Abstract:
Does complete pathological response increase perioperative morbidity risk in rectal cancer?.

AbstractAimThe optimal management of patients with clinical complete response after neoadjuvant treatment for rectal cancer is controversial. The aim of this study is to compare the morbidity between patients with locally advanced rectal cancer who have had a pathological complete response (pCR) or not after neoadjuvant chemoradiotherapy (NCRT) and total mesorectal excision (TME). The study hypothesis was that pCR may impact the surgical complication rate.MethodA retrospective cohort study was conducted of a prospectively maintained database in Australia and New Zealand, the Binational Colorectal Cancer Audit, that identified patients with locally advanced rectal cancer (<15 cm from anal verge) from 1 January 2007 to 31 December 2019. Patients were included if they had locally advanced rectal cancer and had undergone NCRT and proceeded to surgical resection.ResultsThere were 4584 patients who satisfied the inclusion criteria, 65% being male. The mean age was 63 years and 11% had a pCR (ypT0N0). TME with anastomosis was performed in 67.8% of patients, and the majority of the cohort received long‐course radiotherapy (81.7%). Both major and minor complications were higher in the TME without anastomosis group (17.3% vs. 14.7% and 30.6% vs. 20.8%, respectively), and the 30‐day mortality was 1.31%. In the TME with anastomosis group, pCR did not contribute to higher rates of surgical complications, but male gender (p < 0.0012), age (p < 0.0001), preoperative N stage (p = 0.0092) and American Society of Anesthesologists (ASA) score ≥3 (p < 0.0002) did. In addition, pCR had no significant effect (p = 0.44) but male gender (p = 0.0047) and interval to surgery (p = 0.015) contributed to higher rates of anastomotic leak. In the TME without anastomosis cohort, the only variable that contributed to higher rates of complications was ASA score ≥3 (p = 0.033).ConclusionPatients undergoing TME dissection for rectal cancer following NCRT showed no difference in complications whether they had achieved pCR or not. 

Abstract:
Designing the service delivery system for prevention-oriented goals: insights from two case studies.

This research explores how to design service delivery systems to facilitate a customer experience that enables the realisation of prevention-oriented goals.
Case-based research is undertaken to inform the design of service delivery systems for prevention-oriented consumption goals. Data from multiple informants, from both the provider and customer perspective, in two in-depth case studies, provides empirical insights.
Drawing on customer and provider perspectives, a model of service design for prevention-oriented goals is presented. The model is informed through the identification of service delivery system characteristics (facility layout, staff service orientation, facility appearance, and staff presence and appearance) and perceived experience quality dimensions (control, duration, privacy, and reliability impressions) that contribute to the fulfilment of prevention-oriented consumption goals.
The research affirms that it is critical for organisations to comprehend the goals they want their service delivery systems to enable in the customer experience. Specific attention should be given to the design of facility layout, staff-service orientation, facility appearance, staff presence/appearance to positively impact perceived quality dimensions and to facilitate the realisation of customer prevention goals.
The main research contribution lies in the articulation of the design characteristics of the service delivery system that enable a customer experience supporting the fulfilment of prevention goals. The empirical study draws on both customer and organisational perspectives to identify prevention-oriented goals, and corresponding experience quality dimensions, to inform service delivery system design. 

Abstract:
An in-depth case study of a modular service delivery system in a logistics context.

Purpose: the objective of this work is to empirically investigate the design of a service delivery system that supports the provision of modular service logistics offerings. Design/methodology/approach: an in-depth single-case study relying on interview data and extensive documentary evidence is carried out in the business-to-business (B2B) logistics sector. Three main analytical techniques are used to make sense of the qualitative data: thematic analysis, process mapping and the application of modular operators. Findings: a modular service delivery system comprises three types of processes that collectively deliver modular offerings. The platform consists of core processes that enable the collection, transport and delivery of physical items for all offerings (modular and non-modular). Dedicated modular processes are mandatory and exclusive to individual modular offerings. Optional modular processes are shared across several modular offerings. Interfaces regulate physical (e.g. parcels or parts) and information (e.g. booking data) inputs provided by the customer in order to control the interdependencies within these different process types. Practical implications: the identification of three process types and their interdependencies provides detailed insights into how managers can design modular logistics services that benefit from economies of scale and meet increasingly variable customer requirements. The importance of well-designed interfaces among the customers, the service offering and the service delivery system is highlighted. Originality/value: This study extends previous modularity studies in service logistics. It is the first study to apply modular operators to determine the presence of modularity in the service delivery system and to establish the role of different process types in enabling modularity in the service delivery system. 

Abstract:
Workforce predictive risk modelling: development of a model to identify general practices at risk of a supply-demand imbalance.

OBJECTIVE: This study aimed to develop a risk prediction model identifying general practices at risk of workforce supply-demand imbalance. DESIGN: This is a secondary analysis of routine data on general practice workforce, patient experience and registered populations (2012 to 2016), combined with a census of general practitioners' (GPs') career intentions (2016). SETTING/PARTICIPANTS: a hybrid approach was used to develop a model to predict workforce supply-demand imbalance based on practice factors using historical data (2012-2016) on all general practices in England (with over 1000 registered patients n=6398). The model was applied to current data (2016) to explore future risk for practices in South West England (n=368). PRIMARY OUTCOME MEASURE: the primary outcome was a practice being in a state of workforce supply-demand imbalance operationally defined as being in the lowest third nationally of access scores according to the General Practice Patient Survey and the highest third nationally according to list size per full-time equivalent GP (weighted to the demographic distribution of registered patients and adjusted for deprivation). RESULTS: Based on historical data, the predictive model had fair to good discriminatory ability to predict which practices faced supply-demand imbalance (area under receiver operating characteristic curve=0.755). Predictions using current data suggested that, on average, practices at highest risk of future supply-demand imbalance are currently characterised by having larger patient lists, employing more nurses, serving more deprived and younger populations, and having considerably worse patient experience ratings when compared with other practices. Incorporating findings from a survey of GP's career intentions made little difference to predictions of future supply-demand risk status when compared with expected future workforce projections based only on routinely available data on GPs' gender and age. CONCLUSIONS: it is possible to make reasonable predictions of an individual general practice's future risk of undersupply of GP workforce with respect to its patient population. However, the predictions are inherently limited by the data available. 

Abstract:
Policies and strategies to retain and support the return of experienced GPs in direct patient care: the ReGROUP mixed-methods study.

BackgroundUK general practice faces a workforce crisis, with general practitioner (GP) shortages, organisational change, substantial pressures across the whole health-care system and an ageing population with increasingly complex health needs. GPs require lengthy training, so retaining the existing workforce is urgent and important.Objectives(1) to identify the key policies and strategies that might (i) facilitate the retention of experienced GPs in direct patient care or (ii) support the return of GPs following a career break. (2) to consider the feasibility of potentially implementing those policies and strategies.DesignThis was a comprehensive, mixed-methods study.SettingThis study took place in primary care in England.ParticipantsGeneral practitioners registered in south-west England were surveyed. Interviews were with purposively selected GPs and primary care stakeholders. A RAND/UCLA Appropriateness Method (RAM) panel comprised GP partners and GPs working in national stakeholder organisations. Stakeholder consultations included representatives from regional and national groups.Main outcome measuresSystematic review – factors affecting GPs’ decisions to quit and to take career breaks. Survey – proportion of GPs likely to quit, to take career breaks or to reduce hours spent in patient care within 5 years of being surveyed. Interviews – themes relating to GPs’ decision-making. RAM – a set of policies and strategies to support retention, assessed as ‘appropriate’ and ‘feasible’. Predictive risk modelling – predictive model to identify practices in south-west England at risk of workforce undersupply within 5 years. Stakeholder consultation – comments and key actions regarding implementing emergent policies and strategies from the research.ResultsPast research identified four job-related ‘push’ factors associated with leaving general practice: (1) workload, (2) job dissatisfaction, (3) work-related stress and (4) work–life balance. The survey, returned by 2248 out of 3370 GPs (67%) in the south-west of England, identified a high likelihood of quitting (37%), taking a career break (36%) or reducing hours (57%) within 5 years. Interviews highlighted three drivers of leaving general practice: (1) professional identity and value of the GP role, (2) fear and risk associated with service delivery and (3) career choices. The RAM panel deemed 24 out of 54 retention policies and strategies to be ‘appropriate’, with most also considered ‘feasible’, including identification of and targeted support for practices ‘at risk’ of workforce undersupply and the provision of formal career options for GPs wishing to undertake portfolio roles. Practices at highest risk of workforce undersupply within 5 years are those that have larger patient list sizes, employ more nurses, serve more deprived and younger populations, or have poor patient experience ratings. Actions for national organisations with an interest in workforce planning were identified. These included collection of data on the current scope of GPs’ portfolio roles, and the need for formal career pathways for key primary care professionals, such as practice managers.LimitationsThe survey, qualitative research and modelling were conducted in one UK region. The research took place within a rapidly changing policy environment, providing a challenge in informing emergent policy and practice.ConclusionsThis research identifies the basis for current concerns regarding UK GP workforce capacity, drawing on experiences in south-west England. Policies and strategies identified by expert stakeholders after considering these findings are likely to be of relevance in addressing GP retention in the UK. Collaborative, multidisciplinary research partnerships should investigate the effects of rolling out some of the policies and strategies described in this report.Study registrationThis study is registered as PROSPERO CRD42016033876 and UKCRN ID number 20700.FundingThe National Institute for Health Research Health Services and Delivery Research programme. 

Abstract:
A customer journey perspective on service delivery system design: insights from healthcare.

Purpose
The purpose of this paper is to provide novel theoretical insight into service delivery system (SDS) design. To do so, this paper adopts a customer journey perspective, using it as a frame to explore dimensions of experience quality that inform design requirements.

Methodology
This study utilises UK Patient Opinion data to analyse the stories of 200 cancer patients. Using a critical incident technique, 1,207 attributes of experience quality are generated and classified into 17 quality dimensions across five stages of the customer (patient) journey.

Findings
Analysis reveals both similarity and difference in dimensions of experience quality across the patient journey: seven dimensions are common to all five journey stages, from receiving diagnosis to end of life care; ten dimensions were found to vary, present in one or several of the stages but not in all.

Limitations
Limitations include a lack of representativity of the story sample and the impossibility to verify the factual occurrence of the stories.

Practical implications
Adopting a patient journey perspective can improve practitioner understanding of the design requirements of SDS in healthcare. The results of the study can be applied by managers to configure SDS that achieve higher quality of patient care throughout the patient journey.

Originality/value
This paper extends existing literature on SDS design by adopting a customer journey perspective, revealing heterogeneity in experience quality across the customer journey currently unaccounted for in SDS design frameworks. Specifically, the findings challenge homogeneity in extant SDS design frameworks, evidencing the need for multiple, stage specific SDS design requirements. 

Abstract:
The Use of Communication Apps by Medical Staff in the Australian Health Care System: Survey Study on Prevalence and Use.

BACKGROUND: the use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor's attitudes towards them, or what guides clinician choice of app. OBJECTIVE: the objective of this study was to quantify and qualify the use of communication apps among medical staff in clinical situations, their role in patient care, and knowledge and attitudes towards safety, key benefits, potential disadvantages, and policy implications. METHODS: Medical staff in hospitals across Victoria (Australia) were invited to participate in an anonymous 33-question survey. The survey collected data on respondent's demographics, their use of communication apps in clinical settings, attitudes towards communication apps, perceptions of data "safety," and why one communication app was chosen over others. RESULTS: Communication apps in Victorian hospitals are in widespread use from students to consultants, with WhatsApp being the primary app used. The median number of messages shared per day was 12, encompassing a range of patient information. All respondents viewed these apps positively in quickly communicating patient information in a clinical setting; however, all had concerns about the privacy implications arising from sharing patient information in this way. In total, 67% (60/90) considered patient data "moderately safe" on these apps, and 50% (46/90) were concerned the use of these apps was inconsistent with current legislation and policy. Apps were more likely to be used if they were fast, easy to use, had an easy login process, and were already in widespread use. CONCLUSIONS: Communication app use by medical personnel in Victorian hospitals is pervasive. These apps contribute to enhanced communication between medical staff, but their use raises compliance issues, most notably with Australian privacy legislation. Development of privacy-compliant apps such as MedX needs to prioritize a user-friendly interface and market the product as a privacy-compliant comparator to apps previously adapted to health care settings. 

Abstract:
The Use of Communication Apps by Medical Staff in the Australian Health Care System: Survey Study on Prevalence and Use (Preprint).

. BACKGROUND
. The use of communication apps on mobile phones offers an efficient, unobtrusive, and portable mode of communication for medical staff. The potential enhancements in patient care and education appear significant, with clinical details able to be shared quickly within multidisciplinary teams, supporting rapid integration of disparate information, and more efficient patient care. However, sharing patient data in this way also raises legal and ethical issues. No data is currently available demonstrating how widespread the use of these apps are, doctor’s attitudes towards them, or what guides clinician choice of app.
.
.
. OBJECTIVE
. The objective of this study was to quantify and qualify the use of communication apps among medical staff in clinical situations, their role in patient care, and knowledge and attitudes towards safety, key benefits, potential disadvantages, and policy implications.
.
.
. METHODS
. Medical staff in hospitals across Victoria (Australia) were invited to participate in an anonymous 33-question survey. The survey collected data on respondent’s demographics, their use of communication apps in clinical settings, attitudes towards communication apps, perceptions of data “safety,” and why one communication app was chosen over others.
.
.
. RESULTS
. Communication apps in Victorian hospitals are in widespread use from students to consultants, with WhatsApp being the primary app used. The median number of messages shared per day was 12, encompassing a range of patient information. All respondents viewed these apps positively in quickly communicating patient information in a clinical setting; however, all had concerns about the privacy implications arising from sharing patient information in this way. In total, 67% (60/90) considered patient data “moderately safe” on these apps, and 50% (46/90) were concerned the use of these apps was inconsistent with current legislation and policy. Apps were more likely to be used if they were fast, easy to use, had an easy login process, and were already in widespread use.
.
.
. CONCLUSIONS
. Communication app use by medical personnel in Victorian hospitals is pervasive. These apps contribute to enhanced communication between medical staff, but their use raises compliance issues, most notably with Australian privacy legislation. Development of privacy-compliant apps such as MedX needs to prioritize a user-friendly interface and market the product as a privacy-compliant comparator to apps previously adapted to health care settings.
.  

Abstract:
Contingencies and characteristics of service recovery system design.

Purpose
The purpose of this paper is to explore the contingencies and characteristics of service recovery system (SRS) design.


Design/methodology/approach
Informed by extensive case study data from two large Italian retail banks, the theory-building study builds on the seven design characteristics proposed by Smith et al. (2009). In all, 19 sub-dimensions are identified that provide a finer-grain view of the SRS at the operational level. The design characteristics and the corresponding sub-dimensions comprise the SRS design framework. These sub-dimensions are then analysed across the two cases. Specific attention is given to sub-dimensions that are contingent upon service recovery strategy.


Findings
The findings suggest that the extended set of SRS sub-dimensions (providing greater specificity) contributes to identifying commonality and difference between SRS configurations. This specificity facilitates the identification of two sets of SRS design characteristics (S-type and C-type) that correspond with the SR strategy. Two propositions have been formulated with respect to this SR strategy – SRS contingency. An additional set of sub-dimensions, common to both cases, is explained by conformance to regulatory control.


Originality/value
The paper provides novel theoretical insights into SRS design. The increased specificity of the SRS framework and the sets of sub-dimensions contingent on SR strategy extend the current theory. This provides opportunities for both practising managers and for future theoretical development.
 

Abstract:
Healthcare experience quality: an empirical exploration using content analysis techniques.

Purpose – the purpose of this paper is to set out to explore how cancer patients and their carers perceive and evaluate the healthcare experience in order to develop and validate a classification framework for experience quality in healthcare. Design/methodology/approach – the empirical work is centred on the systematic analysis of 200 cancer patient stories published on an independent healthcare feedback web site. Using the critical incident method, the authors captured 1,351 experience quality data items. Three judges independently sorted and classified these data items. Findings – the authors identify and describe 22 main categories and 51 sub-categories that underlie the experience quality concept in healthcare and present them in a classification framework. The framework is informed through the categorisation of direct, indirect, and independent interactions. It also suggests a relationship between experience quality and satisfaction and loyalty behaviours. Research limitations/implications – This study provides researchers with a foundation for the further development and validation of a measurement scale for experience quality in healthcare. Practical implications – the framework assists managers and healthcare professionals with the definition, evaluation, and improvement of the quality of the experience of patients and their carers. Originality/value – the main contributions of this study lie in: first, a comprehensive classification framework for experience quality in healthcare; second, dimensions that extend existing health service quality models; third, dimensions that contextualise the generic concept of customer experience quality to healthcare. 

Abstract:
End-to-end process management: Implications for theory and practice.

The term end-to-end process management is now commonplace in the language and practice of operations. Managers are encouraged to migrate from functional process management to end-to-end process management to realise a range of performance improvements. However, these improvements are often elusive; the specific challenges associated with such a migration are under-researched. This paper uses a cross-sector study to identify the challenges of end-to-end process management and to generate practical managerial guidance. Three areas are identified that demand particular managerial attention: the need to move beyond process mapping, the role of IT in process management and maintaining the process infrastructure as a strategic asset. More significantly, the findings highlight the need for greater conceptual clarity regarding the end-to-end concept itself. The existing literature suggests that scope is the primary differentiator of the end-to-end process - the requirement to manage an extended boundary from customer order through to customer fulfilment. However, this research suggests that the end-to-end concept is more complex, comprising of three core constructs with seven dimensions: scope (boundary conditions, sequence/flow and controls); scale (resources and input/output transformation) and complexity (interrelationships and orientation). End-to-end process management involves much more than an extended boundary. It requires a systemic perspective and clarity regarding controls and transforming resources. 

Abstract:
Four archetypes of process improvement: a Q-methodological study.

This paper explores the process improvement approaches of organisations. It seeks to identify process redesign principles and the combinations of these principles that are used successfully in industry. We use Q-methodology to explore the viewpoints of a range of highly experienced process experts about the success of 16 improvement practices. Q-methodology enables the examination of the similarities and differences in the success of the improvement principles used by organisations in order to inform archetypes of process improvement. Overall, our findings suggest that process improvement is determined through the application of two foundational principles combined with one of four archetypes. Remove non-value-adding tasks and re-sequence tasks are described as foundational principles of process improvement, whilst outsourcing needs to be approached with caution. Furthermore, we articulate four distinctive archetypes comprising unique configurations of improvement principles that can be used to redesign operational processes. Based on this evidence we propose a typology of process improvement. This work suggests that rather than adopting generic improvement frameworks, managers should consult the typology to determine the archetype in closest proximity to their specific requirements. This study has several limitations including the small number of items populating the concourse and the fact that implementation problems are not taken into account. © 2013 Taylor & Francis. 

Abstract:
Leadership in om research: a social network analysis of european researchers.

Purpose – the purpose of this paper is to examine the leadership role of authors, institutions, and countries based on research co-authorship networks in the field of operations management (OM) and ranks European authors, institutions, and countries using network centrality measures. It also identifies the primary research areas of each of the leading European authors and maps the areas that European research in general has focussed most on. Design/methodology/approach – Based on co-authorships in publications appearing in a representative set of three leading OM journals over the 15-year period of 1998-2012, network measures of total degree centrality and betweenness centrality are used to identify influential European agents serving as leaders and bridge builders in OM research. Keyword analysis is used to identify the dominant areas of OM research in Europe as well as the primary areas of research of the leading authors. Findings – with UK, Spain, the Netherlands, and Italy accounting for the dominant share of authorship of papers in the journal set, many authors and institutions from these countries are also found to rank high on network centrality measures. While certain authors, institutions, and countries are found ranking high on total degree centrality based on number of direct connections in the network, others are found to play uniquely important roles as gatekeepers and bridge builders in network relationships. The body of research is found to be focussed most on the area of supply chain management. It is also found to be focussed more on manufacturing than service. Research limitations/implications – the examination of networks in this study based on co-authorships in publications in the set of three leading journals: Journal of Operations Management, International Journal of Operations & Production Management, and Production and Operations Management, is not all encompassing as there are likely other co-authorship relationships of OM researchers that go beyond publications in this set of journals. Practical implications – Co-authorship of papers in the leading academic journals in a discipline provides a window on patterns of collaboration among key researchers within that academic community. The findings of this study inform the community of stakeholders on who the leading European agents in OM research are, what the primary areas of research of the leading European authors are, and areas that European research has focussed most on. Originality/value – This is the first study of its kind that identifies and maps key European authors, institutions, and countries based on the analysis of co-authorship networks of researchers who have published in a set of leading OM journals that are considered to be among the most relevant outlets in the field of OM. It also maps the primary areas of research. 

Abstract:
Service delivery system design: characteristics and contingencies.

PurposeThe aim of this paper is to explore and empirically investigate the characteristics and contingencies of service delivery system design.Design/methodology/approachInformed by the service strategy triad, a single embedded case study was designed to explore empirical data on four target markets, four service concepts, and on the design characteristics of the corresponding four service delivery systems. Data were collected in a market‐leading organisation in the business‐to‐business sector within the power industry. The service delivery systems comprise processes that sell electricity contracts and processes that bill against those contracts.FindingsFirst, the findings indicate what design characteristics are contingent upon the degree of customisation of the service concept. The authors show how this contingency has implications for the extents of employee skills, employee discretion, task routineness, automation, and for front office (FO)‐back office (BO) configurations. Second, the authors challenge the consensus that low customer‐contact processes are designed for the purpose of efficiency. Third, the findings contradict Metters and Vargas who state that it is not possible to have different FO‐BO configurations in a single organisation.Research limitations/implicationsWhile there are major interactions between the four service delivery systems supporting each individual service concept, this paper does not examine the trade‐offs between the various possible designs of these service delivery systems.Practical implicationsThe paper emphasises the importance of considering the complexity of the service offering, the customer relationship strategy, and of taking a process‐orientation to address service delivery system design.Originality/valueThis paper extends current understanding of service delivery system design characteristics and contingencies. The authors show how design characteristics are contingent on the service concept. Research propositions are formulated to emphasise this contingency. Additionally, we report findings which challenge existing FO‐BO design theory. 

Abstract:
Patient safety: a casualty of target success?.

PurposeThis paper aims to develop a conceptual resilience‐based model that takes account of the competing success factors of patient safety, finance, improvement targets and staff workload in NHS hospitals in the UK.Design/methodology/approachA safe working envelope model was developed from the literature and adapted for use in the NHS. The proposition that finance and targets receive greater management attention was then tested by a pilot study using content analysis of risk management documents of four NHS hospitals.FindingsThe need to succeed on finance and targets received greater attention in the risk management documents than patient safety and staff workload.Research limitations/implicationsThis is a pilot study only, using content analysis of risk management documents from four hospitals to see whether the model developed from the literature warrants further study.Practical implicationsUsing the proposed safe working model will allow the setting and monitoring of failure and marginal boundaries and make more explicit the pressures from the competing success factors in public sector hospitals in the UK.Originality/valueThe development of the conceptual model using ideas from resilience engineering and applying them to NHS hospital management provides a policy and practical approach to improving patient safety. 

Abstract:
Symbiotic simulation system: Hybrid systems model meets big data analytics.