Reducing the time before consulting with symptoms of lung cancer:a randomised controlled trial in primary care

Background: Most individuals with lung cancer have symptoms for several months before presenting to their GP. Earlier consulting may improve survival. Aim: To evaluate whether a theory-based primary care intervention increased timely consulting of individuals with symptoms of lung cancer. Design and setting: Open randomised controlled trial comparing intervention with usual care in two general practices in north-east Scotland. Method: Smokers and ex-smokers aged ≥55 years were randomised to receive a behavioural intervention or usual care. The intervention comprised a single nurse consultation at participants' general practice and a self-help manual. The main outcomes were consultations within target times for individuals with new chest symptoms (≤3 days haemoptysis, ≤3 weeks other symptoms) in the year after the intervention commenced, and intentions about consulting with chest symptoms at 1 and 6 months. Results: Two hundred and twelve participants were randomised and 206 completed the trial. The consultation rate for new chest symptoms in the intervention group was 1.19 (95% confidence interval [CI] = 0.92 to 1.53; P = 0.18) times higher than in the usual-care group and the proportion of consultations within the target time was 1.11 (95% CI = 0.41 to 3.03; P = 0.83) times higher. One month after the intervention commenced, the intervention group reported intending to consult with chest symptoms 31 days (95% CI = 7 to 54; P = 0.012) earlier than the usual care group, and at 6 months this was 25 days (95% CI = 1.5 to 48; P = 0.037) earlier. Conclusion: Behavioural intervention in primary care shortened the time individuals at high risk of lung disease intended to take before consulting with new chest symptoms (the secondary outcome of the study), but increases in consultation rates and the proportions of consultations within target times were not statistically significant. © British Journal of General Practice.

Management consulting firms as institutional agents:strategies for creating and sustaining institutional capital

We classify the strategies by which management consultancies can create and sustain the institutional capital that makes it possible for them to extract competitive resources from their institutional context. Using examples from the German consulting industry, we show how localized competitive actions can enhance both individual firms’ positions, and also strengthen the collective institutional capital of the consulting industry thus legitimizing consulting services in broader sectors of society and facilitating access to requisite resources. Our findings counter the image of institutional entrepreneurship as individualistic, “heroic” action. We demonstrate how distributed, embedded actors can collectively shape the institutional context from within to enhance their institutional capital.

Institutional entrepreneurship:a literature review and analysis of the maturing consulting field

With few exceptions (e.g. Fincham & Clark, 2002; Lounsbury, 2002, 2007; Montgomery & Oliver, 2007), we know little about how emerging professions, such as management consulting, professionalize and establish their services as a taken-for-granted element of social life. This is surprising given that professionals have long been recognized as “institutional agents” (DiMaggio & Powell, 1983; Scott, 2008) (see Chapter 17) and professionalization projects have been closely associated with institutionalization (DiMaggio, 1991). Therefore, in this chapter we take a closer look at a specific type of entrepreneurship in PSFs; drawing on the concept of “institutional entrepreneurship” (DiMaggio, 1988; Garud, Hardy, & Maguire, 2007; Hardy & Maguire, 2008) we describe some generic strategies by which proto-professions can enhance their “institutional capital” (Oliver, 1997), that is, their capacity to extract institutionally contingent resources such as legitimacy, reputation, or client relationships from their environment.

Acceptability of Lean Six Sigma in a developing economy:results from exploratory research in Nigerian consulting companies

The application of Lean Six Sigma (LSS) varies in different regions of the world in terms of both level of understanding and acceptability. Employing a qualitative methodological approach, this paper aims to explore factors hindering the acceptability of the LSS initiative in organizations and list factors required for successful application and implementation in a developing economy from the perspective of LSS consultants. Using Nigeria as a case study, primary data were collected though a number of semi-structured interviews with representatives of leading continuous improvement consultancy firms in Nigeria. Finding draws out links between major factors such as drivers and motivation, LSS performance, marketability and challenges to the acceptability and applicability of LSS in Nigeria. Further findings highlight major factors such as lack of management buy-in, level of awareness, certification driven market, Nigerian environment and culture, etc as problems that hinder successful implementation of LSS in Nigeria. This paper contributes to the theoretical foundation of critical success factors required for the implementation of Lean Six Sigma, with results from the experience of a developing economy.

Science or practice? UK undergraduate experiences and attitudes to the MPharm degree

Objective: The debate surrounding the science/practice balance in the teaching of undergraduate pharmacy has been played out in the professional literature for years. The objective of this work was to explore the attitudes of pharmacy undergraduates on the practice-science debate. Setting: The study was undertaken as part of a national study of teaching, learning and assessment methods in United Kingdom (UK) schools of pharmacy. Method: Six focus groups were carried out. The sample was 44 volunteer students from nine UK schools of pharmacy, representing all 4 years of the MPharm programme. Groups were tape recorded and transcribed. Analysis of the transcripts was theme based by topic. Main Outcome Measure: Qualitative data on student attitudes and experiences. Results: Most students thought that there was too strong an emphasis placed on the science components of the course in the early part of their studies. Later in the course they realised that the majority of the science was necessary; it just had not been apparent to them at the time. There were strongly held attitudes across all 4 years that it would be beneficial to include more practice-related material at the beginning of their studies. This would be beneficial for three reasons: to make the course more interesting, to aid in the contextualisation of the science component and to assist the students in any early placement or vacational work. Conclusion: Internationally, changes to the role of the pharmacist from a traditional supply function to a more clinical role has resulted in differing educational needs for the pharmacist of the future. Pharmacy will remain a degree built on a strong scientific background, but students advise that the contextualisation and sequencing of material within the degree could make a considerable improvement to their learning. Consulting students helps us to understand the teaching, learning and assessment experience better by giving insights into ways of improving the delivery. In the case of the UK, there are legislative changes impending which may provide an opportunity to review the balance of practice-and science in the curriculum. © 2006 Springer Science+Business Media B.V.

Journey making group workshops as a research tool

Problem-structuring group workshops can be used in organizations as a consulting tool and as a research tool. One example of the latter is using a problem-structuring method (PSM) to help a group tackle an organizational issue; meanwhile, researchers collect the participants' initial views, discussion of divergent views, the negotiated agreement, and the reasoning for outcomes emerging. Technology can help by supporting participants in freely sharing their opinions and by logging data for post-workshop analyses. For example, computers let participants share views anonymously and without being influenced by others (as well as logging those views), and video-cameras can record discussions and intra-group dynamics. This paper evaluates whether technology-supported Journey Making workshops can be effective research tools that can capture quality research data when compared against theoretical performance benchmarks and other qualitative research tools. © 2006 Operational Research Society Ltd. All rights reserved.

Development of a computerised library system in the construction industry

This thesis examines the ways that libraries have employed computers to assist with housekeeping operations. It considers the relevance of such applications to company libraries in the construction industry, and describes more specifically the development of an integrated cataloguing and loan system. A review of the main features in the development of computerised ordering, cataloguing and circulation control systems shows that fully integrated packages are beginning to be completed, and that some libraries are introducing second generation programs. Cataloguing is the most common activity to be computerised, both at national and company level. Results from a sample of libraries in the construction industry suggest that the only computerised housekeeping system is at Taylor Woodrow. Most of the firms have access to an in-house computer, and some of the libraries, particularly those in firms of consulting engineers, might benefit from computerisation, but there are differing attitudes amongst the librarians towards the computer. A detailed study of the library at Taylor Woodrow resulted in a feasibility report covering all the areas of its activities. One of the main suggestions was the possible use of a computerised loans and cataloguing system. An integrated system to cover these two areas was programmed in Fortran and implemented. This new system provides certain benefits and saves staff time, but at the cost of time on the computer. Some improvements could be made by reprogramming, but it provides a general system for small technical libraries. A general equation comparing costs for manual and computerised operations is progressively simplified to a form where the annual saving from the computerised system is expressed in terms of staff and computer costs and the size of the library. This equation gives any library an indication of the savings or extra cost which would result from using the computerised system.

Management consultancies as institutional agents:strategies for creating and sustaining institutional capital

Management consultants have long been recognized as carriers of management knowledge and disseminators of management fashions. While it is well understood how they promote the acceptance of their concepts, surprisingly little has been said about their strategies to promote the acceptability of their services. In this paper, we elaborate a typology of strategies by which management consultancies can create and sustain such “institutional capital” (Oliver, 1997) that helps them extract competitive resources from their institutional context. Drawing on examples from the German consulting industry, we show how localized competitive actions can enhance individual firm’s positions, but also the collective institutional capital of the consulting industry as a whole, legitimize consulting services in broader sectors of society and facilitating access to requisite resources. These accounts counter prevailing imagery of institutional entrepreneurship as individualistic, “heroic” action and demonstrate how distributed, embedded actors can collectively shape the institutional context from within to enhance their institutional capital.

Building a strategy toolkit:lessons from business : executive briefings

In an increasingly competitive business environment, the ability to spot and seize new opportunities, to plot a path of successful growth for an organisation, and to use resources effectively and efficiently, becomes paramount. Managers have a number of management tools at their disposal to help meet the challenges that they face. By consulting with both business academics and alumni on their knowledge and use of strategy tools, this report contains a number of strategy tools that managers would benefit from being familiar and using in their work, particularly as their experience and seniority increases.

Discovering the preferences of physicians with regards to rank-ordered medical documents

The practice of evidence-based medicine involves consulting documents from repositories such as Scopus, PubMed, or the Cochrane Library. The most common approach for presenting retrieved documents is in the form of a list, with the assumption that the higher a document is on a list, the more relevant it is. Despite this list-based presentation, it is seldom studied how physicians perceive the importance of the order of documents presented in a list. This paper describes an empirical study that elicited and modeled physicians' preferences with regard to list-based results. Preferences were analyzed using a GRIP method that relies on pairwise comparisons of selected subsets of possible rank-ordered lists composed of 3 documents. The results allow us to draw conclusions regarding physicians' attitudes towards the importance of having documents ranked correctly on a result list, versus the importance of retrieving relevant but misplaced documents. Our findings should help developers of clinical information retrieval applications when deciding how retrieved documents should be presented and how performance of the application should be assessed. © 2012 Springer-Verlag Berlin Heidelberg.

An investigation into enterprise structure and ERP implementations:a contribution to praxis

This professional doctoral research reports on the relationship between Enterprise Systems, specifically Enterprise Resource Planning Systems, and enterprise structures. It offers insights and guidance to practitioners on factors for consideration in the implementation of ERP systems in organisations operating in modern enterprise structures. It reports on reflective ethnographic action research conducted in a number of companies from a diverse range of industries covering supply chains for both goods and services. The primary contribution is in highlighting areas in which clients, practitioners and ERP software vendors can bring a greater awareness of internet era enterprise structures and business requirements into the ERP arena. The concepts and insights have been explored in a focus group setting, comprised of practitioners from the enterprise systems implementation and consulting fraternity and revealed limitations and constraints in the implementation of enterprise systems. However, it also showed that current systems do not have the full capabilities required to support, in use, modern era enterprise structures, as required by practitioners and decision makers.

Evaluation of options for energy recovery from municipal solid waste in India using the hierarchical analytical network process

In this paper a Hierarchical Analytical Network Process (HANP) model is demonstrated for evaluating alternative technologies for generating electricity from MSW in India. The technological alternatives and evaluation criteria for the HANP study are characterised by reviewing the literature and consulting experts in the field of waste management. Technologies reviewed in the context of India include landfill, anaerobic digestion, incineration, pelletisation and gasification. To investigate the sensitivity of the result, we examine variations in expert opinions and carry out an Analytical Hierarchy Process (AHP) analysis for comparison. We find that anaerobic digestion is the preferred technology for generating electricity from MSW in India. Gasification is indicated as the preferred technology in an AHP model due to the exclusion of criteria dependencies and in an HANP analysis when placing a high priority on net output and retention time. We conclude that HANP successfully provides a structured framework for recommending which technologies to pursue in India, and the adoption of such tools is critical at a time when key investments in infrastructure are being made. Therefore the presented methodology is thought to have a wider potential for investors, policy makers, researchers and plant developers in India and elsewhere. © 2013 Elsevier Ltd. All rights reserved.

The cost of sin:the effect of social norms on audit pricing

In this paper we provide evidence for the effects of social norms on audit pricing by studying companies belonging to the alcohol, firearms, gambling, military, nuclear power, and tobacco industries,which are often described as “sin” companies. We hypothesize that the disparities between “sin” firms operations and prevailing social norms create an adverse context which heightens the client's business risk assessment by auditors and is, thereby, reflected in the pricing decisions for audit and consulting services. Having controlled for the impact of variables relating to client attributes, auditor attributes and engagement attributes, we demonstrate that audit firms charge significantly higher audit and consulting fees to companies that deviate from prevailing social norms. Additionally,we show that audit pricing levels within the “sin” group depend both on prevailing political views and on the level of “vice” exhibited by “sin” companies.

E-business planning and analysis framework

This chapter reports on a framework that has been successfully used to analyze the e-business capabilities of an organization with a view to developing their e-capability maturity levels. This should be the first stage of any systems development project. The framework has been used widely within start-up companies and well-established companies both large and small; it has been deployed in the service and manufacturing sectors. It has been applied by practitioners and consultants to help improve e-business capability levels, and by academics for teaching and research purposes at graduate and undergraduate levels. This chapter will provide an account of the unique e-business planning and analysis framework (E-PAF) and demonstrate how it works via an abridged version of a case study (selected from hundreds that have been produced). This will include a brief account of the three techniques that are integrated to form the analysis framework: quality function deployment (QFD) (Akao, 1972), the balanced scorecard (BSC) (Kaplan & Norton, 1992), and value chain analysis (VCA) (Porter, 1985). The case study extract is based on an online community and dating agency service identified as VirtualCom which has been produced through a consulting assignment with the founding directors of that company and has not been published previously. It has been chosen because it gives a concise, comprehensive example from an industry that is relatively easy to relate to.