Innovation and learning for sustainable competitive advantage : preliminary findings

Achieving and sustaining competitive advantage is a major challenge for firms in today’s dynamic global marketplace. The notion of sustained competitive advantage has been investigated through a number of paradigms, from the resource based view of the firm to dynamic capabilities. This paper reports preliminary findings from research which investigates the characteristics of innovative firms that have demonstrated competitive advantage over time, targeting factors that contribute to the firm’s performance. Key factors to sustaining competitive advantage include working with demanding customers, team based organizational cultures, engaging in challenging projects to make new to the world products, and using projects to generate the necessity for learning by doing, learning by using and learning by interacting in new product and process development.

University library virtual reference services : best practices and continuous improvement

The inclusion or not of chat services within Virtual Reference (VR) is an important topic for university libraries. Increasingly, email supported by a Frequently Asked Questions (FAQ) database is suggested in the scholarly literature as the preferred, cost-effective means for providing university VR services. This paper examines these issues and identifies some best practices for university library VR services relating to chat and email service, collaborative service provision, services staffing, and staff training. Further studies are required to more completely identify best practices for the complete range of VR services.

Examining the role of human resource management in continuous improvement

The objective of this paper is to take a first step in developing a theoretical framework describing the role of HRM in successful CI, based on the current literature from both fields. To this end, elements from the CI Maturity Model and a framework depicting the role of HRM in innovation serve as a foundation for examining how specific bundles of HRM practices utilised during different phases of the CI implementation process may contribute to sustained organisational and enhanced operational performance. The primary contribution of this paper is theoretical; however, the framework has practical value in that it suggests important relationships between HRM practices and behaviours necessary for successful CI. A preliminary test of the framework in an empirical setting is summarised at the conclusion of this paper, where a number of possible research avenues are also suggested.

Performance measurement and continuous improvement : are they linked to manufacturing strategy?

To maintain or achieve competitiveness and profitability, a manufacturing firm or enterprise must respond to a range of challenges, including rapid improvements in technology; declining employment and output; globalisation of markets and environmental requirements. In addition, substantial changes in government policy have had important impacts in many countries, as have the increasing levels of global trade. Manufacturing enterprises need to have a clear understanding of what their customers want and why customers purchase their products rather than purchase from their competitors. They need to fully understand the aims of the business in terms of its customers, market segments, product attributes, geographical markets and performance. Continuous Improvement (CI) methods have become widely adopted and regarded as providing an important component of increased company competitiveness. This article examines the extent to which continuous improvement activities have contributed to the different areas of business performance.

An examination of factors influencing effective and continuous improvement of Indonesian contractors' quality management systems

This paper presents the results of a pilot study examining the factors that impact most on the effective implementation of, and improvement to, Quality Mangement Sytems (QMSs) amongst Indonesian construction companies. Nine critical factors were identified from an extensive literature review, and a survey was conducted of 23 respondents from three specific groups (Quality Managers, Project Managers, and Site Engineers) undertaking work in the Indonesian infrastructure construction sector. The data has been analyzed initially using simple descriptive techniques. This study reveals that different groups within the sector have different opinions of the factors regardless of the degree of importance of each factor. However, the evaluation of construction project success and the incentive schemes for high performance staff, are the two factors that were considered very important by most of the respondents in all three groups. In terms of their assessment of tools for measuring contractor’s performance, additional QMS guidelines, techniques related to QMS practice provided by the Government, and benchmarking, a clear majority in each group regarded their usefulness as ‘of some importance’.

The identification of Malaysian contractor satisfaction dimensions : a strategy for continuous improvement

The unique characteristics of the construction industry - such as the fragmentation of its processes, varied scope of works and diversity of its participants - are contributory factors to poor project performance. Several issues are unresolved due to the lack of a comprehensive technique to measure project outcomes including: inefficient decision making, insufficient communication, uncertain site conditions, a continuously changing environment, inharmonious working relationships, mismatched objectives within the project team and a blame culture. One approach to overcoming these problems appears to be to measure performance by gauging contractor satisfaction (Co-S) levels, but this has not been widely investigated as yet. Additionally, the key Co-S dimensions at the project level are still not fully identified. ----- ----- This paper concerns a study of satisfaction dimensions, primarily by a postal questionnaire survey of construction contractors registered by the Malaysian Construction Industry Development Board (CIDB). Eight satisfaction dimensions are identified that are significantly and substantially relate to these contractors - comprising: project cost performance, schedule performance, product performance, design satisfaction, site safety, project profitability, business performance and relationships between participants. -Each of these dimensions is accorded different priority levels of satisfaction by different contractors. ----- ----- The output of this study will be useful in raising the awareness and understanding of project teams regarding contractors’ needs, mutual objectives and open communication to help to deliver a successful project.

Corneal confocal microscopy shown an improvement in small-fibre neuropathy in subjects with type 1 diabetes on continuous subcutaneous insulin infusion compared to multiple daily injection

Improved glycemic control is the only treatment that has been shown to be effective for diabetic peripheral neuropathy in patients with type 1 diabetes (1). Continuous subcutaneous insulin infusion (CSII) is superior to multiple daily insulin injection (MDI) for reducing HbA1c and hypoglycemic events (2). Here, we have compared the benefits of CSII compared withMDI for neuropathy over 24months....

Continuous infusion of ticarcillin-clavulanate for home treatment of serious infections : clinical efficacy, safety, pharmacokinetics and pharmacodynamics

Continuous infusion (CI) ticarcillin–clavulanate is a potential therapeutic improvement over conventional intermittent dosing because the major pharmacodynamic (PD) predictor of efficacy of β-lactams is the time that free drug levels exceed the MIC. This study incorporated a 6-year retrospective arm evaluating efficacy and safety of CI ticarcillin–clavulanate in the home treatment of serious infections and a prospective arm additionally evaluating pharmacokinetics (PK) and PD. In the prospective arm, steady-state serum ticarcillin and clavulanate levels and MIC testing of significant pathogens were performed. One hundred and twelve patients (median age, 56 years) were treated with a CI dose of 9.3–12.4 g/day and mean CI duration of 18.0 days. Infections treated included osteomyelitis (50 patients), septic arthritis (6), cellulitis (17), pulmonary infections (12), febrile neutropenia (7), vascular infections (7), intra-abdominal infections (2), and Gram-negative endocarditis (2); 91/112 (81%) of patients were cured, 14 (13%) had partial response and 7 (6%) failed therapy. Nine patients had PICC line complications and five patients had drug adverse events. Eighteen patients had prospective PK/PD assessment although only four patients had sufficient data for a full PK/PD evaluation (both serum steady-state drug levels and ticarcillin and clavulanate MICs from a bacteriological isolate), as this was difficult to obtain in home-based patients, particularly as serum clavulanate levels were found to deteriorate rapidly on storage. Three of four patients with matched PK/PD assessment had free drug levels exceeding the MIC of the pathogen. Home CI of ticarcillin–clavulanate is a safe, effective, convenient and practical therapy and is a therapeutic advance over traditional intermittent dosing when used in the home setting.

Evaluation of financial incentives as a quality improvement strategy in the public hospital context : clinician attitudes, design variables, and economic costs

In 2008, a three-year pilot ‘pay for performance’ (P4P) program, known as ‘Clinical Practice Improvement Payment’ (CPIP) was introduced into Queensland Health (QHealth). QHealth is a large public health sector provider of acute, community, and public health services in Queensland, Australia. The organisation has recently embarked on a significant reform agenda including a review of existing funding arrangements (Duckett et al., 2008). Partly in response to this reform agenda, a casemix funding model has been implemented to reconnect health care funding with outcomes. CPIP was conceptualised as a performance-based scheme that rewarded quality with financial incentives. This is the first time such a scheme has been implemented into the public health sector in Australia with a focus on rewarding quality, and it is unique in that it has a large state-wide focus and includes 15 Districts. CPIP initially targeted five acute and community clinical areas including Mental Health, Discharge Medication, Emergency Department, Chronic Obstructive Pulmonary Disease, and Stroke. The CPIP scheme was designed around key concepts including the identification of clinical indicators that met the set criteria of: high disease burden, a well defined single diagnostic group or intervention, significant variations in clinical outcomes and/or practices, a good evidence, and clinician control and support (Ward, Daniels, Walker & Duckett, 2007). This evaluative research targeted Phase One of implementation of the CPIP scheme from January 2008 to March 2009. A formative evaluation utilising a mixed methodology and complementarity analysis was undertaken. The research involved three research questions and aimed to determine the knowledge, understanding, and attitudes of clinicians; identify improvements to the design, administration, and monitoring of CPIP; and determine the financial and economic costs of the scheme. Three key studies were undertaken to ascertain responses to the key research questions. Firstly, a survey of clinicians was undertaken to examine levels of knowledge and understanding and their attitudes to the scheme. Secondly, the study sought to apply Statistical Process Control (SPC) to the process indicators to assess if this enhanced the scheme and a third study examined a simple economic cost analysis. The CPIP Survey of clinicians elicited 192 clinician respondents. Over 70% of these respondents were supportive of the continuation of the CPIP scheme. This finding was also supported by the results of a quantitative altitude survey that identified positive attitudes in 6 of the 7 domains-including impact, awareness and understanding and clinical relevance, all being scored positive across the combined respondent group. SPC as a trending tool may play an important role in the early identification of indicator weakness for the CPIP scheme. This evaluative research study supports a previously identified need in the literature for a phased introduction of Pay for Performance (P4P) type programs. It further highlights the value of undertaking a formal risk assessment of clinician, management, and systemic levels of literacy and competency with measurement and monitoring of quality prior to a phased implementation. This phasing can then be guided by a P4P Design Variable Matrix which provides a selection of program design options such as indicator target and payment mechanisms. It became evident that a clear process is required to standardise how clinical indicators evolve over time and direct movement towards more rigorous ‘pay for performance’ targets and the development of an optimal funding model. Use of this matrix will enable the scheme to mature and build the literacy and competency of clinicians and the organisation as implementation progresses. Furthermore, the research identified that CPIP created a spotlight on clinical indicators and incentive payments of over five million from a potential ten million was secured across the five clinical areas in the first 15 months of the scheme. This indicates that quality was rewarded in the new QHealth funding model, and despite issues being identified with the payment mechanism, funding was distributed. The economic model used identified a relative low cost of reporting (under $8,000) as opposed to funds secured of over $300,000 for mental health as an example. Movement to a full cost effectiveness study of CPIP is supported. Overall the introduction of the CPIP scheme into QHealth has been a positive and effective strategy for engaging clinicians in quality and has been the catalyst for the identification and monitoring of valuable clinical process indicators. This research has highlighted that clinicians are supportive of the scheme in general; however, there are some significant risks that include the functioning of the CPIP payment mechanism. Given clinician support for the use of a pay–for-performance methodology in QHealth, the CPIP scheme has the potential to be a powerful addition to a multi-faceted suite of quality improvement initiatives within QHealth.

A longitudinal study of corporate earnings guidance in Australia’s continuous disclosure environment

Since the introduction of a statutory‐backed continuous disclosure regime (CDR) in 1994, regulatory reforms have significantly increased litigation risk in Australia for failure to disclose material information or for false and misleading disclosure. However, there is almost no empirical research on the impact of the reforms on corporate disclosure behaviour. Motivated by the absence of research and using management earnings forecasts (MEFs) as a disclosure proxy, this study examines (1) why managers issue earnings forecasts, (2) what firm‐specific factors influence MEF characteristics, and (3) how MEF behaviour changes as litigation risk increases. Based on theories in information economics, a theoretical framework for MEF behaviour is formulated which includes antecedent influencing factors related to firms‟ internal and external environments. Applying this framework, hypotheses are developed and tested using multivariate models and a large sample of hand-collected MEFs (7,213) issued by top 500 ASX-listed companies over the 1994 to 2008 period. The results reveal strong support for the hypotheses. First, MEFs are issued to reduce information asymmetry, litigation risk and signal superior performance. Second, firms with better financial performance, smaller earnings changes, and lower operating uncertainty provide better quality MEFs. Third, forecast frequency and quality (accuracy, timeliness and precision) noticeably improve as litigation risk increases. However, managers appear to be still reluctant to disclose earnings forecasts when there are large earnings changes, and an asymmetric treatment of news type continues to prevail (a good news bias). Thus, the findings generally provide support for the effectiveness of the CDR regulatory reforms in improving disclosure behaviour and will be valuable to market participants and corporate regulators in understanding the implications of management forecasting decisions and areas for further improvement.

Improvement of the statutory framework for construction and demolition waste management exemplified in Germany and Australia

Construction and demolition (C&D) waste occupies the largest share of overall waste generation in many countries. However, waste management practices and outcomes may differ between countries. For instance, in Australia, C&D waste recovery is continuously improving during the last years but the amount of C&D waste increases every year, as there has been little improvement in waste avoidance and minimization. In contrast, in Germany, waste generation remains constant over many years despite the continuous economic growth. The waste recycling rate in Germany is one of the highest in the world. However, most waste recycled is from demolition work rather than from waste generated during new construction. In addition, specific laws need to be developed to further reduce landfill of non-recycled waste. Despite of the differences, C&D waste generation and recovery in both countries depend on the effectiveness of the statutory framework, which regulates their waste management practices. This is an issue in other parts of the world as well. Therefore countries can learn from each other to improve their current statutory framework for C&D waste management. By taking Germany and Australia as an example, possible measures to improve current practices of C&D waste management through better statutory tools are identified in this paper. After providing an overview of the statutory framework of both countries and their status in waste generation and recovery, a SWOT analysis is conducted to identify strengths, weaknesses, opportunities and threats of the statutory tools. Recommendations to improve the current statutory frameworks, in order to achieve less waste generation and more waste recovery in the construction industry are provided for the German and Australian government and they can also be transferred to other countries.

Analysis of regionally enhanced GPS orbit and clock solutions and contribution to improvement of real-time precise point positioning

This work experimentally examines the performance benefits of a regional CORS network to the GPS orbit and clock solutions for supporting real-time Precise Point Positioning (PPP). The regionally enhanced GPS precise orbit solutions are derived from a global evenly distributed CORS network added with a densely distributed network in Australia and New Zealand. A series of computational schemes for different network configurations are adopted in the GAMIT-GLOBK and PANDA data processing. The precise GPS orbit results show that the regionally enhanced solutions achieve the overall orbit improvements with respect to the solutions derived from the global network only. Additionally, the orbital differences over GPS satellite arcs that are visible by any of the five Australia-wide CORS stations show a higher percentage of overall improvements compared to the satellite arcs that are not visible from these stations. The regional GPS clock and Uncalibrated Phase Delay (UPD) products are derived using the PANDA real time processing module from Australian CORS networks of 35 and 79 stations respectively. Analysis of PANDA kinematic PPP and kinematic PPP-AR solutions show certain overall improvements in the positioning performance from a denser network configuration after solution convergence. However, the clock and UPD enhancement on kinematic PPP solutions is marginal. It is suggested that other factors, such as effects of ionosphere, incorrectly fixed ambiguities, may be the more dominating, deserving further research attentions.

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.

Continuous disclosure compliance: Does corporate governance matter?

Our study investigates the quality of firms’ continuous disclosure compliance during mandatory continuous disclosure reform, and whether the compliance quality is impacted by corporate governance, using the New Zealand market as the setting. We use a novel coding of different categories of disclosures (nonroutine, non-procedural and internal), which represents the extent of proprietary insider information inherent in disclosures, to evaluate firms’compliance quality. Our findings provide evidence that firms’ compliance quality improved after the reform, and this improvement is inconsistently impacted by corporate gvernance. Our findings provide important implications for regulators in their quest for a superior disclosure regime