Integrated Lean Six Sigma approach for patient flow improvement in hospital emergency department

Because of increased competition between healthcare providers, higher customer expectations, stringent checks on insurance payments and new government regulations, it has become vital for healthcare organisations to enhance the quality of the care they provide, to increase efficiency, and to improve the cost effectiveness of their services. Consequently, a number of quality management concepts and tools are employed in the healthcare domain to achieve the most efficient ways of using time, manpower, space and other resources. Emergency departments are designed to provide a high-quality medical service with immediate availability of resources to those in need of emergency care. The challenge of maintaining a smooth flow of patients in emergency departments is a global problem. This study attempts to improve the patient flow in emergency departments by considering Lean techniques and Six Sigma methodology in a comprehensive conceptual framework. The proposed research will develop a systematic approach through integration of Lean techniques with Six Sigma methodology to improve patient flow in emergency departments. The results reported in this paper are based on a standard questionnaire survey of 350 patients in the Emergency Department of Aseer Central Hospital in Saudi Arabia. The results of the study led us to determine the most significant variables affecting patient satisfaction with patient flow, including waiting time during patient treatment in the emergency department; effectiveness of the system when dealing with the patient’s complaints; and the layout of the emergency department. The proposed model will be developed within a performance evaluation metric based on these critical variables, to be evaluated in future work within fuzzy logic for continuous quality improvement.

The schooling experience of six adolescent boys who have been diagnosed with Attention Deficit/ Hyperactivity Disorder (AD/HD)

This thesis explored the experience of schooling of six adolescent boys diagnosed with AD/HD from the perspectives of the boys, their mothers and their teachers. The study utilised social constructionism as the theoretical orientation and an explanatory theory of AD/HD, the Dynamic Developmental Theory (DDT) of AD/HD as a framework. Findings included the importance of making and managing friendships for young people with AD/HD, the importance of being informed about AD/HD as well classroom strategies that support the learning of students for teachers, and the apparent role that medication in concert with an engaging classroom environment can play in the successful schooling of boys with AD/HD.

Australian journalism students' motivations and job expectations : evidence from a survey across six universities

The value of tertiary journalism education is an often hotly-debated topic among journalism educators and in the industry. Yet, the voices of students are often not heard in these debates. For example, we know relatively little about why young people actually decide to study journalism, what area of journalism they want to work in and what they are looking for in a job. To shed more light on the student perspective, this paper reports on a survey of 320 undergraduate journalism students at six Australian universities. The results show that only a minority actually want to work in news journalism, while most prefer entertainment-focussed areas. Students are motivated mainly by a love for writing and because they like journalism as a profession. In terms of job characteristics, they are particularly interested in their own career progression, but also in the extent to which they can provide a public service.

The Six Core Elements of Business Process Management

The previous chapters gave an insightful introduction into the various facets of Business Process Management. We now share a rich understanding of the essential ideas behind designing and managing processes for organizational purposes. We have also learned about the various streams of research and development that have influenced contemporary BPM. As a matter of fact, BPM has become a holistic management discipline. As such, it requires that a plethora of facets needs to be addressed for its successful und sustainable application. This chapter provides a framework that consolidates and structures the essential factors that constitute BPM as a whole. Drawing from research in the field of maturity models, we suggest six core elements of BPM: strategic alignment, governance, methods, information technology, people, and culture. These six elements serve as the structure for this BPM Handbook.

Irregular readers : Arthur Conan Doyle’s “six dirty scoundrels”, boyhood and literacy in contemporary Sherlockian children’s literature

Young adult (YA) literature is a socialising genre that encourages young readers to take up particular ways of relating to historical or cultural materials. The first decade of the twenty-first century witnessed a boom in Sherlockian YA fiction using the Conan Doyle canon as a context and vocabulary for stories focused on the Baker Street Irregulars as figures of identification. This paper reads YA fiction’s deployment of Conan Doyle’s fictional universe as a strategy for negotiating anxieties of adolescent masculinity, particularly in relation to literacy and social agency.

Six theories of neoliberalism

This article takes as its starting point the observation that neoliberalism is a concept that is ‘oft-invoked but ill-defined’. It provides a taxonomy of uses of the term neoliberalism to include: (1) an all-purpose denunciatory category; (2) ‘the way things are’; (3) an institutional framework characterizing particular forms of national capitalism, most notably the Anglo-American ones; (4) a dominant ideology of global capitalism; (5) a form of governmentality and hegemony; and (6) a variant within the broad framework of liberalism as both theory and policy discourse. It is argued that this sprawling set of definitions are not mutually compatible, and that uses of the term need to be dramatically narrowed from its current association with anything and everything that a particular author may find objectionable. In particular, it is argued that the uses of the term by Michel Foucault in his 1978–9 lectures, found in The Birth of Biopolitics, are not particularly compatible with its more recent status as a variant of dominant ideology or hegemony theories. It instead proposes understanding neoliberalism in terms of historical institutionalism, with Foucault’s account of historical change complementing MaxWeber’s work identifying the distinctive economic sociology of national capitalisms.

The impact of diabetic ketoacidosis and age on behavior six months post-diagnosis in children with type 1 diabetes

Objectives: Children with type 1 diabetes mellitus (DM1) may be at increased risk of psychosocial and adjustment difficulties. We examined behavioral outcomes six months post-diagnosis in a group of children with newly diagnosed DM1. Methods: This study formed part of a larger longitudinal project examining pathophysiology and neuropsychological outcomes in diabetic patients with or without diabetic ketoacidosis (DKA). Participants were 61 children (mean age 11.8 years, SD 2.7 years) who presented with a new diagnosis of DM1 at the Royal Children’s Hospital, Melbourne. Twenty-three (11 female) presented in DKA and 38 (14 female) without DKA. Parents completed the behavior assessment system for children, second edition six months post-diagnosis. Results: There was a non-linear relationship between age and behavior. Internalising problems (i.e. anxiety depression, withdrawal) peaked in the transition from childhood to adolescence; children aged 10–13 years had elevated rates relative to the normal population (t = 2.55, P = 0.018). There was a non-significant trend for children under 10 to display internalising problems (P = 0.052), but rates were not elevated in children over 13 (P = 0.538). Externalising problems were not significantly elevated in any age group. Interestingly, children who presented in DKA were at lower risk of internalising problems than children without DKA (t = 3.83, P < 0.001). There was no effect of DKA on externalising behaviors. Conclusions: Children transitioning from childhood to adolescence are at significant risk for developing internalising problems such as anxiety and lowered mood after diagnosis of DM1. Somewhat counter-intuitively, parents of children presenting in DKA reported fewer internalising symptoms than parents of children without DKA. These results highlight the importance of monitoring and supporting psychosocial adjustment in newly diagnosed children even when they seem physically well.

Learning from Eames : six lessons

"Eventually everything connects—people, ideas, objects. The quality of the connections is the key toquality per se.” (Charles Eames) On 8 November, 2007, in a moment charged with serendipity, an Exhibition titled ‘The Gifted Eye of Charles Eames—A Portfolio of 100 images’ was opened exclusively to Brisbane. The Artisan Gallery in Fortitude Valley became the launch point for an international orbit of Fringe locations hosting one of 18 sets of 100 images each...

A comparative analysis of Mitochondrial genomes in Coleoptera (Arthropoda: Insecta) and genome descriptions of six new beetles

Coleoptera is the most diverse group of insects with over 360,000 described species divided into four suborders: Adephaga, Archostemata, Myxophaga, and Polyphaga. In this study, we present six new complete mitochondrial genome (mtgenome) descriptions, including a representative of each suborder, and analyze the evolution of mtgenomes from a comparative framework using all available coleopteran mtgenomes. We propose a modification of atypical cox1 start codons based on sequence alignment to better reflect the conservation observed across species as well as findings of TTG start codons in other genes. We also analyze tRNA-Ser(AGN) anticodons, usually GCU in arthropods, and report a conserved UCU anticodon as a possible synapomorphy across Polyphaga. We further analyze the secondary structure of tRNA-Ser(AGN) and present a consensus structure and an updated covariance model that allows tRNAscan-SE (via the COVE software package) to locate and fold these atypical tRNAs with much greater consistency. We also report secondary structure predictions for both rRNA genes based on conserved stems. All six species of beetle have the same gene order as the ancestral insect. We report noncoding DNA regions, including a small gap region of about 20 bp between tRNA-Ser(UCN) and nad1 that is present in all six genomes, and present results of a base composition analysis.

Is there a bone-nail specific entry point? automated fit quantification of tibial nail designs during the insertion for six different nail entry points

Intramedullary nailing is the standard fixation method for displaced diaphyseal fractures of tibia. Selection of the correct nail insertion point is important for axial alignment of bone fragments and to avoid iatrogenic fractures. However, the standard entry point (SEP) may not always optimise the bone-nail fit due to geometric variations of bones. This study aimed to investigate the optimal entry for a given bone-nail pair using the fit quantification software tool previously developed by the authors. The misfit was quantified for 20 bones with two nail designs (ETN and ETN-Proximal Bend) related to the SEP and 5 entry points which were 5 mm and 10 mm away from the SEP. The SEP was the optimal entry point for 50% of the bones used. For the remaining bones, the optimal entry point was located 5 mm away from the SEP, which improved the overall fit by 40% on average. However, entry points 10 mm away from the SEP doubled the misfit. The optimised bone-nail fit can be achieved through the SEP and within the range of a 5 mm radius, except posteriorly. The study results suggest that the optimal entry point should be selected by considering the fit during insertion and not only at the final position.

Are Australian homes liveable and adaptable for Muslim families? - Six case studies in Brisbane

This paper investigates how Muslims living in Brisbane live within their current Australian homes and the liveability and adaptability of these homes from the perspective of home dwellers with respect to their Islamic faiths, cultural traditions and lifestyle. A qualitative case study approach was used to gather information about Muslims’ use of domestic spaces through their lived experiences, within an Australian context. Six participants were interviewed, including: a) three Muslim families residing in one suburb of Brisbane, and; b) three international Muslim students living in three different Brisbane suburbs. These cases indicate that apart from minor difficulties, case study participants were able to perform their daily activities within their current homes through various adaptations made to ensure their respective domestic domains provided their families with privacy and a sense of security and safety. Insight gained from these cases suggest the need for more research into the homes of Muslims homes within an Australian context and the development of culturally adaptable housing as a means of meeting the diverse needs of modern Australian multicultural society.

No child’s play: Recognising the agency of former child soldiers in peace building processes

Engaging with the emerging discourse on children that recognises childhood as culturally specific and that children actively engage with their environment, this paper questions the dominant discourse’s view of children as passive recipients of socialisation. This paper argues that the discourse on children’s agency is a more useful framework for understanding the experiences of former child soldiers and that engaging meaningfully with this discourse will both improve life outcomes and reduce the risk of ongoing instability. This argument is made by an examination of the two discourses; examining their development and arguing for the usefulness of the agency discourse. This provides for an examination of children’s agency in education and skills training programs and of their political involvement (or marginalisation) in three conflicts: Colombia, Sierra Leone and Uganda. Recognising children as agents and engaging with how they navigate their lived experiences after involvement in conflict testifies to children’s resilience and their desire for change. Challenging the dominant discourse through the agency discourse allows for the acknowledgement of former child soldiers as both social and political agents in their own right and of their potential for contributing to stable and lasting peace.

Adaptive compliance control of a multi‐legged stair‐climbing robot based on proprioceptive data

Purpose – The purpose of this paper is to describe an innovative compliance control architecture for hybrid multi‐legged robots. The approach was verified on the hybrid legged‐wheeled robot ASGUARD, which was inspired by quadruped animals. The adaptive compliance controller allows the system to cope with a variety of stairs, very rough terrain, and is also able to move with high velocity on flat ground without changing the control parameters. Design/methodology/approach – The paper shows how this adaptivity results in a versatile controller for hybrid legged‐wheeled robots. For the locomotion control we use an adaptive model of motion pattern generators. The control approach takes into account the proprioceptive information of the torques, which are applied on the legs. The controller itself is embedded on a FPGA‐based, custom designed motor control board. An additional proprioceptive inclination feedback is used to make the same controller more robust in terms of stair‐climbing capabilities. Findings – The robot is well suited for disaster mitigation as well as for urban search and rescue missions, where it is often necessary to place sensors or cameras into dangerous or inaccessible areas to get a better situation awareness for the rescue personnel, before they enter a possibly dangerous area. A rugged, waterproof and dust‐proof corpus and the ability to swim are additional features of the robot. Originality/value – Contrary to existing approaches, a pre‐defined walking pattern for stair‐climbing was not used, but an adaptive approach based only on internal sensor information. In contrast to many other walking pattern based robots, the direct proprioceptive feedback was used in order to modify the internal control loop, thus adapting the compliance of each leg on‐line.