Using design research and human-centered design to address growing pains in a busy, urban emergency department: a faculty, clinician, and student collaboration between nursing, design, and medicine

In 2021, a large urban university-based hospital transitioned to a new two-floor emergency department. Despite the new environment, there were usability and workflow challenges with the space. The authors of this paper created a multidisciplinary, human-centered design collaborative of clinicians, university faculty, and students in an effort to increase emergency department efficiency. After thorough design-research and clinician-focused collaboration, the authors and design team identified the need to improve medical supply retrieval time, which directly impacts patient care and clinician satisfaction. The primary interventions consisted of a redesign that is as follows: (a) created standardized icons related to organ system, (b) increased visibility of supply labels, and (c) reorganized supplies based on usage data. Although a successful project, it was not without several barriers discussed in this article, including design researcher and clinician-level setting and engagement, academic/institutional policies, and conflicting schedules. In addition, the lessons learned from implementing human-centered design concepts into clinical workflow sets forth future research opportunities and inspiration for other institutions to collaborate.

Factors influencing procurement behaviour and decision-making: an exploratory qualitative study in a UK healthcare provider

Background

In 2016 the UK Department of Health and Social Care published the results of a comprehensive review of efficiency in hospitals, identifying “unwarranted variation” in procurement (or purchasing) practices for materials, supplies and devices. Addressing this variation in materials and supplies procurement practice has been identified as particularly important for creating efficiencies in health service delivery. However, little is known about the behaviour and experiences of front-line individuals who make these procurement decisions, which has implications for the development of strategies to improve efficiency. The objective of this study is to improve understanding of the factors influencing procurement behaviour and decisions among requisitioners who use an internal electronic procurement portal for medical supplies and equipment, and identify areas where efficiency could be improved.

Methods

Qualitative semi-structured individual interview study, following approximately 70 h of exploratory observations on site. The study context was a large London National Health Service (NHS) healthcare provider (the Trust), where we focussed primarily on purchases managed by a large hospital. Participants were drawn from requisitioners from multiple directorates across the Trust (n = 15; of these n = 2 clinical staff members, n = 13 non-clinical).

Results

Four factors stood out in our analysis as directly affecting procurement decisions: (1) a high level of variation in electronic purchasing and inventory management procedures throughout the Trust, (ii) an inaccurate and cumbersome search facility on the internal electronic procurement platform, exacerbated by poor IT skills training and support (iii) an inefficient purchase approvals system and (iv) multiple working sites and cluttered environments. We observed that these factors led requisitioners to employ a variety of strategies or so-called ‘workarounds’ to overcome the challenges they encountered, including stockpiling, relying on internal and supplier relationships, by-passing procedures to save time, purchasing outside existing agreements to save cost, and (re) delegating purchasing responsibilities among requisitioner staff - which both addressed and created difficulties.

Conclusions

Working with the assumption that staff ‘workarounds’ indicate where main issues lie, we offer four possible explanations to why they occur: (a) to maintain services and prepare for future care requirements, (b) to save on costs for the organisation, (c) to develop skills and development in purchasing and (d) to break silos and work collaboratively. These four explanations help provide initial starting points for improving efficiencies in health supplies’ procurement processes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-021-07065-0.

Recent advances in flue gas desulfurization gypsum processes and applications - A review

Flue gas desulfurization gypsum (FGDG) is an industrial by-product generated during the flue gas desulfurization process in coal-fired power plants. Due to its abundance, chemical and physical properties, FGDG has been used in several beneficial applications. However, during the past decade, the rate of beneficially used FGDG has gradually decreased, while its production has drastically increased. The presence of hazardous elements such as arsenic, mercury, cadmium, lead, and selenium in FGDG has reduced its beneficial value. Nevertheless, due to the recent developments in flue gas desulfurization processes, the "modern" FGDG contains lesser amounts of these elements, thus increasing its beneficial value and appeal to be included in other products. Hence, there are novel and traditional FGDG applications in different reuse scenarios investigated recently that have been deemed to pose minimal environmental concern - these need to be better understood. This review summarizes beneficial FGDG applications that have been deemed to pose minimal environmental concern, emphasizing their principles, research gaps, and potential developments, with the aim of increasing the reuse rate of FGDG.

Optimization of multi-pathway production chains and multi-criteria decision-making through sustainability evaluation: a biojet fuel production case study

Selection of optimal technologies for novel biobased products and processes is a major challenge in process design, especially when are considered many alternatives available to transform materials into valuable products. Furthermore, such technological alternatives vary in their technical performances and cause different levels of economic and environmental impacts throughout their life cycles. Additionally, selection of optimal production pathways requires a shift from the traditional materials management practices to more sustainable practices. This contribution provides a method for optimizing multi-product network systems from a sustainability perspective by applying the GREENSCOPE framework as a sustainable objective function. A case study is presented in which the four GREENSCOPE target areas (i.e., efficiency, energy, economics, and environment) are evaluated by 21 preselected indicators as part of a multi-objective optimization problem of a biojet fuel production network. The biojet fuel production network evaluated in this study consists of four main elements: (1) feedstocks management, (2) conversion technologies, (3) co-products upgrading, and (4) auxiliary sections for in situ production of raw materials and utilities. For the sustainability objective function, the 21 indicators are analyzed considering multiple perspectives of stakeholders to study their influence on the decision-making process. It is, different sets of weighting factors are assigned to each of the four target areas. Hence, this sustainability evaluation from different stakeholders' perspectives allows identifying optimal networks, specific target areas with great potential for improvements, and processing steps with great influence in the entire network performance. As a result, diverse optimal network arrangements were obtained according to the multiple stakeholders' perspectives. This evidences that a win-win situation for all sustainability aspects considered can hardly be reached. Finally, this contribution demonstrated the applicability of the proposed methodology for sustainability evaluation, optimization, and decision-making in the context of a multi-product material facility by developing a multi-objective optimization model.

Establishing and testing the "reuse potential" indicator for managing wastes as resources

This study advances contemporary ideas promoting the importance of managing wastes as resources such as closed-loop or circular material economies, and sustainable materials management by reinforcing the notion of a resource-based paradigm rather than a waste-based one. It features the creation of a quantitative tool, the "reuse potential indicator" to specify how "resource-like" versus how "waste-like" specific materials are on a continuum. Even with increasing attention to waste reuse and resource conservation, constant changes in product composition and complexity have left material managers without adequate guidance to make decisions about what is technically feasible to recover from the discard stream even before markets can be considered. The reuse potential indicator is developed to aid management decision-making about waste based not on perception but more objectively on the technical ability of the materials to be reused in commerce. This new indicator is based on the extent of technological innovation and commercial application of actual reuse approaches identified and cataloged. Coal combustion by-products (CCBs) provide the test case for calculating the reuse potential indicator. While CCBs are often perceived as wastes and then isolated in landfills or surface impoundments, there is also a century-long history in the industry of developing technologies to reuse CCBs. The recent statistics show that most CCBs generated in Europe and Japan are reused (90-95%), but only 40-45% of CCBs are used in the United States. According to the reuse potential calculation, however, CCBs in the United States have high technical reusability. Of the four CCBs examined under three different regulatory schemes, reuse potential for boiler slag and flue-gas desulfurization gypsum maintains a value greater than 0.8 on a 0-1 scale, indicating they are at least 80% resource-like. Under current regulation in the United States, both fly ash and bottom ash are 80-90% resource-like. Very strict regulation would remove many reuse options decreasing potential for these two CCBs to 30% resource-like. A more holistic view of waste and broad application of the new indicator would make clear what technologies are available and assist public and private decision makers in setting quantitative material reuse targets from a new knowledge base that reinforces a resource-based paradigm.