Maximising the economic and social impact of Six Sigma

This paper reports on how Six Sigma training can be made more effective. The research is empirically based. To date it has engaged with over 100 respondents from 60 different organisations around the world. The questionnaire has been derived from leading refereed sources and expert practitioner experience and addresses both success factor and tools issues from three perspectives: (i) academic, (ii) training, and (iii) practice to help maximise economic and social impact of programmes. This topic is important because the popularity of Six Sigma adoption in organisations has grown dramatically over recent years. This is probably because many accounts of great cost savings and quality improvements have been published by major international companies. However, other companies striving to emulate this success are finding that effective implementation needs experienced and well trained individuals. To date, there have been few such surveys and this work-in-progress benchmarking study provides unique insight.

Betwixt spaces: student accounts of turning point experiences in first year transitions

‘Not belonging’ is becoming a prevalent theme within accounts of the first-year student experience at university. In this study the notion of not belonging is extended by assuming a more active role for the idea of liminality in a student’s transition into the university environments of academic and student life. In doing so, the article suggests that the transition between one place (home) and another (university) can result in an ‘in-between-ness’ – a betwixt space. Through an interpretative methodology, the study explores how students begin to move from this betwixt space into feeling like fully-fledged members of university life. It is concluded that there is a wide range of turning points associated with the students’ betwixt transition, which shapes, alters or indeed accentuates the ways in which they make meaningful connections with university life. Moreover, transitional turning point experiences reveal a cast of characters and symbolic objects; capture contrasting motivations and evolving relationships; display multiple trajectories of interpersonal tensions and conflicts; highlight discontinuities as well as continuities; and together, simultaneously liberate and constrain the students’ transition into university life.

The valuation of travel time savings in least developed countries:theoretical and empirical challenges and results from a field study

In developed countries travel time savings can account for as much as 80% of the overall benefits arising from transport infrastructure and service improvements. In developing countries they are generally ignored in transport project appraisals, notwithstanding their importance. One of the reasons for ignoring these benefits in the developing countries is that there is insufficient empirical evidence to support the conventional models for valuing travel time where work patterns, particularly of the poor, are diverse and it is difficult to distinguish between work and non-work activities. The exclusion of time saving benefits may lead to a bias against investment decisions that benefit the poor and understate the poverty reduction potential of transport investments in Least Developed Countries (LDCs). This is because the poor undertake most travel and transport by walking and headloading on local roads, tracks and paths and improvements of local infrastructure and services bring large time saving benefits for them through modal shifts. The paper reports on an empirical study to develop a methodology for valuing rural travel time savings in the LDCs. Apart from identifying the theoretical and empirical issues in valuing travel time savings in the LDCs, the paper presents and discusses the results of an analysis of data from Bangladesh. Some of the study findings challenge the conventional wisdom concerning the time saving values. The Bangladesh study suggests that the western concept of dividing travel time savings into working and non-working time savings is broadly valid in the developing country context. The study validates the use of preference methods in valuing non-working time saving values. However, stated preference (SP) method is more appropriate than revealed preference (RP) method.

Contextualising accounts of illness:Notions of responsibility and blame in white and South Asian respondents' accounts of diabetes causation

We undertook a secondary analysis of in-depth interviews with white (n = 32) and Pakistani and Indian (n = 32) respondents who had type 2 diabetes, which explored their perceptions and understandings of disease causation. We observed subtle, but important, differences in the ways in which these respondent groups attributed responsibility and blame for developing the disease. Whereas Pakistani and Indian respondents tended to externalise responsibility, highlighting their life circumstances in general and/or their experiences of migrating to Britain in accounting for their diabetes (or the behaviours they saw as giving rise to it), white respondents, by contrast, tended to emphasise the role of their own lifestyle 'choices' and 'personal failings'. In seeking to understand these differences, we argue for a conceptual and analytical approach which embraces both micro- (i.e. everyday) and macro- (i.e. cultural) contextual factors and experiences. In so doing, we provide a critique of social scientific studies of lay accounts/understandings of health and illness. We suggest that greater attention needs to be paid to the research encounter (that is, to who is looking at whom and in what circumstances) to understand the different kinds of contexts researchers have highlighted in presenting and interpreting their data. © 2007 Foundation for the Sociology of Health & Illness/Blackwell Publishing Ltd.

Issues of cause and control in patient accounts of Type 2 diabetes

Patients experience considerable difficulties in making and sustaining health-related lifestyle changes. Many Type 2 diabetes patients struggle to follow disease risk-management advice even when they receive extensive information and support. Drawing on a qualitative study of patients with Type 2 diabetes, the paper uses discourse analysis to examine their accounts about disease causation and disease management, and the implications for how they respond to their condition and health services advice. As it is a multifactorial disease, biomedical discourse around Type 2 diabetes is complex. Patients are encouraged to grasp the complicated message that both cause and medical outcomes related to their condition are partly, but not wholly, within their control. Discursive constructions identified from respondent accounts indicate how these two messages are deployed variously by respondents when accounting for disease causation and management. While these constructions (identified in respondent accounts as 'Up to me' and 'Down to them') are a valuable resource for patients, equally they may be deployed in a selective and detrimental way. We conclude that clear messages from health professionals about effective disease management may help patients to position themselves more effectively in relation to their condition. More importantly, they might serve to hinder the availability of inappropriate and potentially harmful patient positions where patients either relinquish responsibility for disease management or reject all input from health professionals. © The Author 2005. Published by Oxford University Press. All rights reserved.

Sex and diabetes:a thematic analysis of gay and bisexual men's accounts

Around 50 per cent of men with diabetes experience erectile dysfunction. Much of the literature focuses on quality of life measures with heterosexual men in monogamous relationships. This study explores gay and bisexual men's experiences of sex and diabetes. Thirteen interviews were analysed and three themes identified: erectile problems; other 'physical' problems; and disclosing diabetes to sexual partners. Findings highlight a range of sexual problems experienced by non-heterosexual men and the significance of the cultural and relational context in which they are situated. The personalized care promised by the UK government should acknowledge the diversity of sexual practices which might be affected by diabetes.

Development of reasoning:Behavioral evidence to support reinforcement over cognitive control accounts

Speed's theory makes two predictions for the development of analogical reasoning. Firstly, young children should not be able to reason analogically due to an undeveloped PFC neural network. Secondly, category knowledge enables the reinforcement of structural features over surface features, and thus the development of sophisticated, analogical, reasoning. We outline existing studies that support these predictions and highlight some critical remaining issues. Specifically, we argue that the development of inhibition must be directly compared alongside the development of reasoning strategies in order to support Speed's account. © 2010 Psychology Press.

Shifting accountability:a longitudinal qualitative study of diabetes causation accounts

We undertook a longitudinal qualitative study involving of 20 patients from Scotland who had type 2 diabetes. We looked at their perceptions and understandings of why they had developed diabetes and how, and why, their causation accounts had changed or remained stable over time. Respondents, all of whom were white, were interviewed four times over a 4-year period (at baseline, 6, 12 and 48 months). Their causation accounts often shifted, sometimes subtly, sometimes radically, over the 4 years. The experiential dimensions of living with, observing, and managing their disease over time were central to understanding the continuities and changes we observed. We also highlight how, through a process of removing, adding and/or de-emphasising explanatory factors, causation accounts could be used as “resources” to justify or enable present treatment choices. We use our work to support critiques of social cognition theories, with their emphasis upon beliefs being antecedent to behaviours. We also provide reflections upon the implications of our findings for qualitative research designs and sampling strategies.

Moving beyond heterosexism? The good, the bad and the indifferent in accounts of others’ reactions to important life events

Latterly the psychology of sexualities has diversified. There has been increased engagement with queer theory and a heightened focus on sexual practices alongside continued interrogation of heteronormativity via analyses of talk-in-interaction. In this article, I offer an argument for juxtaposing the incongruent in order to further interrogate manifestations of heterosexism in lesbian, gay, bisexual, trans and queer (LGBTQ) people’s lives. In this case, accounts of others’ reactions to a happy event and to a sad experience. By drawing on two contrasting data corpuses – 124 people planning or in a civil partnership and 60 women who had experienced pregnancy loss – there is increased potential for understanding variation in ‘normative’ and/or heteronormative interpretations of LGBTQ lives. I suggest that, despite significant legal and structural gains for LGBTQ communities in a number of Western countries in recent years, and lively internal debates within the psychology of sexualities field, critical examination of manifestations of heterosexism should remain a central focus.

How to manual:the valuation of rural travel time savings in least developed countries (LDCs)

The manual is designed to bring out issues that are relevant in the valuation of rural travel time savings in Least Developed Countries (LDCs). It should also be relevant for other developing countries which do not have LDC status but have rural economy features typical of low income developing countries. The manual elaborates step-by-step procedures on how to design and execute studies to estimate the value of time (VoT) savings of rural travellers.

Estimating the scope for savings in referrals and drug prescription costs in the general Practice units of a UK primary care trust

This paper explores the potential for cost savings in the general Practice units of a Primary Care Trust (PCT) in the UK. We have used Data Envelopment Analysis (DEA) to identify benchmark Practices, which offer the lowest aggregate referral and drugs costs controlling for the number, age, gender, and deprivation level of the patients registered with each Practice. For the remaining, non-benchmark Practices, estimates of the potential for savings on referral and drug costs were obtained. Such savings could be delivered through a combination of the following actions: (i) reducing the levels of referrals and prescriptions without affecting their mix (£15.74 m savings were identified, representing 6.4% of total expenditure); (ii) switching between inpatient and outpatient referrals and/or drug treatment to exploit differences in their unit costs (£10.61 m savings were identified, representing 4.3% of total expenditure); (iii) seeking a different profile of referral and drug unit costs (£11.81 m savings were identified, representing 4.8% of total expenditure). © 2012 Elsevier B.V. All rights reserved.

Using DEA to estimate potential savings at GP units at medical specialty level

The aim of this paper is to identify benchmark cost-efficient General Practitioner (GP) units at delivering health care in the Geriatric and General Medicine (GMG) specialty and estimate potential cost savings. The use of a single medical specialty makes it possible to reflect more accurately the medical condition of the List population of the Practice so as to contextualize its expenditure on care for patients. We use Data Envelopment Analysis (DEA) to estimate the potential for cost savings at GP units and to decompose these savings into those attributable to the reduction of resource use, to altering the mix of resources used and to those attributable to securing better resource 'prices'. The results reveal a considerable potential for savings of varying composition across GP units. © 2013 Elsevier Ltd.

Returns on key accounts:do the results justify the expenditures?

Purpose – The use of key accounts has become a mature trend and most industrial firms use this concept in some form. Selling firms establish key account teams to attend to important customers and consolidate their selling activities. Yet, despite such increased efforts on behalf of key accounts, sufficient research has not quantified the returns on key account strategy nor has it firmly established performance differences between key and non-key accounts within a firm. In response to this shortcoming, this study aims to examine returns on key accounts. Design Methodology/approach – Data were collected from a global consulting firm. The data collection started two years after the implementation of the key account program. Data were collected on recently acquired customers (within the previous year) at two time periods: year 1 and year 3 (based on company access of data). Findings – Initially, key accounts perform as well or better than other types of accounts. However, in the long term, key accounts are less satisfied, less profitable and less beneficial for a firm’s growth than other types of accounts. Because the returns to key account expenditures, thus, appear mixed, firms should be cautious in expanding their key account strategies. Research limitations implications – The study contributes to research in three areas. First, most research on the effectiveness of key accounts refers to the between-firm level, whereas this study examines the effect within a single firm. Second, this study examines the temporal aspects of key accounts, namely, what happens to key accounts over time, in comparison with other accounts in a fairly large sample. Third, it considers the survival rates of key accounts versus other types of accounts. Practical implications – The authors suggest that firms also need to track their key accounts better because the results show that key accounts are less satisfied, less profitable and less beneficial for a firm’s growth than other types of accounts. Originality/value – Extant research has not examined these issues.

Identifying the scope for savings at inpatient episode level:an illustration applying DEA to chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is characterized by a largely irreversible obstruction of the airways, and is one of the leading causes of chronic morbidity and mortality worldwide. This paper illustrates the use of Data Envelopment Analysis (DEA) to assess the potential for cost savings at COPD inpatient episode level. The analysis uses the length of stay of each episode as a surrogate for expenditure on that episode while allowing for the medical condition of the patient and the quality of care received. We find substantial possible reductions in length of stay which would translate to cost savings. The paper also explores differences both between hospitals and between care teams within hospitals so that cost efficient protocols of treatment can be identified and disseminated.