers in the child care system of Reggio Emilia encourage us to think about our image of childhood and the ways we interact with children, plan curriculum, and design environments. This article examines experiences in a rural…

Using Lean to Rapidly and Sustainably Transform a Behavioral Health Crisis Program: Impact on Throughput and Safety.

PubMed

Balfour, Margaret E; Tanner, Kathleen; Jurica, Paul J; Llewellyn, Dawn; Williamson, Robert G; Carson, Chris A

2017-06-01

Lean has been increasingly applied in health care to reduce waste and improve quality, particularly in fast-paced and high-acuity clinical settings such as emergency departments. In addition, Lean's focus on engagement of frontline staff in problem solving can be a catalyst for organizational change. In this study, ConnectionsAZ demonstrates how they applied Lean principles to rapidly and sustainably transform clinical operations in a behavioral health crisis facility. A multidisciplinary team of management and frontline staff defined values-based outcome measures, mapped the current and ideal processes, and developed new processes to achieve the ideal. Phase I was implemented within three months of assuming management of the facility and involved a redesign of flow, space utilization, and clinical protocols. Phase II was implemented three months later and improved the provider staffing model. Organizational changes such as the development of shift leads and daily huddles were implemented to sustain change and create an environment supportive of future improvements. Post-Phase I, there were significant decreases (pre vs. post and one-year post) in median door-to-door dwell time (343 min vs. 118 and 99), calls to security for behavioral emergencies (13.5 per month vs. 4.3 and 4.8), and staff injuries (3.3 per month vs. 1.2 and 1.2). Post-Phase II, there were decreases in median door-to-doctor time (8.2 hours vs. 1.6 and 1.4) and hours on diversion (90% vs. 17% and 34%). Lean methods can positively affect safety and throughput and are complementary to patient-centered clinical goals in a behavioral health setting. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

Critical thinking in health professions education: summary and consensus statements of the Millennium Conference 2011.

PubMed

Huang, Grace C; Newman, Lori R; Schwartzstein, Richard M

2014-01-01

Critical thinking is central to the function of health care professionals. However, this topic is not explicitly taught or assessed within current programs, yet the need is greater than ever, in an era of information explosion, spiraling health care costs, and increased understanding about metacognition. To address the importance of teaching critical thinking in health professions education, the Shapiro Institute for Education and Research and the Josiah Macy Jr. Foundation jointly sponsored the Millennium Conference 2011 on Critical Thinking. Teams of physician and nurse educators were selected through an application process. Attendees proposed strategies for integrating principles of critical thinking more explicitly into health professions curricula. Working in interprofessional, multi-institutional groups, participants tackled questions about teaching, assessment, and faculty development. Deliberations were summarized into consensus statements. Educational leaders participated in a structured dialogue about the enhancement of critical thinking in health professions education and recommend strategies to teach critical thinking.

Notes on TQM (Total Quality Management) and Education

ERIC Educational Resources Information Center

Daniel, Carter A.

2005-01-01

Application of Deming's TQM principles to education is long overdue. Principles that have proven their worth in businesses for decades could revolutionize our thinking about education. But they require a total commitment, from the highest to the lowest level. Deming's 14 points, and Gray Rinehart's suggestions, are presented, discussed, and…

Politeness Principle in Cross-Culture Communication

ERIC Educational Resources Information Center

Huang, Yongliang

2008-01-01

As we all know, different people hold different views about politeness. To be polite, Leech thinks you should follow "Politeness Principle" while Levinson suggests paying attention to others' "Face Wants". Sometimes what the Chinese people considered to be polite may not be true according to western culture. In order to…

Music Learning: Greater than the Sum of Its Parts.

ERIC Educational Resources Information Center

Zentz, Donald M.

1992-01-01

Discusses that Gestalt principles are especially well suited to teaching music. Identifies the laws of proximity, similarity, common direction, and simplicity in the notation system. Suggests that music teachers use these principles by following a logical progression to teach students to improve musical skills, solve problems, and think in…

Think Big, Bigger ... and Smaller

ERIC Educational Resources Information Center

Nisbett, Richard E.

2010-01-01

One important principle of social psychology, writes Nisbett, is that some big-seeming interventions have little or no effect. This article discusses a number of cases from the field of education that confirm this principle. For example, Head Start seems like a big intervention, but research has indicated that its effects on academic achievement…

NCTM Principles and Standards for Mathematically Talented Students

ERIC Educational Resources Information Center

Deal, Linda J.; Wismer, Michael G.

2010-01-01

The "Principles and Standards for School Mathematics" published in 2000 by the National Council of Teachers of Mathematics (NCTM) created a vision of mathematical concepts and processes to establish core educational guidelines for instruction from grades K to 12. The overall plan does emphasize higher level thinking, problem solving, and…

Math Activities that Encourage Inductive Thinking

ERIC Educational Resources Information Center

Freeman, Christopher

2005-01-01

There are two kinds of logical reasoning: "inductive" and "deductive". Inductive reasoning proceeds from effect back to cause, from special case to general principle. Detectives use it, examining the clues and conjecturing the actions that caused them. On the other hand, deductive reasoning proceeds from cause to effect, from principle to…

Teaching Tree-Thinking to Undergraduate Biology Students.

PubMed

Meisel, Richard P

2010-07-27

Evolution is the unifying principle of all biology, and understanding how evolutionary relationships are represented is critical for a complete understanding of evolution. Phylogenetic trees are the most conventional tool for displaying evolutionary relationships, and "tree-thinking" has been coined as a term to describe the ability to conceptualize evolutionary relationships. Students often lack tree-thinking skills, and developing those skills should be a priority of biology curricula. Many common student misconceptions have been described, and a successful instructor needs a suite of tools for correcting those misconceptions. I review the literature on teaching tree-thinking to undergraduate students and suggest how this material can be presented within an inquiry-based framework.

Development and Evaluation of a Systems Thinking Education Strategy for Baccalaureate Nursing Curriculum: A Pilot Study.

PubMed

Fura, Louise A; Wisser, Kathleen Z

Nurse educators are charged to develop and evaluate curricula on systems thinking to prepare future nurses to provide safe nursing care. The goal of this pilot study was to design and evaluate a four-hour educational strategy that prepares future professional nurses to use systems thinking approaches in the delivery of safe patient care. This study exposed prelicensure baccalaureate nursing students to systems thinking principles, which included didactic and experiential activities. A descriptive design was used to determine the effect of an on-campus educational strategy. A paired samples t-test revealed statistical significance from pretest to posttest.

Systems thinking perspectives applied to healthcare transition for youth with disabilities: a paradigm shift for practice, policy and research.

PubMed

Hamdani, Y; Jetha, A; Norman, C

2011-11-01

Healthcare transition (HCT) for youth with disabilities is a complex phenomenon influenced by multiple interacting factors, including health, personal and environmental factors. Current research on the transition to adulthood for disabled youth has primarily focused on identifying these multilevel factors to guide the development of interventions to improve the HCT process. However, little is known about how this complex array of factors interacts and contributes to successful HCT. Systems thinking provides a theoretically informed perspective that accounts for complexity and can contribute to enhanced understanding of the interactions among HCT factors. The objective of this paper is to introduce general concepts of systems thinking as applied to HCT practice and research. Several systems thinking concepts and principles are introduced and a discussion of HCT as a complex system is provided. Systems dynamics methodology is described as one systems method for conceptualizing HCT. A preliminary systems dynamics model is presented to facilitate discourse on the application of systems thinking principles to HCT practice, policy and research. An understanding of the complex interactions and patterns of relationships in HCT can assist health policy makers and practitioners in determining key areas of intervention, the impact of these interventions on the system and the potential intended and unintended consequences of change. This paper provides initial examination of applying systems thinking to inform future research and practice on HCT. © 2011 Blackwell Publishing Ltd.

Integrating Safety and Mission Assurance in Design

NASA Technical Reports Server (NTRS)

Cianciola, Chris; Crane, Kenneth

2008-01-01

This presentation describes how the Ares Projects are learning from the successes and failures of previous launch systems in order to maximize safety and reliability while maintaining fiscal responsibility. The Ares Projects are integrating Safety and Mission Assurance into design activities and embracing independent assessments by Quality experts in thorough reviews of designs and processes. Incorporating Lean thinking into the design process, Ares is also streamlining existing processes and future manufacturing flows which will yield savings during production. Understanding the value of early involvement of Quality experts, the Ares Projects are leading launch vehicle development into the 21st century.

Drive for leanness, anorexia nervosa, and overactivity: the missing link.

PubMed

Arun, C P

2008-12-01

Anorexia nervosa (AN) is a psychiatric condition characterized by deliberate reduction of body weight. Some patients with AN exhibit overactivity that can worsen their state of malnutrition. Employing an evolutionary psychiatry line of inquiry, we propose that rigidity of thinking and overactivity are behavioral phenotypic changes in AN patients that are normal to tree-dwelling mammals, such as monkeys. Such behavior can lead to good functioning as ballet dancers and athletes but lead to certain disadvantages in other areas of modern life. The overactivity in AN, though under conscious control may be neurobehavioral and driven subconsciously by disordered cerebral neuropsychopharmacology.

Twenty-First Century Creativity: An Investigation of How the Partnership for 21st Century Instructional Framework Reflects the Principles of Creativity

ERIC Educational Resources Information Center

Guo, Jiajun; Woulfin, Sarah

2016-01-01

The purpose of this study is to consider how the 21st-century learning framework reflects principles of creativity. This article provides a qualitative analysis of the Partnership for 21st Century's (P21) policy documents, with a specific focus on how the principles of creativity, one of the 4Cs (creativity, critical thinking, collaboration, and…

How to Increase Value in the Footwear Supply Chain

NASA Astrophysics Data System (ADS)

Fornasiero, Rosanna; Tescaro, Mauro; Scarso, Enrico; Gottardi, Giorgio

The Lean approach has been implemented in many different sectors as a methodology to improve industrial performance at company level. In the latest years this approach has been further developed in literature and in practice to integrate the principles of agility, adaptability and the mass customization paradigm where product and services have to be designed together to meet specific requirements, and where value originated by the supply chain enhance the value of single company thanks to the use of ICT and remote control. In this paper we analyze the Beyond-Lean paradigm and propose a path for companies in the footwear sector to improve their performance based on high-value-added products and processes. A detailed process analysis based on Value Stream Mapping is used to define criticalities and suggest improvements paths both at technological and organizational level.

Evaluation of Mean Platelet Volume values in lean women with polycystic ovary syndrome

PubMed Central

Silfeler, Dilek Benk; Kurt, Raziye Keskin; Yengil, Erhan; Un, Burak; Arica, Secil; Baloglu, Ali

2014-01-01

Objective: Mean Platelet Volume (MPV) is an important indicator of platelet activation. It is known that MPV increases in patients with coronory artery disease, diabetes mellitus, atherosclerosis and Polycystic ovary syndrome (PCOS). Our aim was to measure the MPV in lean patients with polycystic ovary syndrome. Methods: The present study was designed to examine the platelet function by measuring MPV in non-obese women with PCOS. A total of 50 outpatients with PCOS were included. The control group consisted of 50 healthy subjects. Serum platelet, MPV, and white blood cell (WBC) levels were compared and evaluated retrospectively in all participants. These values were compared by statistical analysis. Results: There were no statistically significant difference in between groups regarding MPV (p═0.357), WBC (p═0,414) and platelet (p═0,666). Conclusion: There are studies implying MPV increase in PCOS patients, in our patients MPV levels did not correlate with PCOS except for patients with obesity. We think that PCOS itself has no effect on MPV levels and obesity changes MPV levels. PMID:24948985

Lean Six Sigma in health care and the challenge of implementation of Six Sigma methodologies at a Veterans Affairs Medical Center.

PubMed

Pocha, Christine

2010-01-01

Six Sigma and Lean Thinking are quality initiatives initially deployed in industry to improve operational efficiency leading to better quality and subsequent cost savings. The financial rationale for embarking on this quality journey is clear; applying it to today's health care remains challenging. The cost of medical care is increasing at an alarming rate; most of these cost increases are attributed to an aging population and technological advances; therefore, largely beyond control. Furthermore, health care cost increases are caused by unnecessary operational inefficiency associated with the direct medical service delivery process. This article describes the challenging journey of implementing Six Sigma methodology at a tertiary care medical center. Many lessons were learned; however, of utmost importance were team approach, "buy in" of the stakeholders, and the willingness of team members to change daily practice and to adapt new and innovative ways how health care can be delivered. Six Sigma incorporated as part of the "company's or hospital's culture" would be most desirable but the learning curve will be steep.

Developing a lean culture in the laboratory.

PubMed

Napoles, Leyda; Quintana, Maria

2006-07-25

The Director of Pathology at Jackson Memorial Hospital was interested in improving the operational efficiencies of the department in order to enhance the department's level of service in conjunction with the expansion of the overall health system. The decision was made to implement proven Lean practices in the laboratory under the direction of a major consulting firm. This article details the scope of the initial project as well as the operating principles of Lean manufacturing practices as applied to the clinical laboratory. The goals of the project were to improve turnaround times of laboratory results, reduce inventory and supply costs, improve staff productivity, maximize workflow, and eliminate waste. Extensive data gathering and analysis guided the work process by highlighting the areas of highest opportunity. This systematic approach resulted in recommendations for the workflow and physical layout of the laboratory. It also included the introduction of "standard workflow" and "visual controls" as critical items that streamlined operational efficiencies. The authors provide actual photographs and schematics of the reorganization and improvements to the physical layout of the laboratory. In conclusion, this project resulted in decreased turnaround times and increased productivity, as well as significant savings in the overall laboratory operations.

Platonic Dialogue, Maieutic Method and Critical Thinking

ERIC Educational Resources Information Center

Leigh, Fiona

2007-01-01

In this paper I offer a reading of one of Plato's later works, the "Sophist", that reveals it to be informed by principles comparable on the face of it with those that have emerged recently in the field of critical thinking. As a development of the famous Socratic method of his teacher, I argue, Plato deployed his own pedagogical method, a…

Southeast Asia Report

DTIC Science & Technology

1987-01-12

bourgeoisie and strictly punish the speculators and black marketers, while using appropriate policies and measures to develop the positive aspects and...allowed to produce and distribute the goods themselves. The commercial bourgeoisie must be eliminated. However, small and medium-sized traders who have...production forces urgently demand new economic thinking. To renovate the party’s economic thinking is to apply the basic principle of Marxism - Leninism

Integration of a Zebrafish Research Project into a Molecular Biology Course to Support Critical Thinking and Course Content Goals

ERIC Educational Resources Information Center

Felzien, Lisa K.

2016-01-01

Engaging undergraduates in research is essential for teaching them to think like scientists, and it has become a desired component of classroom and laboratory instruction. Research projects that span an entire semester expose students to a variety of concepts and techniques and allow students to use experiments to learn scientific principles,…

Developing Students' Creative Self-Efficacy Based on Design-Thinking: Evaluation of an Elective University Course

ERIC Educational Resources Information Center

Ohly, Sandra; Plückthun, Laura; Kissel, Dorothea

2017-01-01

The development of novel and useful ideas is a process that can be described in multiple steps, including information gathering, generating ideas and evaluating ideas. We evaluated a university course that was developed based on design thinking principles which employ similar steps. Our results show that the course was not effective in enhancing…

Engaged Partners: The Achieving the Dream Partnership. Principles for Effective Education Grantmaking. Case Study Number 6

ERIC Educational Resources Information Center

Clayton, Tonika Cheek

2008-01-01

Confronting two unhealthy approaches that surface frequently in philanthropy--the tendency for grantmakers to think they alone have all the answers and the tensions that arise when national and local funders try to work together--this case study is intended to help grantmakers think more deeply about the concept of "engaged partners," one of…

"Leaning" the process of venous thromboembolism prophylaxis.

PubMed

Biffl, Walter L; Beno, Matthew; Goodman, Philip; Bahia, Amit; Sabel, Allison; Snow, Karen; Steele, Andrew W; Swartwood, Claire; Thienelt, Christiane; MacKenzie, Thomas D; Mehler, Philip S

2011-03-01

Lean principles have been used at Denver Health Medical Center since 2005 to streamline nonclinical processes. Despite allocation of significant resources, particularly the expense of low molecular weight heparin (LMWH), to prophylaxis of venous thromboembolism (VTE), the incidence of postoperative VTE was significantly worse than national benchmarks. VTE risk factors were not consistently assessed, and the prescribing of prophylaxis varied widely. Lean was employed to standardize and implement risk assessment and evidence-based VTE prophylaxis for the institution. In a rapid improvement event, a multidisciplinary group formulated an evidence-based risk assessment tool and clinical practice guideline for VTE prophylaxis, with plans for hospitalwide implementation and monitoring. The effects were immediate and improved steadily with feedback to clinicians. Within six months, compliance with the standard approached 100%. One year after implementation, the use of LMWH decreased more than 60% below baseline, and the use of sequential compression devices decreased by nearly 30%. With increased use of unfractionated heparin, the cost savings on VTE prophylaxis exceeded $15,000 per month, for a total of $425,000 since implementation. Moreover, the incidence of VTE decreased markedly during the same period. By reducing VTE rates, a total cost savings of $6.2 million was estimated for the past 28 months. Applying Lean to the clinical management of VTE prophylaxis improved compliance with standards and saved the hospital a significant amount of money. This was achieved without compromising clinical outcomes. This experience could be replicated at other institutions.

Assurance of Myeloid Growth Factor Administration in an Infusion Center: Pilot Quality Improvement Initiative.

PubMed

Ramirez, Pamela Maree; Peterson, Barry; Holtshopple, Christine; Borja, Kristina; Torres, Vincent; Valdivia-Peppers, Lucille; Harriague, Julio; Joe, Melanie D

2017-12-01

Four incident reports involving missed doses of myeloid growth factors (MGFs) triggered the need for an outcome-driven initiative. From March 1, 2015, to February 29, 2016, at University of California Irvine Health Chao Infusion Center, 116 of 3,300 MGF doses were missed (3.52%), including pegfilgrastim, filgrastim, and sargramostim. We hypothesized that with the application of Lean Six Sigma methodology, we would achieve our primary objective of reducing the number of missed MGF doses to < 0.5%. This quality improvement initiative was conducted at Chao Infusion Center as part of a Lean Six Sigma Green Belt Certification Program. Therefore, Lean Six Sigma principles and tools were used throughout each phase of the project. Retrospective and prospective medical record reviews and data analyses were performed to evaluate the extent of the identified problem and impact of the process changes. Improvements included systems applications, practice changes, process modifications, and safety-net procedures. Preintervention, 24 missed doses (20.7%) required patient supportive care measures, resulting in increased hospital costs and decreased quality of care. Postintervention, from June 8, 2016, to August 7, 2016, zero of 489 MGF doses were missed after 2 months of intervention ( P < .001). Chao Infusion Center reduced missed doses from 3.52% to 0%, reaching the goal of < 0.5%. The establishment of simplified and standardized processes with safety checks for error prevention increased quality of care. Lean Six Sigma methodology can be applied by other institutions to produce positive outcomes and implement similar practice changes.

Opinions of Social Workers in Turkey About the Principles on Die with Dignity.

PubMed

Duyan, Veli; Serpen, Ayşe Sezen; Duyan, Gülsüm; Yavuz, Sutay

2016-12-01

The conditions how people will spend their very last moments are an increasingly debated topic in Turkey. This study is planned to learn the opinions of Social Workers in Turkey on "Principles of a good death." The results of this study reveal that social workers in Turkey agree with principles of a good death in general. The degree of support for some specific principles changes by the sex and age of the participants. Despite the significant support given to principles by social workers, majority of them do not think that these principles are currently followed in medical and care institutions in Turkey.

PROFIT-MAXIMIZING PRINCIPLES, INSTRUCTIONAL UNITS FOR VOCATIONAL AGRICULTURE.

ERIC Educational Resources Information Center

BARKER, RICHARD L.

THE PURPOSE OF THIS GUIDE IS TO ASSIST VOCATIONAL AGRICULTURE TEACHERS IN STIMULATING JUNIOR AND SENIOR HIGH SCHOOL STUDENT THINKING, UNDERSTANDING, AND DECISION MAKING AS ASSOCIATED WITH PROFIT-MAXIMIZING PRINCIPLES OF FARM OPERATION FOR USE IN FARM MANAGEMENT. IT WAS DEVELOPED UNDER A U.S. OFFICE OF EDUCATION GRANT BY TEACHER-EDUCATORS, A FARM…

Motivating Students to Read in the Content Classroom: Six Evidence-Based Principles

ERIC Educational Resources Information Center

Brozo, William G.; Flynt, E. Sutton

2008-01-01

Teachers who plan content area instruction with evidence-based principles of reading engagement in mind will seek ways of making learning interesting and worthwhile; will create learning contexts that maximize participation in reading, writing, and thinking; and will always account for motivation and engagement when considering students' classroom…

10 Principles for Building a High-Quality System of Assessments

ERIC Educational Resources Information Center

Jobs for the Future, 2018

2018-01-01

Many states and districts are working toward developing and implementing high-quality systems that align assessments with each other, and to college and career readiness, and a comprehensive set of higher-order thinking skills. In order to support states, districts, and communities in this, the following 10 principles as guidance and common…

When the Medium Illustrates the Content: Exploiting the Unique Features of Online Communication

ERIC Educational Resources Information Center

Foertsch, Julie; Gernsbacher, Morton Ann

2008-01-01

Julie Foertsch and Morton Ann Gernsbacher present the results of an evaluation of an online undergraduate course in psychology that adheres to the seven widely accepted principles of effective online teaching and suggests an eighth principle: using the unique benefits and constraints of online communication to prompt critical thinking about…

A Sketch of Politically Liberal Principles of Social Justice in Higher Education

ERIC Educational Resources Information Center

Bull, Barry L.

2012-01-01

In light of the importance and the potential danger of education during childhood for politically liberal societies, the author has devoted much of his professional career to thinking about and formulating the moral principles that should govern such a society's educational institutions. However, this task cannot be accomplished for all such…

From the Performance Principle to the Developmental Principle: Every Kid a Winner?

ERIC Educational Resources Information Center

Ingham, Alan G.; Chase, Melissa A.; Butt, Joanne

2002-01-01

Addresses the hegemony of the Prolympic system, especially its effects on children, asserting that it abrogates the liberal democratic promise that all people are entitled to develop their talents to the fullest extent and making suggestions to combine sport psychology and sociology when thinking about a sport pedagogy system oriented to…

Using Mental Map Principles to Interpret American Indian Cartography

ERIC Educational Resources Information Center

Mitchell, Martin D.

2014-01-01

The understanding of maps drawn or significantly influenced by American Indians fosters critical thinking, cultural diversity, and awareness of a much-neglected topic in cartography. Line styles, scale depiction, and the sizing of individual entities are discussed in the context of applying principles from mental maps to American Indian maps and…

Time-Frequency Representations for Speech Signals.

DTIC Science & Technology

1987-06-01

and subsequent processing can take these weights into account . This is, in principle , safer, but pratically it is much harder to think about processing...and frequency along the other. But how should this idea be made precise (the well-known uncertainty principle of fourier analysis is one of the thorny...produce similar results. q2.3. Non-stationarity 19 it is the unique shape that meets the uncertainty principle with equality. 2.2. The quasi-stationary

The effects of critical thinking instruction on training complex decision making.

PubMed

Helsdingen, Anne S; van den Bosch, Karel; van Gog, Tamara; van Merriënboer, Jeroen J G

2010-08-01

Two field studies assessed the effects of critical thinking instruction on training and transfer of a complex decision-making skill. Critical thinking instruction is based on studies of how experienced decision makers approach complex problems. Participants conducted scenario-based exercises in both simplified (Study I) and high-fidelity (Study 2) training environments. In both studies, half of the participants received instruction in critical thinking. The other half conducted the same exercises but without critical thinking instruction. After the training, test scenarios were administered to both groups. The first study showed that critical thinking instruction enhanced decision outcomes during both training and the test. In the second study, critical thinking instruction benefited both decision outcomes and processes, specifically on the transfer to untrained problems. The results suggest that critical thinking instruction improves decision strategy and enhances understanding of the general principles of the domain. The results of this study warrant the implementation of critical thinking instruction in training programs for professional decision makers that have to operate in complex and highly interactive, dynamic environments.

"Wood already touched by fire is not hard to set alight": Comment on "Constraints to applying systems thinking concepts in health systems: A regional perspective from surveying stakeholders in Eastern Mediterranean countries".

PubMed

Agyepong, Irene Akua

2015-03-01

A major constraint to the application of any form of knowledge and principles is the awareness, understanding and acceptance of the knowledge and principles. Systems Thinking (ST) is a way of understanding and thinking about the nature of health systems and how to make and implement decisions within health systems to maximize desired and minimize undesired effects. A major constraint to applying ST within health systems in Low- and Middle-Income Countries (LMICs) would appear to be an awareness and understanding of ST and how to apply it. This is a fundamental constraint and in the increasing desire to enable the application of ST concepts in health systems in LMIC and understand and evaluate the effects; an essential first step is going to be enabling of a wide spread as well as deeper understanding of ST and how to apply this understanding.

Uncertainty and the difficulty of thinking through disjunctions.

PubMed

Shafir, E

1994-01-01

This paper considers the relationship between decision under uncertainty and thinking through disjunctions. Decision situations that lead to violations of Savage's sure-thing principle are examined, and a variety of simple reasoning problems that often generate confusion and error are reviewed. The common difficulty is attributed to people's reluctance to think through disjunctions. Instead of hypothetically traveling through the branches of a decision tree, it is suggested, people suspend judgement and remain at the node. This interpretation is applied to instances of decision making, information search, deductive and inductive reasoning, probabilistic judgement, games, puzzles and paradoxes. Some implications of the reluctance to think through disjunctions, as well as potential corrective procedures, are discussed.

The Use of Operational Excellence Principles in a University Hospital.

PubMed

Edelman, Eric R; Hamaekers, Ankie E W; Buhre, Wolfgang F; van Merode, Godefridus G

2017-01-01

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+'s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential.

The Use of Operational Excellence Principles in a University Hospital

PubMed Central

Edelman, Eric R.; Hamaekers, Ankie E. W.; Buhre, Wolfgang F.; van Merode, Godefridus G.

2017-01-01

The introduction of Operational Excellence in the Maastricht University Medical Center (MUMC+) has been the first of its kind and scale for a university hospital. The policy makers of the MUMC+ have combined different elements from various other business, management, and healthcare philosophies and frameworks into a unique mix. This paper summarizes the journey of developing this system and its most important aspects. Special attention is paid to the role of the operating rooms and the improvements that have taken place there, because of their central role in the working of the hospital. The MUMC+ is the leading tertiary healthcare center for the South-East region of The Netherlands and beyond. Regional, national, and international developments encouraged the MUMC+ to start significantly reorganizing its care processes from 2009 onward. First experiments with Lean Six Sigma and Business Modeling were combined with lessons learned from other centers around the world to form the MUMC+’s own type of Operational Excellence. At the time of writing, many improvement projects of different types have been successfully completed. Every single department in the hospital now uses Operational Excellence and design thinking in general as a method to develop new models of care. An evaluation in 2014 revealed several opportunities for improvement. A large number of projects were in progress, but 75% of all projects had not been completed, despite the first projects being initiated back in 2012. This led to a number of policy changes, mainly focusing on more intensive monitoring of projects and trying to do more improvement projects directly under the responsibility of the line manager. Focusing on patient value, continuous improvement, and the reduction of waste have proven to be very fitting principles for healthcare in general and specifically for application in a university hospital. Approaching improvement at a systems level while directly involving the people on the work floor in observing opportunities for improvement and realizing these has shown itself to be essential. PMID:28752089

Raising a Thinking Child: Help Your Young Child To Resolve Everyday Conflicts and Get Along with Others. First Edition.

ERIC Educational Resources Information Center

Shure, Myrna B.; DiGeronimo, Theresa Foy

Based upon the principles of "I Can Problem Solve" (ICPS), this books offers parents dialogues, activities, and communication techniques to teach their children how to resolve day-to-day conflicts with friends, teachers, and family members. The book provides parents with tools to teach their children how to think about everyday problems and…

La Meme Chose: How Mathematics Can Explain the Thinking of Children and the Thinking of Children Can Illuminate Mathematical Philosophy

ERIC Educational Resources Information Center

Cable, John

2014-01-01

This article offers a new interpretation of Piaget's decanting experiments, employing the mathematical notion of equivalence instead of conservation. Some reference is made to Piaget's theories and to his educational legacy, but the focus in on certain of the experiments. The key to the new analysis is the abstraction principle, which…

A Mathematical Analysis of Semantic Maps, with Theoretical and Applied Implications for Blended Learning Software

ERIC Educational Resources Information Center

Tang, Michael; David, Hyerle; Byrne, Roxanne; Tran, John

2012-01-01

This paper is a mathematical (Boolean) analysis a set of cognitive maps called Thinking Maps[R], based on Albert Upton's semantic principles developed in his seminal works, Design for Thinking (1961) and Creative Analysis (1961). Albert Upton can be seen as a brilliant thinker who was before his time or after his time depending on the future of…

Bringing CASE in from the Cold: the Teaching and Learning of Thinking

NASA Astrophysics Data System (ADS)

Oliver, Mary; Venville, Grady

2017-02-01

Thinking Science is a 2-year program of professional development for teachers and thinking lessons for students in junior high school science classes. This paper presents research on the effects of Thinking Science on students' levels of cognition in Australia. The research is timely, with a general capability focused on critical thinking in the newly implemented F-10 curriculum in Australia. The design of the research was a quasi-experiment with pre- and post-intervention cognitive tests conducted with participating students ( n = 655) from nine cohorts in seven high schools. Findings showed significant cognitive gains compared with an age-matched control group over the length of the program. Noteworthy is a correlation between baseline cognitive score and school Index of Community Socio-Educational Advantage (ICSEA). We argue that the teaching of thinking be brought into the mainstream arena of educational discourse and that the principles from evidence-based programs such as Thinking Science be universally adopted.

The application of systems thinking in health: why use systems thinking?

PubMed

Peters, David H

2014-08-26

This paper explores the question of what systems thinking adds to the field of global health. Observing that elements of systems thinking are already common in public health research, the article discusses which of the large body of theories, methods, and tools associated with systems thinking are more useful. The paper reviews the origins of systems thinking, describing a range of the theories, methods, and tools. A common thread is the idea that the behavior of systems is governed by common principles that can be discovered and expressed. They each address problems of complexity, which is a frequent challenge in global health. The different methods and tools are suited to different types of inquiry and involve both qualitative and quantitative techniques. The paper concludes by emphasizing that explicit models used in systems thinking provide new opportunities to understand and continuously test and revise our understanding of the nature of things, including how to intervene to improve people's health.

[Alienation and adaptation in English translation of traditional Chinese medicinal literature].

PubMed

Liang, Jun-xiong; Wang, Guan-jun

2006-10-01

Alienation and adaptation are two of the principles and methods in translation, each possessing their own values. Alienation should be applied in translating linguistic content in order to transfer the imbedded cultural messages trustfully; while the principle of adaptation should be followed in linguistic structure translation due to the different thinking patterns between Chinese and English which results in a great linguistic structure difference. Therefore, the translator must express the original meaning trustfully, on the other hand, to make the Chinese version more smooth, linguistic structure should be transformed to conform to the thinking habit of the readers. In brief,alienation and adaptation should complement each other in translation to make it a bridge connecting the different cultures.

Maupertuis, Leibniz, Least Action and Design

NASA Astrophysics Data System (ADS)

Simmons, James K.

2006-12-01

In current controversies regarding Intelligent Design (ID), critics of ID often claim that naturalisitc science (i.e., science that attempts to explain natural phenomena in terms of strictly non-supernatural processes) has such a good track record that there is no need to introduce supernatural design hypotheses into our thinking. Since ID is not a new idea, we can search through the history of science and look also at ID's track record. In this talk, we focus on the ID thinking of Maupertuis and Leibniz when the former developed the Principle of Least Action and when both of them applied the principle to Snell's law of refraction. In this case, we find that ID did no harm and made no lasting contribution.

Thinking beyond the Books: Sociological Biases of Our Military Institutions

DTIC Science & Technology

2016-01-01

instance, when military professionals at- tempt to establish rules and “principles of warfare” cast within the interpretivist writings in The Art of...for technology , war theory, conflict, and human societies. In the situation that the US Air Force has used this work (and may have retired it from... writings and shares with them the radical structuralist paradigm. Summer 2016 | 29 Thinking beyond the Books Military Readings with Interpretivism

Agile, a guiding principle for health care improvement?

PubMed

Tolf, Sara; Nyström, Monica E; Tishelman, Carol; Brommels, Mats; Hansson, Johan

2015-01-01

The purpose of this paper is to contribute to increased understanding of the concept agile and its potential for hospital managers to optimize design of organizational structures and processes to combine internal efficiency and external effectiveness. An integrative review was conducted using the reSEARCH database. Articles met the following criteria: first, a definition of agility; second, descriptions of enablers of becoming an agile organization; and finally, discussions of agile on multiple organizational levels. In total, 60 articles qualified for the final analysis. Organizational agility rests on the assumption that the environment is uncertain, ranging from frequently changing to highly unpredictable. Proactive, reactive or embracive coping strategies were described as possible ways to handle such uncertain environments. Five organizational capacities were derived as necessary for hospitals to use the strategies optimally: transparent and transient inter-organizational links; market sensitivity and customer focus; management by support for self-organizing employees; organic structures that are elastic and responsive; flexible human and resource capacity for timely delivery. Agile is portrayed as either the "new paradigm" following lean, the needed development on top of a lean base, or as complementary to lean in distinct hybrid strategies. Environmental uncertainty needs to be matched with coping strategies and organizational capacities to design processes responsive to real needs of health care. This implies that lean and agile can be combined to optimize the design of hospitals, to meet different variations in demand and create good patient management. While considerable value has been paid to strategies to improve the internal efficiency within hospitals, this review raise the attention to the value of strategies of external effectiveness.

The Confluence of Perceiving and Thinking in Consciousness Phenomenology

PubMed Central

Wagemann, Johannes

2018-01-01

The processual relation of thinking and perceiving shall be examined from a historical perspective as well as on the basis of methodically conducted first-person observation. Historically, these two psychological aspects of human knowledge and corresponding philosophical positions have predominant alternating phases. At certain historical points, thinking and perceiving tend to converge, while in the interim phases they seem to diverge with an emphasis on one of them. While at the birth of modern science, for instance, these two forms of mental life were deeply interlinked, today they seem to be separated more than ever before – as a number of scientific crises have shown. Turning from the outer to the inner aspect of this issue, a phenomenological view becomes relevant. In terms of the consciousness phenomenology developed by Steiner (1861–1925) and Witzenmann’s (1905–1988) Structure Phenomenology, this article will show how a methodical integration of thinking and perceiving can be carried out on the basis of first-person observation. In the course of a skilled introspective or meditative self-observation the individual’s own mental micro-actions of separating and integrating come into view, jointly constituting what we usually call thinking and perceiving. Consequently, this approach includes a conceptual as well as a perceptual dimension the experimental confluence of which ties in with the methodological core principle of modern natural science. At the same time, making this principle explicit may open the way to a further development of human consciousness and its scientific delineation. PMID:29375432

Lean Six Sigma to Reduce Intensive Care Unit Length of Stay and Costs in Prolonged Mechanical Ventilation.

PubMed

Trzeciak, Stephen; Mercincavage, Michael; Angelini, Cory; Cogliano, William; Damuth, Emily; Roberts, Brian W; Zanotti, Sergio; Mazzarelli, Anthony J

Patients with prolonged mechanical ventilation (PMV) represent important "outliers" of hospital length of stay (LOS) and costs (∼$26 billion annually in the United States). We tested the hypothesis that a Lean Six Sigma (LSS) approach for process improvement could reduce hospital LOS and the associated costs of care for patients with PMV. Before-and-after cohort study. Multidisciplinary intensive care unit (ICU) in an academic medical center. Adult patients admitted to the ICU and treated with PMV, as defined by diagnosis-related group (DRG). We implemented a clinical redesign intervention based on LSS principles. We identified eight distinct processes in preparing patients with PMV for post-acute care. Our clinical redesign included reengineering daily patient care rounds ("Lean ICU rounds") to reduce variation and waste in these processes. We compared hospital LOS and direct cost per case in patients with PMV before (2013) and after (2014) our LSS intervention. Among 259 patients with PMV (131 preintervention; 128 postintervention), median hospital LOS decreased by 24% during the intervention period (29 vs. 22 days, p < .001). Accordingly, median hospital direct cost per case decreased by 27% ($66,335 vs. $48,370, p < .001). We found that a LSS-based clinical redesign reduced hospital LOS and the costs of care for patients with PMV.

Innovation leading the way: application of lean manufacturing to sample management.

PubMed

Allen, M; Wigglesworth, M J

2009-06-01

Historically, sample management successfully focused on providing compound quality and tracking distribution within a diverse geographic. However, if a competitive advantage is to be delivered in a changing environment of outsourcing, efficiency and customer service must now improve or face reconstruction. The authors have used discrete event simulation to model the compound process from chemistry to assay and applied lean manufacturing techniques to analyze and improve these processes. In doing so, they identified a value-adding process time of just 11 min within a procedure that took days. Modeling also allowed the analysis of equipment and human resources necessary to complete the expected demand in an acceptable cycle time. Layout and location of sample management and screening departments are key in allowing process integration, creating rapid flow of work, and delivering these efficiencies. Following this analysis and minor process changes, the authors have demonstrated for 2 programs that solid compounds can be converted to assay-ready plates in less than 4 h. In addition, it is now possible to deliver assay data from these compounds within the same working day, allowing chemistry teams more flexibility and more time to execute the next chemistry round. Additional application of lean manufacturing principles has the potential to further decrease cycle times while using fewer resources.

Using lean methodology to improve efficiency of electronic order set maintenance in the hospital.

PubMed

Idemoto, Lori; Williams, Barbara; Blackmore, Craig

2016-01-01

Order sets, a series of orders focused around a diagnosis, condition, or treatment, can reinforce best practice, help eliminate outdated practice, and provide clinical guidance. However, order sets require regular updates as evidence and care processes change. We undertook a quality improvement intervention applying lean methodology to create a systematic process for order set review and maintenance. Root cause analysis revealed challenges with unclear prioritization of requests, lack of coordination between teams, and lack of communication between producers and requestors of order sets. In March of 2014, we implemented a systematic, cyclical order set review process, with a set schedule, defined responsibilities for various stakeholders, formal meetings and communication between stakeholders, and transparency of the process. We first identified and deactivated 89 order sets which were infrequently used. Between March and August 2014, 142 order sets went through the new review process. Processing time for the build duration of order sets decreased from a mean of 79.6 to 43.2 days (p<.001, CI=22.1, 50.7). Applying Lean production principles to the order set review process resulted in significant improvement in processing time and increased quality of orders. As use of order sets and other forms of clinical decision support increase, regular evidence and process updates become more critical.

Sea Lions and Honors Students: More in Common than You May Think

ERIC Educational Resources Information Center

Lindemann-Biolsi, Kristy L.

2014-01-01

One can easily find a link between the general principles of learning in relation to both nonhuman and human animals. What may be a more difficult but equally important parallel is how these learning principles are applied to the training of animals and the teaching of honors students. The author considers what teachers can learn from observing…

How You Store Information Affects How You Can Retrieve It: A Fundamental Principle for Business Students Studying Information Systems and Technology

ERIC Educational Resources Information Center

Silver, Mark S.

2017-01-01

During the current period of rapid technological change, business students need to emerge from their introductory course in Information Systems (IS) with a set of fundamental principles to help them "think about Information Technology (IT)" in future courses and the workplace. Given the digital revolution, they also need to appreciate…

The integrate model of emotion, thinking and self regulation: an application to the "paradox of aging".

PubMed

Williams, Leanne M; Gatt, Justine M; Hatch, Ainslie; Palmer, Donna M; Nagy, Marie; Rennie, Christopher; Cooper, Nicholas J; Morris, Charlotte; Grieve, Stuart; Dobson-Stone, Carol; Schofield, Peter; Clark, C Richard; Gordon, Evian; Arns, Martijn; Paul, Robert H

2008-09-01

This study was undertaken using the INTEGRATE Model of brain organization, which is based on a temporal continuum of emotion, thinking and self regulation. In this model, the key organizing principle of self adaption is the motivation to minimize danger and maximize reward. This principle drives brain organization across a temporal continuum spanning milliseconds to seconds, minutes and hours. The INTEGRATE Model comprises three distinct processes across this continuum. Emotion is defined by automatic action tendencies triggered by signals that are significant due to their relevance to minimizing danger-maximizing reward (such as abrupt, high contrast stimuli). Thinking represents cognitive functions and feelings that rely on brain and body feedback emerging from around 200 ms post-stimulus onwards. Self regulation is the modulation of emotion, thinking and feeling over time, according to more abstract adaptions to minimize danger-maximize reward. Here, we examined the impact of dispositional factors, age and genetic variation, on this temporal continuum. Brain Resource methodology provided a standardized platform for acquiring genetic, brain and behavioral data in the same 1000 healthy subjects. Results showed a "paradox" of declining function in the "thinking" time scale over the lifespan (6 to 80+ years), but a corresponding preservation or even increase in automatic functions of "emotion" and "self regulation". This paradox was paralleled by a greater loss of grey matter in cortical association areas (assessed using MRI) over age, but a relative preservation of subcortical grey matter. Genetic polymorphisms associated with both healthy function and susceptibility to disorder (including the BDNFVal(66)Met, COMTVal(158/108)Met, MAOA and DRD4 tandem repeat and 5HTT-LPR polymorphisms) made specific contributions to emotion, thinking and self regulatory functions, which also varied according to age.

First-principles-based kinetic Monte Carlo simulation of nitric oxide decomposition over Pt and Rh surfaces under lean-burn conditions

NASA Astrophysics Data System (ADS)

Mei, Donghai; Ge, Qingfeng; Neurock, Matthew; Kieken, Laurent; Lerou, Jan

First-principles-based kinetic Monte Carlo simulation was used to track the elementary surface transformations involved in the catalytic decomposition of NO over Pt(100) and Rh(100) surfaces under lean-burn operating conditions. Density functional theory (DFT) calculations were carried out to establish the structure and energetics for all reactants, intermediates and products over Pt(100) and Rh(100). Lateral interactions which arise from neighbouring adsorbates were calculated by examining changes in the binding energies as a function of coverage and different coadsorbed configurations. These data were fitted to a bond order conservation (BOC) model which is subsequently used to establish the effects of coverage within the simulation. The intrinsic activation barriers for all the elementary reaction steps in the proposed mechanism of NO reduction over Pt(100) were calculated by using DFT. These values are corrected for coverage effects by using the parametrized BOC model internally within the simulation. This enables a site-explicit kinetic Monte Carlo simulation that can follow the kinetics of NO decomposition over Pt(100) and Rh(100) in the presence of excess oxygen. The simulations are used here to model various experimental protocols including temperature programmed desorption as well as batch catalytic kinetics. The simulation results for the temperature programmed desorption and decomposition of NO over Pt(100) and Rh(100) under vacuum condition were found to be in very good agreement with experimental results. NO decomposition is strongly tied to the temporal number of sites that remain vacant. Experimental results show that Pt is active in the catalytic reaction of NO into N2 and NO2 under lean-burn conditions. The simulated reaction orders for NO and O2 were found to be +0.9 and -0.4 at 723 K, respectively. The simulation also indicates that there is no activity over Rh(100) since the surface becomes poisoned by oxygen.

Distinguishing science from pseudoscience in school psychology: science and scientific thinking as safeguards against human error.

PubMed

Lilienfeld, Scott O; Ammirati, Rachel; David, Michal

2012-02-01

Like many domains of professional psychology, school psychology continues to struggle with the problem of distinguishing scientific from pseudoscientific and otherwise questionable clinical practices. We review evidence for the scientist-practitioner gap in school psychology and provide a user-friendly primer on science and scientific thinking for school psychologists. Specifically, we (a) outline basic principles of scientific thinking, (b) delineate widespread cognitive errors that can contribute to belief in pseudoscientific practices within school psychology and allied professions, (c) provide a list of 10 key warning signs of pseudoscience, illustrated by contemporary examples from school psychology and allied disciplines, and (d) offer 10 user-friendly prescriptions designed to encourage scientific thinking among school psychology practitioners and researchers. We argue that scientific thinking, although fallible, is ultimately school psychologists' best safeguard against a host of errors in thinking. Copyright © 2011 Society for the Study of School Psychology. Published by Elsevier Ltd. All rights reserved.

Argumentation: A Methodology to Facilitate Critical Thinking.

PubMed

Makhene, Agnes

2017-06-20

Caring is a difficult nursing activity that involves a complex nature of a human being in need of complex decision-making and problem solving through the critical thinking process. It is mandatory that critical thinking is facilitated in general and in nursing education particularly in order to render care in diverse multicultural patient care settings. This paper aims to describe how argumentation can be used to facilitate critical thinking in learners. A qualitative, exploratory and descriptive design that is contextual was used. Purposive sampling method was used to draw a sample and Miles and Huberman methodology of qualitative analysis was used to analyse data. Lincoln and Guba's strategies were employed to ensure trustworthiness, while Dhai and McQuoid-Mason's principles of ethical consideration were used. Following data analysis the findings were integrated within literature which culminated into the formulation of guidelines that can be followed when using argumentation as a methodology to facilitate critical thinking.

Experiment Clarifies Buoyancy

ERIC Educational Resources Information Center

Oguz, Ayse; Yurumezoglu, Kemal

2008-01-01

This article presents a simple activity using Archimedes' principle that helps students to develop their scientific thinking and also to identify and correct their misconceptions. The exercise consists of linear and reverse processes.

La Meme Chose: How Mathematics Can Explain the Thinking of Children and the Thinking of Children Can Illuminate Mathematical Philosophy

NASA Astrophysics Data System (ADS)

Cable, John

2014-01-01

This article offers a new interpretation of Piaget's decanting experiments, employing the mathematical notion of equivalence instead of conservation. Some reference is made to Piaget's theories and to his educational legacy, but the focus in on certain of the experiments. The key to the new analysis is the abstraction principle, which has been formally enunciated in mathematical philosophy but has universal application. It becomes necessary to identity fluid objects (both configured and unconfigured) and configured and unconfigured sets-of-objects. Issues emerge regarding the conflict between philosophic realism and anti-realism, including constructivism. Questions are asked concerning mathematics and mathematical philosophy, particularly over the nature of sets, the wisdom of the axiomatic method and aspects of the abstraction principle itself.

Elements of the cognitive universe

NASA Astrophysics Data System (ADS)

Topsøe, Flemming

2017-06-01

"The least biased inference, taking available information into account, is the one with maximum entropy". So we are taught by Jaynes. The many followers from a broad spectrum of the natural and social sciences point to the wisdom of this principle, the maximum entropy principle, MaxEnt. But "entropy" need not be tied only to classical entropy and thus to probabilistic thinking. In fact, the arguments found in Jaynes' writings and elsewhere can, as we shall attempt to demonstrate, profitably be revisited, elaborated and transformed to apply in a much more general abstract setting. The approach is based on game theoretical thinking. Philosophical considerations dealing with notions of cognition - basically truth and belief - lie behind. Quantitative elements are introduced via a concept of description effort. An interpretation of Tsallis Entropy is indicated.

Ares Project Overview - Quality in Design

NASA Technical Reports Server (NTRS)

Cianciola, Chris; Crane, Kenneth

2008-01-01

This presentation introduces the audience to the overall goals of the Ares Project, which include providing human access to low-Earth orbit, the Moon, and beyond. The presentation also provides an overview of with the vehicles that will execute those goals and progress made on the vehicles to date. The briefing will provide an introduction to Lean, Six Sigma, and Kaizen practices Ares will use to improve the overall effectiveness and quality of its efforts. Finally, the briefing includes a summary of Safety and Mission Assurance practices being implemented within[Ares to ensure safety and quality early in the design process. Integrating Safety and Mission Assurance in Design: This presentation describes how the Ares Projects are learning from the successes and failures of previous launch systems in order to maximize safety and reliability while maintaining fiscal responsibility. The Ares Projects are integrating Safer T and Mission Assurance into design activities and embracing independent assessments by Quality experts in thorough reviews of designs and processes. Incorporating Lean thinking into the design process, Ares is also streamlining existing processes and future manufacturing flows which will yield savings during production. Understanding the value of early involvement of Quality experts, the Ares Projects are leading launch vehicle development into the 21st century.

How power influences moral thinking.

PubMed

Lammers, Joris; Stapel, Diederik A

2009-08-01

The authors conducted 5 studies to test the idea that both thinking about and having power affects the way in which people resolve moral dilemmas. It is shown that high power increases the use of rule-based (deontological) moral thinking styles, whereas low power increases reliance on outcome-based (consequentialist) moral thinking. Stated differently, in determining whether an act is right or wrong, the powerful focus on whether rules and principles are violated, whereas the powerless focus on the consequences. For this reason, the powerful are also more inclined to stick to the rules, irrespective of whether this has positive or negative effects, whereas the powerless are more inclined to make exceptions. The first 3 experiments show that thinking about power increases rule-based thinking and decreases outcome-based thinking in participants' moral decision making. A 4th experiment shows the mediating role of moral orientation in the effect of power on moral decisions. The 5th experiment demonstrates the role of self-interest by showing that the power-moral link is reversed when rule-based decisions threaten participants' own self-interests.

Using root cause analysis to promote critical thinking in final year Bachelor of Midwifery students.

PubMed

Carter, Amanda G; Sidebotham, Mary; Creedy, Debra K; Fenwick, Jennifer; Gamble, Jenny

2014-06-01

Midwives require well developed critical thinking to practice autonomously. However, multiple factors impinge on students' deep learning in the clinical context. Analysis of actual case scenarios using root cause analysis may foster students' critical thinking and application of 'best practice' principles in complex clinical situations. To examine the effectiveness of an innovative teaching strategy involving root cause analysis to develop students' perceptions of their critical thinking abilities. A descriptive, mixed methods design was used. Final 3rd year undergraduate midwifery students (n=22) worked in teams to complete and present an assessment item based on root cause analysis. The cases were adapted from coroners' reports. After graduation, 17 (77%) students evaluated the course using a standard university assessment tool. In addition 12 (54%) students provided specific feedback on the teaching strategy using a 16-item survey tool based on the domain concepts of Educational Acceptability, Educational Impact, and Preparation for Practice. Survey responses were on a 5-point Likert scale and analysed using descriptive statistics. Open-ended responses were analysed using content analysis. The majority of students perceived the course and this teaching strategy positively. The domain mean scores were high for Educational Acceptability (mean=4.3, SD=.49) and Educational Impact (mean=4.19, SD=.75) but slightly lower for Preparation for Practice (mean=3.7, SD=.77). Overall student responses to each item were positive with no item mean less than 3.42. Students found the root cause analysis challenging and time consuming but reported development of critical thinking skills about the complexity of practice, clinical governance and risk management principles. Analysing complex real life clinical cases to determine a root cause enhanced midwifery students' perceptions of their critical thinking. Teaching and assessment strategies to promote critical thinking need to be made explicit to students in order to foster ongoing development. © 2013.

Conceptualizing strategic environmental assessment: Principles, approaches and research directions

DOE Office of Scientific and Technical Information (OSTI.GOV)

Noble, Bram, E-mail: b.noble@usask.ca; Nwanekezie, Kelechi

Increasing emphasis has been placed in recent years on transitioning strategic environmental assessment (SEA) away from its environmental impact assessment (EIA) roots. Scholars have argued the need to conceptualize SEA as a process designed to facilitate strategic thinking, thus enabling transitions toward sustainability. The practice of SEA, however, remains deeply rooted in the EIA tradition and scholars and practitioners often appear divided on the nature and purpose of SEA. This paper revisits the strategic principles of SEA and conceptualizes SEA as a multi-faceted and multi-dimensional assessment process. It is suggested that SEA can be conceptualized as series of approaches operatingmore » along a spectrum from less to more strategic – from impact assessment-based to strategy-based – with each approach to SEA differentiated by the specific objectives of SEA application and the extent to which strategic principles are reflected in its design and implementation. Advancing the effectiveness of SEA requires a continued research agenda focused on improving the traditional SEA approach, as a tool to assess the impacts of policies, plans and programs (PPPs). Realizing the full potential of SEA, however, requires a new research agenda — one focused on the development and testing of a deliberative governance approach to SEA that can facilitate strategic innovations in PPP formulation and drive transitions in short-term policy and initiatives based on longer-term thinking. - Highlights: • SEA facilitates strategic thinking, enabling transitions toward sustainability. • SEA is conceptualized as a spectrum of approaches, from IA-based to strategy-based. • Each approach variably emphasizes strategic principles in its design and practice. • There is no one conceptualization of SEA that is best, SEA is fit for PPP purpose. • Research is needed to advance SEA to facilitate strategic PPP transformations.« less

Tailoring and Critical Thinking - Key Principles for Acquisition Success

DTIC Science & Technology

2015-10-01

Defense AT&L: September–October 2015 6 Tailoring and Critical Thinking— Key Principles for Acquisition Success Mike Kotzian, D.M. n Michael Paul...well as program success . 7 Defense AT&L: September–October 2015 The Long Range Anti-Ship Missile Opportunity To ensure DARPA maintains its ability... successful flight demonstra- tions that initially proved the technical approach. Concurrent with these technical accomplishments came two important

2018 Cyber Enabled Emerging Technologies Symposium

DTIC Science & Technology

2018-03-08

Principles • Better data = better outcomes • Training > Programming • AI anxiety?... Think IA (Intelligent Assistant) • Ingest much more information • Make...Local Marketing 7 Usage: “Local” / Specific AI • Healthcare (oncology) • Data Mining/Discovery • Chat bots • Personnel • Finance • Sourcing...cognitive- principles / So, Our Priorities for AI Adoption and Ethics • Purpose: human augmentation versus replacement • Human decision-making • Human

Language in Thinking and Learning: Pedagogy and the New Whorfian Framework.

ERIC Educational Resources Information Center

Lee, Penny

1997-01-01

Reviews 12 elements of Whorf's theory complex, particularly the linguistic relativity principle. Shows how the theory illuminates language-mind-experience relationships with applicability to classroom practices. (SK)

Lean and Green Hand Surgery.

PubMed

Van Demark, Robert E; Smith, Vanessa J S; Fiegen, Anthony

2018-02-01

Health care in the United States is both expensive and wasteful. The cost of health care in the United States continues to increase every year. Health care spending for 2016 is estimated at $3.35 trillion. Per capita spending ($10,345 per person) is more than twice the average of other developed countries. The United States also leads the world in solid waste production (624,700 metric tons of waste in 2011). The health care industry is second only to the food industry in annual waste production. Each year, health care facilities in the United States produce 4 billion pounds of waste (660 tons per day), with as much as 70%, or around 2.8 billion pounds, produced directly by operating rooms. Waste disposal also accounts for up to 20% of a hospital's annual environmental services budget. Since 1992, waste production by hospitals has increased annually by a rate of at least 15%, due in part to the increased usage of disposables. Reduction in operating room waste would decrease both health care costs and potential environmental hazards. In 2015, the American Association for Hand Surgery along with the American Society for Surgery of the Hand, American Society for Peripheral Nerve Surgery, and the American Society of Reconstructive Microsurgery began the "Lean and Green" surgery project to reduce the amount of waste generated by hand surgery. We recently began our own "Lean and Green" project in our institution. Using "minor field sterility" surgical principles and Wide Awake Local Anesthesia No Tourniquet (WALANT), both surgical costs and surgical waste were decreased while maintaining patient safety and satisfaction. As the current reimbursement model changes from quantity to quality, "Lean and Green" surgery will play a role in the future health care system. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

The impact of fit manufacturing on green manufacturing: A review

NASA Astrophysics Data System (ADS)

Qi, Ang Nian; Sin, Tan Chan; Fathullah, M.; Lee, C. C.

2017-09-01

Fit manufacturing and Green manufacturing are a new trend principle and concept. They are getting popular in industrial. This paper is identifying the impact between Fit manufacturing and Green manufacturing. Besides Fit manufacturing, Lean manufacturing, Agile manufacturing and Sustainable manufacturing gives big impacts to Green Manufacturing. On top of that, this paper also discuss the benefits of applying Fit manufacturing and Green manufacturing in industrial as well as environment. Hence, applications of Fit manufacturing and Green Manufacturing are increasing year by year.

Use of Process Improvement Tools in Radiology.

PubMed

Rawson, James V; Kannan, Amogha; Furman, Melissa

2016-01-01

Process improvement techniques are common in manufacturing and industry. Over the past few decades these principles have been slowly introduced in select health care settings. This article reviews the Plan, Do, Study, and Act cycle, Six Sigma, the System of Profound Knowledge, Lean, and the theory of constraints. Specific process improvement tools in health care and radiology are presented in the order the radiologist is likely to encounter them in an improvement project. Copyright © 2015 Mosby, Inc. All rights reserved.

HONDA'S IDEA ABOUT THE UTILIZATION OF NATURAL SCENERY ON "THE USE OF SCENIC LANDSCAPES"

NASA Astrophysics Data System (ADS)

Ogawa, Toru; Sanada, Junko

Essentially, natural scenery area plan must include scenery conservation and utilization as well as natural conservation, actually however, it is said that natural scenery area plan leans much toward natural conservation. So this study aims to focus on Seiroku Honda who has a major thinking about "utilization of scenery" in the Japanese national park's formation stage and clarify Honda's idea about the utilization of natural scenery by analyzing his "the Use of Scenic Landscapes". As a result, following three points are clarified. 1) Honda has four ideas in the base of each plans. 2) scenic landscape as resources in Honda's own ideas. 3) there was some conflict between modification ways and landscape resources.

Six Sigma and Lean concepts, a case study: patient centered care model for a mammography center.

PubMed

Viau, Mark; Southern, Becky

2007-01-01

Boca Raton Community Hospital in South Florida decided to increase return while enhancing patient experience and increasing staff morale. They implemented a program to pursue "enterprise excellence" through Six Sigma methodologies. In order to ensure the root causes to delays and rework were addressed, a multigenerational project plan with 3 major components was developed. Step 1: Stabilize; Step 2: Optimize; Step 3: Innovate. By including staff and process owners in the process, they are empowered to think differently about what they do and how they do it. A team that works collaboratively to identify problems and develop solutions can only be a positive to any organization.

Precautionary discourse. Thinking through the distinction between the precautionary principle and the precautionary approach in theory and practice.

PubMed

Dinneen, Nathan

2013-01-01

This paper addresses the distinction, arising from the different ways the European Union and United States have come to adopt precaution regarding various environmental and health-related risks, between the precautionary principle and the precautionary approach in both theory and practice. First, this paper addresses how the precautionary principle has been variously defined, along with an exploration of some of the concepts with which it has been associated. Next, it addresses how the distinction between the precautionary principle and precautionary approach manifested itself within the political realm. Last, it considers the theoretical foundation of the precautionary principle in the philosophy of Hans Jonas, considering whether the principled-pragmatic distinction regarding precaution does or doesn't hold up in Jonas' thought.

Creating a culture of patient-focused care through a learner-centered philosophy.

PubMed

Linscott, J; Spee, R; Flint, F; Fisher, A

1999-01-01

This paper will discuss the teaching-learning process used in the Patient-Focused Care Course at a major teaching hospital in Canada that is transforming nursing practice from a provider driven to a patient-focused approach. The experiential and reflective nature of the course offers opportunities for nurses to link theory with practice, to think critically and reflectively about their own values and beliefs and to translate that meaning into practice. The learning process reflects principles of adult learning based on Knowles andragogical model which differs from the traditional pedagogical model of teaching. The essence of andragogy is a constant unfolding process of discovery based on dialogue. Utilization of adult learning principles that support critical thinking and foster transformational change present an alternative to traditional ways of teaching and learning the art and science of nursing practice.

Lean Transformation of the Eye Clinic at The Hospital for Sick Children: Challenging an Implicit Mental Model and Lessons Learned.

PubMed

Wong, Agnes M F; During, David; Hartman, Michael; Lappan-Gracon, Stephanie; Hicks, Melody; Bajwa, Shiraz

2016-01-01

Long patient dwell time (i.e., the time between patients arriving and leaving the clinic) has been a long-standing issue in the eye clinic at The Hospital for Sick Children. By applying the Lean principles of eliminating waste and enhancing flow, we achieved a 26% reduction in the mean patient dwell time over an eight-month period. Importantly, the average time a patient spent with healthcare providers (value-added time) increased from 21% to 31%. In this paper, we summarized our experience by illustrating how an implicit mental model (conscious or unconscious conceptual framework from which we understand the world) pervades in the healthcare system based on deeply held but unexamined assumptions that arise from heuristics (general rules of thumb) and biases; how these assumptions can be tested by objective data; and how we can build a new mental model based on objective findings to improve the healthcare system.

Optimal utilization of a breast care advanced practice clinician.

PubMed

Russell, Katie W; Mone, Mary C; Serpico, Victoria J; Ward, Cori; Lynch, Joanna; Neumayer, Leigh A; Nelson, Edward W

2014-12-01

Incorporation of "lean" business philosophy within health care has the goal of adding value by reducing cost and improving quality. Applying these principles to the role of Advance Practice Clinicians (APCs) is relevant because they have become essential members of the healthcare team. An independent surgical breast care clinic directed by an APC was created with measurements of success to include the following: time to obtain an appointment, financial viability, and patient/APC/MD satisfaction. During the study period, there was a trend toward a decreased median time to obtain an appointment. Monthly APC charges increased from $388 to $30,800. The mean provider satisfaction score by Press Ganey was 96% for the APC and 95.8% for the surgeon. Both clinicians expressed significant satisfaction with clinic development. Overall, initiation of an APC breast clinic met the proposed goals of success. The use of lean philosophy demonstrates that implementation of change can result in added value in patient care. Copyright © 2014 Elsevier Inc. All rights reserved.

Implementation of a formulary management process.

PubMed

Karel, Lauren I; Delisle, Dennis R; Anagnostis, Ellena A; Wordell, Cindy J

2017-08-15

The application of lean methodology in an initiative to redesign the formulary maintenance process at an academic medical center is described. Maintaining a hospital formulary requires clear communication and coordination among multiple members of the pharmacy department. Using principles of lean methodology, pharmacy department personnel within a multihospital health system launched a multifaceted initiative to optimize formulary management systemwide. The ongoing initiative began with creation of a formulary maintenance redesign committee consisting of pharmacy department personnel with expertise in informatics, automation, purchasing, drug information, and clinical pharmacy services. The committee met regularly and used lean methodology to design a standardized process for management of formulary additions and deletions and changes to medications' formulary status. Through value stream analysis, opportunities for process and performance improvement were identified; staff suggestions on process streamlining were gathered during a series of departmental kaizen events. A standardized template for development and dissemination of monographs associated with formulary additions and status changes was created. In addition, a shared Web-based checklist was developed to facilitate information sharing and timely initiation and completion of tasks involved in formulary status changes, and a permanent formulary maintenance committee was established to monitor and refine the formulary management process. A clearly defined, standardized process within the pharmacy department was developed for tracking necessary steps in enacting formulary changes to encourage safe and efficient workflow. Copyright © 2017 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

Experimental and Computational Study of Trapped Vortex Combustor Sector Rig with Tri-pass Diffuser

NASA Technical Reports Server (NTRS)

Hendricks, Robert C.; Shouse, D. T.; Roquemore, W. M.; Burrus, D. L.; Duncan, B. S.; Ryder, R. C.; Brankovic, A.; Liu, N.-S.; Gallagher, J. R.; Hendricks, J. A.

2001-01-01

The Trapped Vortex Combustor (TVC) potentially offers numerous operational advantages over current production gas turbine engine combustors. These include lower weight, lower pollutant emissions, effective flame stabilization, high combustion efficiency, excellent high altitude relight capability, and operation in the lean burn or RQL (Rich burn/Quick mix/Lean burn) modes of combustion. The present work describes the operational principles of the TVC, and provides detailed performance data on a configuration featuring a tri-pass diffusion system. Performance data include EINOx (NO(sub x) emission index) results for various fuel-air ratios and combustor residence times, combustion efficiency as a function of combustor residence time, and combustor lean blow-out (LBO) performance. Computational fluid dynamics (CFD) simulations using liquid spray droplet evaporation and combustion modeling are performed and related to flow structures observed in photographs of the combustor. The CFD results are used to understand the aerodynamics and combustion features under different fueling conditions. Performance data acquired to date are favorable in comparison to conventional gas turbine combustors. Further testing over a wider range of fuel-air ratios, fuel flow splits, and pressure ratios is in progress to explore the TVC performance. In addition, alternate configurations for the upstream pressure feed, including bi-pass diffusion schemes, as well as variations on the fuel injection patterns, are currently in test and evaluation phases.

Review of modern low emissions combustion technologies for aero gas turbine engines

NASA Astrophysics Data System (ADS)

Liu, Yize; Sun, Xiaoxiao; Sethi, Vishal; Nalianda, Devaiah; Li, Yi-Guang; Wang, Lu

2017-10-01

Pollutant emissions from aircraft in the vicinity of airports and at altitude are of great public concern due to their impact on environment and human health. The legislations aimed at limiting aircraft emissions have become more stringent over the past few decades. This has resulted in an urgent need to develop low emissions combustors in order to meet legislative requirements and reduce the impact of civil aviation on the environment. This article provides a comprehensive review of low emissions combustion technologies for modern aero gas turbines. The review considers current high Technologies Readiness Level (TRL) technologies including Rich-Burn Quick-quench Lean-burn (RQL), Double Annular Combustor (DAC), Twin Annular Premixing Swirler combustors (TAPS), Lean Direct Injection (LDI). It further reviews some of the advanced technologies at lower TRL. These include NASA multi-point LDI, Lean Premixed Prevaporised (LPP), Axially Staged Combustors (ASC) and Variable Geometry Combustors (VGC). The focus of the review is placed on working principles, a review of the key technologies (includes the key technology features, methods of realising the technology, associated technology advantages and design challenges, progress in development), technology application and emissions mitigation potential. The article concludes the technology review by providing a technology evaluation matrix based on a number of combustion performance criteria including altitude relight auto-ignition flashback, combustion stability, combustion efficiency, pressure loss, size and weight, liner life and exit temperature distribution.

Theoretical study of band gap in CuAlO2: Pressure dependence and self-interaction correction

NASA Astrophysics Data System (ADS)

Nakanishi, Akitaka; Katayama-Yoshida, Hiroshi

2012-08-01

By using first-principles calculations, we studied the energy gaps of delafossite CuAlO2: (1) pressure dependence and (2) self-interaction correction (SIC). Our simulation shows that CuAlO2 transforms from a delafossite structure to a leaning delafossite structure at 60 GPa. The energy gap of CuAlO2 increases through the structural transition due to the enhanced covalency of Cu 3d and O 2p states. We implemented a self-interaction correction (SIC) into first-principles calculation code to go beyond local density approximation and applied it to CuAlO2. The energy gap calculated within the SIC is close to experimental data while one calculated without the SIC is about 1 eV smaller than the experimental data.

Teaching Tree-Thinking to Undergraduate Biology Students

PubMed Central

2011-01-01

Evolution is the unifying principle of all biology, and understanding how evolutionary relationships are represented is critical for a complete understanding of evolution. Phylogenetic trees are the most conventional tool for displaying evolutionary relationships, and “tree-thinking” has been coined as a term to describe the ability to conceptualize evolutionary relationships. Students often lack tree-thinking skills, and developing those skills should be a priority of biology curricula. Many common student misconceptions have been described, and a successful instructor needs a suite of tools for correcting those misconceptions. I review the literature on teaching tree-thinking to undergraduate students and suggest how this material can be presented within an inquiry-based framework. PMID:21572571

The Scientific Method - Critical and Creative Thinking

NASA Astrophysics Data System (ADS)

Cotton, John; Scarlise, Randall

2011-10-01

The ``scientific method'' is not just for scientists! Combined with critical thinking, the scientific method can enable students to distinguish credible sources of information from nonsense and become intelligent consumers of information. Professors John Cotton and Randall Scalise illustrate these principles using a series of examples and demonstrations that is enlightening, educational, and entertaining. This lecture/demonstration features highlights from their course (whose unofficial title is ``debunking pseudoscience'' ) which enables students to detect pseudoscience in its many guises: paranormal phenomena, free-energy devices, alternative medicine, and many others.

Computational materials science: Think locally, act globally

NASA Astrophysics Data System (ADS)

Rabe, Karin M.

2002-11-01

New first-principles calculations reveal the range of atomic arrangements underlying the average crystallographic structure of a perovskite oxide, PZT. This work opens the door to understanding the exceptional physical behaviour of PZT and related systems.

JPRS Report, Soviet Union, World Economy & International Relations, No. 6, June 1989.

DTIC Science & Technology

1989-10-05

analysis of the discussions, held in France, is presented in the article "On Single European Market" written by I. EGOROV, our Paris correspondent... analysis that it studies current problems of international politics. But what are the basic theoretical principles of the new political thinking...loyalty to Marxism-Leninism is tested by the ability of its followers to use its theoretical and methodological principles for the creative analysis of

Medical ethics: four principles plus attention to scope.

PubMed

Gillon, R

1994-07-16

The "four principles plus scope" approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. The approach, developed in the United States, is based on four common, basic prima facie moral commitments--respect for autonomy, beneficence, nonmaleficence, and justice--plus concern for their scope of application. It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help doctors and other health care workers to make decisions when reflecting on moral issues that arise at work.

Accounting and Economics: A Meaningful Merger.

ERIC Educational Resources Information Center

Porreca, Anthony G.

1984-01-01

Develops a rationale for teaching selected economic concepts concurrently with accounting principles and attempts to stimulate thinking and discussion among secondary teachers regarding the commonalities that exist between the work of the accountant and that of the economist. (JOW)

Incorporation of Consumer Products in the Teaching of Analytical Chemistry.

ERIC Educational Resources Information Center

Lieu, Van T.; Kalbus, Gene E.

1988-01-01

Describes eight experiments involving the use of common consumer products that could be incorporated into quantitative and instrumental analysis laboratories. Discusses these activities in terms of illustration of principles, awareness, and critical thinking. (CW)

Autonomy and the principle of respect for autonomy.

PubMed

Gillon, R

1985-06-15

Autonomy is defined as the capacity to think, decide, and act freely and independently on the basis of such thought and decisions. Three types of autonomy are distinguished: autonomy of thought, which embraces the wide range of human intellectual activities called "thinking for oneself"; autonomy of will, or the capacity to decide to do things on the basis of one's deliberations; and autonomy of action, the absence of which is illustrated by the situation of a patient whose voluntary muscles are paralyzed by curariform drugs and who thus cannot tell the surgeon that the anesthetist has forgotten the nitrous oxide. Autonomy is viewed as a prerequisite for all the virtues, rather than as a virtue in its own right. The arguments of Immanuel Kant and John Stuart Mill concerning the principle of respect for autonomy are summarized as exemplars respectively of the deontological and utilitarian philosophical approaches.

Leveraging design thinking to build sustainable mobile health systems.

PubMed

Eckman, Molly; Gorski, Irena; Mehta, Khanjan

Mobile health, or mHealth, technology has the potential to improve health care access in the developing world. However, the majority of mHealth projects do not expand beyond the pilot stage. A core reason why is because they do not account for the individual needs and wants of those involved. A collaborative approach is needed to integrate the perspectives of all stakeholders into the design and operation of mHealth endeavours. Design thinking is a methodology used to develop and evaluate novel concepts for systems. With roots in participatory processes and self-determined pathways, design thinking provides a compelling framework to understand and apply the needs of diverse stakeholders to mHealth project development through a highly iterative process. The methodology presented in this article provides a structured approach to apply design thinking principles to assess the feasibility of novel mHealth endeavours during early conceptualisation.

Using A3 thinking to improve the STAT medication process.

PubMed

Manojlovich, Milisa; Chase, Valerie J; Mack, Megan; Conroy, Meghan K; Belanger, Karen; Zawol, Debbie; Corr, Karen M; Fowler, Karen E; Viglianti, Elizabeth

2014-08-01

Although the term STAT conveys a sense of urgency, it is sometimes used to circumvent a system that may be too slow to accomplish tasks in a timely manner. We describe a quality-improvement project undertaken by a US Department of Veterans Affairs (VA) hospital to improve the STAT medication process. We adapted A3 Thinking, a problem-solving process common in Lean organizations, to our problem. In the discovery phase, a color-coded flow map of the existing process was constructed, and a real-time STAT order was followed in a modified "Go to the Gemba" exercise. In the envisioning phase, the team brainstormed to come up with as many improvement ideas as possible, which were then prioritized based on the anticipated effort and impact. The team then identified initial experiments to be carried out in the experimentation phase; each experiment followed a standard Plan-Do-Study-Act cycle. On average, the number of STAT medications ordered per month decreased by 9.5%. The average time from STAT order entry to administration decreased by 21%, and time from medication delivery to administration decreased by 26%. Improvements were also made in technician awareness of STAT medications and nurse notification of STAT medication delivery. Adapting A3 Thinking for process improvement was a low-cost/low-tech option for a VA facility. The A3 Thinking process led to a better understanding of the meaning of STAT across disciplines, and promoted a collaborative culture in which other hospital-wide problems may be addressed in the future. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Thinking like Leonardo da Vinci and its implications for the modern doctor.

PubMed

Baum, Neil

2013-01-01

Most people when asked to name the most creative, innovative, and multidimensional people in history would agree that Leonardo da Vinci is either at the top or very close to the number one position on that list. Wouldn't it be nice to think like da Vinci? This article shares the seven unique principles of thinking that da Vinci used that enabled him to be the greatest painter, sculptor, architect, musician, mathematician, engineer, inventor, anatomist, geologist, cartographer, botanist, and writer of his (if not of all) time. This article will take you deep into the notebooks and codices of da Vinci, and suggest ways his ideas can be used by anyone in the healthcare profession to make them a better healthcare provider.

Integration of context sensitive solutions in the transportation planning process

DOT National Transportation Integrated Search

2007-01-01

Since the 1998 Thinking Beyond the Pavement workshop, the national movement of the use of context sensitive solutions for project development is well documented. Better understanding of the application of CSS principles in the transportation pl...

Teaching Principles of Inference with ANOVA

ERIC Educational Resources Information Center

Tarlow, Kevin R.

2016-01-01

Analysis of variance (ANOVA) is a test of "mean" differences, but the reference to "variances" in the name is often overlooked. Classroom activities are presented to illustrate how ANOVA works with emphasis on how to think critically about inferential reasoning.

Clinical transformation: the key to green nephrology.

PubMed

Connor, Andrew; Mortimer, Frances; Tomson, Charles

2010-01-01

Climate change represents a major global public health threat. The very provision of healthcare itself has a significant untoward effect on the environment, to which kidney care is likely to contribute disproportionately. In this article we describe the four principles we believe will underpin a successful transformation to lower carbon kidney care: disease prevention, patient empowerment, lean service delivery and the preferential use of low-carbon technologies. We illustrate their application and their co-benefits, such as improvements in patient care and reductions in cost, with examples. Copyright © 2010 S. Karger AG, Basel.

[Comprehensive and competition-oriented quality management in social medicine expert services].

PubMed

Seger, W

1996-05-01

In free competition expert services in Social Medicine must supply their expertise with high quality in a short time and at low cost. The demands by customers in respect of motivation of the staff and innovative organisation are as important competitive factors as high quality standards for expertise production. These guiding principles completed by "Kaizen" and "Lean production" are necessary requirements for the further existence of the enterprise in competition. Quality assurance must be promoted in a process looking to the future in active quality management.

Priority-setting in New Zealand: translating principles into practice.

PubMed

Ashton, T; Cumming, J; Devlin, N

2000-07-01

In May 1998 the New Zealand Health Funding Authority released a discussion paper which proposed a principles-based approach to setting purchasing priorities that incorporates the economic methods of programme budgeting and marginal analysis, and cost-utility analysis. The principles upon which the process was to be based are effectiveness, cost, equity of health outcomes, Maori health and acceptability. This essay describes and critiques issues associated with translating the principles into practice, most particularly the proposed methods for evaluating the effectiveness and measuring the cost of services. It is argued that the proposals make an important contribution towards the development of a method for prioritizing services which challenges our thinking about those services and their goals, and which is systematic, explicit, and transparent. The shift towards 'thinking at the margin' and systematically reviewing the value for money of competing claims on resources is likely to improve the quality of decision-making compared with the status quo. This does not imply that prioritization can, or should, be undertaken by means of any simple formula. Any prioritization process should always be guided by informed judgement. The approach is more appropriate for some services than for others. Key methodological issues that need further consideration include the choice of instrument for measuring health gains, the identification of marginal services, how to combine qualitative and quantitative information, and how to ensure consistency across different levels of decision-making.

Space Toxicology Challenges and Ethical Considerations

NASA Technical Reports Server (NTRS)

James, John T.

2010-01-01

Before delineating specific ways that nanotechnology enterprises might contribute to better management of toxicological risks during spaceflight, I will show how ethical considerations and several theories of justice can be applied to nanotechnology strategic plans. The principles that guide an ethical technical enterprise include autonomy, beneficence, non-maleficence, veracity and justice. Veracity (truth) is the underpinning principle; however, beyond this, proponents of nanotechnology must think carefully about balancing conflicting principles. For example, autonomy must yield to beneficence when fearful individuals simply lack knowledge to appreciate nanotechnology's beneficial advances. Justice is a complex topic upon which I will place six models: utilitarian, distributive, free-exchange/choice, individual dignity (social participation), equity vs. greed, and liberation of the poor. After briefly summarizing each model, I will present what I call an iterative-hybrid model of justice to show specifically how our thinking can be applied to nanotechnology enterprises. Within that broad landscape, I will discuss a single feature: how our early effort to understand health risks of carbon nanotubes fits into the iterative model. Finally, I will suggest ways that nanotechnology might advance our management of toxicological risks during spaceflight, but always with an eye toward how such advances might result in a more just world.

Beckham as physicist?

NASA Astrophysics Data System (ADS)

Ireson, Gren

2001-01-01

It is hard to think of a medium that does not use football or soccer as a means of promotion. It is also hard to think of a student who has not heard of David Beckham. If football captures the interest of students it can be used to teach physics; in this case a Beckham free-kick can be used to introduce concepts such as drag, the Bernoulli principle, Reynolds number and the Magnus effect, by asking the simple question: How does he curve the ball so much? Much basic mechanics can also be introduced along the way.

DOE Office of Scientific and Technical Information (OSTI.GOV)

Campbell, Philip LaRoche

This report is a summary of and commentary on (a) the seven lectures that C. S. Peirce presented in 1903 on pragmatism and (b) a commentary by P. A. Turrisi, both of which are included in Pragmatism as a Principle and Method of Right Thinking: The 1903 Harvard Lectures on Pragmatism, edited by Turrisi [13]. Peirce is known as the founder of the philosophy of pragmatism and these lectures, given near the end of his life, represent his mature thoughts on the philosophy. Peirce's decomposition of thinking into abduction, deduction, and induction is among the important points in the lectures.

Listening Responsively

ERIC Educational Resources Information Center

Callahan, Kadian M.

2011-01-01

Standards documents, such as the Common Core State Standards for Mathematics and "Principles and Standards for School Mathematics", expect teachers to foster mathematics learning by engaging students in meaningful mathematical discourse to expose students to different ways of thinking about and solving problems and positively influence their…

Kool-Aid Chromatography

ERIC Educational Resources Information Center

Jenkins, Christie L.

1986-01-01

Offers guidelines and suggests activities that can introduce middle school students to the process and principles of chromatography in an inexpensive and safe manner. Proposes that experiences with Kool-aid and food coloring chromatography can provide insights into how scientists think, work, and communicate. (ML)

Democratic Postsecondary Vocational Education

ERIC Educational Resources Information Center

Molnar, Christopher J.

2010-01-01

This dissertation offers a critique of current approaches to postsecondary vocational education. It concludes that the traditional apprenticeship and didactic model leads to inadequate preparation of students for independent thinking and problem solving. An alternative model is proposed that uses "democratic education" principles. These include…

Sharing a Birthday Cake

ERIC Educational Resources Information Center

Switzer, J. Matt

2016-01-01

National Council of Teachers of Mathematics' (NCTM's) "Principles to Actions: Ensuring Mathematical Success for All" outlines eight teaching practices for effective teaching and learning of mathematics (NCTM 2014). One of the teaching practices, "elicit and use evidence of student thinking," states, "Effective teaching of…

Sharing Craft Knowledge: The Soul of Principal Peer Assessment.

ERIC Educational Resources Information Center

Abbott, James E.

1996-01-01

Describes the implementation of a peer assessment process for school principals using a New Skills Profile of essential craft skills: teaching methods, budgetary competence, networking, technological literacy, communication, leadership, conflict resolution, diversity, systems thinking, and Total Quality Management principles. Participating…

Developing a performance data suite to facilitate lean improvement in a chemotherapy day unit.

PubMed

Lingaratnam, Senthil; Murray, Danielle; Carle, Amber; Kirsa, Sue W; Paterson, Rebecca; Rischin, Danny

2013-07-01

A multidisciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia, developed a performance data suite to support a service improvement project based on lean manufacturing principles in its 19-chair chemotherapy day unit (CDU) and cytosuite chemotherapy production facility. The aims of the project were to reduce patient wait time and improve equity of access to the CDU. A project team consisting of a pharmacist and CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes, analyze root causes, eliminate non-value-adding steps, reduce variation, and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, medical record audits, and interrogation of electronic treatment records were undertaken. This project delivered a 38% reduction in median wait time on the day (from 32 to 20 minutes; P < .01), 7-day reduction in time to commencement of treatment for patients receiving combined chemoradiotherapy regimens (from 25 to 18 days; P < .01), and 22% reduction in wastage associated with expired drug and pharmacy rework (from 29% to 7%; P < .01). Improvements in efficiency enabled the cytosuite to increase the percentage of product manufactured within 10 minutes of appointment times by 29% (from 47% to 76%; P < .01). A lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU, resulting in improved access to treatment and reduced waiting times on the day.

Reducing door-to-needle times using Toyota's lean manufacturing principles and value stream analysis.

PubMed

Ford, Andria L; Williams, Jennifer A; Spencer, Mary; McCammon, Craig; Khoury, Naim; Sampson, Tomoko R; Panagos, Peter; Lee, Jin-Moo

2012-12-01

Earlier tissue-type plasminogen activator (tPA) treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times. We used lean process improvement methodology to develop a streamlined intravenous tPA protocol. In early 2011, a multidisciplinary team analyzed the steps required to treat patients with acute ischemic stroke with intravenous tPA using value stream analysis (VSA). We directly compared the tPA-treated patients in the "pre-VSA" epoch with the "post-VSA" epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to the room; serial processing of workflow; and delays in waiting for laboratory results. On March 1, 2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT before the patient room, using parallel process workflow, and implementing point-of-care laboratories. In the pre and post-VSA epochs, 132 and 87 patients were treated with intravenous tPA, respectively. Compared with pre-VSA, door-to-needle times and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 minutes versus 39 minutes (P<0.0001) and 52% versus 78% (P<0.0001), respectively, with no change in symptomatic hemorrhage rate. Lean process improvement methodology can expedite time-dependent stroke care without compromising safety.

Reducing Door-to-Needle Times using Toyota’s Lean Manufacturing Principles and Value Stream Analysis

PubMed Central

Ford, Andria L.; Williams, Jennifer A.; Spencer, Mary; McCammon, Craig; Khoury, Naim; Sampson, Tomoko; Panagos, Peter; Lee, Jin-Moo

2012-01-01

Background Earlier tPA treatment for acute ischemic stroke increases efficacy, prompting national efforts to reduce door-to-needle times (DNTs). We utilized lean process improvement methodology to develop a streamlined IV tPA protocol. Methods In early 2011, a multi-disciplinary team analyzed the steps required to treat acute ischemic stroke patients with IV tPA, utilizing value stream analysis (VSA). We directly compared the tPA-treated patients in the “pre-VSA” epoch to the “post-VSA” epoch with regard to baseline characteristics, protocol metrics, and clinical outcomes. Results The VSA revealed several tPA protocol inefficiencies: routing of patients to room, then to CT, then back to room; serial processing of work flow; and delays in waiting for lab results. On 3/1/2011, a new protocol incorporated changes to minimize delays: routing patients directly to head CT prior to patient room, utilizing parallel process work-flow, and implementing point-of-care labs. In the pre-and post-VSA epochs, 132 and 87 patients were treated with IV tPA, respectively. Compared to pre-VSA, DNTs and percent of patients treated ≤60 minutes from hospital arrival were improved in the post-VSA epoch: 60 min vs. 39 min (p<0.0001) and 52% vs. 78% (p<0.0001), respectively, with no change in symptomatic hemorrhage rate. Conclusions Lean process improvement methodology can expedite time-dependent stroke care, without compromising safety. PMID:23138440

[Martin Heidegger, beneficence, health, and evidence based medicine--contemplations regarding ethics and complementary and alternative medicine].

PubMed

Oberbaum, Menachem; Gropp, Cornelius

2015-03-01

Beneficence is considered a core principle of medical ethics. Evidence Based Medicine (EBM) is used almost synonymously with beneficence and has become the gold standard of efficiency of conventional medicine. Conventional modern medicine and EBM in particular are based on what Heidegger called calculative thinking, whereas complementary medicine (CM) is often based on contemplative thinking according to Heidegger's distinction of different thinking processes. A central issue of beneficence is the striving for health and wellbeing. EBM is little concerned directly with wellbeing, though it does claim to aim at improving quality of life by correcting pathological processes and conditions like infectious diseases, ischemic heart disease but also hypertension and hyperlipidemia. On the other hand, wellbeing is central to therapeutic efforts of CM. Scientific methods to gauge results of EBM are quantitative and based on calculative thinking, while results of treatments with CM are expressed in a qualitative way and based on meditative thinking. In order to maximize beneficence it seems important and feasible to use both approaches, by combining EBM and CM in the best interest of the individual patient.

Medical ethics: four principles plus attention to scope.

PubMed Central

Gillon, R.

1994-01-01

The "four principles plus scope" approach provides a simple, accessible, and culturally neutral approach to thinking about ethical issues in health care. The approach, developed in the United States, is based on four common, basic prima facie moral commitments--respect for autonomy, beneficence, nonmaleficence, and justice--plus concern for their scope of application. It offers a common, basic moral analytical framework and a common, basic moral language. Although they do not provide ordered rules, these principles can help doctors and other health care workers to make decisions when reflecting on moral issues that arise at work. Images p184-a p187-a PMID:8044100

Thinking like a scientist: innateness as a case study.

PubMed

Knobe, Joshua; Samuels, Richard

2013-01-01

The concept of innateness appears in systematic research within cognitive science, but it also appears in less systematic modes of thought that long predate the scientific study of the mind. The present studies therefore explore the relationship between the properly scientific uses of this concept and its role in ordinary folk understanding. Studies 1-4 examined the judgments of people with no specific training in cognitive science. Results showed (a) that judgments about whether a trait was innate were not affected by whether or not the trait was learned, but (b) such judgments were impacted by moral considerations. Study 5 looked at the judgments of both non-scientists and scientists, in conditions that encouraged either thinking about individual cases or thinking about certain general principles. In the case-based condition, both non-scientists and scientists showed an impact of moral considerations but little impact of learning. In the principled condition, both non-scientists and scientists showed an impact of learning but little impact of moral considerations. These results suggest that both non-scientists and scientists are drawn to a conception of innateness that differs from the one at work in contemporary scientific research but that they are also both capable of 'filtering out' their initial intuitions and using a more scientific approach. Copyright © 2012 Elsevier B.V. All rights reserved.

Evaluation of Safety, Quality and Productivity in Construction

NASA Astrophysics Data System (ADS)

Usmen, M. A.; Vilnitis, M.

2015-11-01

This paper examines the success indicators of construction projects, safety, quality and productivity, in terms of their implications and impacts during and after construction. First safety is considered during construction with a focus on hazard identification and the prevention of occupational accidents and injuries on worksites. The legislation mandating safety programs, training and compliance with safety standards is presented and discussed. Consideration of safety at the design stage is emphasized. Building safety and the roles of building codes in prevention of structural failures are also covered in the paper together with factors affecting building failures and methods for their prevention. Quality is introduced in the paper from the perspective of modern total quality management. Concepts of quality management, quality control, quality assurance and Six Sigma and how they relate to building quality and structural integrity are discussed with examples. Finally, productivity concepts are presented with emphasis on effective project management to minimize loss of productivity, complimented by lean construction and lean Six Sigma principles. The paper concludes by synthesizing the relationships between safety, quality and productivity.

From soil mechanics to chick development.

PubMed

Wolpert, Lewis

2018-01-01

Here, I provide some recollections of my life, starting as a civil engineer in South Africa and how I gradually became interested in biology, particularly pattern formation. In retrospect, I think that my decision to work on chick embryos to study limb development back in 1966 turned out to be the right one. The principles discovered in these 50 years, both by my collaborators and by other colleagues, have established the principles of how the limb develops in higher vertebrates, including humans.

The Celestial Vault: The Magic of Astrology

NASA Astrophysics Data System (ADS)

McGaha, J.

2004-11-01

Astrology is a "Geocentric System" that supports the "Astrological Principle". This principle, that human beings and their actions are influenced by the positions of celestial objects, is not objectively supported. The "planetary gods" found in the heavens provided order to help explain the chaotic events in life on earth. Is this why many people think their horoscopes are correct, with the "stars" taking credit? Do "celestial movements" foretell the future? What is the evidence for Astrology? The historical, psychological and physical foundations of astrology will be discussed.

The GATE Way to Equity.

ERIC Educational Resources Information Center

Belz, Helene F.

Systematic observations of thousands of high school students in the California Mentally Gifted Minors/Gifted and Talented Education programs identified five principles underlying the development of high level thinking skills in this population: (1) Exceptional performance on any criterion requires mutually reinforcing antecedents, the effects of…

Drawing Analogies to Deepen Learning

ERIC Educational Resources Information Center

Fava, Michelle

2017-01-01

This article offers examples of how drawing can facilitate thinking skills that promote analogical reasoning to enable deeper learning. The instructional design applies cognitive principles, briefly described here. The workshops were developed iteratively, through feedback from student and teacher participants. Elements of the UK National…

Principles of Gestalt Psychology and Their Application to Teaching Junior High School Science

ERIC Educational Resources Information Center

Blosser, Patricia E.

1973-01-01

Discusses insightful learning, trace system,'' and laws of perception and Pragnanz in connection with problem solving and critical thinking in science teaching. Suggests 19 guidelines for sequencing curriculum and identifying activities for use in science classes. (CC)

Lean intervention improves patient discharge times, improves emergency department throughput and reduces congestion.

PubMed

Beck, Michael J; Okerblom, Davin; Kumar, Anika; Bandyopadhyay, Subhankar; Scalzi, Lisabeth V

2016-12-01

To determine if a lean intervention improved emergency department (ED) throughput and reduced ED boarding by improving patient discharge efficiency from a tertiary care children's hospital. The study was conducted at a tertiary care children's hospital to study the impact lean that changes made to an inpatient pediatric service line had on ED efficiency. Discharge times from the general pediatrics' service were compared to patients discharged from all other pediatric subspecialty services. The intervention was multifaceted. First, team staffing reconfiguration permitted all discharge work to be done at the patient's bedside using a new discharge checklist. The intervention also incorporated an afternoon interdisciplinary huddle to work on the following day's discharges. Retrospectively, we determined the impact this had on median times of discharge order entry, patient discharge, and percent of patients discharged before noon. As a marker of ED throughput, we determined median hour of day that admitted patients left the ED to move to their hospital bed. As marker of ED congestion we determined median boarding times. For the general pediatrics service line, the median discharge order entry time decreased from 1:43pm to 11:28am (p < 0.0001) and the median time of discharge decreased from 3:25pm to 2:25pm (p < 0.0001). The percent of patients discharged before noon increased from 14.0% to 26.0% (p < 0.0001). The discharge metrics remained unchanged for the pediatric subspecialty services group. Median ED boarding time decreased by 49 minutes (p < 0.0001). As a result, the median time of day admitted patients were discharged from the ED was advanced from 5 PM to 4 PM. Lean principles implemented by one hospital service line improved patient discharge times enhanced patient ED throughput, and reduced ED boarding times.

Using Quantitative Literacy to Enhance Critical Thinking Skills in Undergraduate Nursing Students.

PubMed

Asknes, Edna

2017-04-01

Critical thinking and quantitative literacy (QL) are similarly grounded: both focus on analyzing and evaluating evidence, identifying implications and consequences, drawing inferences, and communicating information. This teaching strategy was based on those commonalities and was designed so that undergraduate nursing students would enhance their critical thinking skills as they used their QL skills. QL skills are most effective when taught, learned, and used to solve significant, pertinent problems. Using the principles of learner-centered, team-based learning, QL was integrated into the curriculum of the Maternal-Newborn Nursing course at an urban community college with a diverse student population. Students were engaged and demonstrated enhanced and ongoing development of their critical thinking and problem-solving skills. They also reported a better understanding of data interpretation and use. The positive outcome of this project revealed further opportunities for incorporating QL into nursing curricula and highlighted the need for research on the use of QL in nursing education. [J Nurs Educ. 2017;56(4):240-242.]. Copyright 2017, SLACK Incorporated.

A Tribute to David Tiedeman

ERIC Educational Resources Information Center

Jepsen, David A.

2008-01-01

This tribute to Tiedeman takes the form of an invitation to read his written work. The author concludes that Tiedeman's body of work is unique and paradoxical, abstract and challenging, and deeply practical. He offered principles intended to change the way counselors think about careers and career development.

Has Chemical Education Reached Equilibrium?

NASA Astrophysics Data System (ADS)

Moore, John W.

1997-06-01

The other day I got to thinking about whether something akin to Le Chatelier's principle operates in chemical education. That is, whenever someone alters the conditions under which we interact with students, there is a shift in the system that attempts to minimize or counteract the change.

Earth Algebra: Real-Life Mathematics in Navajoland.

ERIC Educational Resources Information Center

Schaufele, Christopher; Srivastava, Ravindra

1995-01-01

An algebra class at Navajo Community College (Shiprock, New Mexico) uses traditional algebra topics to study real-life situations, focuses on environmental issues, encourages collaborative learning, uses modern technology, and promotes development of critical thinking and decision-making skills. Students follow principles of Dine educational…

Expert Behavior in Children's Video Game Play.

ERIC Educational Resources Information Center

VanDeventer, Stephanie S.; White, James A.

2002-01-01

Investigates the display of expert behavior by seven outstanding video game-playing children ages 10 and 11. Analyzes observation and debriefing transcripts for evidence of self-monitoring, pattern recognition, principled decision making, qualitative thinking, and superior memory, and discusses implications for educators regarding the development…

Try This: Parachute Drop

ERIC Educational Resources Information Center

Preston, Christine

2017-01-01

If you think of play as "the work of children" (Whitebread, Basilio, Kuvalja & Verma, 2012) then toys are surely the "tools of their trade". The involvement of scientific principles in how they work makes certain toys ideal stimuli for science investigations. This article describes a practical investigation suitable for…

IBSE and Gifted Students

ERIC Educational Resources Information Center

Trna, Josef

2014-01-01

Inquiry-based science education (IBSE) seems to be the appropriate method to encourage interest in science and technology education. The core principles of IBSE are involvement of students in discovering natural laws, linking information into a meaningful context, developing critical thinking and promoting positive attitudes towards science. IBSE…

The Dynamic Difference: Montessori's Legacy for the New Century.

ERIC Educational Resources Information Center

Loeffler, Margaret Howard

2000-01-01

Maintains that Montessori education must regain its dynamism by recognizing barriers that separate Montessori from mainstream educational thinking and entering into meaningful dialog with other educators. Suggests ways to improve understanding of Montessori's basic principles and practices and their current relevance, including defining core…

Restorative Justice: Principles, Practices, and Application

ERIC Educational Resources Information Center

O'Brien, Sandra Pavelka

2007-01-01

A modern-day movement is transforming the way that communities and justice systems think about and respond to crime and wrongful occurrences. This response implements a holistic continuum of services, providing for prevention, intervention, diversion, commitment, probation, reentry, and aftercare. This approach--known as restorative justice--seeks…

Promoting the teaching of critical thinking skills through faculty development.

PubMed

Behar-Horenstein, Linda S; Schneider-Mitchell, Gail; Graff, Randy

2009-06-01

Practical and effective faculty development programs are vital to individual and institutional success. However, there is little evidence that program outcomes result in instructional changes. The purpose of this study was to determine if and how faculty development would enhance participants' use of critical thinking skills in instruction. Seven faculty members from the University of Florida College of Dentistry and one faculty member from another health science college participated in six weekly two-hour faculty development sessions in spring 2007 that focused on enhancing critical thinking skills in instruction. Kaufman's and Rachal's principles of andragogy (adult learning) were used to design the sessions. Participants used learning journals to respond to four instructor-assigned prompts and provided one presentation to peers. With the use of qualitative methods, eight themes emerged across the learning journals: teaching goals, critical thinking, awareness of learners, planned instructional change, teaching efficacy, self-doubt, external challenges, and changes made. Five of eight participants incorporated critical thinking skills into their presentations at a mean level of 2.4 or higher on a 5-point scale using Paul and Elder's behavioral definition of critical thinking skills. Faculty development opportunities that cause participants to reason through learning journals, peer presentations, and group discussion demonstrated the incorporation of critical thinking concepts in 63 percent of this cohort group's presentations, suggesting that if evidence-based pedagogies are followed, instructional changes can result from faculty development.

Hooke's law: applications of a recurring principle.

PubMed

Giuliodori, Mauricio J; Lujan, Heidi L; Briggs, Whitney S; Palani, Gurunanthan; DiCarlo, Stephen E

2009-12-01

Students generally approach topics in physiology as a series of unrelated phenomena that share few underlying principles. However, if students recognized that the same underlying principles can be used to explain many physiological phenomena, they may gain a more unified understanding of physiological systems. To address this concern, we developed a simple, inexpensive, and easy to build model to demonstrate the underlying principles regarding Starling's Law of the Heart as well as lung and arterial elastic recoil. A model was chosen because models significantly enhance student understanding. Working with models also encourages research-oriented learning and helps our students understand complex ideas. Students are drawn into discussion by the power of learning that is associated with manipulating and thinking about objects. Recognizing that the same underlying principles can be used to explain many physiological phenomena may help students gain a more complete understanding of physiological systems.

Principles of unit charging.

PubMed

Lunnon, R J

1989-07-01

Unfortunately, training medical photographers and artists does not include finance management, but in the 'cost effective' atmosphere of both NHS and universities today we must learn to approach the subject in a manner likely to satisfy our financial masters. The experience gained in introducing a unit cost system and using it for 17 years will be reviewed but more importantly, as the system has been adopted and adapted by so many, the benefits of using such a system and changing to concur with current financial thinking will also be discussed. Are we in such a Korner as we might think?

[Descartes' influence on the development of the anatomoclinical method].

PubMed

González Hernández, A; Domínguez Rodríguez, M V; Fabre Pi, O; Cubero González, A

2010-01-01

The development of the anatomical-clinical method was a huge advance for modern medicine since it revealed a new approach to understanding diagnostic procedures. This change in medical thinking towards a more scientific basis has gradually evolved over several centuries, reaching its brilliant zenith with the contributions of the French school. There are certain similarities between the guidelines of the anatomical-clinical method and René Descartes' philosophical principles, so it is fair to consider him as one of the major precursors in this new line of thinking that definitely influenced the historical course of medicine.

Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic.

PubMed

Smith, Chad; Wood, Suzanne; Beauvais, Bradley

2011-01-01

The timely coordination of care in clinics that require frequent assessments by multiple specialists can be challenging for both patients and providers. The cornerstone of care at cystic fibrosis (CF) centers with superior clinical outcomes, as with reduced acuity of episodic disease and incidence of hospitalizations, is frequent clinical encounters coupled with aggressive therapies. However, inefficiencies in the clinical practice structure prevent optimal utilization of resources. To decrease non-value-added time, defined as time a patient spends alone in an examination room, without altering the time providers spend caring for a patient, the application of Lean methods was used to see whether reducing variation could significantly decrease lead time, considered the length of a patient visit, within a CF clinic setting. Baseline capability analyses revealed only 19.3% of patient visits were completed in 60min or less, with mean and median visit times of 84 and 81min, respectively. Final capability analyses demonstrated that 41.5% of patient visits were completed in 60min or less, 23% greater than the baseline capability. Mean and median visit times decreased by 10min per visit. Research efforts increased the available capacity by 500 patient visits per year, representing additional revenue of over US$165,000 annually with no additional administrative costs incurred. © 2011 National Association for Healthcare Quality.

Hospital quality: a product of good management as much as good treatment.

PubMed

Hyde, Andy; Frafjord, Anders

2013-01-01

In Norway, as in most countries, the demands placed on hospitals to reduce costs and improve the quality of services are intense. Although many say that improving quality reduces costs, few can prove it. Futhermore, how many people can show that improving quality improves patient satisfaction. Diakonhjemmet hospital in Norway has designed and implemented a hospital management system based on lean principles and the PDCA (Plan-Do-Check-Act) quality circle introduced by WE Deming (Deming 2000). The results are quite impressive with improvements in quality and patient satisfaction. The hospital also runs at a profit.

[Measurement of human body fat by means of gravimetry. Application of Archimedes' principle].

PubMed

Dettwiler, W; Ribordy, M; Donath, A; Scherrer, J R

1978-12-02

The weighing of the human body under water is an application of Archimedes' law. Fat being lighter than water or than the structures of lean body mass, body fat can be measured by determining the specific gravity of the human body; that is, by underwater weighing. Body fat has been determined in an "ideal" sample of 14 men and 23 women, all aged 20 years. Testing against a reference measure of body fat makes it possible to test the validity of some anthropometric measurements and of some indices of obesity. These indices offer no advantages over anthropometric measurements.

Pressure-Induced Structural Transition and Enhancement of Energy Gap of CuAlO2

NASA Astrophysics Data System (ADS)

Nakanishi, Akitaka

2011-02-01

By using first-principles calculations, we studied the stable crystal structures and energy gaps of CuAlO2 under high pressure. Our simulation shows that CuAlO2 transforms from a delafossite structure to a leaning delafossite structure. The critical pressure of the transition was determined to be 60 GPa. The energy gap of CuAlO2 increases through the structural transition due to the enhanced covalency of Cu 3d and O 2p states. We found that a chalcopyrite structure does not appear as a stable structure under high pressure.

Ares Launch Vehicles Lean Practices Case Study

NASA Technical Reports Server (NTRS)

Doreswamy, Rajiv, N.; Self, Timothy A.

2008-01-01

This viewgraph presentation describes test strategies and lean philisophies and practices that are applied to Ares Launch Vehicles. The topics include: 1) Testing strategy; 2) Lean Practices in Ares I-X; 3) Lean Practices Applied to Ares I-X Schedule; 4) Lean Event Results; 5) Lean, Six Sigma, and Kaizen Practices in the Ares Projects Office; 6) Lean and Kaizen Success Stories; and 7) Ares Six Sigma Practices.

Risk of Disordered Eating Among Division I Female College Athletes

PubMed Central

WELLS, ELIZABETH K.; CHIN, ALEXANDRA D.; TACKE, JENNIFER A.; BUNN, JENNIFER A.

2015-01-01

The purpose of this study was to assess the risk of disordered eating (DE) among female athletes in lean and non-lean sports using the ATHLETE survey. The ATHLETE survey is divided into six different constructs, and a high score indicates a high risk for DE. Eighty-three varsity female athletes from eight Campbell University sports teams completed the survey and a medical history form anonymously. The sports were divided into sports that traditionally have a high risk for DE (lean sports) and those with a low risk (non-lean sports). The lean sports included: cheerleading, cross country/track and field, swimming, and volleyball. The non-lean sports included: basketball, golf, soccer, and softball. The total mean score of the ATHLETE survey for the lean sports was 100.1 ± 17.4, compared to the non-lean sports scoring 90.1 ± 16.9, p = 0.011. The two constructs that showed significant difference between lean and non-lean sports were Social Pressure on Body Shape (lean: 12.2 ± 3.9, non-lean: 9.4 ± 4.6, p = 0.005) and Team Trust (lean: 7.4 ± 3.3, non-lean: 5.6 ± 2.2, p = 0.004). The results indicate that lean sports exhibited a higher risk for development of DE compared to athletes participating in non-lean sports. It appears that the primary influence of DE in these female athletes came from external social pressures that may therefore dictate their exercise and nutritional habits. PMID:27293502

Copernicus, Kant, and the anthropic cosmological principles

NASA Astrophysics Data System (ADS)

Roush, Sherrilyn

In the last three decades several cosmological principles and styles of reasoning termed 'anthropic' have been introduced into physics research and popular accounts of the universe and human beings' place in it. I discuss the circumstances of 'fine tuning' that have motivated this development, and what is common among the principles. I examine the two primary principles, and find a sharp difference between these 'Weak' and 'Strong' varieties: contrary to the view of the progenitors that all anthropic principles represent a departure from Copernicanism in cosmology, the Weak Anthropic Principle is an instance of Copernicanism. It has close affinities with the step of Copernicus that Immanuel Kant took himself to be imitating in the 'critical' turn that gave rise to the Critique of Pure Reason. I conclude that the fact that a way of going about natural science mentions human beings is not sufficient reason to think that it is a subjective approach; in fact, it may need to mention human beings in order to be objective.

Principles, Feelings and Reality

ERIC Educational Resources Information Center

Noddings, Nel

2006-01-01

Two of Susan Moller Okin's articles are discussed: "Reason and feeling in thinking about justice", "Ethics" 99(2), 1989: 229-49 and "Mistresses of their own destiny: group rights, gender, and realistic rights of exit", "Ethics" 112(2), 2002: 205-30. Her argument on the foundation necessary for Rawls's…

Technology: Educational Media and Materials for the Handicapped Program. Final Report.

ERIC Educational Resources Information Center

Johns Hopkins Univ., Laurel, MD. Applied Physics Lab.

Results are presented of a project that developed 12 social studies (specifically, directionality and geography) and critical thinking computerized instructional modules using multimedia instruction for students with learning disabilities at the upper elementary and lower intermediate school levels. Seven overarching principles were identified as…

Connecting Conscious and Unconscious Processing

ERIC Educational Resources Information Center

Cleeremans, Axel

2014-01-01

Consciousness remains a mystery--"a phenomenon that people do not know how to think about--yet" (Dennett, D. C., 1991, p. 21). Here, I consider how the connectionist perspective on information processing may help us progress toward the goal of understanding the computational principles through which conscious and unconscious processing…

Structure-Function Relations in Physiology Education: Where's the Mechanism?

ERIC Educational Resources Information Center

Lira, Matthew E.; Gardner, Stephanie M.

2017-01-01

Physiology demands systems thinking: reasoning within and between levels of biological organization and across different organ systems. Many physiological mechanisms explain how structures and their properties interact at one level of organization to produce emergent functions at a higher level of organization. Current physiology principles, such…

Roadblocks to Scientific Thinking in Educational Decision Making

ERIC Educational Resources Information Center

Yates, Gregory C. R.

2008-01-01

Principles of scientific data accumulation and evidence-based practices are vehicles of professional enhancement. In this article, the author argues that a scientific knowledge base exists descriptive of the relationship between teachers' activities and student learning. This database appears barely recognised however, for reasons including (a)…

Critical Thinking in Respiratory Therapy Students: Comparing Baccalaureate and Associate Degree Students

ERIC Educational Resources Information Center

Clark, Myava C.

2012-01-01

Respiratory care is an allied health discipline that specializes in cardiopulmonary function and health. Respiratory therapists apply scientific principles to prevent, identify, and treat acute and chronic dysfunction of the cardiopulmonary system. Respiratory care specifically focuses on the assessment, treatment, management, control, diagnostic…

Thinking about Flexibility

ERIC Educational Resources Information Center

Villa, Mario Diaz

2009-01-01

This article emphasizes the complexity of the term flexibility and discusses its meanings and political dimensions, along with its expressions or realizations within the field of higher education. It proposes a new principle of flexibility that overcomes an understanding of flexibility within higher education as the mere ability or versatility to…

Word Links: A Strategy for Developing Word Knowledge

ERIC Educational Resources Information Center

Yopp, Ruth Helen

2007-01-01

Word Links, an effective strategy for developing students' vocabulary, is based on four principles. It provides contextual and definitional information; offers repeated exposure to words and opportunities to practice them; encourages students to think about relationships among word meanings; and involves active engagement in learning tasks. Yopp…

What Undergraduates Think about Clouds and Fog

ERIC Educational Resources Information Center

Rappaport, Elliot D.

2009-01-01

Weather events are part of every student's experience, and are controlled by basic principles involving the behavior of matter and energy. Despite this, many students have difficulty explaining simple atmospheric phenomena, even after exposure to primary and secondary science curricula. This study investigated the level to which undergraduates…

Friendly Alternatives to the Argumentative Essay.

ERIC Educational Resources Information Center

Costanzo, William V.

Many teachers would like to counter what Deborah Tannen calls "The Argument Culture." They recognize that teaching students traditional principles of argument may perpetuate the kind of adversarial thinking that erupts all too often: in aggressive newspaper headlines, on confrontational television shows, in court rooms, and in school…

Reducing waste and errors: piloting lean principles at Intermountain Healthcare.

PubMed

Jimmerson, Cindy; Weber, Dorothy; Sobek, Durward K

2005-05-01

The Toyota Production System (TPS), based on industrial engineering principles and operational innovations, is used to achieve waste reduction and efficiency while increasing product quality. Several key tools and principles, adapted to health care, have proved effective in improving hospital operations. Value Stream Maps (VSMs), which represent the key people, material, and information flows required to deliver a product or service, distinguish between value-adding and non-value-adding steps. The one-page Problem-Solving A3 Report guides staff through a rigorous and systematic problem-solving process. PILOT PROJECT at INTERMOUNTAIN HEALTHCARE: In a pilot project, participants made many improvements, ranging from simple changes implemented immediately (for example, heart monitor paper not available when a patient presented with a dysrythmia) to larger projects involving patient or information flow issues across multiple departments. Most of the improvements required little or no investment and reduced significant amounts of wasted time for front-line workers. In one unit, turnaround time for pathologist reports from an anatomical pathology lab was reduced from five to two days. TPS principles and tools are applicable to an endless variety of processes and work settings in health care and can be used to address critical challenges such as medical errors, escalating costs, and staffing shortages.

An analysis of mobile whole blood collection labor efficiency.

PubMed

Rose, William N; Dayton, Paula J; Raife, Thomas J

2011-07-01

Labor efficiency is desirable in mobile blood collection. There are few published data on labor efficiency. The variability in the labor efficiency of mobile whole blood collections was analyzed. We determined to improve our labor efficiency using lean manufacturing principles. Workflow changes in mobile collections were implemented with the goal of minimizing labor expenditures. To measure success, data on labor efficiency measured by units/hour/full-time equivalent (FTE) were collected. The labor efficiency in a 6-month period before the implementation of changes, and in months 1 to 6 and 7 to 12 after implementation was analyzed and compared. Labor efficiency in the 6-month period preceding implementation was 1.06 ± 0.4 units collected/hour/FTE. In months 1 to 6, labor efficiency declined slightly to 0.92 ± 0.4 units collected/hour/FTE (p = 0.016 vs. preimplementation). In months 7 to 12, the mean labor efficiency returned to preimplementation levels of 1.09 ±0.4 units collected/hour/FTE. Regression analysis correlating labor efficiency with total units collected per drive revealed a strong correlation (R(2) = 0.48 for the aggregate data from all three periods), indicating that nearly half of labor efficiency was associated with drive size. The lean-based changes in workflow were subjectively favored by employees and donors. The labor efficiency of our mobile whole blood drives is strongly influenced by size. Larger drives are more efficient, with diminishing returns above 40 units collected. Lean-based workflow changes were positively received by employees and donors. © 2011 American Association of Blood Banks.

Developing a Performance Data Suite to Facilitate Lean Improvement in a Chemotherapy Day Unit

PubMed Central

Lingaratnam, Senthil; Murray, Danielle; Carle, Amber; Kirsa, Sue W.; Paterson, Rebecca; Rischin, Danny

2013-01-01

Purpose: A multidisciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia, developed a performance data suite to support a service improvement project based on lean manufacturing principles in its 19-chair chemotherapy day unit (CDU) and cytosuite chemotherapy production facility. The aims of the project were to reduce patient wait time and improve equity of access to the CDU. Methods: A project team consisting of a pharmacist and CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes, analyze root causes, eliminate non–value-adding steps, reduce variation, and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, medical record audits, and interrogation of electronic treatment records were undertaken. Results: This project delivered a 38% reduction in median wait time on the day (from 32 to 20 minutes; P < .01), 7-day reduction in time to commencement of treatment for patients receiving combined chemoradiotherapy regimens (from 25 to 18 days; P < .01), and 22% reduction in wastage associated with expired drug and pharmacy rework (from 29% to 7%; P < .01). Improvements in efficiency enabled the cytosuite to increase the percentage of product manufactured within 10 minutes of appointment times by 29% (from 47% to 76%; P < .01). Conclusion: A lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU, resulting in improved access to treatment and reduced waiting times on the day. PMID:23942927

Energy requirements, protein-energy metabolism and balance, and carbohydrates in preterm infants.

PubMed

Hay, William W; Brown, Laura D; Denne, Scott C

2014-01-01

Energy is necessary for all vital functions of the body at molecular, cellular, organ, and systemic levels. Preterm infants have minimum energy requirements for basal metabolism and growth, but also have requirements for unique physiology and metabolism that influence energy expenditure. These include body size, postnatal age, physical activity, dietary intake, environmental temperatures, energy losses in the stool and urine, and clinical conditions and diseases, as well as changes in body composition. Both energy and protein are necessary to produce normal rates of growth. Carbohydrates (primarily glucose) are principle sources of energy for the brain and heart until lipid oxidation develops over several days to weeks after birth. A higher protein/energy ratio is necessary in most preterm infants to approximate normal intrauterine growth rates. Lean tissue is predominantly produced during early gestation, which continues through to term. During later gestation, fat accretion in adipose tissue adds increasingly large caloric requirements to the lean tissue growth. Once protein intake is sufficient to promote net lean body accretion, additional energy primarily produces more body fat, which increases almost linearly at energy intakes >80-90 kcal/kg/day in normal, healthy preterm infants. Rapid gains in adiposity have the potential to produce later life obesity, an increasingly recognized risk of excessive energy intake. In addition to fundamental requirements for glucose, protein, and fat, a variety of non-glucose carbohydrates found in human milk may have important roles in promoting growth and development, as well as production of a gut microbiome that could protect against necrotizing enterocolitis. © 2014 S. Karger AG, Basel.

Obese and overweight individuals are less sensitive to information about meal times in portion size judgements.

PubMed

Zimmerman, A R; Mason, A; Rogers, P J; Brunstrom, J M

2017-11-16

Obesity is related to a tendency to discount the future. Information regarding inter-meal interval (IMI) allows meal planning. We sought to assess how obese, overweight, and lean people select portion sizes based on the length of an IMI. We hypothesised that individuals with a high BMI would discount information about the IMI. In addition, we investigated how reduced sensitivity to IMIs relates to monetary temporal discounting. Participants (lean, n=35; overweight, n=31; obese, n=22), selected lunchtime portion sizes in response to information about the timings of their next meal. In seven trials, the time of the IMI was systematically manipulated, ranging from 'right now' to '8 h'. Participants then completed a monetary temporal discounting task. BMI was included as a continuous measure. For each participant, we conducted a linear regression of portion size on IMI to yield a gradient that reflected reduced sensitivity to future meal timings. As expected, participants selected larger portion sizes in response to a long IMI. Consistent with our hypothesis, individuals with a high BMI discounted information about the IMI (β=-3.49, P=0.015; confidence interval (CI) 6.29 to -0.70). Monetary discounting also negatively predicted BMI (β=-8.1, P=0.003; CI=-13.43 to -2.77), but did not correlate with IMI sensitivity (P>0.05). These results are the first to demonstrate that temporal discounting operates in planning from one meal to the next, and is more prevalent in obese and overweight, relative to lean individuals. Participants with a high BMI discounted concerns about potential future fullness and hunger in the IMI. Our observations might begin to explain associations between obesity and irregular meal timings or help to form the basis for a targeted intervention that promotes future thinking in meal planning.International Journal of Obesity accepted article preview online, 16 November 2017. doi:10.1038/ijo.2017.275.

Evolutionary Science as a Method to Facilitate Higher Level Thinking and Reasoning in Medical Training.

PubMed

Graves, Joseph L; Reiber, Chris; Thanukos, Anna; Hurtado, Magdalena; Wolpaw, Terry

2016-10-15

Evolutionary science is indispensable for understanding biological processes. Effective medical treatment must be anchored in sound biology. However, currently the insights available from evolutionary science are not adequately incorporated in either pre-medical or medical school curricula. To illuminate how evolution may be helpful in these areas, examples in which the insights of evolutionary science are already improving medical treatment and ways in which evolutionary reasoning can be practiced in the context of medicine are provided. In order to facilitate the learning of evolutionary principles, concepts derived from evolutionary science that medical students and professionals should understand are outlined. These concepts are designed to be authoritative and at the same time easily accessible for anyone with the general biological knowledge of a first-year medical student. Thus we conclude that medical practice informed by evolutionary principles will be more effective and lead to better patient outcomes.Furthermore, it is argued that evolutionary medicine complements general medical training because it provides an additional means by which medical students can practice the critical thinking skills that will be important in their future practice. We argue that core concepts from evolutionary science have the potential to improve critical thinking and facilitate more effective learning in medical training. © The Author(s) 2016. Published by Oxford University Press on behalf of the Foundation for Evolution, Medicine, and Public Health.

"I Left the Museum Somewhat Changed": Visual Arts and Health Ethics Education.

PubMed

Delany, Clare; Gaunt, Heather

2018-07-01

A common goal of ethics education is to equip students who later become health practitioners to not only know about the ethical principles guiding their practice, but to also autonomously recognize when and how these principles might apply and assist these future practitioners in providing care for patients and families. This article aims to contribute to discussions about ethics education pedagogy and teaching, by presenting and evaluating the use of the visual arts as an educational approach designed to facilitate students' moral imagination and independent critical thinking about ethics in clinical practice. We describe a sequence of ethics education strategies over a 3 year Doctor of Physiotherapy program, focusing on the final year professional ethics assessment task, which involved the use of visual arts to stimulate the exploration of ethics in healthcare. The data (in the form of student essays about their chosen artwork) were analyzed using both thematic and content analysis. Two key themes centered on emotional responses and lateral thinking. The use of artwork appeared to facilitate imaginative, emotional, and conceptual thinking about ethics and clinical experience (both past and future). This study provides some evidence to support the effectiveness of the use of the visual arts in promoting students' recognition of ethical dimensions within their clinical experience and reflection on their emerging professional identity. As one student noted, she left the museum "somewhat changed."

[Study on culture and philosophy of processing of traditional Chinese medicines].

PubMed

Yang, Ming; Zhang, Ding-Kun; Zhong, Ling-Yun; Wang, Fang

2013-07-01

According to cultural views and philosophical thoughts, this paper studies the cultural origin, thinking modes, core principles, general regulation and methods of processing, backtracks processing's culture and history which contains generation and deduction process, experienced and promoting process, and core value, summarizes processing's basic principles which are directed by holistic, objective, dynamic, balanced and appropriate thoughts; so as to propagate cultural characteristic and philosophical wisdom of traditional Chinese medicine processing, to promote inheritance and development of processing and to ensure the maximum therapeutic value of Chinese medical clinical.

Increasing readers' comprehension of health education brochures: a qualitative study into how professional writers make texts coherent.

PubMed

Kools, Marieke; Ruiter, Robert A C; van de Wiel, Margaretha W J; Kok, Gerjo

2004-12-01

The aim of this study was to gain insight into the extent to which health education text writers apply writing principles derived from cognitive psychological theory. Seventeen professional text writers of health education materials participated in a qualitative study, consisting of a rewriting task combined with a think-aloud procedure and a semistructured interview. The verbal data were explored carefully in light of seven text coherence principles that have proven effective in cognitive psychological research to increase text comprehension. Findings indicate text writers vary in their ideas and use of coherence principles to make a text comprehensible. It is argued that the health education profession can benefit greatly from knowledge about cognitive text processing and cognitive coherence principles for realizing effective comprehension of written health education messages.

[DSM-III: the 3d edition of the Diagnostic and Statistical Manual of Mental Disorders from the American Psychiatric Association].

PubMed

Pichot, P

1986-01-01

The Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM-III) published by the American Psychiatric Association in 1980, and now translated in many languages, has raised a great interest in the whole world. It has probably had on psychiatric thinking as important an impact as the Treatise of Psychiatry of E. Kraepelin at the beginning of the century. The evolution of psychiatric nosology and the circumstances of the birth of DSM-III are described. In discussing the general principles and the technical aspects, the influence of several currents of thought are emphasized: recent remedicalization of psychiatry in the United States, suspicion about speculative theories, return to an a-theoretical clinical descriptive nosology, influence of quantitative differential psychology and of the models provided by computer diagnosis. The nature of the two basic principles: the necessity of attaining a proven high interjudge reliability in diagnosis, and the descriptive a-theoretical nature of the description of each category is analyzed. From those principles derive the most original features of the DSM-III: the use of stringent diagnostic criteria, of a possible quantitative nature and the adoption of a multi-axial system. Some of the most striking changes introduced are the logical consequences of the principles e.g. the deletion of the term "neurosis". Others changes such as the introduction of new diagnostic categories or changes in the limits of classical ones (especially schizophrenia and manic-depressive psychosis) reflect a reaction against previous trends of American psychiatry and a strict adherence to a pragmatic and empirical thinking. In addition, the flexibility of its structure allows for the incorporation of new empirical results. In spite of many criticisms, either against the general orientation or against specific positions, some of which are presented in the course of this article, it is concluded that the success of the DSM-III results from a trend in psychiatric thinking not confined to the United States. Its controversial nature has stimulated the reappraisal of old concepts, and it can be considered as an important contribution towards a closer integration of psychiatry to medicine.

Redesigning printed educational materials for primary care physicians: design improvements increase usability.

PubMed

Grudniewicz, Agnes; Bhattacharyya, Onil; McKibbon, K Ann; Straus, Sharon E

2015-11-04

Printed educational materials (PEMs) are a frequently used tool to disseminate clinical information and attempt to change behavior within primary care. However, their effect on clinician behavior is limited. In this study, we explored how PEMs can be redesigned to better meet the needs of primary care physicians (PCPs) and whether usability and selection can be increased when design principles and user preferences are used. We redesigned a publicly available PEM using physician preferences, design principles, and graphic designer support. We invited PCPs to select their preferred document between the redesigned and original versions in a discrete choice experiment, followed by an assessment of usability with the System Usability Scale and a think aloud process. We conducted this study in both a controlled and opportunistic setting to determine whether usability testing results vary by study location. Think aloud data was thematically analyzed, and results were interpreted using the Technology Acceptance Model. One hundred and eighty four PCPs participated in the discrete choice experiment at the 2014 Family Medicine Forum, a large Canadian conference for family physicians. Of these, 87.7 % preferred the redesigned version. Follow-up interviews were held with a randomly selected group of seven participants. We repeated this in a controlled setting in Toronto, Canada, with a set of 14 participants. Using the System Usability Scale, we found that usability scores were significantly increased with the redesign (p < 0.001). We also found that when PCPs were given the choice between the two versions, they selected the redesigned version as their preferred PEM more often than the original (p < 0.001). Results did not appear to differ between the opportunistic and controlled setting. We used the results of the think aloud process to add to a list of end user preferences developed in a previous study. We found that redesigning a PEM with user preferences and design principles can improve its usability and result in the PEM being selected more often than the original. We feel this finding supports the involvement of the user, application of design principles, and the assistance of a graphic designer in the development of PEMs.

Focus on Ethics and Public Relations Practice in a University Classroom

ERIC Educational Resources Information Center

Smudde, Peter M.

2011-01-01

Public relations action relies on sound decision making about how to inspire cooperation between an organization and its publics. Such thinking must uphold principles for ethical communication. Effectively combining ethics with public relations practice for students is key. A pedagogical approach to public relations ethics, hinging on selected…

Developing the Area of a Trapezoid

ERIC Educational Resources Information Center

Manizade, Agida G.; Mason, Marguerite M.

2014-01-01

A mathematics classroom that reflects the vision of NCTM's "Principles and Standards for School Mathematics" will have the teacher posing problems, asking questions that build on students' thinking, and encouraging students to explore different solutions. In teaching about area, it is not sufficient to give students the…

Confucius' Analysis of the Human Nature of Irrationality and His Quest for Moral Education

ERIC Educational Resources Information Center

Jiawei, Xing

2015-01-01

This study uses mainly Confucian classic Lunyu to explore Confucius' insightful thinking about humans' strong innate nature of irrationality out of their physical needs. Irrationality causes interpersonal disturbances and chaos, and as such moral education is indispensable. Confucius advocated humanity, the principles of conscientiousness and…

From Principles to Practice in Education for Intercultural Citizenship

ERIC Educational Resources Information Center

Byram, Michael, Ed.; Golubeva, Irina, Ed.; Hui, Han, Ed.; Wagner, Manuela, Ed.

2016-01-01

The contributors to this volume have collaborated to present their work on introducing competences in intercultural communication and citizenship into foreign language education. The book examines how learners and teachers think about citizenship and interculturality, and shows how teachers and researchers from primary to university education can…

A CS1 Pedagogical Approach to Parallel Thinking

ERIC Educational Resources Information Center

Rague, Brian William

2010-01-01

Almost all collegiate programs in Computer Science offer an introductory course in programming primarily devoted to communicating the foundational principles of software design and development. The ACM designates this introduction to computer programming course for first-year students as CS1, during which methodologies for solving problems within…

Be Happy

ERIC Educational Resources Information Center

Bragdon, Julie

2013-01-01

The author has been thinking a lot about happiness lately. This started in earnest when she watched researcher Shawn Achor's 7-minute TEDX talk, entitled "The Happy Secret to Better Work," with parents and staff. Afterward, she was compelled to buy his book to learn more. "The Happiness Advantage: The Seven Principles of Positive Psychology That…

A Study of Moral Development and Personality Relationships in Adolescents and Young Adult Catholic Students.

ERIC Educational Resources Information Center

Polovy, Patricia

1980-01-01

Those who preferred principled levels of moral reasoning were seen as being dependable, rational, creative, intelligent, and accepting of rules and constraints of society, but at the same time, able to think independently and aware of the need for change. (Author)

Making It Happen: A Positive Guide to the Future.

ERIC Educational Resources Information Center

Richardson, John M., Jr., Ed.

This compilation of articles, photographs, commentaries, diagrams, and political cartoons presents positive, practical, and action-oriented core ideas on which to base future-oriented thinking and creative activity. The first of 10 parts presents articles on traditional American principles, ways of facing the future, America's character and…

Teachers Judging without Scripts, or Thinking Cosmopolitan

ERIC Educational Resources Information Center

Todd, Sharon

2007-01-01

A cosmopolitan ethic invites both an appreciation of the rich diversity of values, traditions and ways of life "and" a commitment to broad, universal principles of human rights that can secure the flourishing of that diversity. Despite the tension between universalism and particularism inherent in this outlook, it has received much…

The Importance of Engaging Pupils Actively in Demonstrations

ERIC Educational Resources Information Center

Suomela, Liisa; Juuti, Kalle; Ahtee, Maija

2013-01-01

Demonstrating is a traditional method in teaching science that can raise interest and encourage pupils to think about a topic. While demonstrating, the teacher can focus the pupils' attention on the relevant facts and introduce scientific principles and concepts. Through discussion and actively making observations and inferences, rather than…

An Ecological Approach to the On-Line Assessment of Problem-Solving Paths: Principles and Applications.

ERIC Educational Resources Information Center

Shaw, Robert E.; And Others

1997-01-01

Proposes a theoretical framework for designing online-situated assessment tools for multimedia instructional systems. Uses a graphic method based on ecological psychology to monitor student performance through a learning activity. Explores the method's feasibility in case studies describing instructional systems teaching critical-thinking and…

Evaluation of Natural Resource Education Materials: Implications for Resource Management.

ERIC Educational Resources Information Center

Pomerantz, Gerri A.

1991-01-01

An analysis of elementary school natural resource lessons (n=700) that focus on ecological principles, on resource management issues, and on analytical skill development affecting students' environmental behavior is presented. The fundamental conclusion is that very few of the lesson materials help to develop critical thinking skills and behaviors…

Learning Unlimited: Transforming Learning in the Workplace. 2nd Edition.

ERIC Educational Resources Information Center

Rylatt, Alastair

This book is intended to provide managers, trainers, and others responsible for improving learning within their workplace with the tools, perspectives, and strategies to transform their workplace into a learning organization. Throughout the book, key principles underpinning recent thinking on positive workplace transformation are combined with…

Sustainability Education's Gift: Learning Patterns and Relationships

ERIC Educational Resources Information Center

Williams, Dilafruz

2008-01-01

The crisis of sustainability can be linked to the traditional forms of schooling driven by mechanistic and technocratic worldviews. Progressing to a more sustainable world requires a fundamental shift in the framework of formal education--its structure, content and process--to include principles of systems thinking and holistic learning. A case…

Wilderness management principles: science, logical thinking or personal opinion?

Treesearch

David N. Cole

1995-01-01

Recreational use adversely affects the ecological integrity of wilderness. Wilderness managers face the challenge of keeping this loss of ecological integrity to minimal levels, a task that must be accomplished primarily through management of wilderness visitors. For the past 30 years, researchers have assisted managers by assessing problems associated with...

Dyslexia and the Individual.

ERIC Educational Resources Information Center

Meredith, Patrick

The main objective of this book is to explain the thinking that is involved in working out a systematic scheme of the variables related to dyslexia. The contents of the book include "Origins of the Approach,""Some Principles of Instruction"; "Verbal Behavior"; "Our Ideas about Language"; "Left and Right"; "The Biology of the Book"; "Exploring…

Innovation in the Elementary Classroom

ERIC Educational Resources Information Center

Wright, Geoffrey A.; Jones, Matthew D.

2018-01-01

In this article, the authors outline an innovation curriculum that can be taught to elementary-aged students to expand their creative and innovative abilities and potential. The curriculum focuses on divergent and convergent thinking principles embedded in a hands-on learning pedagogy. The curriculum framework is based on an innovation model known…

Buddhism and Autonomy-Facilitating Education

ERIC Educational Resources Information Center

Morgan, Jeffrey

2013-01-01

This article argues that Buddhists can consistently support autonomy as an educational ideal. The article defines autonomy as a matter of thinking and acting according to principles that one has oneself endorsed, showing the relationship between this ideal and the possession of an enduring self. Three central Buddhist doctrines of conditioned…

Enhancing Teacher Education Students' Generic Skills through Problem-Based Learning

ERIC Educational Resources Information Center

Murray-Harvey, Rosalind; Curtis, David D.; Cattley, Georgina; Slee, Phillip T.

2005-01-01

Claims made for the value of problem-based learning (PBL) as an effective method for professional education programmes draw on constructivist principles of teaching and learning to achieve essential content knowledge, higher order thinking skills, and a team approach to problem-solving through the interdisciplinary, student-directed study of…

The Role of the Humanities in the Teaching of Chemistry.

ERIC Educational Resources Information Center

Labianca, Dominick A.

1984-01-01

Describes an interdisciplinary approach designed to use the humanities as a source of material to exemplify chemical principles, stimulate critical thinking along scientific lines, and demonstrate to nonscience majors that chemistry is relevant to their academic experiences. A sample unit on environmental pollution, drugs, and poisons is also…

Fostering Critical Thinking Skills in Students with Learning Disabilities: An Instructional Program.

ERIC Educational Resources Information Center

Leshowitz, Barry; And Others

1993-01-01

Twenty-two secondary students with learning disabilities were successfully taught the principles of scientific reasoning. Using student-teacher dialogs, students analyzed information presented in magazine articles and advertisements. Students improved their ability to identify the principal claim made in an article or advertisement, graph the…

A "Fair Play" Perspective of Ethics for Intercollegiate Debate.

ERIC Educational Resources Information Center

Gallagher, Jeanne

The philosophy behind competitive debate is to teach students the art of rational discourse with emphasis on correct use of evidence, analysis of argument, logical thinking and persuasive delivery. Although ethics help define the goals of the activity, the extreme competitiveness of intercollegiate debate threatens to undermine the principles of…

Beyond Stewardship: Common World Pedagogies for the Anthropocene

ERIC Educational Resources Information Center

Taylor, Affrica

2017-01-01

Interdisciplinary Anthropocene debates are prompting calls for a paradigm shift in thinking about what it means to be human and about our place and agency in the world. Within environmental education, sustainability remains centre stage and oddly disconnected from these Anthropocene debates. Framed by humanist principles, most sustainability…

Engaging Frontline Leaders and Staff in Real-Time Improvement.

PubMed

Phillips, Jennifer; Hebish, Linda J; Mann, Sharon; Ching, Joan M; Blackmore, C Craig

2016-04-01

The relationship of staff satisfaction and engagement to organizational success, along with the integral influence of frontline managers on this dimension, is well established in health care and other industries. To specifically address staff engagement, Virginia Mason Medical Center, an integrated, single-hospital health system, developed an approach that involved leaders, through the daily use of standard work for leaders, as well as staff, through a Lean-inspired staff idea system. Kaizen Promotion Office (KPO) staff members established three guiding principles: (1) Staff engagement begins with leader engagement; (2) Integrate daily improve- ment (kaizen) as a habitual way of life not as an add-on; and (3) Create an environment in which staff feel psycho- logically safe and valued. Two design elements--Standard Work for Leaders (SWL) and Everyday Lean Ideas (ELIs) were implemented. For the emergency department (ED), an early adopter of the staff engagement work, the challenge was to apply the guiding principles to improve staff engagement while improving quality and patient and staff satisfaction, even as patient volumes were increasing. Daily huddles for the KPO staff members and weekly leader rounds are used to elicit staff ideas and foster ELIs in real time. Overall progress to date has been tracked in terms of staff satisfaction surveys, voluntary staff turnover, adoption of SWL, and testing and implementation of staff ideas. For example, voluntary turnover of ED staff decreased from 14.6% in 2011 to 7.5% in 2012, and 2.0% in 2013. Organizationwide, at least 800 staff ideas are in motion at any given time, with finished ones posted in an idea supermarket website. A leadership and staff engagement approach that focuses on SWL and on capturing staff ideas for daily problem solving and improvement can contribute to organization success and improve the quality of health care delivery.

Reinventing Design Principles for Developing Low-Viscosity Carbon Dioxide-Binding Organic Liquids for Flue Gas Clean Up.

PubMed

Malhotra, Deepika; Koech, Phillip K; Heldebrant, David J; Cantu, David C; Zheng, Feng; Glezakou, Vassiliki-Alexandra; Rousseau, Roger

2017-02-08

Anthropogenic CO 2 emissions from point sources (e.g., coal fired-power plants) account for the majority of the greenhouse gases in the atmosphere. Water-lean solvent systems such as CO 2 -binding organic liquids (CO 2 BOLs) are being developed to reduce the energy requirement for CO 2 capture. Many water-lean solvents such as CO 2 BOLs are currently limited by the high viscosities of concentrated electrolyte solvents, thus many of these solvents have yet to move toward commercialization. Conventional standard trial-and-error approaches for viscosity reduction, while effective, are time consuming and economically expensive. We rethink the metrics and design principles of low-viscosity CO 2 -capture solvents using a combined synthesis and computational modeling approach. We critically study the effects of viscosity reducing factors such as orientation of hydrogen bonding, introduction of higher degrees of freedom, and cation or anion charge solvation, and assess whether or how each factor affects viscosity of CO 2 BOL CO 2 capture solvents. Ultimately, we found that hydrogen bond orientation and strength is the predominant factor influencing the viscosity in CO 2 BOL solvents. With this knowledge, a new CO 2 BOL variant, 1-MEIPADM-2-BOL, was synthesized and tested, resulting in a solvent that is approximately 60 % less viscous at 25 mol % CO 2 loading than our base compound 1-IPADM-2-BOL. The insights gained from the current study redefine the fundamental concepts and understanding of what influences viscosity in concentrated organic CO 2 -capture solvents. © 2017 Wiley-VCH Verlag GmbH & Co. KGaA, Weinheim.

TRUNK LEAN DURING A SINGLE-LEG SQUAT IS ASSOCIATED WITH TRUNK LEAN DURING PITCHING.

PubMed

Plummer, Hillary A; Oliver, Gretchen D; Powers, Christopher M; Michener, Lori A

2018-02-01

Impaired trunk motion during pitching may be a risk factor for upper extremity injuries. Specifically, increased forces about the shoulder and elbow have been observed in pitchers with excessive contralateral trunk lean during pitching. Because of the difficulty in identifying abnormal trunk motions during a high-speed task such as pitching, a clinical screening test is needed to identify pitchers who have impaired trunk motion during pitching. The purpose of this study was to determine the relationship between the degree of lateral trunk lean during the single-leg squat and amount of trunk lean during pitching and if trunk lean during pitching can be predicted from lean during the single-leg squat. Controlled Laboratory Study; Cross-sectional. Seventy-three young baseball pitchers (11.4 ± 1.7 years; 156.3 ± 11.9 cm; 50.5 ± 8.8 kg) participated. An electromagnetic tracking system was used to obtain trunk kinematic data during a single-leg squat task (lead leg) and at maximum shoulder external rotation of a fastball pitch. Pearson correlation coefficients for trunk lean during the single-leg squat and pitching were calculated. A linear regression analysis was performed to determine if trunk lean during pitching can be predicted from lean during the single-leg squat. There was a positive correlation between trunk lean during the single-leg squat and trunk lean during pitching (r = 0.53; p<0.001). Lateral trunk lean during the single-leg squat predicted the amount of lateral trunk lean during pitching (R 2 = 0.28; p < 0.001). A moderate positive correlation was observed between trunk lean during an SLS and pitching. Trunk lean during the single-leg squat explained 28% of the variance in trunk lean during pitching. Diagnosis, level 3.

TRUNK LEAN DURING A SINGLE-LEG SQUAT IS ASSOCIATED WITH TRUNK LEAN DURING PITCHING

PubMed Central

Oliver, Gretchen D.; Powers, Christopher M.; Michener, Lori A.

2018-01-01

Background Impaired trunk motion during pitching may be a risk factor for upper extremity injuries. Specifically, increased forces about the shoulder and elbow have been observed in pitchers with excessive contralateral trunk lean during pitching. Because of the difficulty in identifying abnormal trunk motions during a high-speed task such as pitching, a clinical screening test is needed to identify pitchers who have impaired trunk motion during pitching. Hypothesis/Purpose The purpose of this study was to determine the relationship between the degree of lateral trunk lean during the single-leg squat and amount of trunk lean during pitching and if trunk lean during pitching can be predicted from lean during the single-leg squat. Study Design Controlled Laboratory Study; Cross-sectional. Methods Seventy-three young baseball pitchers (11.4 ± 1.7 years; 156.3 ± 11.9 cm; 50.5 ± 8.8 kg) participated. An electromagnetic tracking system was used to obtain trunk kinematic data during a single-leg squat task (lead leg) and at maximum shoulder external rotation of a fastball pitch. Pearson correlation coefficients for trunk lean during the single-leg squat and pitching were calculated. A linear regression analysis was performed to determine if trunk lean during pitching can be predicted from lean during the single-leg squat. Results There was a positive correlation between trunk lean during the single-leg squat and trunk lean during pitching (r = 0.53; p<0.001). Lateral trunk lean during the single-leg squat predicted the amount of lateral trunk lean during pitching (R2 = 0.28; p < 0.001). Conclusions A moderate positive correlation was observed between trunk lean during an SLS and pitching. Trunk lean during the single-leg squat explained 28% of the variance in trunk lean during pitching. Level of Evidence Diagnosis, level 3 PMID:29484242

A Web-Based Lean Simulation Game for Office Operations: Training the Other Side of a Lean Enterprise

ERIC Educational Resources Information Center

Kuriger, Glenn W.; Wan, Huang-da; Mirehei, S. Moussa; Tamma, Saumya; Chen, F. Frank

2010-01-01

This research proposes a Web-based version of a lean office simulation game (WeBLOG). The game is designed to be used to train lean concepts to office and administrative personnel. This group belongs to the frequently forgotten side of a lean enterprise. Over four phases, the game presents the following seven lean tools: one-piece flow,…

How to get the most out of your orthopaedic fellowship: thinking about practice-based learning.

PubMed

Templeman, David

2012-09-01

Practice-based learning and improvement is an important skill set to develop during an orthopaedic trauma fellowship and is 1 of the 6 core competencies stated by the ACGME. The review of clinic cases is best done using a few simple models to develop a structured approach for studying cases. Three common sense and easy-to-use strategies to improve clinical practice are as follows: performing each case three times, studying the 4 quadrants of patient outcomes, and the application of the Pareto 80/20 rule. These principles help to develop a structured approach for analyzing and thinking about practice-based experiences.

Simulation of value stream mapping and discrete optimization of energy consumption in modular construction

NASA Astrophysics Data System (ADS)

Chowdhury, Md Mukul

With the increased practice of modularization and prefabrication, the construction industry gained the benefits of quality management, improved completion time, reduced site disruption and vehicular traffic, and improved overall safety and security. Whereas industrialized construction methods, such as modular and manufactured buildings, have evolved over decades, core techniques used in prefabrication plants vary only slightly from those employed in traditional site-built construction. With a focus on energy and cost efficient modular construction, this research presents the development of a simulation, measurement and optimization system for energy consumption in the manufacturing process of modular construction. The system is based on Lean Six Sigma principles and loosely coupled system operation to identify the non-value adding tasks and possible causes of low energy efficiency. The proposed system will also include visualization functions for demonstration of energy consumption in modular construction. The benefits of implementing this system include a reduction in the energy consumption in production cost, decrease of energy cost in the production of lean-modular construction, and increase profit. In addition, the visualization functions will provide detailed information about energy efficiency and operation flexibility in modular construction. A case study is presented to validate the reliability of the system.

Overview of the TriBITS Lifecycle Model: Lean/Agile Software Lifecycle Model for Research-based Computational Science and Engineering Software

DOE Office of Scientific and Technical Information (OSTI.GOV)

Bartlett, Roscoe A; Heroux, Dr. Michael A; Willenbring, James

2012-01-01

Software lifecycles are becoming an increasingly important issue for computational science & engineering (CSE) software. The process by which a piece of CSE software begins life as a set of research requirements and then matures into a trusted high-quality capability is both commonplace and extremely challenging. Although an implicit lifecycle is obviously being used in any effort, the challenges of this process--respecting the competing needs of research vs. production--cannot be overstated. Here we describe a proposal for a well-defined software lifecycle process based on modern Lean/Agile software engineering principles. What we propose is appropriate for many CSE software projects thatmore » are initially heavily focused on research but also are expected to eventually produce usable high-quality capabilities. The model is related to TriBITS, a build, integration and testing system, which serves as a strong foundation for this lifecycle model, and aspects of this lifecycle model are ingrained in the TriBITS system. Indeed this lifecycle process, if followed, will enable large-scale sustainable integration of many complex CSE software efforts across several institutions.« less

The happiest thought of Einstein's life.

NASA Astrophysics Data System (ADS)

Heller, M.

It is a commonly told story that Einstein formulated his famous principle of equivalence when thinking about what happens in a freely falling elevator, and that it was an original idea of his genius distinguished by the rare capability to see deep problems in the most ordinary things. In the reading of Einstein's and Ernst Mach's works the author has discovered that it was not a physicist in an elevator which led to the principle of equivalence but rather somebody falling from a roof; moreover, the idea behind the principle was not invented by Einstein himself but rather read by him from the book by Mach entitled The Science of Mechanics. The influence this book had on young Einstein is very well known.

Cull sow knife-separable lean content evaluation at harvest and lean mass content prediction equation development.

PubMed

Abell, Caitlyn E; Stalder, Kenneth J; Hendricks, Haven B; Fitzgerald, Robert F

2012-07-01

The objectives of this study were to develop a prediction equation for carcass knife-separable lean within and across USDA cull sow market weight classes (MWC) and to determine carcass and individual primal cut knife separable lean content from cull sows. There were significant percent lean and fat differences in the primal cuts across USDA MWC. The two lighter USDA MWC had a greater percent carcass lean and lower percent fat compared to the two heavier MWC. In general, hot carcass weight explained the majority of carcass lean variation. Additionally, backfat was a significant variation source when predicting cull sow carcass lean. The findings support using a single lean prediction equation across MWC to assist processors when making cull sow purchasing decisions and determine the mix of animals from various USDA MWC that will meet their needs when making pork products with defined lean:fat content. Copyright © 2012 Elsevier Ltd. All rights reserved.

Prevalence and hemodynamic effects of leaning during CPR

PubMed Central

Niles, Dana E.; Sutton, Robert M.; Nadkarni, Vinay M.; Glatz, Andrew; Zuercher, Mathias; Maltese, Matthew R.; Eilevstjønn, Joar; Abella, Benjamin S.; Becker, Lance B.; Berg, Robert A.

2013-01-01

Background Cardiopulmonary resuscitation (CPR) guidelines recommend complete release between chest compressions (CC). Objective Evaluate the hemodynamic effects of leaning (incomplete chest wall release) during CPR and the prevalence of leaning during CPR. Results In piglet ventricular fibrillation cardiac arrests, 10% and 20% (1.8 kg and 3.6 kg, respectively), leaning during CPR increased right atrial pressures, decreased coronary perfusion pressures, and decreased cardiac index and left ventricular myocardial blood flow by nearly 50%. In contrast, residual leaning of a 260 g accelerometer/ force feedback device did not adversely affect cardiac index or myocardial blood flow. Among 108 adult in-hospital CPR events, leaning ≥2.5 kg was demonstrable in 91% of the events and 12% of the evaluated CC. For 12 children with in-hospital CPR, 28% of CC had residual leaning ≥2.5 kg and 89% had residual leaning ≥0.5 kg. Conclusions Leaning during CPR increases intrathoracic pressure, decreases coronary perfusion pressure, and decreases cardiac output and myocardial blood flow. Leaning is common during CPR. PMID:22208173

The PCOS Patients differ in Lipid Profile According to their Phenotypes.

PubMed

Spałkowska, Magdalena; Mrozińska, Sandra; Gałuszka-Bednarczyk, Anna; Gosztyła, Katarzyna; Przywara, Agnieszka; Guzik, Justyna; Janeczko, Marek; Milewicz, Tomasz; Wojas-Pelc, Anna

2018-01-31

Polycystic ovary syndrome (PCOS) affects 4-18% of women of reproductive age. The number of reports exploring the lipid profiles among PCOS patients and number of studied patients are limited. The aim of our study was to assess the lipid profile separately in lean and non-lean women with polycystic ovary syndrome divided according to hyperandrogenemia, defined as free androgen index (FAI)≥5. The second aim was to compare the lipid profiles among lean and non-lean PCOS patients with respect to hyperandrogenemia and regularity of menstruation cycles. We evaluated 232 patients from Department of Endocrinological Gynecology, Jagiellonian University Medical College in Krakow diagnosed with PCOS. The population consisted of 166 lean and 66 non-lean women. We observed higher levels of total cholesterol, high-density lipoprotein cholesterol (HDL-C) in lean patients with FAI<5 than in lean patients with FAI≥5. There were no differences in lipid profile between non-lean patients with FAI≥5 and non-lean patients with FAI<5. Among lean patients higher total cholesterol levels were observed in those with irregular menstruation cycles and FAI<5 than in patients with FAI≥5 and regular cycles. There were no differences in lipid profiles between four phenotypes among non-lean PCOS patients. The results of our study showed differences in lipid profile between lean PCOS patients according to their phenotype based on androgens' level. This effect was abandoned by fat tissue mass in non-lean ones. Further studies should be conducted to explore these associations. © Georg Thieme Verlag KG Stuttgart · New York.

[Proposal for a physiologic concept of thought based on the results of stereotaxic psychosurgery].

PubMed

Nádvorník, P; Pogády, J; Bernadic, M

2003-05-01

Authors have fifty years long experience with psychostereotactic surgery. On the bases of 209 operations of different types of mentally ill patients, authors built their own physiological conception of the central nervous system function. The new conception is described using block operators of thinking at the level of hypothalamus, limbic system, and neocortex in the hierarchic order. The basic physiological hypothalamic block contains two operators: stimulus evaluation and decision to act. Both operators together form reasonable, objective substantiation of thinking, which is transformed into psychological, subjective description at higher cerebral levels. New operator is added to the block diagram at the level of the limbic system: the choice of response base on experience stored in the high capacity memory. Vast neocortical memory creates a model of the individual world and it enables a new operator to be involved: prediction of the future events. Thinking, originally based on concrete images, is using abstract terms, subjected to the principles of grammar. Physiological basis of thinking enables the convergence of subjective and objective.

Teaching Health versus Treating Illness: The Efficacy of Three Principles Correctional Counseling with People in an English Prison.

PubMed

Kelley, Thomas M; Hollows, Jacqueline; Lambert, Eric G; Savard, Dennis M; Pransky, Jack

2018-07-01

Three principles correctional counseling (3PCC) posits that people in prison have inner mental health they have obscured to varying degrees with their own thinking. 3PCC further posits that people in prison can rekindle and sustain this inner health via understanding how three psychospiritual principles-Universal Mind, consciousness, and thought-coalesce to form people's psychological experience. We review the three principles and explain how exposure to these principles can lead to improved mental health and improved behavior. Then, we describe 3PCC and distinguish it from prevailing correctional counseling methods. Finally, we present a preliminary study that examines the efficacy of 3PCC for improving the mental health and behavior of people in an English prison. Our findings show that participants exposed to 3PCC showed a significant improvement in mental well-being and purpose in life, significant reductions in anxiety and anger, and improved behavior in the prison community.

A case study on Measurement of Degree of Performance of an Industry by using Lean Score Technique

NASA Astrophysics Data System (ADS)

Srinivasa Rao, P.; Niraj, Malay

2016-09-01

Lean manufacturing concept is becoming a very important strategy for both academicians and practitioners in the recent times, and Japanese are using this practice for more than a decade. In this present scenario, this paper describes an innovative approach for lean performance evaluation by using fuzzy membership functions before and after implementing lean manufacturing techniques and formulating a model to establish the lean score through the lean attributes by eliminating major losses. It shows a systematic lean performance measurement by producing a final integrated unit less-score.

Development of framework for sustainable Lean implementation: an ISM approach

NASA Astrophysics Data System (ADS)

Jadhav, Jagdish Rajaram; Mantha, S. S.; Rane, Santosh B.

2014-07-01

The survival of any organization depends upon its competitive edge. Even though Lean is one of the most powerful quality improvement methodologies, nearly two-thirds of the Lean implementations results in failures and less than one-fifth of those implemented have sustained results. One of the most significant tasks of top management is to identify, understand and deploy the significant Lean practices like quality circle, Kanban, Just-in-time purchasing, etc. The term `bundle' is used to make groups of inter-related and internally consistent Lean practices. Eight significant Lean practice bundles have been identified based on literature reviewed and opinion of the experts. The order of execution of Lean practice bundles is very important. Lean practitioners must be able to understand the interrelationship between these practice bundles. The objective of this paper is to develop framework for sustainable Lean implementation using interpretive structural modelling approach.

Using Lean Process Improvement to Enhance Safety and Value in Orthopaedic Surgery: The Case of Spine Surgery.

PubMed

Sethi, Rajiv; Yanamadala, Vijay; Burton, Douglas C; Bess, Robert Shay

2017-11-01

Lean methodology was developed in the manufacturing industry to increase output and decrease costs. These labor organization methods have become the mainstay of major manufacturing companies worldwide. Lean methods involve continuous process improvement through the systematic elimination of waste, prevention of mistakes, and empowerment of workers to make changes. Because of the profit and productivity gains made in the manufacturing arena using lean methods, several healthcare organizations have adopted lean methodologies for patient care. Lean methods have now been implemented in many areas of health care. In orthopaedic surgery, lean methods have been applied to reduce complication rates and create a culture of continuous improvement. A step-by-step guide based on our experience can help surgeons use lean methods in practice. Surgeons and hospital centers well versed in lean methodology will be poised to reduce complications, improve patient outcomes, and optimize cost/benefit ratios for patient care.

Playground Exploration: An Opportunity for Incidental Learning of Mechanical Principles

ERIC Educational Resources Information Center

Lyons, Brian

2005-01-01

Play involves unstructured activity that is freely entered into and intrinsically rewarding. When children engage in play there is little intentional learning. There are no lesson plans. There are no daily objectives or specific learning outcomes. Incidental learning can cause relatively permanent changes in the way one thinks; accidental learning…

Case Study of an Epistemic Mathematics Computer Game

ERIC Educational Resources Information Center

Buteau, Chantal; Muller, Eric

2018-01-01

E-Brock Bugs is a serious educational game (SEG) about probability which was created based on Devlin's design principles for games whose players adopt identities of mathematically able persons. This kind of games in which "players think and act like real world professionals" has been called epistemic. This article presents an empirical…

Evaluating the Cooperative Component in Cooperative Learning: A Quasi-Experimental Study

ERIC Educational Resources Information Center

Emerson, Tisha L. N.; English, Linda K.; McGoldrick, KimMarie

2015-01-01

In this study, the authors employed a quasi-experimental research design to examine the efficacy of a cooperative learning pedagogy (i.e., think-pair-share exercises) integrated into sections of microeconomic principles. Materials, exercises, and assessment instruments for all study sections are identical except for the nature of the…

Re-Presenting the Library Collections: A Story of Principles, Pathways and Partnerships

ERIC Educational Resources Information Center

Kattau, Maureen

2012-01-01

Macquarie University Library's planning for a new library coincided with a major renewal of the university's curriculum and research activity. This provided a significant opportunity to re-think the presentation of the library collections in the new environment. This article describes how strategic alignment with university goals and the framework…

Ecopedagogy: A Movement between Critical Dialogue and Complexity: Proposal for a Categories System

ERIC Educational Resources Information Center

Norat, María de los Ángeles Vilches; Herrería, Alfonso Fernández; Rodríguez, Francisco Miguel Martínez

2016-01-01

This qualitative research has been undertaken with the purpose of developing an integrated system of categories based on ecopedagogy. Founded on the critical pedagogy of Paulo Freire, this movement moves towards complex thinking and holism. Its theoretical bases are set on principles of sustainability, biosensibility, ethics of care and global…

Commentary: Reflecting on and Navigating Projects in Humanization

ERIC Educational Resources Information Center

Lee, Carol D.

2017-01-01

Timothy San Pedro and Valerie Kinloch are among a powerful cohort of scholars who are pushing the ontological boundaries surrounding how we think about the conduct of educational research. A longstanding tension in the history of educational research has been conceptualizations of the goal of such work as discovering foundational principles about…

Enhancing the Cultural Identity of Early Adolescent Male African Americans.

ERIC Educational Resources Information Center

Bass, Christopher K.; Coleman, Hardin L. K.

This paper reports on the development of a school-based Afrocentric intervention for middle school male adolescents who are at risk for academic failure or underachievement. The intervention combined the principles of the rites of passage movement within African American communities and current thinking on the process of second culture acquisition…

Let's Start Leveling about Leveling

ERIC Educational Resources Information Center

Glasswell, Kath; Ford, Michael

2011-01-01

In this article, the authors propose a revised way of thinking about reading levels, one that promotes a wider and more flexible view of teacher decision making about the use of leveled texts in classrooms. They share five key principles to consider when looking at the use of instruction that involves matching leveled materials with readers.…

Teaching for Statistical Literacy: Utilising Affordances in Real-World Data

ERIC Educational Resources Information Center

Chick, Helen L.; Pierce, Robyn

2012-01-01

It is widely held that context is important in teaching mathematics and statistics. Consideration of context is central to statistical thinking, and any teaching of statistics must incorporate this aspect. Indeed, it has been advocated that real-world data sets can motivate the learning of statistical principles. It is not, however, a…

Fostering Undergraduate Research Experiences in Management Information Systems through the "Research Group" Framework

ERIC Educational Resources Information Center

Bartkus, Ken; Mills, Robert; Olsen, David

2010-01-01

The purpose of this paper is to propose an innovative approach to engaged learning. Founded on the principles of a scholarly think-tank and administered along the lines of a consulting organization, the proposed "Research Group" framework is designed to facilitate effective and efficient undergraduate research experiences in Management…

Classroom Experiments: Teaching Specific Topics or Promoting the Economic Way of Thinking?

ERIC Educational Resources Information Center

Emerson, Tisha L. N.; English, Linda K.

2016-01-01

The authors' data contain inter- and intra-class variations in experiments to which students in a principles of microeconomics course were exposed. These variations allowed the estimation of the effect on student achievement from the experimental treatment generally, as well as effects associated with participation in specific experiments. The…

Thinking for a Living: Education and the Wealth of Nations.

ERIC Educational Resources Information Center

Marshall, Ray; Tucker, Marc

This book addresses the issue of the appalling mismatch between what the economy needs and what the educational institutions actually provide. The book provides a blueprint for the radical reconstruction of schools, following many of the same principles that allowed some of the U.S. leading industrial organizations to rescue themselves from the…

Bright Hopes, Dim Realities: Vocational Innovation in American Correctional Education.

ERIC Educational Resources Information Center

Schlossman, Steven; And Others

Correctional education has thrived only in the context of a broader ideological consensus in favor of rehabilitation rather than punishment. This consensus has been far from the mainstream of correctional thinking in the United States during the 1980s. Modern advocates of prison industries are attempting to reinstate a once-operative principle.…

Community-Building Principles: Implications for Professional Development

ERIC Educational Resources Information Center

Austin, Sandra

2005-01-01

This article reviews a Think Tank meeting among child welfare practitioners at the 2003 Building Communities for 21st-Century Child Welfare Symposium. The Child Welfare League of America's focus on community building is recognition of the vital importance of promoting and fostering collaboration with community members to enhance the well-being of…

Using the Principles of SoTL to Redesign an Advanced Evolutionary Biology Course

ERIC Educational Resources Information Center

deBraga, Michael; Boyd, Cleo; Abdulnour, Shahad

2015-01-01

A primary goal of university instruction is the students' demonstration of improved, highly developed critical thinking (CT) skills. However, how do faculty encourage CT and its potential concomitant increase in student workload without negatively impacting student perceptions of the course? In this investigation, an advanced biology course is…

The Age of the Network: Organizing Principles for the 21st Century.

ERIC Educational Resources Information Center

Lipnack, Jessica; Stamps, Jeffrey

A practical view is offered to leaders, managers, and teams of how to think about their companies and reinvent them without losing the value and knowledge embedded in their current organization. Organizations can break through challenges and recognize entirely new business opportunities through the creation of interlocking, boundary-crossing…

The Influence of Traditional Beliefs on Vietnamese College Lecturers' Perceptions of Face

ERIC Educational Resources Information Center

Nguyen, Thi Quynh Trang

2015-01-01

In an East Asian context heavily influenced by Confucian ideas on principles for living and behaving, "face" plays a significant role in Vietnamese people's thinking and behaviour. In the context of education, Vietnamese teachers' concerns of saving face in classrooms have been implicitly taken for granted but not yet seriously examined…

Thinking about Bernoulli

ERIC Educational Resources Information Center

Kamela, Martin

2007-01-01

One of the most fun demonstrations in a freshman mechanics class is the levitation of a ball in a steady air stream even when the jet is directed at an angle. This and other demonstrations are often used to argue for the validity of Bernoulli's principle. As cautioned by some authors, however, it is important to avoid making sweeping statements…

Integrating Effective Pedagogies in Science Education with a Design of Alternative Experiments on Electromagnetics

ERIC Educational Resources Information Center

Zhou, Shaona; Yeung, Yau-Yuen; Wang, Yanlin; Wang, Xiaojun; Xiao, Hua

2014-01-01

Learning electromagnetics often involves dealing with problems with strong mathematical skills or thinking about problems in abstract and multiple spaces. Moreover, many students are often unable to explain some related physical phenomena using the appropriate electromagnetic principles. In this paper, we report on integrating two effective…

We Are the Champions: Organizational Learning and Change for Responsible Management Education

ERIC Educational Resources Information Center

Solitander, Nikodemus; Fougere, Martin; Sobczak, Andre; Herlin, Heidi

2012-01-01

As the number of institutions adopting the United Nations' Principles for Responsible Management Education (PRME) initiative grows, there is an overhanging risk that many of them will merely add "responsibility" as a topic to the existing curriculum. The authors contend that a serious reading of PRME should instead entail thinking in…