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Despite well‐documented benefits of rehabilitation and therapy services for children with disabilities, long waiting lists to access these services are common. There is a growing body of evidence, primarily from mixed or adult services, demonstrating that waiting times can be reduced through strategies that target wasteful processes and support services to keep up with demand. However, providers of rehabilitation and therapy services for children face additional complexities related to the long‐term nature of many developmental conditions and the need to consider timing of interventions with developmental milestones and education transition points. This review aimed to synthesise available evidence on service redesign strategies in reducing waiting time for paediatric therapy services. We conducted a systematic review of studies conducted in outpatient paediatric rehabilitation or therapy settings, including physical and mental health services, evaluating a service redesign intervention and presenting comparative data on time to access care. Two reviewers independently applied inclusion criteria, assessed risk of bias and extracted data. Findings were analysed descriptively and the certainty of evidence was synthesised according to criteria for health service research. From 1934 studies identified, 33 met the criteria for inclusion. Interventions were categorised as rapid response strategies, process efficiency interventions or substitution strategies (using alternative providers in place of medical specialists). Reductions in waiting time were reported in 30 studies. Evidence is limited by study designs with high risk of bias, but this is mitigated by consistency of findings and large effect sizes. There is moderate‐certainty evidence that service redesign strategies similar to those used in adult populations can be applied in paediatric rehabilitation and therapy settings to reduce waiting time. [ABSTRACT FROM AUTHOR]

Offices are evolving rapidly to facilitate organizational cost reductions and to better support contemporary working practices. We investigate relationships between the design of contemporary offices (physical proximity and breakout areas) and autonomy in predicting individual outcomes (ease of communication, job satisfaction, and well-being). We extend Social Interference Theory to include features of contemporary office design and explicitly explore the moderating role of autonomy. Working in differing office configurations of a global engineering company, 406 employees provided data. Access to breakout areas was strongly related to ease of communication, higher job satisfaction, and well-being. In the absence of breakout areas, employees with higher autonomy were able to better manage the challenges arising from contemporary offices. Practical implications include incorporating breakout areas to enhance employee experience within open-plan offices, using job design to optimize employee experience in open-plan offices, and manager and employee involvement in office design. [ABSTRACT FROM AUTHOR]

Background: Although automation has become widely utilized in certain areas of diagnostic testing, its adoption in diagnostic microbiology has proceeded much more slowly. Objective: To describe our real-world experience of integrating an automated instrument for diagnostic microbiology (Walk-Away Specimen Processor, WASPLab) within a model of total laboratory automation (TLA). Methods: The implementation process was divided into 2 phases. The former period, lasting approximately 6 weeks, entailed the installation of the WASPLab processor to operate as a standalone instrumentation, whereas the latter, lasting approximately 2 weeks, involved physical connection of the WASPLab with the automation. Results: Using the WASPLab instrument in conjunction with the TLA model, we obtained a time savings equivalent to the work of 1.2 full-time laboratory technicians for diagnostic microbiology. The connection of WASPLab to TLA allowed its management by a generalist or clinical chemistry technician, with no need for microbiology skills on the part of either worker. Hence, diagnostic microbiology could be performed by the staff that is already using the TLA, extending their activities to include processing urgent clinical chemistry and hematology specimens. The time to result was also substantially improved. Conclusions: According to our experience, using the WASPLab instrument as part of a TLA in diagnostic microbiology holds great promise for optimizing laboratory workflow and improving the quality of testing. [ABSTRACT FROM AUTHOR]

As healthcare providers cope with pricing pressures and increased accountability for performance, they should be rededicating themselves to improving the value they deliver to their patients: better outcomes and lower costs. Time-driven activity-based costing offers the potential for clinicians to redesign their care processes toward that end. This costing approach, however, is new to healthcare and has not yet been systematically implemented and evaluated. This article describes early time-driven activity-based costing work at several leading healthcare organizations in the United States and Europe. It identifies the opportunities they found to improve value for patients and demonstrates how this costing method can serve as the foundation for new bundled payment reimbursement approaches. [ABSTRACT FROM AUTHOR]

A project undertaken in the Central Cleaning Department of Janssen, a Johnson and Johnson pharmaceutical company, demonstrates how ergonomics, environmental and industrial hygiene risks and quality concerns can be tackled simultaneously. The way equipment was cleaned was re-designed by an in-house cross-functional team to ensure a ‘clean, lean and green’ process. Initiatives included a new layout of the area, and new work processes and equipment to facilitate cleaning and handling items. This resulted in significant improvements: all ergonomics high risk tasks were reduced to moderate or low risk; hearing protection was no longer required; respirator requirement reduced by 67%; solvent use reduced by 73%; productivity improved, with 55% fewer operator hours required; and quality improved 40-fold. The return on investment was estimated at 3.125 years based on an investment of over €1.5 million (2008 prices). This win-win intervention allowed ergonomics, environmental, industrial hygiene, productivity and quality concerns all to be addressed. [ABSTRACT FROM AUTHOR]

Most western economies have in recent years been experiencing one of the longest and deepest economic recessions since the Great Depression. During a recession health-care expenditures are often among the first to be cut. However, what is occurring in daily practice from the point of view of care has not been documented to date. Describing the cost containment interventions undertaken and their effects as perceived in daily practice by Italian nurses was the aim of the study. A longitudinal study design was adopted from 2010 to 2011 involving 1,001 nurses each year. In the 2-year period taken into consideration, participants reported a significant increase in the number of cost containment measures adopted by their health-care organisations. The effects of these cost containment measures have been perceived by nurses especially in terms of (1) increased stress levels, (2) increased number of patients with social problems, and (3) increased nursing workloads. In addition, greater difficulties in finding clinical placement for nursing students and fewer resources devoted to nursing professional development were reported, indicating that some cost containment measures will have long-term effects. The economic crisis seems to affect mainly the most vulnerable groups of society. Innovative solutions for the need to reduce the costs of National Health Services do not seem to emerge from the findings. [ABSTRACT FROM AUTHOR]

This work presents the design of nonlinear stabilization techniques for the finite element discretization of Euler equations in both steady and transient form. Implicit time integration is used in the case of the transient form. A differentiable local bounds preserving method has been developed, which combines a Rusanov artificial diffusion operator and a differentiable shock detector. Nonlinear stabilization schemes are usually stiff and highly nonlinear. This issue is mitigated by the differentiability properties of the proposed method. Moreover, in order to further improve the nonlinear convergence, we also propose a continuation method for a subset of the stabilization parameters. The resulting method has been successfully applied to steady and transient problems with complex shock patterns. Numerical experiments show that it is able to provide sharp and well resolved shocks. The importance of the differentiability is assessed by comparing the new scheme with its non-differentiable counterpart. Numerical experiments suggest that, for up to moderate nonlinear tolerances, the method exhibits improved robustness and nonlinear convergence behavior for steady problems. In the case of transient problem, we also observe a reduction in the computational cost. • A nonlinear stabilization technique for the finite element discretization of Euler equations is proposed. • The method is differentiable, linearly and local bounds preserving for Euler equations. • A continuation method using parameters of the stabilization is also proposed to enhance nonlinear convergence. • Numerical results show an improvement of the robustness and the nonlinear convergence. [ABSTRACT FROM AUTHOR]