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Evidence-based practice is an integral part of multi-disciplinary healthcare, but its routine clinical implementation remains a challenge internationally. Written asthma action plans are an example of sub-optimal evidence-based practice because, despite being recommended, these plans are under-issued by health professionals and under-used by patients/carers. This thesis is a critical analysis of the generation and implementation of evidence in this area and provides fresh insight into this specific theory/practice gap. This submission brings together, in five published papers, a body of work conducted by the candidate. Findings report that known barriers to action plan use (such as a lack of practitioner time) are symptomatic of deeper and more complex underlying factors. In particular, over-reliance on knowledge derived from randomised controlled trials and their systematic review, as the primary and sole source of evidence for healthcare practice, hindered the implementation of these plans. A lack of evidence reflecting the personal experience of using these plans in the real world, rather than in trial settings, contributed to a mismatch between what patients/carers want from asthma action plans and what they are currently being provided with by professionals. This submission illustrates the benefits of utilising a broader range of knowledge as a basis for clinical practice. The presented papers report how new and innovative research methodologies (including meta-ethnography and cross-study synthesis) can be used to synthesise individual studies reporting the personal experiences of patients and professionals and how such findings can then be used to better understand why interventions can be implemented in trial settings rather than everyday practice. Whilst these emerging approaches have great potential to contribute to evidence-based practice by, for example, strengthening the ‘weight’ of experiential knowledge, there are methodological challenges which, whilst acknowledged, have yet to be fully addressed.

Background: Podoconiosis, lymphatic filariasis (LF) and leprosy are neglected tropical diseases (NTDs) that cause lymphoedema. Morbidity management and disability prevention (MMDP) services have been shown to reduce their physical impacts, but little is known both about how to address the psychosocial needs of patients and how to integrate services into the primary care unit and scale up these interventions in the resource-limited countries where they are most needed. Objectives: To evaluate the clinical (physical), mental health and psychosocial outcomes of an integrated holistic care package for lower limb disorders due to podoconiosis, LF and leprosy in north-western Ethiopia, and to determine the fidelity of implementation of the integrated care package. These objectives were set following a systematic review to identify gaps in knowledge surrounding disability, psychosocial and mental health outcomes of people affected by podoconiosis, LF and leprosy. Methods: For the systematic review we searched papers reporting on disability, psychosocial and mental health outcomes of these three NTDs. Peer-reviewed articles were searched and extracted from Medline, PsychInfo, Global Health and Embase. Data were extracted and narratively summarized, as the studies were heterogenous and used different outcome measures. The review has been published. After baseline data collection, a holistic integrated care package was piloted as part of the EnDPoINT (Excellence in Disability Prevention Integrated across Neglected Tropical Diseases) project in Gusha district, Awi zone, Ethiopia. To assess the acceptability, scalability and sustainability of the care package and barriers to its implementation, a qualitative study was conducted. The qualitative data analysis results have been published. We quantitatively assessed the impact of the care package at three months and twelve months post-initiation by using validated measurement tools. For this, mixed effect linear regression and mixed effect logistic regression were conducted; with a fixed effect for time point and a random effect for participant. The cohort study results have been accepted for publication. Results: During the systematic review, fourteen studies provided evidence on the disability associated with leprosy, podoconiosis or LF. Ten studies provided evidence on the association with mental health or psychosocial outcomes. High burden of mental illness was reported, with prevalence varying from 12.6% to 71.7%. During the baseline study, among the 251 patients with lymphoedema who were included, 119 (47.4%) had moderate to severe depression and overall quality of life (QOL) was poor (mean ± SD DLQI score: 11.4 ± 4.2). Disability was significantly associated with depression (β=0.26; 95% CI: 0.19, 0.33) and poor quality of life (β=−0.08; 95%CI: −0.15, −0.01). In the qualitative study, the integrated lymphoedema care package resulted in improved awareness of the causes, treatment and prevention of lymphoedema and in reduced stigma and discrimination. Barriers to integrated care were unrealistic patient expectations, inadequate dissemination across health workers, and poor transportation access In the quantitative follow-up study, we found significant improvements in both physical and psychosocial outcomes. There was reduction in acute adenolymphangioadenitis (ADLA) (adjusted odds ratio [aOR] was -2.1; 95% confidence interval [CI] -2.5, -1.79; p<0.001), and overall level of disability (mean reduction in WHODAS 2.0 score -11.0; 95% CI -12.1, -9.9; p<0.001). Significant improvements were also notified in QOL (mean difference in adjusted DLQI score -7.2; 95% CI -7.9, 6.5; p<0.001), and depression (mean PHQ-9 score -7.2; 95% CI -7.9, -6.5; p<0.001). Conclusion: There is high burden of disability, and poor psychosocial and mental health outcomes associated with podoconiosis, LF and leprosy. Health professionals, decision makers and patients believed the integrated lymphoedema care package to be acceptable, and potentially scalable and sustainable. Following implementation of the integrated holistic care package there was significant improvement in both physical and psychosocial-mental health outcomes. This research provides evidence that the EnDPoINT care package is effective across a range of physical and psychosocial outcomes. Following itsscale-up and cost-effectiveness assessment in three more districts, we recommend it to be scaled up to other endemic districts in Ethiopia and elsewhere.

Two trends are currently driving the need for supply chain firms to form closely integrated relationships: collaboration and digitisation. One of the ways to achieve digitisation of supply chain operations is to implement Inter-Organisational Information Systems (IOIS) with selected supply chain partners for a much more efficient, streamlined and orchestrated supply chain operations. Whilst IOIS can be implemented to support various cross-functional business processes (ranging from operational information exchange to pursuing strategic initiatives such as sharing ideas, identifying new market opportunities, and pursing a continuous improvement approach), in the context of this thesis, the purpose of IOIS implementation is to facilitate the inter-firm procurement-related operations with downstream supply chain firms. The study undertaken in this research project was initiated in response to an industry requirement to investigate the implementation of IOIS against a backdrop of improved Supply Chain Management and integration practices by large contractor organisations. A case study research strategy was adopted to investigate the IOIS project related, IOIS (system) related issues encountered in ex-ante and ex-post implementation stages of the IOIS. The study concludes that it is the non-technical factors that are critical to the successful delivery of IOIS projects and provides a guideline on IOIS implementation by large contractor organisations. The findings of this research project have been published in a number of peer-reviewed papers.

The use of mobile computing on the construction site has been a well-researched area since the early 1990's, however, there still remains a lack of computing on the construction site. Where computers are utilised on the site this tends to be by knowledge workers utilising a laptop or PC in the site office with electronic data collection being the exception rather than the norm. The problems associated with paper-based documentation on the construction site have long been recognised (Baldwin, et al, 1994; McCullough, 1993) yet there still seems to be reluctance to replace this with electronic alternatives. Many reasons exist for this such as; low profit margins, perceived high cost; perceived lack of available hardware and perceived inability of the workforce. However, the benefits that can be gained from the successful implementation of IT on the construction site and the ability to re-use construction site data to improve company performance, whilst difficult to cost, are clearly visible. This thesis represents the development and implementation of a data capture system for the management of the construction of rotary bored piles (SHERPA). Operated by the site workforce, SHERPA comprises a wireless network, site-based server and webbased data capture using tablet computers. This research intends to show that mobile computing technologies can be implemented on the construction site and substantial benefits can be gained for the company from the re-use and integration of the captured site data.

The construction industry has inherent problems due to its structure and fragmentation. Its poor performance has been challenged by its client base and it has been forced to seek ways to deliver improved performance. This project was initiated as a response to this challenge and represents one organisation's attempt to deliver improvements. This organisation provides both design and construction solutions, offering ‘total life of asset support' from business consultancy through to decommissioning, in a neutral contractual environment. Initial investigations of the integration of design and construction and of the use of the EFQM Excellence Model concluded that a holistic view of the organisation's performance was needed. Most organisations use traditional, easily quantifiable measures, such as time and cost, whilst neglecting the softer cultural issues, as a way of assessing overall business performance. This prompted further research into the use of performance measurement and also a review of the culture that existed within the organisation. It became clear that many performance initiatives failed because of the lack of ‘Change Action driven by Results (CAR)'. The failure to initiate change or implement action based on the results achieved, means that performance measures are not being integrated into the management systems of the organisations. Based on the conclusions of this work, this project has developed and implemented the Integrated Business Improvement System (IBIS) within the primary case study unit and also two other organisations, all of which are part of AMEC Plc. The project details the barriers that were experienced during the development and implementation of the system and concludes that it is the human component that is critical for the successful implementation and use of any improvement system. The findings of this work have been presented in five peer- reviewed papers.

It is essential for project managers to be in a position to assess the costs and time involved in almost any project that has to be considered by their companies. The existence of their companies and institutions might depend on how accurate these assessments are and how they are used to quantify the risk involved in the venture. The thesis reviews the existing literature of risk assessment methodologies and evaluates the advantages and the disadvantages of the approaches which have been used. Many papers have been produced which have illustrated and explained most of the current methods and techniques used in the assessment of risk and also suggestions have been made about how and when to use these methods. Chapman, C. for example, has employed the "Controlled Interval" approach in his work over the last ten years, with only limited accuracy involved in his final estimates of the total time/cost of a given project. His co-operation with Cooper, D. has resulted in producing the "PERK" software package. We have fully examined and studied in this thesis other methodologies, like Functional and Numerical Integration, and some improvements have been suggested. Substantial work has been done on the Moments Method and further developments on the applicability of the method to parallel activities has been carried out. The accuracy of the estimates obtained with the use of Pearson's curves, has been investigated. The particular contribution of this work to Project Planning Risk Assessment involves the development and assessment of mathematical techniques which have been used in Project Management Planning. We develop an approach which is mathematically justifiable and practically feasible to project managers. A new Unified Methodology is tested and found to be appropriate in a variety of project management contexts. Our new approach -The New Unified Methodology- makes use of The Progressive Reduction Procedure to collapse activity networks and uses the first four moments of Erlang activity time distributions to fit Pearson curves to the distribution of project completion time.