Benchmarking the business and operations strategy link.

This paper reports on the use of benchmarking to improve the links between business and operations strategies. The use of benchmarking as a tool to facilitate improvement in these crucial links is examined. The existing literature on process benchmarking is used to form a structured questionnaire to apply to six case studies of major maunfacturing companies. Four of these case studies are presented drawing upon the critical success factors identified both in the literature and on the case results. Recommendations for further work are outlined.

Design thinking - a critical analysis.

The latest buzz phrase to enter the world of design research is “Design Thinking”. But is this anything new and does it really have any practical or theoretical relevance to the design world? Many sceptics believe the term has more to do with business strategy and little to do with the complex process of designing products, services and systems. Moreover, many view the term as misleading and a cheap attempt to piggyback the world of business management onto design. This paper seeks to ask is design thinking anything new? Several authors have explicitly or implicitly articulated the term “Design Thinking” before, such as Peter Rowe’s seminal book “Design Thinking” [1] first published in 1987 and Herbert Simon’s “The Sciences of the Artificial” [2] first published in 1969. In Tim Brown’s “Change by Design” [3], design thinking is thought of as a system of three overlapping spaces rather than a sequence of orderly steps namely inspiration – the problem or opportunity that motivates the search for solutions; ideation – the process of generating, developing and testing ideas; and implementation – the path that leads from the design studio, lab and factory to the market. This paper seeks to examine and critically analyse the tenets of this new design thinking manifesto set against three case studies of modern design practice. As such, the paper will compare design thinking theory with the reality of design in practice.

Heritage interpretation challenges and management issues at film-induced tourism heritage attractions: Case studies of Rosslyn Chapel and Alnwick Castle

Although previous research has widely acknowledged the phenomenon of film-induced tourism, there is a paucity of research in relation to management of film-induced tourism at built heritage sites. This research, underpinned by a constructivist paradigm, draws on three distinct fields of study – heritage tourism management, film-induced tourism and heritage interpretation – in order to provide a contribution to the heritage management field and address this particular gap in knowledge. Relying on the method of semi-structured interviews with managers, guides and visitors at Rosslyn Chapel (RC) and Alnwick Castle (AC), this thesis provides a rich understanding of how heritage interpretation can address a range of management challenges at heritage sites where film-induced tourism has occurred. These heritage visitor attractions (HVAs) were specifically selected as case studies as they have played different roles in media products. Rosslyn Chapel (RC) was an actual place named in The Da Vinci Code (TDVC) book and then film, whereas Alnwick Castle (AC) served as a backdrop for the first two Harry Potter (HP) films. Findings of this research include a range of management challenges at both RC and AC such as an increase in visitor numbers; seasonality issues; changes in visitor profile; revenue generation concerns; conservation, access, and visitor experience; and the complex relationship between heritage management and tourism activities. The findings also reveal film-induced tourism’s implications for heritage interpretation such as the various visitors’ expectations for heritage interpretation, changes to heritage interpretation as a result of film-induced tourism, and issues with commodification. These findings also demonstrate that film-induced tourism to some extent influenced visitors’ preferences for heritage interpretation, though visitors’ preferences differed from one to another. This thesis argues that, in the context of film-induced tourism at HVAs, as evident from the two case studies considered, heritage interpretation can be a valuable management tool and can also play a significant role in the quality of the visitors’ experience.

Development of process control methodology for tracking the quality and safety of pain, agitation and sedation management in critical care units

Objective: To develop sedation, pain, and agitation quality measures using process control methodology and evaluate their properties in clinical practice. Design: A Sedation Quality Assessment Tool was developed and validated to capture data for 12-hour periods of nursing care. Domains included pain/discomfort and sedation-agitation behaviors; sedative, analgesic, and neuromuscular blocking drug administration; ventilation status; and conditions potentially justifying deep sedation. Predefined sedation-related adverse events were recorded daily. Using an iterative process, algorithms were developed to describe the proportion of care periods with poor limb relaxation, poor ventilator synchronization, unnecessary deep sedation, agitation, and an overall optimum sedation metric. Proportion charts described processes over time (2 monthly intervals) for each ICU. The numbers of patients treated between sedation-related adverse events were described with G charts. Automated algorithms generated charts for 12 months of sequential data. Mean values for each process were calculated, and variation within and between ICUs explored qualitatively. Setting: Eight Scottish ICUs over a 12-month period. Patients: Mechanically ventilated patients. Interventions: None. Measurements and Main Results: The Sedation Quality Assessment Tool agitation-sedation domains correlated with the Richmond Sedation Agitation Scale score (Spearman [rho] = 0.75) and were reliable in clinician-clinician (weighted kappa; [kappa] = 0.66) and clinician-researcher ([kappa] = 0.82) comparisons. The limb movement domain had fair correlation with Behavioral Pain Scale ([rho] = 0.24) and was reliable in clinician-clinician ([kappa] = 0.58) and clinician-researcher ([kappa] = 0.45) comparisons. Ventilator synchronization correlated with Behavioral Pain Scale ([rho] = 0.54), and reliability in clinician-clinician ([kappa] = 0.29) and clinician-researcher ([kappa] = 0.42) comparisons was fair-moderate. Eight hundred twenty-five patients were enrolled (range, 59-235 across ICUs), providing 12,385 care periods for evaluation (range 655-3,481 across ICUs). The mean proportion of care periods with each quality metric varied between ICUs: excessive sedation 12-38%; agitation 4-17%; poor relaxation 13-21%; poor ventilator synchronization 8-17%; and overall optimum sedation 45-70%. Mean adverse event intervals ranged from 1.5 to 10.3 patients treated. The quality measures appeared relatively stable during the observation period. Conclusions: Process control methodology can be used to simultaneously monitor multiple aspects of pain-sedation-agitation management within ICUs. Variation within and between ICUs could be used as triggers to explore practice variation, improve quality, and monitor this over time