Using Discrete Event Simulation (DES) to manage theatre operations in healthcare: An audit-based case study

This paper discusses the application of Discrete Event Simulation (DES) in modelling the complex relationship between patient types, case-mix and operating theatre allocation in a large National Health Service (NHS) Trust in London. The simulation model that was constructed described the main features of nine theatres, focusing on operational processes and patient throughput times. The model was used to test three scenarios of case-mix and to demonstrate the potential of using simulation modelling as a cost effective method for understanding the issues of healthcare operations management and the role of simulation techniques in problem solving. The results indicated that removing all day cases will reduce patient throughput by 23.3% and the utilization of the orthopaedic theatre in particular by 6.5%. This represents a case example of how DES can be used by healthcare managers to inform decision making. © 2008 IEEE.

Patterns of interaction in construction team meetingsξ

Sir John Egan’s 1998 report on the construction industry (Construction Task Force 1998) noted its confrontational and adversarial nature. Both the original report and its subsequent endorsement in Accelerating Change (Strategic Forum 2002) called for improved working relationships—so-called ‘integration’—within and between both design and construction aspects. In this paper, we report on our observations of on-site team meetings for a major UK project during its construction phase. We attended a series of team meetings and recorded the patterns of verbal interaction that took place within them. In reporting our findings, we have deliberately used a graphical method for presenting the results, in the expectation that this will make them more readily accessible to designers. Our diagrams of these interaction patterns have already proved to be intuitively and quickly understood, and have generated interest and discussion among both those we observed and others who have seen them. We noted that different patterns of communication occurred in different types of meetings. Specifically, in the problem-solving meeting, there was a richness of interaction that was largely missing from progress meetings and technical meetings. Team members expressed greater satisfaction with this problem-solving meeting where these enriched exchanges took place. By making comparisons between the different patterns, we are also able to explore functional roles and their interactions. From this and other published evidence, we conclude that good teamworking practices depend on a complex interplay of relations and dependencies embedded within the team.

Growth setbacks in new firms

New firms in emerging industries are subject to complex dynamic processes which defy the attempts at prediction embodied in business conjectures. Discontinuous growth is common, but the issue of interruptions in the early growth of new firms has not been adequately addressed in the mainstream literature. We examine the prevalence of interruptions to growth in a cohort study of the growth trajectories of firms founded in 1990, then look to cases studies of individual firms to investigate underlying causes. We find that substantial growth is rare and continuous growth unusual, and that growth interruptions are the result of both internal and external dynamics. The managers of growing firms face shortages of vital resources and significant problems of resource synchronisation and coordination, many of which can lead to what are, in effect, changes of phase state. Meanwhile, the volatile environment of an emerging industry presents particular problems to young firms which have not yet built up reserves to sustain them through short-term crises. However, problem solving by those that survive provides an important source of learning which can underpin their future development. © 2004 Elsevier Ltd. All rights reserved.

Solving problems in production scheduling

Traditionally, production scheduling has been viewed as a problem-solving task that involves a single problem - generation of a suitable schedule. This paper presents an alternative model in which individual difficulties are viewed as problems, and the task is to maintain a suitable schedule by resolving as many of these problems as possible. Decision support software is described that has facilities for defining policies to handle numerous minor problems and complete problem-solving strategies to deal with major problems. The paper then discusses the potential for this style of decision support to improve the performance of human schedulers. © 1995.

A review of TRIZ, and its benefits and challenges in practice

TRIZ (the theory of inventive problem solving) has been promoted by several enthusiasts as a systematic methodology or toolkit that provides a logical approach to developing creativity for innovation and inventive problem solving. The methodology, which emerged from Russia in the 1960s, has spread to over 35 countries across the world. It is now being taught in several universities and it has been applied by a number of global organisations who have found it particularly useful for spurring new product development. However, while its popularity and attractiveness appear to be on a steady increase, there are practical issues which make the use of TRIZ in practice particularly challenging. These practical difficulties have largely been neglected by TRIZ literature. This paper takes a step away from conventional TRIZ literature, by exploring not just the benefits associated with TRIZ knowledge, but the challenges associated with its acquisition and application based on practical experience. Through a survey, first-hand information is collected from people who have tried (successfully and unsuccessfully) to understand and apply the methodology. The challenges recorded cut across a number of issues, ranging from the complex nature of the methodology to underlying organisational and cultural issues which hinder its understanding and application. Another contribution of this paper, potentially useful for TRIZ beginners, is the indication of what tools among the several contained in the TRIZ toolkit would be most useful to learn first, based on their observed degree of usage by the survey respondents. © 2012 Elsevier Ltd. All rights reserved.

Manufacturing excellent engineers: Skill development in a Masters programme

An MPhil programme, delivered by the Engineering Department at the University of Cambridge, claims to be excellent at preparing graduates for manufacturing industry careers. The course uses a combination of different educational experiences, including industry-based assignments, industrial visits and practical exercises. This research explores how problem solving skills are developed during the first module, Induction, which is designed to enable students to undertake their first industrial assignment. From the literature, four conditions necessary for skill development were identified: Provision of a skill description, making explicit key components A number of different experiences with a range of contextual variables A teaching process which includes regular feedback and student reflection Students motivated to learn. These were used to construct a skill development framework (SDF). Using a case study research design, multiple types of evidence were collected to test for the above conditions using both classroom observation and questionnaire methods. The results confirmed the presence of the SDF conditions at different levels, with reflection aspects considered the weakest. Conflicting results were obtained regarding the students' self-awareness of skill levels. A plausible explanation is a change in the students' frame of reference. This initial study set out to develop a better understanding of the process of skill development. Whilst the SDF appears reasonable, there is a need for further work in three broad areas of defining skills, assessing skills and developing reflection skills.