Strategic Planning: Moving From Plan to Implementation

Successful organizations depend on strategic thinkers who understand strategic planning and strategic management. These strategic leaders can proactively manage the constant environmental changes to position their organizations for a competitive advantage and avoid acting in a reactive and defensive manner. However, while organizations are often adept at developing extensive strategic plans, implementation of the plan is often poor or without a definitive strategy. This article addresses key strategies for successful implementation of changes to bring about sustainable cultural change in an organization to meet the organization's overall strategic goals, specifically through the use of implementation science.

Risk evaluation of secondary malignancies after radiotherapy of breast cancer in light of the continuous development of planning techniques

Secondary cancer risk is a significant concern for women treated with breast radiation therapy due to improved long-term survival rates. We evaluated the potential of new advanced automated planning algorithms together with hybrid techniques to minimize the excess absolute risk (EAR) for secondary cancer in various organs after radiation treatment for early staged breast cancer. Using CT data set of 25 patients, we generated 4 different radiation treatment plans of different complexity, including 3-dimensional conformal radiotherapy (3D-CRT), field-in-field (FinF), hybrid-IMRT (HMRT) and automated hybrid-VMAT (HVMAT) techniques. The organ-equivalent dose (OED) was calculated from differential dose-volume histograms on the basis of the "linear-exponential," "plateau," and "full mechanistic" dose-response models and was used to evaluate the EAR for secondary cancer in the contralateral breast (CB), contralateral lung (CL), and ipsilateral lung (IL). Statistical comparisons of data were performed by a Kruskal-Wallis analysis of variance. The planning objectives were fulfilled with all the planning techniques for both target coverage and organs-at-risk sparing. The differences in EAR for CB, CL and IL secondary tumor induction were not significant among the 4 techniques. For the CB and CL, the mean absolute difference did not reach 1 case of 10000 patient-years. For the IL, the mean absolute difference was up to 5 cases of 10,000 patient-years. In conclusion, the automated HVMAT technique allows an EAR reduction at the level of well-consolidated tangential 3D-CRT or FinF techniques, keeping all the HVMAT dosimetric improvements unchanged. On the basis of this analysis, the adoption of the HVMAT technique poses no increase in EAR and could be considered safe also for younger patients.

Development and validation of a route planning methodology for vehicle-based remote measurements of methane and other emissions from oil and gas wells and facilities

Multi-sensor vehicle systems have been implemented in large-scale field programs to detect, attribute, and estimate emissions rates of methane (CH₄) and other compounds from oil and gas wells and facilities. Most vehicle systems use passive sensing; they must be positioned downwind of sources to detect emissions. A major deployment challenge is predicting the best measurement locations and driving routes to sample infrastructure. Here, we present and validate a methodology that incorporates high-resolution weather forecast and geospatial data to predict measurement locations and optimize driving routes. The methodology estimates the downwind road intersection point (DRIP) of theoretical CH₄ plumes emitted from each well or facility. DRIPs serve as waypoints for Dijkstra's shortest path algorithm to determine the optimal driving route. We present a case study to demonstrate the methodology for planning and executing a vehicle-based concentration mapping survey of 50 oil and gas wells near Pecos, Texas. Validation was performed by comparing DRIPs with 174 CH₄ plumes measured by vehicle surveys of oil and gas wells and facilities in Alberta, Canada. Results indicate median Manhattan distances of 145.8 m between DRIPs and plume midpoints and 160.3 m between DRIPs and peak plume enhancements. A total of 46 (26%) of the plume segments overlapped DRIPs. Locational errors of DRIPs are related to misattributions of emissions sources and discrepancies between modeled and instantaneous wind direction measured when the vehicle intersects plumes. Although the development of the methodology was motivated by CH₄ emissions from oil and gas facilities, it should be applicable to other types of point source air emissions from known facilities.Implications: This paper presents and validates a method that addresses the challenge of measuring industrial emissions from public roads. The method can increase the effectiveness and efficiency of targeted vehicle-based emissions surveys where the locations of potential sources are known. We believe the method has broad application in addition to the upstream oil and gas context it was designed for.

Tackling communication and analytical problems in environmental planning: Expert assessment of key definitions and their relationships

Inadequate definition of key terms and their relationships generates significant communication and analytical problems in environmental planning. In this work, we evaluate an ontological framework for environmental planning designed to combat these problems. After outlining the framework and issues addressed, we describe its evaluation by a group of experts representing a range of expertise and institutions. Experts rated their level of agreement with 12 propositions concerning the definitions and models underpinning the framework. These propositions, in turn, were used to assess three assumptions regarding the expected effectiveness of the framework and its contribution to addressing the abovementioned planning problems. In addition to point-based best estimates of their agreement with propositions, expert ratings were also captured on a continuous interval-valued scale. The use of intervals addresses the challenge of measuring and modelling uncertainty associated with complex assessments such as those provided by experts. Combined with written anonymous expert comments, these data provide multiple perspectives on the level of support for the approach. We conclude that the framework can complement existing planning approaches and strengthen key definitions and related models, thus helping avoid communication and analytical problems in environmental planning. Finally, experts highlighted areas that require further development, and we provide recommendations for improving the framework.

Reading Warm-Up, Reading Skill, and Reading Prosody When Reading the My Grandfather Passage: An Exploratory Study Born Out of the Motor Planning Theory of Prosody and Reading Prosody Research

PURPOSE

The Motor Planning Theory of Prosody and reading prosody research indicate that "out of the blue" oral reading, as practiced in clinical and research settings, invokes surface rather than covert prosody, particularly when readers are recorded, less skilled, and/or speech impaired. Warm-up is not considered in passage reading for motor-speech assessment. We report on a preliminary study aimed to investigate the effect of warm-up on reading prosody in two conditions: silent reading alone and reading "out of the blue" followed by silent reading. A secondary aim of the study was to examine the effect of reading skill on reading prosody.

METHOD

Twenty-one monolingual, English-speaking volunteers were recorded reading the My Grandfather Passage (GP) while their eye movements were tracked. Participants were randomly assigned to one of two reading conditions: (a) silent-oral (SO) and (b) oral-silent-oral (OSO). In the SO condition, participants read the GP silently as a warm-up for the subsequent oral reading. In the OSO condition, participants first read the GP aloud ("out of the blue") and then read the same passage silently with the instruction to do this in preparation for a second oral reading. Reading skill was quantified using eye-voice span and Wide Range Achievement Test-Fourth Edition testing. Reading prosody was evaluated using pause indexes, the Acoustic Multidimensional Prosody Index, and speech rate.

CONCLUSIONS

One oral reading before a silent reading but not a silent reading alone before oral reading was shown to affect reading prosody. In terms of reading skill, results indicate that predictive associations patterned differently in the reading conditions explored, suggesting different underlying skill sets.

Virtual reality surgical planning for endoscopic endonasal approaches to the craniovertebral junction

PURPOSE

To demonstrate the utility of virtual reality (VR) for preoperative surgical planning of endoscopic endonasal craniovertebral junction (CVJ) surgery.

MATERIALS AND METHODS

Five patients who had undergone endoscopic endonasal surgery of the craniovertebral junction with preoperative virtual reality surgical planning were identified and described.

RESULTS

The anterior approach to the CVJ has been traditionally accomplished transorally. However, recently the transnasal endoscopic approach to this location has been described. Multiple anatomical studies have been conducted using the nasopalatine, nasoaxial, and rhinopalatine lines (NPL, NAxL, RPL) in an attempt to preoperatively delineate the inferior limits of endoscopic dissection. The use of advanced surgical simulation using immersive virtual reality is an innovative approach for analyzing CVJ anatomy and developing a surgical plan. VR simulation through the use of interactive and highly accurate patient specific models allows for the creation of three-dimensional (3D) digital reconstructions via the fusion of CT and MRI studies. Incorporation of simulation technology has been shown to increase surgeon proficiency while simultaneously decreasing complication rates. The described case series demonstrates the novel utility of VR planning for designing the endoscopic surgical approach to the CVJ.

CONCLUSIONS

VR technology allows for the creation of anatomically accurate 3D models that can be used for preoperative planning of endoscopic endonasal surgery. Such models help in the development of safe surgical plans by predicting inferior and lateral planes of dissection and assisting in the identification of critical structures.

Why enterprise resource planning initiatives do succeed in the long run: A case-based causal network

Despite remarkable academic efforts, why Enterprise Resource Planning (ERP) post-implementation success occurs still remains elusive. A reason for this shortage may be the insufficient addressing of an ERP-specific interior boundary condition, i.e., the multi-stakeholder perspective, in explaining this phenomenon. This issue may entail a gap between how ERP success is supposed to occur and how ERP success may actually occur, leading to theoretical inconsistency when investigating its causal roots. Through a case-based, inductive approach, this manuscript presents an ERP success causal network that embeds the overlooked boundary condition and offers a theoretical explanation of why the most relevant observed causal relationships may occur. The results provide a deeper understanding of the ERP success causal mechanisms and informative managerial suggestions to steer ERP initiatives towards long-haul success.

COVID-19 and the flu: data simulations and computational modelling to guide public health strategies

BACKGROUND

Pandemics threaten lives and economies. This article addresses the global threat of the anticipated overlap of COVID-19 with seasonal-influenza.

OBJECTIVES

Scientific evidence based on simulation methodology is presented to reveal the impact of a dual outbreak, with scenarios intended for propagation analysis. This article aims at researchers, clinicians of family medicine, general practice and policy-makers worldwide. The implications for the clinical practice of primary health care are discussed. Current research is an effort to explore new directions in epidemiology and health services delivery.

METHODS

Projections consisted of machine learning, dynamic modelling algorithms and whole simulations. Input data consisted of global indicators of infectious diseases. Four simulations were run for '20% versus 60% flu-vaccinated populations' and '10 versus 20 personal contacts'. Outputs consisted of numerical values and mathematical graphs. Outputs consisted of numbers for 'never infected', 'vaccinated', 'infected/recovered', 'symptomatic/asymptomatic' and 'deceased' individuals. Peaks, percentages, R0, durations are reported.

RESULTS

The best-case scenario was one with a higher flu-vaccination rate and fewer contacts. The reverse generated the worst outcomes, likely to disrupt the provision of vital community services. Both measures were proven effective; however, results demonstrated that 'increasing flu-vaccination rates' is a more powerful strategy than 'limiting social contacts'.

CONCLUSIONS

Results support two affordable preventive measures: (i) to globally increase influenza-vaccination rates, (ii) to limit the number of personal contacts during outbreaks. The authors endorse changing practices and research incentives towards multidisciplinary collaborations. The urgency of the situation is a call for international health policy to promote interdisciplinary modern technologies in public health engineering.

A company's relational strategy: Linkage between strategic choices, attributes, and outcomes

Nowadays, the idea of firms’ atomization is rejected and companies are perceived as entities embedded in inter-organizational relationships and their configurations, including dyads and networks. The relational view in strategic management thus prompts research on a firm’s relational strategy. This paper taps this gap considering links between strategic choices and attributes of a company’s inter-organizational relationships, as well as the outcomes achieved by collaboration with different groups of stakeholders. We test the model based on research carried out on a representative sample of 400 enterprises operating in Poland and on international markets. The results of structural equation modeling show that 1) the outcomes of collaboration reflect market benefits and are dependent on the durability of the inter-organizational relationships and the heterogeneity of the supply chain relationships, 2) durability as an attribute of the relational strategy depends on the choice of how to create and appropriate value, and 3) in turn, the attribute of heterogeneity of the relational strategy depends on what type of partners are selected. Thereby, we deliver managerial implications on how to create a relational strategy to achieve a relational rent and better a company’s market position.

Introducing a Remote Pre-graduate Medical Education Curriculum Planning Workshop During the COVID-19 Pandemic

PURPOSE

To conduct a thorough online workshop on infection control under COVID-19 and to conduct a questionnaire survey on the online workshop.

OBJECTIVE

The Tokai University School of Medicine has held 39 workshops to acquire the curriculum planning ability required as a faculty member of the School of Medicine. Due to the COVID-19 pandemic, this year (2020) we were unable to hold a workshop. Therefore, we attempted an online workshop using Zoom.

METHODS

To shorten the amount of time required for the workshop, we excluded some content that was used the previous year. The day passed without any major problems, and both the participants and the individuals in charge of the workshop filled out a questionnaire at the end of the day.

RESULTS

Conclusion: Online workshops appear to be a very useful tool in terms of infection control under the COVID-19 pandemic.

Introducing the EPP house (topological space) method to solve MRP problems

The problem of product and process planning analysed so far is how we can take advantage of our strategy in planning. Among the principles of manufacturing and service management concepts is that after planning demand, planning transformation is one of the key steps of integrated efficiency; it makes it possible to save costs that are not value adding and are not necessary from the customer’s point of view. Currently, the methods of material requirements and capacity planning can be seen as classic solutions that are based on dependency relations between different resources, which can be dynamic in space and time. Measuring and recording capacities raise several problems in addition to the fact that our planning methods are not always satisfying. In the literature, the methods of material requirements planning or manufacturing resource planning (MRP) are not typically optimization methods, so they do not guarantee the best solution, and even if our planning methods were satisfying, several manufacturing restrictions (the time allowed, the complexity of the planning process, the lack of testing opportunities, etc.) could prevent us from reaching satisfying application. It is necessary to create a simple planning algorithm that can give the planner a greater degree of freedom and that would be simple and algorithmic in order to maintain continuous conscious control, putting an end to planning uncertainty and leading us to the best solution under the given conditions. The aim of our research is to introduce a novel, simple planning algorithm, similar to heuristic methods that eliminates the problem of defining the order quantity when applying traditional methods, which prevents us from determining in advance which method is desirable (causing unnecessary planning steps); computer-based solutions hide the causal relations of the methodology from the planner (causing unreliability uncertainty).

Optimizing forest road planning in a sustainable forest management area in the Brazilian Amazon

The construction of forest roads in Brazilian Amazon is costly and has a significant environmental impact. Several practices and principles must be observed to comply with legislation, to preserve the remaining forest, and to ensure sustainable exploitation. Road planning is complex in this context, based on the number of aspects and variables that must be considered. This research aimed to evaluate computational methods' effectiveness in planning forest roads, optimizing resources to reduce damage to the remaining forest, compared to traditional planning methods. The study area was a native forest under a sustainable forest management regime located in municipalities of Terra Santa and Oriximiná, in Pará, in Brazilian Amazon. Data obtained from area made it possible formulate six instances of different sizes. A binary integer linear programming model was used, solved using CPLEX software, and Dijkstra, Bellman-Ford, Dial, and D'Esopo-Pape shortest path algorithm, implemented in C programming language. During processing of instances, the time taken to obtain the solution increased according to size of instance, however, time difference was not significant. Among the evaluated algorithms, the D'Esopo-Pape algorithm showed the best performance. The evaluated methods were effective in obtaining an optimal solution for proposed forest road planning. The solutions obtained using computational methods more effectively considered the restrictions associated with sustainable forest management, in contrast to those derived from the traditional planning by forestry company.

The process of developing dynamic capabilities: The conceptualization attempt and the results of empirical studies

While most researchers interested in the concept of dynamic capabilities focus their attention on analyzing how companies transform their resources to compete in their environment, the process of developing dynamic capabilities is treated as a marginal issue. Although the literature suggests various approaches to developing dynamic capabilities, they are formulated in general terms, and doubts can be raised about the links between actions. There is also a lack of empirical research indicating the links between activities in the process of developing dynamic capabilities and their influence on the effectiveness of an organization. The aim of the study is to formulate a proposal for a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of a company and to determine the links between the activities in the model. The theoretical contribution of the paper consists in presenting a model of the process of developing dynamic capabilities aimed at increasing the economic effectiveness of the company. The results presented in the paper refer to an empirical examination of the model of developing dynamic capabilities, covering five activities: searching for opportunities; knowledge management and learning; coordination; configuration and reconfiguration; and organizational adaptation. The study also includes an examination of the possible impact the components of the dynamic capabilities building process have on a company’s performance. The study uses the survey method and data was obtained from top managers. The conclusion, based on data from 471 Polish companies, was made using structural equation modelling. The results of the empirical research suggest that the individual activities in the process of developing dynamic capabilities are interconnected, and through mutual interactions and couplings, they positively affect the economic effectiveness of an enterprise. The results indicate that searching for opportunities is the precursor, and the main factor influencing the other activities in the process, which suggests that managers should focus on improving activities in this area.

How Many Intensive Care Beds are Justifiable for Hospital Pandemic Preparedness? A Cost-effectiveness Analysis for COVID-19 in Germany

INTRODUCTION

Germany is experiencing the second COVID-19 pandemic wave. The intensive care unit (ICU) bed capacity is an important consideration in the response to the pandemic. The purpose of this study was to determine the costs and benefits of maintaining or expanding a staffed ICU bed reserve capacity in Germany.

METHODS

This study compared the provision of additional capacity to no intervention from a societal perspective. A decision model was developed using, e.g. information on age-specific fatality rates, ICU costs and outcomes, and the herd protection threshold. The net monetary benefit (NMB) was calculated based upon the willingness to pay for new medicines for the treatment of cancer, a condition with a similar disease burden in the near term.

RESULTS

The marginal cost-effectiveness ratio (MCER) of the last bed added to the existing ICU capacity is €21,958 per life-year gained assuming full bed utilization. The NMB decreases with an additional expansion but remains positive for utilization rates as low as 2%. In a sensitivity analysis, the variables with the highest impact on the MCER were the mortality rates in the ICU and after discharge.

CONCLUSIONS

This article demonstrates the applicability of cost-effectiveness analysis to policies of hospital pandemic preparedness and response capacity strengthening. In Germany, the provision of a staffed ICU bed reserve capacity appears to be cost-effective even for a low probability of bed utilization.

COVID-19 Planning Among Radiologic Science Programs: Response Mitigation Activities

PURPOSE

To examine radiologic science programs' mitigation activities and educators' experiences related to coronavirus disease 2019 (COVID-19) response planning.

METHODS

Using a mixed-methods approach, educators in magnetic resonance, medical dosimetry, radiation therapy, and radiography programs were surveyed to capture their experiences and mitigation strategies related to COVID-19 response planning. Quantitative data were summarized using descriptive statistics and percentages. Thematic analyses were performed on the qualitative responses.

RESULTS

A total of 274 educators responded. Educators reported being somewhat comfortable with modifying clinical experiences (79, 28.8%), moderately comfortable with adjusting assessment procedures (112, 40.9%), and extremely comfortable with changing delivery of didactic content (115, 42%). Incidentally, 220 (80.3%) educators thought adjusting to a new course delivery approach (eg, face-to-face to online format) was the greatest challenge for faculty during the pandemic. Notably, half of the educators in this study questioned the quality of online (remote) learning. Specific to program policies, educators indicated that access restrictions to campus buildings (263, 96%) and removal of students from clinical sites (254, 92.7%) were implemented during the pandemic.

DISCUSSION

Educators self-reported a moderate to strong comfort level with curricular modification. The area of modification that yielded the most uncertainty arose from alterations of clinical experiences. Thematic analyses revealed concerns related to personal protective equipment procurement and clinical sites prohibiting students from completing rotations. However, educators created innovative alternatives to enhance clinical education by providing simulations, case study analyses, and virtual tours of facilities during the pandemic. Securing educational technology resources, such as lockdown browser software, and working with institutional instructional designers might provide some resolution to educators' concerns regarding the quality of online (remote) learning.

CONCLUSION

Archiving radiologic science programs' COVID-19 response efforts is important. The compilation of mitigation strategies will inform and guide programs on contingency planning for future pandemic and emergent conditions.

Improving Breastfeeding in Rural Tanzania Using Eight-Step Policy Analysis Methodology

Appropriate breastfeeding has the potential to have the broadest impact on childhood survival in children under 5 years compared with all other preventive interventions. The World Health Organization and United Nations International Children's Emergency Fund recommend that all facilities providing maternal services and newborn care have a written policy addressing breastfeeding that is routinely disseminated to staff. A Mara region hospital in rural Tanzania does not have a breastfeeding policy. Collins adapted Bardach's eightfold path for policy analysis specifically for health policies. This eight-step process was used to evaluate three promising policies to improve breastfeeding in populations in and around this hospital. These policies include exclusive breastfeeding education, complementary food education, and community health worker home visits. Analysis identified exclusive breastfeeding with adjunct complementary food education as the most feasible policies to increase breastfeeding in and around the target hospital. With improved feeding practices, chronic malnutrition rates are expected to decline in the villages that the hospital serves. This methodology can be used by nurses to develop health polices addressing a wide range of health issues in a wide variety of settings.

Integrating and maintaining automated external defibrillators and emergency planning in community sport settings: a qualitative case study

INTRODUCTION

A voluntary State Government-led programme in Victoria, Australia 'Defibrillators for Sporting Clubs and Facilities Program' ran from 2015 to 2019, broadly aimed at increasing access to automated external defibrillators (AEDs), together with a greater number of community members trained for management of medical emergencies. This study aimed to understand whether participating sport clubs/facilities had successfully integrated an AED and medical planning with other club/facility safety practices, 12 months after delivery of the programme.

METHODS

This was a qualitative case study of 14 sport clubs/facilities in Victoria, Australia in 2017, underpinned by the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework. We conducted observational audits of facilities (to locate AED placement, signage and other relevant location-specific factors) and semi-structured, face-to-face interviews with representatives of the clubs/facilities. Interview questions were designed to determine if and how the related, mandated emergency management programme was adapted for the long term (embedding), whether this aligned to ongoing organisational mission (active engagement), and whether or not it was still ongoing 6 months postinitial implementation (sustainability). Data were evaluated using qualitative descriptive methodology. For reporting, descriptive summaries of the audit were combined with interview data to contextualise and visualise the sport club/facility setting and key results.

RESULTS

Key issues identified were accessibility and visibility of the AED, with inadequate signage and challenges identifying an efficient location for access and storage. Most interviewees reported the AED and training were received with no further actions taken towards safety planning or integration with club/facility practice. Several challenges regarding remaining up to date with training and ensuring required routine checks of the AED take place were also raised.

CONCLUSIONS

This study identified several challenges for community sport clubs/facilities in the implementation of an AED and medical planning programme, including where to store the AED, how to make its presence known to the community and how to integrate changes alongside other club/facility practices.

Association Between the Proportion of Women on a Conference Planning Committee and the Proportion of Women Speakers at Medical Conferences

This cross-sectional study examines the association of the proportion of women on a medical conference planning committee with the proportion of women speakers at the conference.

Planning methodology for anaerobic digestion systems on animal production facilities under uncertainty

Anaerobic digestion (AD) reduces GHG emission and facilitates renewable energy generation. The slow rate of adoption of this technology is often attributed to economic and technical considerations. Collaboration of two or more dairy farms into a centralized AD system can improve the process economics through economies of scale. However, uncertainties related to the process parameters and the scope/scale of the collaborative implementation impede its adoption. This study presents techno-economic optimization model as a design aid to determine ideal location, capacity, and participation level (cluster size) that maximize economic return on a cooperative digester. This study employs a probabilistic approach to overcome uncertainty regarding project parameters such as manure biomethane potential (BMP), project capital, and electricity sale price. Two case studies based on dairy production regions in Wisconsin were developed to test the model and demonstrate its capabilities. Herd sizes and spatial distribution in a given region were found to be critical factors in determining the viability of digestion projects in general, and collaborative digestion systems in particular. The number of simulation runs needed to capture the probability of profitable AD facility establishment was less than 1000 for both case studies assessed. Electricity sale price and biomethane potential of feedstock utilized were found to be the most restrictive to the feasibility of AD adoption. Changing the optimization objective function, to adopting maximization, favored the formation of collaborative AD facilities for both case studies evaluated.

Incorporating Refraction Measurement Error Into Surgery Planning for Corneal Ablation Procedures, Comparing the Flattening and Correction Indices

PURPOSE

To assess the impact of measurement error on cylinder treatment planning in corneal refractive surgery and to compare the reliability of two indices of cylinder change: the Correction Index, based on the surgically induced astigmatism, and the Flattening Index, based on the flattening effect.

METHODS

Preoperative refractions and surgical outcomes were evaluated using a Monte Carlo simulation. Cylinder change was calculated using vector analysis. The initial distribution of cylinder magnitudes was matched to a population sample of 1,000 eyes prior to LASIK. Refraction measurement error was modeled both preoperatively and postoperatively, with a non-linear optimization solver optimizing treatment effect for each amount of preoperative cylinder. Model assumptions were subsequently tested against LASIK outcomes data.

RESULTS

The mean Flattening Index was approximately 1 for all levels of preoperative cylinder, whereas the Correction Index was significantly higher than 1 for cylinder treatments of 1.00 diopters (D) or less when preoperative and postoperative measurement errors were taken into consideration. Targeting undercorrection minimized postoperative cylinder compared with targeting full correction, with the optimal target dependent on the amount of random error in refraction measurement. It was optimal to partially treat 0.25 D of cylinder, even if the presumed level of measurement error was relatively high.

CONCLUSIONS

The Flattening Index outperforms the Correction Index when accounting for errors in preoperative and postoperative cylinder measurement, particularly when pre-operative cylinder is 1.00 D or less. Treatment nomograms should be adjusted to use the Flattening Index to assess cylinder change, and reporting guidelines should be updated to include the Flattening Index. [J Refract Surg. 2020;36(3):169-174.].

The use and value of maps in Community-Oriented Primary Care: Does process matter?

Background

Maps are important tools in healthcare delivery. In Community-Oriented Primary Care (COPC), they are expected to be used to plan services and resources for defined geographical areas, delineate team practice areas, allocate healthcare workers to households and support service delivery and performance management.

Aim

This is a study of the use and value of maps and mapmaking in the delivery of healthcare services through Ward-Based Outreach Teams (WBOTs).

Setting

This study was conducted between 2014 and 2016 in Mamelodi (South Africa), an urban settlement selected to begin the City of Tshwane’s WBOT implementation programme in 2013.

Methods

This study is based on three qualitative participatory mapmaking projects with WBOT healthcare professionals and workers. Data generated through mapmaking, focused group discussions, individual semi-structured interviews, reflective writing and feedback workshops were analysed thematically.

Results

Through mapmaking and discussions about the maps, healthcare providers took ownership of the maps they were creating or viewing, added their own information onto the maps, voiced issues about their practice, generated new knowledge and shared ideas and solutions for challenges. These processes expanded the use and value of maps beyond assisting participants to gain insights into the context, people and organisations of their places of work.

Conclusion

Maps become creative learning tools that can be used in emergent ways to solve healthcare service and other problems when they are actively generated and engaged through facilitated discussion and reflection. This allows WBOTs to see maps as dynamic canvasses that they can use to improve service delivery.

Applying Systems Engineering to Increase Operating Room Efficiency

Systems engineering is an interdisciplinary approach to creating, evaluating, and managing a complex process in order to increase reliability, cost-effectiveness, and quality. The operating room is a complex environment that requires human-human interaction, human-device interaction, planning, and coordination of scarce resources for the purpose of providing surgery to patients in a safe and efficient manner. The operating room is an important revenue generator, but it can also be responsible for unsustainable costs if not managed effectively. Reducing costs and increasing the efficiency of surgical cases is important for generating health care value. Efficiency efforts that aim for standardization of surgical protocols must be balanced by flexibility in the unpredictable operating room environment. This paper reviews systems engineering efforts to improve efficiency in the operating room including operating room scheduling, personnel factors, resource management, orthopedicspecific initiatives, and future innovations.

Towards successful business process improvement - An extension of change acceleration process model

Change Acceleration Process model (CAP) emerged in early 90's as a set of principles for accelerating change management efforts in organizations. Business Process Improvement (BPI) projects open avenues of opportunity and success for organizations in this highly competitive era. However, most of these projects fail due to lack of commitment, communication, scope creep and inadequate resources. This research attempts to study industry relevant factors most critical to success of a BPI Project in the highly competitive telecom sector. Modified Delphi technique employing a panel of telecom professionals was adopted in order to determine the critical success factors (CSFs) after a thorough review of the literature. Exploratory factor analysis was performed to map extracted factors to the five agents of change. Research outcome defines the relevant CSFs in terms of vision, skills, incentives, resources and action plan. A significant contribution of this research is an extended CAP model for implementation of BPI projects. Practical implications of this research are utilization of the proposed model for BPI project success.

Improving Cardiac Surgery Outcomes by Using an Interdisciplinary Clinical Pathway

A cardiothoracic intensive care unit (CTICU) team evaluated preoperative and postoperative processes to improve outcomes for cardiac surgery patients. The primary aim of this project was to streamline and improve care in the CTICU by implementing a new clinical pathway for patients undergoing coronary artery bypass graft or valve replacement procedures. We analyzed processes, communication, ventilator days, respiratory complications, patient mobility, presence of invasive catheters and lines, CTICU length of stay, and hospital-adjusted length of stay before and after we implemented the clinical pathway. This article outlines the methods we used to plan, implement, and assess the clinical pathway. Implementation of the clinical pathway successfully streamlined care, reduced variations in care, and improved health care quality and resource use.

Does Strategic Planning Matter?

In this Invited Commentary, the author examines the history, use, and effectiveness of strategic planning in higher education, academic medicine, and nonprofit settings. Strategic planning is a process by which an organization differentiates itself from its direct or emergent competition to achieve its mission. This form of planning is distinct from operational planning, in which an organization identifies the ways in which it will continuously improve. Many organizations employ a combination of strategic planning and operational planning but use the former term to describe their planning process without a clear definition or conceptual framework.The empirical literature across disciplines has not demonstrated that strategic planning leads to positive organizational outcomes. Over the modern history of academic medicine in the United States, strategic planning may have had limited impact on organizational outcomes because of favorable environmental circumstances that catalyzed growth and innovation regardless of planning efforts. In the current environment, organizational and departmental leaders need to define trade-offs between the various opportunities that they confront; allow for both planned and emergent strategy formulation; avoid platitudes and fluff; and focus on operational excellence.Theories from anthropology suggest that strategic plans may be more important for what they express than what they produce. Repetition of the themes and language of strategy in formal and informal discourse can have a decisive effect on the culture of the organization. Strategic planning, therefore, matters for its effect on organizational values, rituals, and ability to move the organization in new directions.

Implementation of simulation modelling to improve service planning in specialist orthopaedic and neurosurgical outpatient services

BACKGROUND

Advanced physiotherapist-led services have been embedded in specialist orthopaedic and neurosurgical outpatient departments across Queensland, Australia, to ameliorate capacity constraints. Simulation modelling has been used to inform the optimal scale and professional mix of services required to match patient demand. The context and the value of simulation modelling in service planning remain unclear. We aimed to examine the adoption, context and costs of using simulation modelling recommendations to inform service planning.

METHODS

Using an implementation science approach, we undertook a prospective, qualitative evaluation to assess the use of discrete event simulation modelling recommendations for service re-design and to explore stakeholder perspectives about the role of simulation modelling in service planning. Five orthopaedic and neurosurgical services in Queensland, Australia, were selected to maximise variation in implementation effectiveness. We used the consolidated framework for implementation research (CFIR) to guide the facilitation and analysis of the stakeholder focus group discussions. We conducted a prospective costing analysis in each service to estimate the costs associated with using simulation modelling to inform service planning.

RESULTS

Four of the five services demonstrated adoption by inclusion of modelling recommendations into proposals for service re-design. Four CFIR constructs distinguished and two CFIR constructs did not distinguish between high versus mixed implementation effectiveness. We identified additional constructs that did not map onto CFIR. The mean cost of implementation was AU$34,553 per site (standard deviation = AU$737).

CONCLUSIONS

To our knowledge, this is the first time the context of implementing simulation modelling recommendations in a health care setting, using a validated framework, has been examined. Our findings may provide valuable insights to increase the uptake of healthcare modelling recommendations in service planning.

Biological and Sociopolitical Sources of Uncertainty in Population Viability Analysis for Endangered Species Recovery Planning

Although population viability analysis (PVA) can be an important tool for strengthening endangered species recovery efforts, the extent to which such analyses remain embedded in the social process of recovery planning is often unrecognized. We analyzed two recovery plans for the Mexican wolf that were developed using similar data and methods but arrived at contrasting conclusions as to appropriate recovery goals or criteria. We found that approximately half of the contrast arose from uncertainty regarding biological data, with the remainder divided between policy-related decisions and mixed biological-policy factors. Contrasts arose from both differences in input parameter values and how parameter uncertainty informed the level of precaution embodied in resulting criteria. Policy-related uncertainty originated from contrasts in thresholds for acceptable risk and disagreement as to how to define endangered species recovery. Rather than turning to PVA to produce politically acceptable definitions of recovery that appear science-based, agencies should clarify the nexus between science and policy elements in their decision processes. The limitations we identify in endangered-species policy and how PVAs are conducted as part of recovery planning must be addressed if PVAs are to fulfill their potential to increase the odds of successful conservation outcomes.

Gender equity in planning, development and management of human resources for health: a scoping review

BACKGROUND

Gender equity remains a challenge across various labor markets with the health market being no exception. Despite the increased influx of women into health professions, horizontal and vertical occupational gender inequities persist.

MAIN BODY

The objective of this scoping review is to map the studies on gender equity in healthcare systems in terms of workforce planning, development, and management, as well as to identify the barriers and facilitators for integrating gender equity into healthcare systems. We reviewed the literature on the topic using nine electronic and two grey literature databases with the search strategy combining medical subheadings and keywords for each of the following four concepts of interest: "gender equity," "human resources for health," "healthcare setting," and "management processes." The scoping review included studies focusing on the examination of gender equity at the level of the health workforce. Out of 20,242 studies identified through the database search, the full text of 367 articles was assessed for eligibility and 110 were included in the qualitative analysis. The data of those studies was abstracted and analyzed into themes. Results do not only reveal a global dearth of studies focused on this important topic, but also the concentration of such studies in a few countries around the globe, mainly in North America and Europe. Four out of each five studies included in this review focused on physicians, followed by nurses (14%). In terms of design, an overwhelming majority of studies utilized quantitative designs (75%), followed by qualitative designs and database analyses. Studies were categorized into four pre-determined main themes: facilitators and barriers, workforce planning, HRH management, and HRH development.

CONCLUSION

Future research is needed to better understand poorly covered sub-themes such as mentorship, professional development, and training, as well as recruitment and retention among others. It is also equally needed to fill in the gaps in professional groups, study type, methodology, and region. While the review unearthed a number of well-studied themes, significant aspects of the topic remain untapped especially in developing countries and at the level of health professionals other than physicians.

Theory-based diabetes self-management education with pre-selection of participants: a randomized controlled trial with 2.5 years' follow-up (ELDES Study)

AIMS

To evaluate the (cost-)effectiveness of Beyond Good Intentions (BGI), a 12-week group-based, nurse-led self-management programme, in terms of cardiovascular risk factors, self-management and quality of life, after 2.5 years of follow-up in pre-selected individuals with known Type 2 diabetes of up to 5 years' duration.

METHODS

A parallel randomized controlled trial comparing BGI with usual care, based on a self-management screening questionnaire, was conducted in 43 general practices after pre-selection of participants. After 2.5 years of follow-up, the between-group changes in the abovementioned variables were assessed using analysis of covariance.

RESULTS

A total of 108 participants (BGI group, n =56; control group, n =52) were included. Changes over time in BMI (-0.4 vs -0.5 kg/m² ) were similar in the two groups. Median HbA_1c [BGI group 47 mmol/mol (6.5%); control group: 49 mmol/mol (6.6%)] and mean systolic blood pressure (BGI group: 132±13 mmHg; control group: 133±14 mmHg) were well controlled at baseline and no intervention effect was found. LDL cholesterol levels decreased from 2.4 to 2.2 mmol/l in the control group and remained stable at 2.6 mmol/l in the intervention group (P=0.032). No intervention effect was found for self-management or quality of life.

CONCLUSION

In contrast to the first BGI study, we did not observe significant effects of the BGI intervention, despite pre-selection of individuals. In diabetes populations with target levels for HbA_1c , systolic blood pressure and LDL cholesterol, no further beneficial effects can be expected from self-management programmes with regard to biomedical factors and quality of life.

Analysing public sector institutional capacity for health workforce governance in the South-East Asia region of WHO

BACKGROUND

In order to analyse the institutional capacity for health workforce policy development and implementation in countries in the South-East Asia region, the WHO facilitated a cross-sectional analysis of functions performed, structure, personnel, management and information systems of human resources for health (HRH) units in Ministries of Health.

CASE PRESENTATION

A self-assessment survey on the characteristics and roles of HRH units was administered to relevant Government officials; the responses were validated through face-to-face workshops and by the WHO staff. Findings were tabulated to produce frequency distributions of the variables examined, and qualitative elements categorized according to a framework for capacity building in the health sector. Ten countries out of the 11 in the region responded to the survey. Seven out of 10 reported having an HRH unit, though their scope, roles, capacity and size displayed considerable variability. Some functions (such as planning and health workforce data management) were reportedly carried out in all countries, while others (inter-sectoral coordination, research, labour relations) were only performed in few.

DISCUSSION AND CONCLUSIONS

The strengthening of the HRH governance capacity in countries should follow a logical hierarchy, identifying first and foremost the essential functions that the public sector is expected to perform to optimize HRH governance. The definition of expected roles and functions will in turn allow identifying the upstream system-wide factors and the downstream capacity requirements for the strengthening of the HRH units. The focus should ultimately be on ensuring that all the key strategic functions are performed to quality standards, irrespective of institutional arrangements.

Phylogenetically informed spatial planning as a tool to prioritise areas for threatened plant conservation within a Mediterranean biodiversity hotspot

Global plant diversity is at risk due to anthropogenic changes to ecosystems, but given severely limited conservation resources, a reliable prioritisation strategy for species and sites is needed. Our objective was to identify key areas for conserving the phylogenetic diversity (PD) of threatened vascular plants in Italy, one of the most species-rich regions in the Mediterranean Basin. We used spatial data and the conservation status of 995 threatened vascular plants and applied a phylogenetically informed spatial planning to minimize conservation costs. We then determined the degree of overlap with existing protected areas and evaluated whether this PD-based prioritisation of areas provides adequate protection for threatened phylogenetically distinctive species (EDGE). The cost-effective procedure identified as priority for conservation 12% of the study territory, while achieving over 90% of conservation targets (total PD). We showed that priority areas and protected areas are moderately spatially mismatched. We also showed that not all top-EDGE species were met by the procedure applied, hence we conclude that the PD-based model indicated key areas for protection, but nevertheless additional attention is needed to protect top-EDGE species. This study represents one of the most comprehensive analyses, to date, for the conservation of the native flora in the Mediterranean, incorporating both spatial distribution and evolutionary relationships. Our work on the prioritisation of threatened plant species across Italy can serve as a guide for future conservation applications.

Plan ahead to control parasitic gastroenteritis, husk and fluke

This focus article has been prepared by Arthur Otter, deputy lead of the APHA Cattle Expert Group.

Predictors and Trajectories of Response to the Homework, Organization, and Planning Skills (HOPS) Intervention for Adolescents With ADHD

The goal of the present study was to evaluate the relative importance of adolescent and parent skills acquired during participation in the Homework, Organization, and Planning Skills (HOPS) intervention in predicting intervention response. A sample of 111 middle school students with attention-deficit/hyperactivity disorder (66% male; M_age = 11.99, SD = 1.05) received the HOPS intervention, which includes 16 brief sessions with the adolescent and two parent meetings. Each session, school mental health providers completed checklists measuring students' acquisition of homework recording, materials organization, and time management skills. Parents provided information on whether they monitored and used contingencies to reinforce skills use at home. Outcome measures included parent and teacher ratings of homework problems and organizational/time management skills postintervention. Grade point average and assignment completion were also evaluated as objective outcomes. Regressions found accurate homework recording and time management to be unique predictors of parent-reported homework and organizational skills outcomes. Growth mixture models examining organizational skills trajectories throughout the intervention significantly predicted parent- and teacher-reported outcomes, GPA, and assignment completion; homework recording trajectories predicted parent-reported outcomes and GPA. Sixty-eight percent of participants displayed high acquisition of organization and homework recording skills. Parent-reported use of monitoring and contingencies to support adolescent skills implementation was not associated with outcomes. Results highlight the importance of examining individual differences in school-based intervention studies targeting organization, time management, and planning. Importantly, for a school-based adolescent-focused intervention, improvement in outcomes does not appear to be dependent upon parent skills implementation.

Too soon to worry? Longitudinal examination of financial planning for retirement among Spanish aged workers

The present study analyzes the relationship between three distal antecedents-financial literacy, confidence in retirement, and economic well-being-and financial planning for retirement evaluated at two different times. We used longitudinal data with repeated measures of financial planning for retirement obtained from a sample (N = 269) of active Spanish workers aged 45-62 years. The results confirm that self-perceived financial knowledge, confidence in retirement, and economic well-being are associated with financial planning for retirement at three and six months. The stability of financial planning for retirement over time was a relevant finding in the present research, even though different measures have been employed in the two waves and financial planning decreases slightly at three months. While the first step of planning, at three months, has predictive power over the second, at six months, there are possible moderators in the relationship between financial planning for retirement at time 1 and time 2, which were not explored. The implications of the results both for financial education and Policy-makers are discussed. Future lines of research can explore these relationships including objective measures of income, as wealth accumulation.