Implementing a knowledge management system within an NHS hospital:a case study exploring the roll-out of an Electronic Patient Record (EPR)

This research aims to contribute to understanding the implementation of knowledge management systems (KMS) in the field of health through a case study, leading to theory building and theory extension. We use the concept of the business process approach to knowledge management as a theoretical lens to analyse and explore how a large teaching hospital developed, executed and practically implemented a KMS. A qualitative study was conducted over a 2.5 year period with data collected from semi-structured interviews with eight members of the strategic management team, 12 clinical users and 20 patients in addition to non-participant observation of meetings and documents. The theoretical propositions strategy was used as the overarching approach for data analysis. Our case study provides evidence that true patient centred approaches to supporting care delivery with a KMS benefit from process thinking at both the planning and implementation stages, and an emphasis on the knowledge demands resulting from: the activities along the care pathways; where cross-overs in care occur; and knowledge sharing for the integration of care. The findings also suggest that despite the theoretical awareness of KMS implementation methodologies, the actual execution of such systems requires practice and learning. Flexible, fluid approaches through rehearsal are important and communications strategies should focus heavily on transparency incorporating both structured and unstructured communication methods.

Getting the most out of multidisciplinary teams: a multi-sample study of team innovation in health care

Driven by the assumption that multidisciplinarity contributes positively to team outcomes teams are often deliberately staffed such that they comprise multiple disciplines. However, the diversity literature suggests that multidisciplinarity may not always benefit a team. This study departs from the notion of a linear, positive effect of multidisciplinarity and tests its contingency on the quality of team processes. It was assumed that multidisciplinarity only contributes to team outcomes if the quality of team processes is high. This hypothesis was tested in two independent samples of health care workers (N = 66 and N = 95 teams), using team innovation as the outcome variable. Results support the hypothesis for the quality of innovation, rather than the number of innovations introduced by the teams.

Management information:design of a system for change identification

This thesis deals with the problem of Information Systems design for Corporate Management. It shows that the results of applying current approaches to Management Information Systems and Corporate Modelling fully justify a fresh look to the problem. The thesis develops an approach to design based on Cybernetic principles and theories. It looks at Management as an informational process and discusses the relevance of regulation theory to its practice. The work proceeds around the concept of change and its effects on the organization's stability and survival. The idea of looking at organizations as viable systems is discussed and a design to enhance survival capacity is developed. It takes Ashby's theory of adaptation and developments on ultra-stability as a theoretical framework and considering conditions for learning and foresight deduces that a design should include three basic components: A dynamic model of the organization- environment relationships; a method to spot significant changes in the value of the essential variables and in a certain set of parameters; and a Controller able to conceive and change the other two elements and to make choices among alternative policies. Further considerations of the conditions for rapid adaptation in organisms composed of many parts, and the law of Requisite Variety determine that successful adaptive behaviour requires certain functional organization. Beer's model of viable organizations is put in relation to Ashby's theory of adaptation and regulation. The use of the Ultra-stable system as abstract unit of analysis permits developing a rigorous taxonomy of change; it starts distinguishing between change with in behaviour and change of behaviour to complete the classification with organizational change. It relates these changes to the logical categories of learning connecting the topic of Information System design with that of organizational learning.

General features of Multiple System Atrophy

Multiple system atrophy (MSA) is a rare movement disorder and a member of a group of neurodegenerative diseases referred to collectively as the ‘parkinsonian syndromes’. Characteristic of these syndromes is that the patient exhibits symptoms of ‘parkinsonism’, viz., a range of problems involving movement, most typically manifest in Parkinson’s disease (PD) itself1, but also seen in progressive supranuclear palsy (PSP), and to some extent in dementia with Lewy bodies (DLB). MSA is a relatively ‘new’ descriptive term and is derived from three previously described diseases, viz., olivopontocerebellar atrophy, striato-nigral degeneration, and Shy-Drager syndrome. The classical symptoms of MSA include parkinsonism, ataxia, and autonomic dysfunction.6 Ataxia describes a gross lack of coordination of muscle movements while autonomic dysfunction involves a variety of systems that regulate unconscious bodily functions such as heart rate, blood pressure, bladder function, and digestion. Although primarily a neurological disorder, patients with MSA may also develop visual signs and symptoms that could be useful in differential diagnosis. The most important visual signs may include oculomotor dysfunction and problems in pupil reactivity but are less likely to involve aspects of primary vision such as visual acuity, colour vision, and visual fields. In addition, the eye-care practitioner can contribute to the management of the visual problems of MSA and therefore, help to improve quality of life of the patient. Hence, this first article in a two-part series describes the general features of MSA including its prevalence, signs and symptoms, diagnosis, pathology, and possible causes.

Visual signs and symptoms of Multiple System Atrophy

Multiple system atrophy (MSA) is a rare movement disorder and a member of a group of neurodegenerative diseases, which include Parkinson’s disease (PD) and progressive supranuclear palsy (PSP), and referred to as the ‘parkinsonian syndromes’. Although primarily a neurological disorder, patients with MSA may also develop visual signs and symptoms that could be useful in differential diagnosis. In addition, the eye-care practitioner may contribute to the management of visual problems of MSA patients and therefore, help to improve quality of life. This second article in the series considers the visual signs and symptoms of MSA with special reference to those features most useful in differential diagnosis of the parkinsonian syndromes.

Studies in the marketing strategy of a U.K. producer of conveyor belts

Research was undertaken in the field of marketing strategy, its formulation and implementation in Dunlop Belting Division. Emphasis was placed on marketing channel strategy, but other strategies including product strategy were studied. The research has resulted in changes in management practice in the client organisation. The relevance of theories of company organisation, planning and strategy, and marketing channels was examined in the light of the research evidence. The technique of action-research was used to gain admittance to and effect change within the client organisation. Case study material was collected for subsequent analysis. The factors affecting marketing strategy formulation in the client organisation were studied. Both the external and the internal business environments were considered. The operation of the observed marketing channels was compared with channel theory. Market segmentation and penetration, and the selling and technical resources of the channels were analysed. Recommendations were made to (a) enlarge and resite the client's distribution unit to locate it centrally in England (b) use the resited unit to secure local advantage (c) obtain greater integration of field sales activities with and from the centre. A new ex-stock distribution unit was established. Improvements to the client's ex-stock marketing in Scotland were also recommended, including improvements to the Scottish distributor's stock control procedure, as well as to Dunlop-Distributor relationships at all levels. The influence of company organisation structure and formalised procedures and systems on the formulation of strategy were considered with respect to channel and product strategy, and other aspects of marketing. Conclusions were drawn that the action research resulted in successful implementation of .agreed changes in the client organisation; that theories of strategy formulation and planning, of the operation of decentralised companies, and of industrial market segmentation required modification; that the theory of marketing channels was found relevant and useful.

Speaking out of turn? Taking the initiative in teacher-fronted classroom interaction.

Teacher-fronted interaction is generally seen to place limitations on the contributions that learners can make to classroom discourse and the conclusion is that learners are unable to experiment with, for example, turn-taking mechanisms. This article looks at teacher-fronted interaction in the language classroom from the perspective of learner talk by examining how learners might take the initiative during this apparently more rigid form of interaction. Detailed microanalysis of classroom episodes, using a conversation analysis institutional discourse approach, shows how learners orient to the institutional context to make sophisticated and effective use of turn-taking mechanisms to take the initiative and direct the interaction, even in the controlled environment of teacher-fronted talk. The article describes some of the functions of such learner initiative, examines how learners and teachers co-construct interaction and how learners can create learning opportunities for themselves. It also briefly looks at teacher reactions to such initiative. The article concludes that learner initiative in teacher-fronted interaction may constitute a significant opportunity for learning and that teachers should find ways of encouraging such interaction patterns.

Human performance modelling as an aid in the process of manufacturing system design

Manufacturing system design is an ongoing activity within industry. Modelling tools based on Discrete Event Simulation are often used by practitioners during this design cycle. However, such tools do not adequately model the behaviour of 'direct' workers in manufacturing environments. There is an important need to expand the capability of modelling to include the relationships between human centred factors (demography, attitudes, beliefs, etc), their working environment (physical and organizational), and their subsequent performance in terms of productive routines. Therefore, this paper describes research that has formed a pilot modelling methodology that is an important first step in providing such a capability.

A strategic activity model of Enterprise System implementation and use:scaffolding fluidity

This paper builds on a Strategic Activity Framework (Jarzabkowski, 2005) and activity based theories of development (Vygotsky, 1978) to model how Enterprise Systems are used to support emerging strategy. It makes three contributions. Firstly, it links fluidity and extensiveness of system use to patterns of strategising. Fluidity - the ability to change system use as needs change - is supported by interactive strategising, where top managers communicate directly with the organisation. Extensiveness requires procedural strategising, embedding system use in structures and routines. Secondly, it relates interactive and procedural strategising to the importance of the system - procedural strategising is more likely to occur if the system is strategically important. Thirdly, using a scaffolding metaphor it identifies patterns in the activities of top managers and Enterprise System custodians, who identify process champions within the organisational community, orient them towards system goals, provide guided support, and encourage fluidity through pacing implementation with learning.© 2013 Published by Elsevier B.V. All rights reserved.

Response to out of stock produce and its underlying economic considerations

The goal of this research is to investigate consumer response to out-of-stock product in the produce category. We do this by comparing results from a survey conducted in Greece and the United States to previous research on consumer response to out-of-stock situations for other perishable and non-perishable products. We further examined the underlying economic reasoning as well as the cultural and physical differences between the United States and Greece as explanations of different reactions. Out of Stock produce response proved different in produce than in other perishables and non-perishables. There is some evidence that produce does follow previous the suggested economic reasoning from the previous research, especially within transaction costs. Finally, the respondent’s country proved very significant in dictating response.

Taking the carbon out of the car

Effective measures are being taken to reduce emissions from cars, which are now emerging as a major contributor to climate change. Developed countries will need to reduce emissions by at least 80% by 2050 to achieve stabilization of atmospheric CO2 concentration between 450 and 550 ppm, and have a unique opportunity to avoid the most damaging effects of climate change. The UK is aiming at completely decarbonising transport by 2050 through a combination of more efficient vehicles, cleaner fuels, and smart driving choices. The European Commission has proposed a mandatory CO2 target on new car CO 2 efficiency, which is an urgent needed development. The nation is also using regulatory targets for local schemes, such as free parking or congestion charging, break points for company car tax, and vehicle excise duty. Car ownership and use should thereby continue to drive economic growth and enhance quality of life around the world without destroying the planet.

Visual signs and symptoms of multiple system atrophy

Multiple system atrophy (MSA) is a rare movement disorder and a member of the 'parkinsonian syndromes', which also include Parkinson's disease (PD), progressive supranuclear palsy (PSP), dementia with Lewy bodies (DLB) and corticobasal degeneration (CBD). Multiple system atrophy is a complex syndrome, in which patients exhibit a variety of signs and symptoms, including parkinsonism, ataxia and autonomic dysfunction. It can be difficult to separate MSA from the other parkinsonian syndromes but if ocular signs and symptoms are present, they may aid differential diagnosis. Typical ocular features of MSA include blepharospasm, excessive square-wave jerks, mild to moderate hypometria of saccades, impaired vestibular-ocular reflex (VOR), nystagmus and impaired event-related evoked potentials. Less typical features include slowing of saccadic eye movements, the presence of vertical gaze palsy, visual hallucinations and an impaired electroretinogram (ERG). Aspects of primary vision such as visual acuity, colour vision or visual fields are usually unaffected. Management of the disease to deal with problems of walking, movement, daily tasks and speech problems is important in MSA. Optometrists can work in collaboration with the patient and health-care providers to identify and manage the patient's visual deficits. A more specific role for the optometrist is to correct vision to prevent falls and to monitor the anterior eye to prevent dry eye and control blepharospasm.

On the k-anonymization of time-varying and multi-layer social graphs

The popularity of online social media platforms provides an unprecedented opportunity to study real-world complex networks of interactions. However, releasing this data to researchers and the public comes at the cost of potentially exposing private and sensitive user information. It has been shown that a naive anonymization of a network by removing the identity of the nodes is not sufficient to preserve users’ privacy. In order to deal with malicious attacks, k -anonymity solutions have been proposed to partially obfuscate topological information that can be used to infer nodes’ identity. In this paper, we study the problem of ensuring k anonymity in time-varying graphs, i.e., graphs with a structure that changes over time, and multi-layer graphs, i.e., graphs with multiple types of links. More specifically, we examine the case in which the attacker has access to the degree of the nodes. The goal is to generate a new graph where, given the degree of a node in each (temporal) layer of the graph, such a node remains indistinguishable from other k-1 nodes in the graph. In order to achieve this, we find the optimal partitioning of the graph nodes such that the cost of anonymizing the degree information within each group is minimum. We show that this reduces to a special case of a Generalized Assignment Problem, and we propose a simple yet effective algorithm to solve it. Finally, we introduce an iterated linear programming approach to enforce the realizability of the anonymized degree sequences. The efficacy of the method is assessed through an extensive set of experiments on synthetic and real-world graphs.

Breaking out of the silo mentality

The return to methods focusing on language and experience following the dominance of experimental methods has in the last few decades led to debate, dialogue, and disagreement regarding the status of qualitative and quantitative methods. However, a recent focus on impact has brought an air of pragmatism to the research arena. In what ways, then, is psychology moving from entrenched mono methods approaches that have epitomised its development until recently, to describing and discussing ways in which mixed and pluralistic research can advance and contribute to further, deeper psychological understanding?.