The complexity in the implementation process of empowerment-based chronic kidney care: a case study

Background: This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods: A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results: Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions: The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.

Medición de la cultura de seguridad del paciente en un hospital público de primer nivel en el municipio de Villeta

Esta investigación midió la percepción del personal asistencial sobre la cultura de seguridad de los pacientes en un hospital de primer nivel de complejidad por medio de un estudio descriptivo de corte transversal. Se utilizó como herramienta de medición la encuesta ‘Hospital Survey on Patient Safety Cultura’ (HSOPSC) de la Agency of Healthcare Research and Quality (AHRQ) versión en español, la cual evalúa doce dimensiones. Los resultados mostraron fortalezas como el aprendizaje organizacional, las mejoras continuas y el apoyo de los administradores para la seguridad del paciente. Las dimensiones clasificadas como oportunidades de mejora fueron la cultura no punitiva, el personal, las transferencias y transiciones y el grado en que la comunicación es abierta. Se concluyó que aunque el personal percibía como positivo el proceso de mejoramiento y apoyo de la administración también sentía que era juzgado si reportaba algún evento adverso.

THE IMPLICATION OF PLAY AND FANTASY IN THE CONSTRUCTION OF THE MEANING OF CHILDREN’S ENUNCIATION

The aim of this paper is to contribute to the understanding of issues related to the meanings of children's enunciation, considering particularly the role of play and fantasy. To achieve this, we have based ourselves on theoretical and conceptual contributions from the Theory of Enunciative Operations in association with cognitive psychology, through its position towards the construction process of the enunciations and their meaning (CULIOLI, 1990; DE VOGÜÉ, FRANCKEL, PAILLARD, 2011) – and towards interactions characterized as routinized, integrated into the concept of format (BRUNER, 1983), still stressing the relationship between play, fantasy and language in early childhood (WINNICOTT, 1982). Throughout this study we presented the analysis of the speech of a male child, GUS, registered between 24 and 35 months of age, provided by published audiovisual data, recorded and transcribed through the CLAN system, that is part of NALíngua, a databank that is integrated to interdisciplinary research project coordinated by DEL RE (UNESP/FCLAr-CNPq). The analysis focuses on GUS interactions that are observed at the play with different car toys, a themed card game, also about cars, and the animated film's plot “Cars”(PIXAR, DISNEY, 2006), that are presented within a wide range of supports for the child to interact with, stimulating his verbal and nonverbal production. By examining its presence in the process of acquiring structural aspects of the language, we demonstrated how the child is able to adopt representations accessed by the use of words and expressions, due to an intersubjective process of adjustment that integrates fantasies and ludic experiences.  

Automated Scheduler

Automated Scheduler is a prototype software tool that automatically prepares a construction schedule together with a 4D simulation of the construction process from a 3D CAD building model.

Off-site Manufacture in Australia : Current State and Future Directions

Off-site manufacture (OSM) offers numerous benefits to all parties in the construction process. The uptake of OSM in Australia has, however, been limited. This limited uptake corresponds to similar trends in the UK and US, although the level of OSM there appears to be increasing. This project undertook three workshops — one each in Victoria, Queensland and Western Australia — and 18 interviews with key stakeholders to assist in identifying the general benefits and barriers to OSM uptake in the Australian construction industry. Seven case studies were also undertaken, involving construction projects that used OSM, ranging from civil projects through to residential. Each of these case studies has been analysed to identify what worked and what didn’t, and suggest the lessons to be learned from each project.

Drivers constraints and the future of off-site manufacture in Australia.

Much has been written on Off-site Manufacture (OSM) in construction, particularly regarding the perceived benefits and barriers to implementation. However, very little understanding of the state of OSM in the Australian construction industry exists. A ‘scoping study' has recently been undertaken to determine the ‘state-of-the-art’ of OSM in Australia. This involved several industry workshops, interviews and case studies across four major states of Australia. The study surveyed a range of suppliers across the construction supply-chain, incorporating the civil, commercial and housing segments of the market. This revealed that skills shortages and lack of adequate OSM knowledge are generally the greatest issues facing OSM in Australia. The drivers and constraints that emerged from the research were, in large measure, consistent with those found in the US and UK, although some Australian anomalies are evident, such as the geographical disparity of markets. A comparative analysis with similar studies in the UK and US is reported, illustrating both the drivers and constraints confronting the industry in Australia. OSM uptake into the future is however dependent on many factors, not least of which is a better understanding of the construction process and its associated costs.

Service identification through value chain analysis and prioritization

In a resource constrained business world, strategic choices must be made on process improvement and service delivery. There are calls for more agile forms of enterprises and much effort is being directed at moving organizations from a complex landscape of disparate application systems to that of an integrated and flexible enterprise accessing complex systems landscapes through service oriented architecture (SOA). This paper describes the deconstruction of an enterprise into business services using value chain analysis as each element in the value chain can be rendered as a business service in the SOA. These business services are explicitly linked to the attainment of specific organizational strategies and their contribution to the attainment of strategy is assessed and recorded. This contribution is then used to provide a rank order of business service to strategy. This information facilitates executive decision making on which business service to develop into the SOA. The paper describes an application of this Critical Service Identification Methodology (CSIM) to a case study.

Robot building for preschoolers

This paper describes Electronic Blocks, a new robot construction element designed to allow children as young as age three to build and program robotic structures. The Electronic Blocks encapsulate input, output and logic concepts in tangible elements that young children can use to create a wide variety of physical agents. The children are able to determine the behavior of these agents by the choice of blocks and the manner in which they are connected. The Electronic Blocks allow children without any knowledge of mechanical design or computer programming to create and control physically embodied robots. They facilitate the development of technological capability by enabling children to design, construct, explore and evaluate dynamic robotics systems. A study of four and five year-old children using the Electronic Blocks has demonstrated that the interface is well suited to young children. The complexity of the implementation is hidden from the children, leaving the children free to autonomously explore the functionality of the blocks. As a consequence, children are free to move their focus beyond the technology. Instead they are free to focus on the construction process, and to work on goals related to the creation of robotic behaviors and interactions. As a resource for robot building, the blocks have proved to be effective in encouraging children to create robot structures, allowing children to design and program robot behaviors.

Strategy content analysis for service identification : a case study on government agencies

In a resource constrained business world, strategic choices must be made on process improvement and service delivery. There are calls for more agile forms of enterprises and much effort is being directed at moving organizations from a complex landscape of disparate application systems to that of an integrated and flexible enterprise accessing complex systems landscapes through service oriented architecture (SOA). This paper describes the analysis of strategies to detect supporting business services. These services can then be delivered in a variety of ways: web-services, new application services or outsourced services. The focus of this paper is on strategy analysis to identify those strategies that are common to lines of business and thus can be supported through shared services. A case study of a state government is used to show the analytical method and the detection of shared strategies.

Innovative project procurement in the Queensland government : the Woodford Correctional Centre

Much of the effort of the construction industry is directed towards the provision of services and products, many with substantial long term implications. Systems and procedures have evolved over centuries to provide these services and products, but inefficiencies have developed. One strategy for improving the efficiency of the construction industry is to restructure the systems and procedures which deliver projects so that improved benefits to the end users are provided. In this paper, contemporary systems and procedures for the delivery of projects are reviewed and the roles of the major stakeholders are examined. The recent construction of Woodford Correctional Centre in Queensland is reviewed as a case study in restructuring the delivery process and the lessons learned from this successful project are summarised.

Procuring Sydney’s Olympic Stadium : a world class event?

This paper describes and analyses the procurement processes employed in delivering the Sydney Olympic Stadium – arguably the most significant stadia project in the region today. This current high profile project is discussed in terms of a case study into the procurement processes used. Interviews, personal site visits and questionnaires were used to obtain information on the procurement processes used and comments on their application to the project. The alternative procurement process used on this project—Design and Construction within a Build, Own, Operate and Transfer (BOOT) project—is likely to impact on the construction industry as a whole. Already other projects and sectors are following this lead. Based on a series of on-site interviews and questionnaires, a series of benefits and drawbacks to this procurement strategy are provided.The Olympic Stadium project has also been further analysed during construction through a Degree of Interaction framework to determine anticipated project success. This analysis investigates project interaction and user satisfaction to provide a comparable rating. A series of questionnaires were used to collect data to calculate the Degree of Interaction and User Satisfaction ratings.

Knowledge management strategy for the Building Division, Queensland Department of Public Works

This paper describes the background and methodology developed and employed in undertaking research developing a Knowledge Management Strategy for a key construction focused government agency. This paper reviews this methodology and examines a likely Knowledge Management Strategy. Two central objectives structure this Case Study: 1. Identify categories of important information generated by the Building Division, Queensland Department of Public Works in its service delivery to internal and external stake-holders, and 2. Formulate an appropriate and targeted Knowledge Management Strategy to meet the needs of the Queensland Building Capital Works program. The structure of this paper includes: *Description of the Queensland construction industry setting *Review the relevant literature *Design an appropriate research methodology *Analyse results *Formulate conclusions, contributions and implications of the targeted strategy.

Re-engineering project planning processes : a best practice model for managing project phase integration issues

Competitive markets are increasingly driving new initiatives for shorter cycle times resulting in increased overlapping of project phases. This, in turn, necessitates improving the interfaces between the different phases to be overlapped (integrated), thus allowing transfer of processes, information and knowledge from one individual or team to another. This transfer between phases, within and between projects, is one of the basic challenges to the philosophy of project management. To make the process transfer more transparent with minimal loss of momentum and project knowledge, this paper draws upon Total Quality Management (TQM) and Business Process Re-engineering (BPR) philosophies to develop a Best Practice Model for managing project phase integration. The paper presents the rationale behind the model development and outlines its two key parts; (1) Strategic Framework and (2) Implementation Plan. Key components of both the Strategic Framework and the Implementation Plan are presented and discussed.