The role of Lean at the interface with between operations management and applied services within a large aerospace organisation: a boundary spanning perspective

Increased complexity in large design and manufacturing organisations requires improvements at the operations management (OM)–applied service (AS) interface areas to improve project effectiveness. The aim of this paper is explore the role of Lean in improving the longitudinal efficiency of the OM–AS interface within a large aerospace organisation using Lean principles and boundary spanning theory. The methodology was an exploratory longitudinal case approach including exploratory interviews (n = 21), focus groups (n = 2), facilitated action-research workshops (n = 2) and two trials or experiments using longitudinal data involving both OM and AS personnel working at the interface. The findings draw upon Lean principles and boundary spanning theory to guide and interpret the findings. It was found that misinterpretation, and forced implementation, of OM-based Lean terminology and practice in the OM–AS interface space led to delays and misplaced resources. Rather both OM and AS staff were challenged to develop a cross boundary understanding of Lean-based boundary (knowledge) objects in interpreting OM requests. The longitudinal findings from the experiments showed that the development of Lean Performance measurements and lean Value Stream constructs was more successful when these Lean constructs were treated as boundary (knowledge) objects requiring transformation over time to orchestrate improved effectiveness and in leading to consistent terminology and understanding between the OM–AS boundary spanning team.

Behavior change theory, content and delivery of interventions to enhance adherence in chronic respiratory disease: A systematic review

Background: We sought to describe the theory used to design treatment adherence interventions, the content delivered, and the mode of delivery of these interventions in chronic respiratory disease. Methods: We included randomized controlled trials of adherence interventions (compared to another intervention or control) in adults with chronic respiratory disease (8 databases searched; inception until March 2015). Two reviewers screened and extracted data: post-intervention adherence (measured objectively); behavior change theory, content (grouped into psychological, education and self-management/supportive, telemonitoring, shared decision-making); and delivery. “Effective” studies were those with p < 0.05 for adherence rate between groups. We conducted a narrative synthesis and assessed risk of bias. Results: 12,488 articles screened; 46 included studies (n = 42,91% in OSA or asthma) testing 58 interventions (n = 27, 47% were effective). Nineteen (33%) interventions (15 studies) used 12 different behavior change theories. Use of theory (n = 11,41%) was more common amongst effective interventions. Interventions were mainly educational, self-management or supportive interventions (n = 27,47%). They were commonly delivered by a doctor (n = 20,23%), in face-to-face (n = 48,70%), one-to-one (n = 45,78%) outpatient settings (n = 46,79%) across 2–5 sessions (n = 26,45%) for 1–3 months (n = 26,45%). Doctors delivered a lower proportion (n = 7,18% vs n = 13,28%) and pharmacists (n = 6,15% vs n = 1,2%) a higher proportion of effective than ineffective interventions. Risk of bias was high in >1 domain (n = 43, 93%) in most studies. Conclusions: Behavior change theory was more commonly used to design effective interventions. Few adherence interventions have been developed using theory, representing a gap between intervention design recommendations and research practice.