A karcsú (lean) elvek alkalmazásának tapasztalatai az egészségügyi folyamatok fejlesztésében (Experiences of the adaptation of lean management in the development of healthcare processes)

Az elmúlt néhány évben a külföldi sajtóban és szakmai publikációkban egyre többször jelenik meg a „lean egészségügy”, azaz a karcsú menedzsment alkalmazása az egészségügyben mint téma. Habár az ez irányú kutatások még nemzetközi szinten is csak legfeljebb a hajnalukon tartanak, Magyarországon még szinte teljes a sötétség. Ennek a cikknek az a célja, hogy egyrészről felhívja a kutatók, de még inkább a egészségügyi dolgozók, menedzserek figyelmét erre a menedzsmenteszközre és filozófiára, mely új lehetőségeket kínál, másrészről, hogy áttekintést adjon a területen végzett nemzetközi kutatások eredményeiről. A tanulmány ennek megfelelően alapvetően két részre bontható. Az első felében az egészségügyi szolgáltatások helyzetének rövid jellemzése után a karcsú menedzsment alapjait és az egészségügyi szolgáltatásokban való alkalmazásának eszményét mutatja be. A második fele ugyanakkor 16 esettanulmány elemzésén keresztül bemutatja, hogy meddig jutott a világ a „lean egészségügy” ideájának megvalósításában. _______ In the past few years “Lean Healthcare” – the adaptation of lean management into healthcare settings – turns up as a topic often and often in foreign press and the in the professional publications. Although researches at international level in this field are at best at their dawning, in Hungary the darkness is almost complete. This article aims at one side to draw researchers’ and even more healthcare employees’ and managers’ attention to this management tool and philosophy, which offers new possibilities. From the other side to provide an overview of the results of the researches conducted in this field. Reflecting this doubled aim the study is divided into two major sections. In the first part the situation of the health care providers is shortly described followed by the introduction of the basics of the lean management and the idea of applying it into healthcare services. While the second part of the study shows how far the World reached in realizing the idea of “Lean Healthcare” by analyzing 16 cases.

Vágyott kultúra és reális értékítélet - Tudásmenedzsment-rendszer kiépítésének előfeltétele egy felsőoktatási intézményben (Desired culture and real value judgement – Precondition of development a knowledge management system in a higher education institution)

A tudásmenedzsment-rendszerek kiépítése és működtetése egyre népszerűbb vállalati cél. A legnagyobb igyekezet ellenére is kudarccal végződhet egy ilyen változás megvalósítása, ha a szükséges feltételek nélkül próbálkozunk ezzel a beavatkozással a szervezet életében. Az egyik legfontosabb előfeltétel a bizalomra, közös tanulásra, fejlődésre épülő, nyitott szervezeti kultúra, mely a tanulószervezeti jellemzőkkel írható le. A szerzők kutatásukban arra voltak kíváncsiak, milyen elképzeléseik, vágyaik vannak a felsőoktatásban oktató kollégáknak az ideálisnak nevezett szervezeti kultúráról. Ezeket az elképzeléseket egy külső tanácsadó cég által végzett kérdőíves felmérésen alapuló vizsgálat segítségével tudták meg, melynek kiértékelésére a circumplex-módszer szolgált. Az eredményeket összevetették a tanulószervezeti jellemzőkkel, vizsgálva azt a hipotézist, miszerint az oktató kollégák tudat alatt is olyan ideális szervezetet képzelnek el, mely a tanulószervezeti kultúra jellemzőivel azonos. _________ To create and to operate a knowledge management system is becoming a more and more popular target of the companies. Realizing the changes above can result in a failure – in spite of the biggest will – if organizations lack certain prerequisites which are necessary in companies’ lives. One of the most important prerequisites is organizational culture which can be characterized by confidence, common learning, development and open atmosphere. This is called a learning organizational culture. In their research the authors would have liked to know what kind of dreams the colleagues have about their own organizational culture. They achieve these results from an investigation with questionnaires which were realized by an advisory team. To evaluating the results of this investigation circumplex method was used. These results were compared with the characteristics of learning organization to confirm our hypothesis. According to this idea colleagues have the same images about their successful organization as the characteristics of learning organizations.

Development of an odor management plan for industrial stationary sources in an urban environment: A case study for Broward County, Florida

Objectionable odors remain at the top of air pollution complaints in urban areas such as Broward County that is subject to increasing residential and industrial developments. The odor complaints in Broward County escalated by 150 percent for the 2001 to 2004 period although the population increased by only 6 percent. It is estimated that in 2010 the population will increase to 2.5 million. Relying solely on enforcing the local odor ordinance is evidently not sufficient to manage the escalating odor complaint trends. An alternate approach similar to odor management plans (OMPs) that are successful in managing major malodor sources such as animal farms is required. ^ This study aims to develop and determine the feasibility of implementing a comprehensive odor management plan (COMP) for the entire Broward County. Unlike existing OMPs for single sources where the receptors (i.e. the complainants) are located beyond the boundary of the source, the COMP addresses a complex model of multiple sources and receptors coexisting within the boundary of the entire county. Each receptor is potentially subjected to malodor emissions from multiple sources within the county. Also, the quantity and quality of the source/receptor variables are continuously changing. ^ The results of this study show that it is feasible to develop a COMP that adopts a systematic procedure to: (1) Generate maps of existing odor complaint areas and malodor sources, (2) Identify potential odor sources (target sources) responsible for existing odor complaints, (3) Identify possible odor control strategies for target sources, (4) Determine the criteria for implementing odor control strategies, (5) Develop an odor complaint response protocol, and (6) Conduct odor impact analyses for new sources to prevent future odor related issues. Geographic Information System (GIS) is used to identify existing complaint areas. A COMP software that incorporates existing United States Environmental Protection Agency (EPA) air dispersion software is developed to determine the target sources, predict the likelihood of new complaints, and conduct odor impact analysis. The odor response protocol requires pre-planning field investigations and conducting surveys to optimize the local agency available resources while protecting the citizen's welfare, as required by the Clean Air Act. ^

The early development and pilot -testing of a case management intervention with victims of stalking: An evaluation study

This study evaluated the early development and pilot-testing of Project IMPACT, a case management intervention for victims of stalking. The Design and Development framework (Rothman & Thomas, 1994) was used as a guide for program development and evaluation. Nine research questions examined the processes and outcomes associated with program implementation. ^ The sample included all 36 clients who participated in Project IMPACT between February of 2000 and June of 2001, as well as the victim advocates who provided them with services. Quantitative and qualitative data were drawn from client case files, participant observation field notes and interview transcriptions. Quantitative data were entered into three databases where: (1) clients were the units of analysis (n = 36), (2) services were the units of analysis (n = 1146), and (3) goals were the units of analysis (n = 149). These data were analyzed using descriptive statistics, Pearson's Chi-square, Spearman's Rho, Phi, Cramer's V, Wilcoxon's Matched Pairs Signed-Ranked Test and McNemar's Test Statistic. Qualitative data were reduced via open, axial and selective coding methods. Grounded theory and case study frameworks were utilized to analyze these data. ^ Results showed that most clients noted an improved sense of well-being and safety, although residual symptoms of trauma remained for numerous individuals. Stalkers appeared to respond to criminal and civil justice-based interventions by reducing violent and threatening behaviors; however, covert behaviors continued. The study produced findings that provided preliminary support for the use of several intervention components including support services, psycho-education, safety planning, and boundary spanning. The psycho-education and safety planning in particular seemed to help clients cognitively reframe their perceptions of the stalking experience and gain a sense of increased safety and well-being. A 65% level of satisfactory goal achievement was observed overall, although goals involving justice-based organizations were associated with lower achievement. High service usage was related to low-income clients and those lacking in social support. Numerous inconsistencies in program implementation were found to be associated with the skills and experiences of victim advocates. Thus, recommendations were made to further refine, develop and evaluate the intervention. ^

The Effectiveness of an Online Workshop on Behavior Management as a Professional Development Tool for Teachers

The current study examines the effects of an online workshop pertaining to classroom behavior management on teacher self-efficacy, attitudes, motivation, knowledge, and practices. In addition, information about teacher utilization of the Internet, their opinions about professional development, and experiences with classroom management were collected. Participants included 57 1st through 5th grade special and regular education teachers. Eligible teachers were those who teach an academic subject and had at least one child in the classroom they considered as disruptive. Teachers were randomized to either a training or waitlist group. Classroom observations of teacher practices and questionnaires were utilized. Teachers in the training group participated in two assessment points, baseline and post-workshop, and received access to the online course immediately following the baseline assessment. Teachers in the waitlist group participated in three assessment points, baseline, post-workshop, and follow-up, and received access to the online course immediately following the post-workshop assessment. Findings show that all teachers had access to the Internet at home and at school and used it on a daily basis. The majority of teachers indicated having some past training on all the techniques that were presented in the online workshop. All teachers expressed satisfaction with the workshop, indicating that it should be offered again. Post-workshop, findings showed significant group differences in knowledge with a large effect for the training group scoring higher than the waitlist group on a quiz. Secondly, group differences in self-efficacy, knowledge, and attitudes with teachers’ past-training as a moderator, was examined. Past-training was not found to be a significant moderator of self-efficacy, knowledge, or attitudes. However, the main effect for training group was significant for attitudes. In addition, teacher attitudes, but not knowledge and self-efficacy, significantly predicted motivation to implement. Next, the moderating effect of barriers on motivation and classroom management skill implementation was examined. Barriers were not found to be a significant moderator. Lastly, the training group was observed to be significantly more effective at giving commands compared to the waitlist group. The current study demonstrates the potential of a low-intensity online workshop on classroom management to enhance the accessibility of teacher professional development.

Business information systems:technology, development and management for the e-business

In order to run a successful business, today’s manager needs to combine business skills with an understanding of information systems and the opportunities and benefits that they bring to an organisation. Starting from basic concepts, this book provides a comprehensive and accessible guide to: •understanding the technology of business information systems; •choosing the right information system for an organisation; •developing and managing an efficient business information system; •employing information systems strategically to achieve organisational goals. Taking a problem-solving approach, Business Information Systems looks at information systems theory within the context of the most recent business and technological advances. This thoroughly revised new edition has updated and expanded coverage of contemporary key topics such as: •Web 2.0 •enterprise systems •implementation and design of IS strategy •outsourcing

Enterprise management and ERP development:case study of Zoomlion using dynamic enterprise reference grid

The enterprise management approach provides a holistic view of organizations and their related information systems. In order to cope with the globalization, virtualization, and volatile competitive environment, traditional firms are seeking to reconstruct their organizational structures and establish new IS architectures to transform from single autonomous entities into more open enterprises supported by new Enterprise Resource Planning (ERP) systems. This paper reports on ERP engage-abilities within three different enterprise management patterns based on the theoretical foundations of the "Dynamic Enterprise Reference Grid". An exploratory inductive study in Zoomlion using the narrative research approach has been conducted. Also, this research delivers a conceptual framework to demonstrate the adoption of ERP in the three enterprise management structures and points to a new architectural type (ERPIII) for operating in the virtual enterprise paradigm. © 2010 Springer-Verlag.

Non-Pharmacological Approaches for Pain Management in Sickle Cell Disease: Development of a Mindfulness-Based Intervention

Background: Sickle Cell Disease (SCD) is a genetic hematological disorder that affects more than 7 million people globally (NHLBI, 2009). It is estimated that 50% of adults with SCD experience pain on most days, with 1/3 experiencing chronic pain daily (Smith et al., 2008). Persons with SCD also experience higher levels of pain catastrophizing (feelings of helplessness, pain rumination and magnification) than other chronic pain conditions, which is associated with increases in pain intensity, pain behavior, analgesic consumption, frequency and duration of hospital visits, and with reduced daily activities (Sullivan, Bishop, & Pivik, 1995; Keefe et al., 2000; Gil et al., 1992 & 1993). Therefore effective interventions are needed that can successfully be used manage pain and pain-related outcomes (e.g., pain catastrophizing) in persons with SCD. A review of the literature demonstrated limited information regarding the feasibility and efficacy of non-pharmacological approaches for pain in persons with SCD, finding an average effect size of .33 on pain reduction across measurable non-pharmacological studies. Second, a prospective study on persons with SCD that received care for a vaso-occlusive crisis (VOC; N = 95) found: (1) high levels of patient reported depression (29%) and anxiety (34%), and (2) that unemployment was significantly associated with increased frequency of acute care encounters and hospital admissions per person. Research suggests that one promising category of non-pharmacological interventions for managing both physical and affective components of pain are Mindfulness-based Interventions (MBIs; Thompson et al., 2010; Cox et al., 2013). The primary goal of this dissertation was thus to develop and test the feasibility, acceptability, and efficacy of a telephonic MBI for pain catastrophizing in persons with SCD and chronic pain.

Methods: First, a telephonic MBI was developed through an informal process that involved iterative feedback from patients, clinical experts in SCD and pain management, social workers, psychologists, and mindfulness clinicians. Through this process, relevant topics and skills were selected to adapt in each MBI session. Second, a pilot randomized controlled trial was conducted to test the feasibility, acceptability, and efficacy of the telephonic MBI for pain catastrophizing in persons with SCD and chronic pain. Acceptability and feasibility were determined by assessment of recruitment, attrition, dropout, and refusal rates (including refusal reasons), along with semi-structured interviews with nine randomly selected patients at the end of study. Participants completed assessments at baseline, Week 1, 3, and 6 to assess efficacy of the intervention on decreasing pain catastrophizing and other pain-related outcomes.

Results: A telephonic MBI is feasible and acceptable for persons with SCD and chronic pain. Seventy-eight patients with SCD and chronic pain were approached, and 76% (N = 60) were enrolled and randomized. The MBI attendance rate, approximately 57% of participants completing at least four mindfulness sessions, was deemed acceptable, and participants that received the telephonic MBI described it as acceptable, easy to access, and consume in post-intervention interviews. The amount of missing data was undesirable (MBI condition, 40%; control condition, 25%), but fell within the range of expected missing outcome data for a RCT with multiple follow-up assessments. Efficacy of the MBI on pain catastrophizing could not be determined due to small sample size and degree of missing data, but trajectory analyses conducted for the MBI condition only trended in the right direction and pain catastrophizing approached statistically significance.

Conclusion: Overall results showed that at telephonic group-based MBI is acceptable and feasible for persons with SCD and chronic pain. Though the study was not able to determine treatment efficacy nor powered to detect a statistically significant difference between conditions, participants (1) described the intervention as acceptable, and (2) the observed effect sizes for the MBI condition demonstrated large effects of the MBI on pain catastrophizing, mental health, and physical health. Replication of this MBI study with a larger sample size, active control group, and additional assessments at the end of each week (e.g., Week 1 through Week 6) is needed to determine treatment efficacy. Many lessons were learned that will guide the development of future studies including which MBI strategies were most helpful, methods to encourage continued participation, and how to improve data capture.

Development and Evaluation of a Computer-Based, Self-Management Tool for People Recently Diagnosed with Type 2 Diabetes

Aim. The purpose of this study was to develop and evaluate a computer-based, dietary, and physical activity self-management program for people recently diagnosed with type 2 diabetes. 
Methods. The computer-based program was developed in conjunction with the target group and evaluated in a 12-week randomised controlled trial (RCT). Participants were randomised to the intervention (computer-program) or control group (usual care). Primary outcomes were diabetes knowledge and goal setting (ADKnowl questionnaire, Diabetes Obstacles Questionnaire (DOQ)) measured at baseline and week 12. User feedback on the program was obtained via a questionnaire and focus groups. Results. Seventy participants completed the 12-week RCT (32 intervention, 38 control, mean age 59 (SD) years). After completion there was a significant between-group difference in the “knowledge and beliefs scale” of the DOQ. Two-thirds of the intervention group rated the program as either good or very good, 92% would recommend the program to others, and 96% agreed that the information within the program was clear and easy to understand. 
Conclusions. The computer-program resulted in a small but statistically significant improvement in diet-related knowledge and user satisfaction was high. With some further development, this computer-based educational tool may be a useful adjunct to diabetes self-management.

Review of virtual power plant applications for the power system management and V2G market development

Utilization of renewable energy sources and energy storage systems is increasing with fostering new policies on energy industries. However, the increase of distributed generation hinders the reliability of power systems. In order to stabilize them, a virtual power plant emerges as a novel power grid management system. The VPP has a role to make a participation of different distributed energy resources and energy storage systems. This paper defines core technology of the VPP which are demand response and ancillary service concerning about Korea, America and Europe cases. It also suggests application solutions of the VPP to V2G market for restructuring national power industries in Korea.

Sustainability, creativity and innovation in project management – Model development for assessing organizational performance through projects

Today a number of studies are published on how organizational strategy is developed and how organizations contribute to local and regional development through the realization of these strategies. There are also many articles dealing with the success of a project by identifying the criteria and the factors that influence them. This article introduces the project-oriented strategic planning process that reveals how projects contribute to local and regional development and demonstrates the relationship between this approach and the regional competitiveness model as well as the KRAFT concept. There is a lot of research that focuses on sustainability in business. These studies argue that sustainability is very important to the success of a business in the future. The Project Excellence Model that analyses project success does not contain the sustainability criteria; the GPM P5 standard consists of sustainability components related either to the organizational level. To fill this gap a Project Sustainability Excellence Model (PSEM) was developed. The model was tested by interviews with managers of Hungarian for-profit and non-profit organizations. This paper introduces the PSEM and highlights the most important elements of the empirical analysis.

Draft Project Management Update to the Iowa DOT Project Development Manual, 2016

This work supported drafting project management guidance for the Iowa Department of Transportation (DOT). The goal is to incorporate a greater focus on project management in their project development process. A technical advisory committee (TAC) was assembled to accomplish this effort. The TAC took into consideration the current status of project management with the Iowa DOT, their experience during the demonstration workshop held in Iowa as part of the implementation assistance they received, the project management peer exchange hosted by the Iowa DOT, and additional examples of project management that were presented. With this basis, the TAC participated in a number of discussions to develop draft guidance for the foundation of a Project Management Office (PMO) within the Iowa DOT. The final report describes the process that was used in establishing this guidance. The report details the decisions and decision process that the TAC employed in this endeavor and provides additional thoughts and insight into the draft guidance. Appendix A includes the draft guidance in the form of PMO function details and detailed lists of project management roles and responsibilities. Appendix B includes a starter list of project management resources for the PMO.