Emergency departments in Sweden are usually struggling with long waiting times, delays and bottlenecks in the system. The National Board of Health and Welfare and the County Council of Västra Götaland have established to decrease the average time a patient stays in an emergency department as important priority as well as the waiting time to be seen by a nurse and by a physician. Healthcare systems are usually characterized by its complexity because of the variability and stochastic nature of the different processes involved in the flow of patients, staff and resources. In order to increase the use of the existing resources and to reduce the waiting times of patients, a system improvement methodology involving discrete-event simulation and process analysis has been used. In this project a computer-based simulation tool was applied at the emergency department of the hospital Kärnsjukhuset in Skövde, which belongs to Skaraborgs Sjukhus and is one of the largest emergency departments in the region of Västra Götaland. A three-dimensional model was created to help visualize and understand the problems, as well as to identify improvements by the different stakeholders involved. Continually, the simulation model was modified to test possible improved scenarios with the aim to increase the service level of the system.  The design, implementation and analysis of these scenarios have provided decision makers of the emergency department with the necessary information to implement or reject the ideas of the different improved scenarios. Some of these scenarios had a significant impact with small changes so they were implemented in the real system; some others had non-significant impact in the results so they were not implemented. The main result of this project has been to identify which system changes will lead to a reduction of the different waiting times of patients. In addition, the simulation and experiments of future solutions show a more efficient use of the existing resources. This design of a better configuration of the system gives Kärnsjukhuset the possibility to increase the service level of the system and to meet some of the requirements established by the County Council. This project shows that the use of simulation tools provides enormous benefits for healthcare system analysis and improvement; new ideas and scenarios can be designed without disturbing the normal activities of the hospital, saving considerable time, money and resources.

abstract: The most common approach to improvement of educational systems has been the adoption of episodic initiatives and short-lived improvement programs. In recent years, a continuous improvement (CI) approach has made it onto the education scene, but the effects of continuous improvement in education remain largely unstudied. This study addressed the need to examine the long term impacts of CI in educational organizations. Using a CI framework, this mixed methods action research (MMAR) study was conducted to examine the impact of CI on one school district’s measures of quality, stakeholder satisfaction, and cost savings, as well as to determine the value of CI leadership coaching, according to district leaders. Qualitative data included interviews with and observations of school district leaders and the CI leadership coach. Quantitative data included stakeholder surveys, district scorecards, and state data dashboard reports. Results indicated improvement from a CI approach was slow to occur, though CI positively impacted some quality outcomes, primarily in the area of math. CI positively impacted student satisfaction, though it had minimal impact on employee and parent satisfaction. The district experienced cost savings as a result of CI, and CI leadership coaching was reported as highly valued by district leaders. The results of the study suggest a systematic CI approach and coaching support can impact change over time, but requires patience and a within district executive leader champion. / Dissertation/Thesis / Doctoral Dissertation Leadership and Innovation 2019

In the final master work is analysing the industrial project management, its system and practical issues. Therefore is made analysis of theoretical aspects of fundamental project management methods. Questionnaire of manufacturing sector was made. Collected data about projects and its implementation from 42 enterprises of Lithuania industrial enterprises. Analysis is made by statistical data and empirical research results to evaluate parameters and successfulness of project management in industrial enterprises. Regression relationships are defined between organizational parameters and project implementation success. According to analysis of scientific literature, statistics and results of empirical research formed an improvement model of project management system in industrial organization. / Baigiamajame magistro darbe nagrinėjama pramonės įmonių projektų vadyba, jos metodai ir praktinės problemos.ŠŠiam tikslui atliekamas bedrosios projektų vadybos metodologijos teorinių teiginių analizė. Vykdyta gamybinio sektoriaus įmonių anketinė apklausa. Surinkti duomenys išš 42 Lietuvos pramonės įmonių apie projektus ir ju įgyvendinimą. Atlikta empirinių duomenų anlizė, kurios tikslas remiantis tyrimo ir statistiniais duomenimis įvertinti gamybos įmonių projektų parametrus bei jų įgyvendinamumą. Nustatytos regresinės priklauomybes tarp parinktų kriterijų ir projetų įgyvendinimo sėkmingumo įmonėse. Remiantis mokslinės literaturos analize, statistiniais duomenimis ir empiriniais tyrimo rezultatais suformuotas projektų vadybos sistemos tobulinimo pramonės įmonėms modelis.

El presente estudio tuvo como objetivo incrementar el nivel de servicio en la empresa S&E INOXI S. A. C., la cual se dedica a fabricación y venta de muebles en acero inoxidable y brindar servicios de mantenimiento, ya que se encontraba en un escenario de pérdidas económicas equivalente a S/.28 470,00, debido a la penalización del 5% por incumplimiento de la fecha de entrega. Asimismo, existían pérdidas por materia prima de S/. 96 905,03. El presente trabajo propone una mejora del sistema productivo mediante la implementación de las herramientas de Lean Manufacturing para incrementar su nivel de servicio. Esto se logró mediante la ejecución de un diagnóstico de la situación actual del proceso de fabricación de trampa de sólidos y grasas, evaluación y determinación de los métodos y/o herramientas de ingeniería, seguidamente se elaboraron propuestas de mejora del proceso que contribuyeran a incrementar el nivel de servicio y finalmente se realizó el análisis costobeneficio del proyecto. Como resultado de la investigación se obtuvo un incremento del 23,1% en el nivel de servicio, se redujo la pérdida de materia prima en un 84,13%, esto mediante el incremento del 23,51% de la eficiencia física y se logró una disminución del 51,87% de la distancia recorrida. Además, se redujo el cuello de botella en un 10,64% y el tiempo de flujo del proceso en un 9,88%. También mediante las capacitaciones y el diagrama OT se consiguió la polivalencia del operario, consiguiendo la reducción de un 67,41% del tiempo ocioso para un lote de 3 unidades. / The objective of this study was to increase the level of service in the company S & E INOXI S. A. C., which is dedicated to manufacturing and selling stainless steel furniture and provide maintenance services, since it was in a scenario of economic losses equivalent to S/. 28 470,00, due to the penalty of 5% for breach of the delivery date. Likewise, there were losses by raw material of S/. 96 905,03. The present work proposes an improvement of the productive system through the implementation of Lean Manufacturing tools to increase its level of service. This was achieved through the execution of a diagnosis of the current situation of the manufacturing process of solids and grease traps, evaluation and determination of the methods and / or engineering tools, followed by proposals for improvement of the process that would contribute to increase the level of service and finally the cost-benefit analysis of the project was carried out. As a result of the research, an increase of 23,1% in the level of service was obtained, the loss of raw material was reduced by 84,13%, this by means of the increase of 23,51% of the physical efficiency and it was achieved a decrease of 5,.87% of the distance traveled. In addition, the bottleneck was reduced by 10,64% and the process flow time by 9,88%. Also through the trainings and the OT diagram, the polyvalence of the operator was achieved, achieving a reduction of 67,41% of idle time for a batch of 3 units.

Darbe analizuojamas tarpukario Lietuvos, t.y., I respublikos katalikiškosios visuomenės senosios - jaunosios kartų visuomenininkų bei politikų konfliktas, kuris atspindėjo to meto lietuvių visuomenės politinio brendimo evoliuciją. IV-ojo dešimtmečio pradžioje, baigę Vakarų Europos universitetus į Lietuvą grįžo nauja katalikų intelektualų banga. Pastarieji remdamiesi modernia Vakarų tradicija svarstė Lietuvos santvarkos tobulinimo projektus. A. Smetonos autoritarizmo metais nesant galimybių aktyviai veikti politinėje opozicijoje, pastarieji pradėjo Lietuvos modernizacijos planus skelbdami kultūros ir viešojo gyvenimo lituanizaciją. Subrendę jau 1918 m. nepriklausomoje Lietuvoje jie nejautė sentimentų pokarinei liberaliosios demokratijos tradicijai, tai buvo viena pamatinių konflikto priežasčių su senosios kartos Lietuvos visuomenininkais ir politikais. Politinių santykių įtampos sferoje senosios - jaunosios katalikų kartų konfliktas ryškiausiai pasireiškė demokratijos - partokratijos, konservatizmo - radikalizmo bei pozicijos - opozicijos aspektuose. Jaunoji karta sekdama bei orientuodamasi į modernizacijos Vakarų Europoje procesus kritiškai vertino senosios kartos konservatyvumą, archaišką demokratijos sampratos suvokimą bei politinės opozicijos konstruktyvaus veiksnio valstybės valdyme ignoravimą. Vertindami tuometines Europos santvarkas, tuo pačiu mėgindami kurti savitą lietuvišką modelį jie idealizavo vadizmo, autoriteto svarbą politiniame gyvenime. Žavėjosi dinamiška... [toliau žr. visą tekstą] / This work analyse a period between two world wars in Lithuania when on a first republic political system conflict two sides – catholic society elder and younger generations leading by public-spirited persons and politicians. This conflict was the main reflection of Lithuanian society political ripening evolution. A new catholic character wave has reached Lithuania on a 4th decade. Most of them have just finished West Europe universities. Last-mentioned wave consider a new state system improvement projects in their country going entirely to West countries tradition. Primarily they started Lithuanian modernization plans by propagating culture and public life Lithuanization considering to possibilities for active work in A.Smetona Authoritarianism opposition. The younger generation mature already on 1918. They did not feel any regards to liberal democracy tradition in Lithuania after First World War. That was one of the main conflict reasons with elder generation public-spirited persons and politicians. Elder and younger generations conflict highly expressed on a political relation stress of action field by democracy – party interest, conservatism – radicalism and position – opposition antithesis relation. Younger generation critically valued conservatism of elder generation according to West Europe modernization processes. Also they criticised archaic democracy conception perceive and political opposition slight how one of the main constructive state management factor. Younger... [to full text]

<p>Chronic low back pain is the second most prevalent chronic condition in Canadian primary care settings. The treatment and diagnosis of chronic pain is challenging for primary care clinicians. Their main challenges are lack of knowledge and their approach toward assessing and treating pain. Evidence based guidelines have been developed for neuropathic pain and low back pain.</p> <p>CDSSs for chronic diseases are becoming popular in primary care settings as a mean to implement CPGs. A CDSS prototype for diagnosis and treatment of chronic, non-cancer pain in primary care was developed at McMaster University. It is evident that poor usability can hinder the uptake of health information technologies.</p> <p>The objective of this study was to test the usability of Pain Assistant using think aloud protocols with SUS scores in 2 iterations. In this study 13 primary care providers including family physicians, nurse practitioners and residents used Pain Assistant to complete 3 different patient case scenarios. Participants were asked to comment on both barriers and facilitators of usability of Pain Assistant. Additionally time to complete patient case scenarios was calculated for each participant. A comparison questionnaire gathered user preference between introducing CPGs in paper format and computerized decision support system.</p> <p>This study showed that iterative usability testing of the Pain Assistant with participation of real-end users has the potential to uncover usability issues of the Pain Assistant. Problems of user interface were the main usability barrier in first testing iteration following by problems of content. Changes were made to system design for second round based on the issues came up in the first iteration. However, because of time constrains not all the changes were implemented for second round of testing. Most of the refinements were to resolve user interface issues. In the second iteration, the problems with the content of Pain Assistant were the major barrier. The changes to the system design were successful in resolving user interface problems since the changed issues did not come up again in second round. Pain Assistant had an above the average usability score however no significant changes seen in SUS score. The time needed to complete tasks remained identical in both iterations. In addition, participants preferred to have CPGs in electronic formats than paper. Further study after implementing all the system changes needed to determine the effectiveness of system refinements.</p> / Master of Science (MSc)