Search results

This paper sets out to investigate whether demand for gynaecological theatre time could be described in terms of the time required to undertake elective operations booked for surgery, and so help match the capacity to this.

A questionnaire assessed the estimates for total operation time for seven common operations, sent to surgeons, anaesthetists and nursing staff in one tertiary referral and one district general hospital (total 49 staff; response rate 58 per cent), and estimates were obtained from theatre computer logs. Average timings for each operation were then applied to cases added from clinics to the waiting list at the district general, to yield the mean demand for elective surgery, and were also applied to emergencies to estimate emergency workload. Finally these demand estimates were compared with the theatre capacity available.

The paper found no difference between the estimates of the three staff groups or between these and the theatre logs (p=0.669), nor did it find that estimates differed between the two centers (p=0.628). Including emergencies, the mean (95 per cent confidence intervals) demand at the district general was 2,438 (1,952‐2,924) min/week.

Although the paper modelled the variation in demand using the relevant variation in operation times, any additional variation caused by differences in booking rates from clinics over time was not nodelled. The minimum period over which data should be collected was not established.

The paper finds that the existing capacity of 1,680 min/week did not match these needs and, unless it was increased, a rise in waiting lists was predictable.

The paper concludes that time estimates for scheduled operations can be better used to assess the need for surgical operating capacity than current measures of demand or capacity.

Anecdotally, many hospitals experience shortfalls in anaesthetic consultant staffing. This paper aims to investigate whether these subjective experiences are confirmed objectively.

The paper hypothesises that a simple model that estimated service delivery capability using consultant entitlements to annual and other types of leave would not (null hypothesis) accurately predict the magnitude of any shortfall that existed. It also hypothesises that excessive leave‐taking was an important cause of any shortfall. A comparison is made between the model predictions for total leave taken and service delivery with results from a real data set from a large university teaching hospital's department of anaesthetics.

The model prediction for leave (median total 45 days absence in a year per consultant, range (30‐59)) closely matched the reality (median 41 days (tenth‐ninetieth deciles 30‐69)). Consequently, both model predictions and the real data for annual elective service delivery agreed: median 228 sessions (193‐266) vs 232 (183‐266) per consultant respectively. Taking into account likely service delivery by trainees (2,304‐4,140 elective sessions in total annually) the predicted shortfall of 2,220 sessions was very close to the true elective service shortfall of 2,148 sessions for the department as a whole over the year.

Rejecting the null hypothesis, it is concluded that a simple model that estimates elective service delivery using leave entitlements as the main factor can accurately predict actual service capability for a department. There is no evidence that excessive leave‐taking occurs.

The paper computes an estimate that 2.2‐2.6 consultants per functional operating theatre are necessary to ensure that staffing matches the elective workload.

Social media has transformed communication possibilities for immigrant consumers with their home country in their acculturation efforts. However, the acculturative outcomes of consumer interactions with the home country through social media are largely overlooked in previous research. This study aims to investigate the acculturative processes and outcomes resulting from interacting with the home country through social media.

A netnographic approach is used to collect data from a social media platform that provides an interactive social context in which Iranian immigrants in Australia share their experiences of immigration with non-immigrants who are considering and planning to migrate to Australia.

Findings show how both immigrants and non-immigrant users via social media reflexively contribute to the formation of two competing collective narratives, namely, the dominant, romanticizing narrative and counter, pragmatic narratives. Findings highlight how notions of the home and host countries, and the idea of migrating from home to host, are constructed as the result of the circulation of the dominant and counter narratives. Further findings include how these two collective narratives come into play in the formation of three acculturative outcomes, namely, self-validating, ordinary experts and wellbeing. These insights extend consumer acculturation theory through highlighting the acculturative processes and outcomes of interactions with the home country via a social media platform. This includes, for example, how interacting with the home culture can take on assimilationist properties through the construction of a romanticized representation of the hosting society (i.e. Australia) in the dominant collective narrative.

Implications for ethnic marketing practice, policymakers and non-governmental organisations are advanced, especially regarding using social media as a channel to communicate with current and potential immigrant consumers. Notably, policymakers can use social media to engage with immigrants before and after migration to reduce the potential for cognitive dissonance in recent arrivals. Managerially, brands can advertise on Web-based forums, independent websites and social media platforms to target potential immigrants to sell relevant products immigrants needs after migrating to the host country.

Findings broaden the understanding of the potential acculturative outcomes on social media by moving away from the traditional outcomes, which are restricted to the dichotomy between the home and host cultures.

Scholarly attention is deficient on the role of direct interaction with the home country in immigrant consumer acculturation, especially through social media, which is the focus of this study.

The various quality improvement (QI) frameworks and maturity models described in the health services literature consider some aspects of QI while excluding others. This paper aims to present a concerted attempt to create a quality improvement maturity model (QIMM) derived from holistic principles underlying the successful implementation of system-wide QI programmes.

A hybrid methodology involving a systematic review (Phase 1) of over 270 empirical research articles and books developed the basis for the proposed QIMM. It was followed by expert interviews to refine the core constructs and ground the proposed QIMM in contemporary QI practice (Phase 2). The experts included academics in two academic conferences and 59 QI managers from the New Zealand health-care system. In-depth interviews were conducted with QI managers to ascertain their views on the QIMM and its applicability in their respective health organisations (HOs).

The QIMM consists of four dimensions of organisational maturity, namely, strategic, process, supply chain and philosophical maturity. These dimensions progress through six stages, namely, identification, ad-hoc, formal, process-driven, optimised enterprise and finally a way of life. The application of the QIMM by the QI managers revealed that the scope of QI and the breadth of the principles adopted by the QI managers and their HOs in New Zealand is limited.

The importance of QI in health systems cannot be overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality overstated. The proposed QIMM can help HOs diagnose their current state and provide a guide to action achieving a desirable state of quality improvement maturity. This QIMM avoids reliance on any single QI methodology. HOs – using the QIMM – should retain full control over the process of selecting any QI methodology or may even cherry-pick principles to suit their needs as long as they understand and appreciate the true nature and scope of quality.

This paper contributes new knowledge by presenting a maturity model with an integrated set of quality principles for HOs and their extended supply networks.

Drawing on the ability-motivation-opportunity model, this study investigates how gender-inclusive human resource management practices and overall fairness perception promote the career progression of female employees via psychological empowerment.

Partial least structural equation modelling (PLS-SEM) was applied to two-waves data collected from 308 respondents from Pakistan to confirm hypotheses.

Findings suggest that gender-inclusive HRM practices substantially affect female employees' psychological empowerment and career progression. Psychological empowerment is a mediating mechanism that explains the effect of gender-inclusive HRM practices on female employees' career progression. Finally, overall fairness perception further amplifies the effect of gender-inclusive HRM practices on psychological empowerment and career progression.

The study provides evidence to policymakers that organizations may promote psychological empowerment and career progression of female employees by implementing gender-inclusive HRM practices and promoting overall fairness perception.

This study contributes to achieving the SDGs by examining the impact of gender-inclusive HRM practices and overall fairness perception on female employees' psychological empowerment and career progression. Specifically, it aligns with “Goal 5 - achieve gender equality and empower all women and girls” and “Goal 8 - promote sustained, inclusive, and sustainable economic growth, full and productive employment, and decent work for all”.

The purpose of this paper is to enhance the heat transfer and thermal performance in the trailing edge region of the vane with vortex generators (VGs).

This numerical study presents the enhancement of thermal performance in the trailing part of a gas turbine blade. In the trailing part, generally, pin fins are used either in staggered or in-line arrangements to enhance the heat transfer. In this study, based on the idea from heat exchangers, pin fins are combined with VGs. A pair of VGs is embedded in the boundary layer upstream of each pin fin in the first row of the pin fin array having an in-line configuration. The effects of the VG angle relative to the streamwise direction and streamwise distance between the pin fin and VGs are investigated at various Reynolds numbers.

The results indicated that the endwall heat transfer is enhanced with the addition of VGs and the heat transfer from the surfaces of the pin fins. The level of heat transfer enhancement compared to the case without VGs is more significant at high Reynolds number. The surfaces of the VGs also show a significant amount of heat transfer. Study of the angle of the attack suggested that a high angle of attack is more appropriate for pin fin cooling enhancement whereas an intermediate gap between the VGs and pin fins shows considerable improvement of thermal performance compared to the small and large gaps. The phenomenon of heat transfer augmentation with the VGs is demonstrated by the flow field. It shows that the enhancement of heat transfer is governed by the mixing of the flow as a result of the interaction of vortices generated by the VGs and pin fins.

VGs are used to disturb the thermal boundary layer. It shows that heat transfer is augmented as a result of the interaction of vortices associated with VGs and pin fins.

Cancelled operations are a major drain on health resources: 8 per cent of scheduled elective operations are cancelled nationally, within 24 hours of surgery. The aim of this study is to define the extent of this problem in one Trust, and suggest strategies to reduce the cancellation rate.

A prospective survey was conducted over a 12‐month period to identify cancelled day case and in‐patient elective operations. A dedicated nurse practitioner was employed for this purpose, ensuring that the reasons for cancellation and the timing in relation to surgery were identified. The reasons for cancellation were grouped into patient‐related reasons, hospital clinical reasons and hospital non‐clinical reasons.

In total, 13,455 operations were undertaken during the research period and 1,916 (14 per cent) cancellations were recorded, of which 615 were day cases and 1,301 in‐patients: 45 per cent (n=867) of cancellations were within 24 hours of surgery; 51 per cent of cancellations were due to patient‐related reasons; 34 per cent were cancelled for non‐clinical reasons; and 15 per cent for clinical reasons. The common reasons for cancellation were inconvenient appointment (18.5 per cent), list over‐running (16 per cent), the patients thought that they were unfit for surgery (12.2 per cent) and emergencies and trauma (9.4 per cent).

This study demonstrates that 14 per cent of elective operations are cancelled, nearly half of which are within 24 hours of surgery. The cancellation rates could be significantly improved by directing resources to address patient‐related causes and hospital non‐clinical causes.

This paper is of value in that it is demonstrated that most cancellations of elective operations are due to patient‐related causes and several changes are suggested to try and limit the impact of these cancellations on elective operating lists.

The purpose of this paper is to explore waiting times in improving access to psychological therapies (IAPT) services before and throughout the COVID-19 pandemic. The paper aims to help develop a better understanding of waiting times in IAPT so that interventions can be developed to address them.

IAPT national data reports was analysed to determine access and in-treatment waiting times before, during and after the COVID-19 pandemic. Time-series data was used to examine referral patterns, waiting list size and waiting times between the period of November 2018 and January 2022. The data covers all regions in England where an IAPT service has been commissioned.

There was a dramatic drop in referrals to IAPT services when lockdown started. Waiting list size for all IAPT services in the country reduced, as did incomplete and completed waits. The reduction in waiting times was short-lived, and longer waits are returning.

This paper aims to contribute to the literature on IAPT waiting times both in relation to, and outside of, COVID-19. It is hoped that the conclusions will generate discussion about addressing long waits to treatment for psychological therapy and encourage further research.

To the best of the authors’ knowledge, there is no published research examining the performance of IAPT waiting times to second appointment. The paper also contributes to an understanding of how IAPT waiting times are measured and explores challenges with the system itself. Finally, it offers an overview on the impact of the COVID-19 pandemic on waiting time performance nationally.

Most developed countries have enacted privacy laws to govern the collection and use of personal information (PI) as a response to the increased misuse of PI. Yet, these laws rely heavily on the concept of informational self-determination through the “notice” and “consent” models, which is deeply flawed. This study aims at tackling these flaws achieve the full potential of these privacy laws.

The author critically reviews the concept of informational self-determination through the “notice” and “consent” model identifying its main flaws and how they can be tackled.

Existing approaches present interesting ideas and useful techniques that focus on tackling some specific problems of informational self-determination but fail short in proposing a comprehensive solution that tackles the essence of the overall problem.

This study introduces a model for informed consent, a proposed architecture that aims at empowering individuals (data subjects) to take an active role in the protection of their PI by simplifying the informed consent transaction without reducing its effectiveness, and an ontology that can partially realize the proposed architecture.