Continuous Improvement Strategies Research Articles

Exploring the impact of street play as a powerful pedagogical tool in public health programs

This case study reports on the production, performance and evaluation of a public health street play by MSc Public Health students at York St John University (London Campus) in the United Kingdom. The street play was performed on World AIDS Day 2023. This paper focuses on the dynamic and interactive nature of street play as a pedagogical technique that aligns with constructivist principles, fostering meaningful learning experiences. Increased confidence, engagement and programme commitment were observed in students both in in-person and online sessions following the street play. While recognising these strengths, we discuss the need to address challenges, foster collaborations and implement continuous improvement strategies to make street play even more effective as a teaching method in the public health discipline.

Case Study in Using Value Stream Mapping in Online Graduate Education

Given the rise in demand for online, graduate degree programs there is a need to guide program planning and evaluation professionals within institutions of higher education to utilize continuous quality improvement (CQI) strategies. Using principles of design thinking and CQI, the purpose of this case study was to describe a CQI project that sought to develop a better understanding of adult students’ experience progressing through their plan of study in an online doctoral program. As part of the CQI project, value stream mapping (VSM) was used to gain visibility and perspective on the actions required by faculty and staff to guide students through their plan of study. The VSM process provided information that led to conversations that furthered the CQI efforts and led to changes in the adult education program that would benefit all students. Improvement processes that lead to better quality and more positive experiences for users are valuable. This case study demonstrates the processes, challenges, lessons, and future directions in the use of VSM to better understand online graduate programs designed for adult learners.

Mastering Data Product Development: Strategies, Architectures, and Best Practices

Abstract: The importance of data products for organizations cannot be overstated, as they enable valuable insights and informed decision-making. This article offers a thorough guide to constructing data products, with a specific emphasis on data warehouse architecture and data product management. Key concepts in data product management are explored, such as treating data as a product, understanding the data product lifecycle, and defining roles and responsibilities. The article explores the key elements of a data warehouse, including data integration and ETL processes, data modeling, and storage and retrieval techniques. This approach outlines a systematic process for developing data products, covering everything from identifying opportunities and defining requirements to design, implementation, testing, deployment, and maintenance. Emphasizing the significance of data governance, quality assurance, security, privacy, and regulatory compliance. Additionally, we delve into performance metrics, monitoring, and strategies for continuous improvement of data products. The article showcases case studies, such as Our World in Data [1], to demonstrate real-world applications and best practices. Finally, we will explore future trends, challenges, and opportunities in data p

Transformations in higher vocational education in Japan

This study examines the evolving landscape of vocational education in Japan, driven by transformative policies, strategic initiatives, and substantial reforms. The transition of vocational education to higher education, particularly through the establishment of professional and vocational universities, is explored. Emphasizing the impact on tertiary-level vocational education, the research investigates collaborative approaches, government initiatives, continuous improvement strategies, and the evolving role of educators. Demographic shifts and societal needs are considered within the context of challenges and opportunities. The establishment of professional and vocational universities is analyzed in alignment with international trends, revealing its pivotal role in the global discourse on practical education within higher education. The study identifies challenges such as program governance, lack of articulation pathways, and societal expectations, while highlighting opportunities for reform. Implications for research, policy, and institutional practice are discussed, urging sustained scholarly attention, flexible accreditation frameworks, and international benchmarking to foster a dynamic and responsive higher education system.

Re-examining the quality management and firm performance relationships: meta-analytical investigation on moderating effects of national culture differences

PurposeIn the last 3 decades, organization-wide programs and practices based on the Total Quality Management (TQM) philosophy have become central to continuous improvement (CI) strategy in both public and private enterprises. However, there is paradoxical evidence of TQM-firm performance linkage in non-Japanese contexts. This study presents a meta-analysis of empirical research on TQM-firm performance linkage and investigates the moderating influence of national cultural (NC) values on this relationship.Design/methodology/approachMeta-analytical procedures are adopted to analyse 364 effects accumulated from 135 independent samples across 31 nations, for 30,015 firm observations. Additionally, weighted least square (WLS) meta-regression is used to test the moderation effects of four NC dimensions based on the Global Leadership and Organizational Behavior Effectiveness (GLOBE) model.FindingsThe meta-analysis results reveal that the strengths of the association varied across five soft and hard TQM dimensions and three firm performance dimensions Meta-regression indicate that the effectiveness of the TQM program is high in cultures which reward collectivist behaviours, equity of power distribution and avoidance of ambiguity in rules/structures.Originality/valueThe study contributes to international operational management theory on cultural influences on the effectiveness of operations strategies and decisions.

A Health Service Transition to Adult Patient Care for Sickle Cell Disease

This paper explores the challenges related to long-term conditions, focusing on sickle cell disease (SCD) as a case study. Long-term conditions, characterized by the need for ongoing management, present a substantial burden on healthcare systems globally. A careful transition from pediatric to adult healthcare is needed for SCD. The discussion extends to the broader health service transition to adult patient care in SCD, emphasizing the World Health Organization’s definition of care transitions and the necessity for an integrated healthcare service. The emphasis is on a multidisciplinary approach to medical, mental health, and educational problems. A person-centered model of care should be used more consistently to resolve these long-term condition-related challenges. To evaluate the effectiveness of new interventions in improving the transition of care from pediatrics to adult patients with SCD, continuous quality improvement strategies should be implemented and prospectively measured in younger patients. In conclusion, this study highlights the critical importance of an effective transition from pediatric to adult healthcare. The continued research of effective transition practices is essential for the future and there is still a requirement to develop pragmatic approaches to enhance research on the transition to improve the quality of healthcare for patients with long-term conditions.

Assessing the Level of Employees’ Safety Performance in Northern Malaysian Small & Medium Manufacturings

In the pursuit of fostering workplace safety as an integral aspect of organisational vitality, present research delves into the landscape of safety performance within Small and Medium Enterprises (SMEs) in Malaysia. Despite facing resource constraints, the sector exhibit commendable dedication to safety, as evidenced by notably high levels of safety participation and compliance discovered among production workers through a cross-sectional study involving 107 professional respondents representing small and medium manufacturing firms in northern Malaysia. This study, addressing a crucial gap in research, sheds light on the need for continuous improvement strategies to sustain and amplify this positive safety culture within SMEs. The findings underline the significance of prioritizing safety initiatives, not only ensuring employee well-being but also fortifying the resilience and success of SME operations in Malaysia. Moving forward, it is imperative for these SMEs to invest in ongoing training programs and maintain open communication channels for safety concerns to further fortify their safety culture. Additionally, a longitudinal study could provide insights into the sustainability of these high safety performance levels over time, while exploring the impact of external factors on safety practices within these SMEs could offer valuable avenues for enhancing safety performance in the evolving business landscape.

Student perspectives inspiring change: The vital role of surveys

The absence of simple feedback mechanisms that consider the interest of students hinders the updating of curricula. This impediment is exemplified in the Software Security Technologies course, taught in the last semester of the Information and Communication Technologies Engineering programme. For this study, the descriptive cross-sectional method was adopted, which is characterised by data being collected at a single point in time and at a single point in time. The method was applied in 2022-1, using a convenience sample of 34 students who participated voluntarily. The results obtained support the curricular updating strategy for continuous improvement, in alignment with the institutional development programme of the Tecnológico Nacional de México (TecNM) and to meet CACEI requirements. New course topics were introduced based on the results obtained, including the implementation of Artificial Intelligence as a coaching tool for collaboration and exploration in the development of the final case study.

Venous thromboembolism prophylaxis and multiple myeloma patients in real-life: Results of a large survey and clinical guidance recommendations from the IFM group

Venous thromboembolism (VTE) remains a critical issue in the management of patients with multiple myeloma (MM), particularly when immunomodulatory drugs (IMiDs) combined with dexamethasone therapy are being prescribed as first-line and relapse therapy. One possible explanation for the persistent high rates of VTE, is the use of inappropriate thromboprophylaxis strategies for patients starting antimyeloma treatment. To tackle the issue, the Intergroupe francophone du myélome (IFM) offered convenient guidance for VTE thromboprophylaxis in MM patients initiating systemic therapy. This guidance is mainly supported by the results of a large survey on the clinical habits regarding VTE of physicians who are substantially involved in daily care of MM patients. VTE prophylaxis should be considered for all patients treated with IMiDs in combination with dexamethasone, in the absence of significant comorbidities, such as renal failure or bleeding risk. Anticoagulant should be preferred to antiplatelet agents for thromboprophylaxis. Despite the absence of large randomized controlled trials comparing those attitudes/options, available data on direct oral anticoagulants, which are already used in daily management of MM patients, are consistent with their potential usefulness for VTE prophylaxis in such patients. However, in order to implement a personalized continuous improvement strategy, clinicians must to be organized to collect all the data regarding this management. In other situations, thromboprophylaxis should be evaluated by using risk models and after careful evaluation of the risk/benefit ratio.

Implementation of an Enterprise Resource Planning (ERP) System and its Impact on Manufacturing Company Operational Efficiency

This article explores the implementation of an Enterprise Resource Planning (ERP) system and its consequential impact on operational efficiency within manufacturing companies. The research delves into the intricate process of integrating ERP systems, emphasizing their role in streamlining various business functions such as supply chain management, production planning, and inventory control.
 The study investigates the challenges faced during the ERP implementation phase and elucidates strategies employed to overcome these hurdles. It also examines the role of employee training and change management in ensuring a smooth transition to the new system, emphasizing their pivotal contribution to operational success.
 Furthermore, the article meticulously analyzes the tangible outcomes of ERP implementation, focusing on key performance indicators (KPIs) that gauge improvements in operational efficiency. This includes reductions in production lead times, enhanced accuracy in demand forecasting, and optimized resource allocation.
 The research methodology incorporates case studies and empirical data from manufacturing companies that have undergone ERP implementation. Comparative analyses highlight the variations in operational efficiency before and after ERP adoption, providing a comprehensive understanding of the system’s impact.
 The findings underscore the positive correlation between ERP implementation and operational efficiency, offering insights that contribute to the body of knowledge in both information systems and manufacturing management. Additionally, the article discusses potential challenges that may persist post-implementation and proposes ongoing strategies for continuous improvement.
 In conclusion, this article contributes valuable insights into the dynamics of implementing ERP systems in manufacturing companies, shedding light on their transformative impact on operational efficiency and providing a foundation for future research in the field.

Abstract 065: Advancing Stroke Care Services through Collaborative Efforts: Mission Thrombectomy Surveys of Slovenia

Introduction Acute stroke care must always be improved because stroke is still a leading cause of mortality and adult‐onset disability. The Mission Thrombectomy Slovenia Regional Committee (RC) has established a forward‐thinking initiative to improve stroke treatment services in response to this challenge. With a focus on showcasing the complete picture of stroke systems and identifying areas for improvement to achieve better patient outcomes and increase accessibility to mechanical thrombectomy (MT) treatments in Slovenia, this partnership aims to conduct extensive surveys, analyses, and propose a roadmap to overcome obstacles and optimize the stroke care ecosystem. The SVIN Mission Thrombectomy Slovenia Regional committee (RC) comprises distinguished experts, including Zoran Miloševič as Neurointerventional co‐chair, and Senta Frol and Janja Pretnar Oblak as stroke co‐chairs, respectively, and Igor Rigler as ER co‐chair, whose expertise and collaborative efforts form the backbone of this initiative. Methods As an initial step, we have commenced surveys with UMC Ljubljana, Slovenia. UMC Ljubljana, as a Mechanical Thrombectomy Center, has demonstrated consistent growth in the number of procedures conducted. There is a projection of 180 procedures in 2023, an increase from 135 in 2021 and 109 in 2022. The increased projected procedure volume indicates the hospital's proactive approach in delivering cutting‐edge stroke treatments. A pivotal aspect of UMC Ljubljana's stroke care model lies in its advanced imaging capabilities, including CTA/CTP and MRI/MRP, enabling precise and swift diagnoses, fostering better treatment planning, and optimizing patient outcomes. Furthermore, the presence of a well‐equipped Angio suite, staffed with competent MT operators, ensures seamless execution of interventional procedures. Results The collaboration's future vision involves conducting surveys and analyzing data to identify barriers to MT access, streamlining the patient journey, and improving overall stroke care efficiency. The ongoing efforts of building a Stroke Registry at UMC Ljubljana will enable in‐depth analysis, fostering continuous evolution in stroke care practices. Additionally, investments in Intermediate/Step down care and Telemetry beds will play a vital role in strengthening the continuum of care, enabling smooth patient transitions, and reducing potential delays in treatment. Healthcare practitioners' awareness for stroke triage and Physician Training emerge as the most impactful Thrombectomy Patient Health Initiatives. By prioritizing these initiatives, UMC Ljubljana and Mission Thrombectomy aim to foster early recognition, prompt treatment, and streamlined care for stroke patients. Conclusion In conclusion, the collaborative efforts of UMC Ljubljana and Mission Thrombectomy Slovenia RC are poised to elevate stroke care and MT services through data‐driven analysis and the proposed roadmap. By incorporating future surveys and continuous improvement strategies, the collaboration aims to create a paradigm shift in stroke care, ensuring accessible, efficient, and optimized services to patients in need. Moving forward, we will continue to conduct surveys within the current EVT and stroke centers examining the calculated MT Operator availability (MTOA), MT Center availability (MTCA), and MT Access Rate (MTAR) scores to identify the current barriers to increase access to mechanical thrombectomy.

Collaborative implementation of an evidence-based package of integrated primary mental healthcare using quality improvement within a learning health systems approach: Lessons from the Mental health INTegration programme in South Africa.

The treatment gap for mental health disorders persists in low- and middle-income countries despite overwhelming evidence of the efficacy of task-sharing mental health interventions. Key barriers in the uptake of these innovations include the absence of policy to support implementation and diverting of staff from usual routines in health systems that are already overstretched. South Africa enjoys a conducive policy environment; however, strategies for operationalizing the policy ideals are lacking. This paper describes the Mental health INTegration Programme (MhINT), which adopted a health system strengthening approach to embed an evidence-based task-sharing care package for depression to integrate mental health care into chronic care at primary health care (PHC). The MhINT care package consisting of psycho-education talks, nurse-led mental health assessment, and a structured psychosocial counselling intervention provided by lay counsellors was implemented in Amajuba district in KwaZulu-Natal over a 2-year period. A learning health systems approach was adopted, using continuous quality improvement (CQI) strategies to facilitate embedding of the intervention.MhINT was implemented along five phases: the project phase wherein teams to drive implementation were formed; the diagnostic phase where routinely collected data were used to identify system barriers to integrated mental health care; the intervention phase consisting of capacity building and using Plan-Do-Study-Act cycles to address implementation barriers and the impact and sustaining improvement phases entailed assessing the impact of the program and initiation of system-level interventions to sustain and institutionalize successful change ideas. Integrated planning and monitoring were enabled by including key mental health service indicators in weekly meetings designed to track the performance of noncommunicable diseases and human immunovirus clinical programmes. Lack of standardization in mental health screening prompted the validation of a mental health screening tool and testing feasibility of its use in centralized screening stations. A culture of collaborative problem-solving was promoted through CQI data-driven learning sessions. The province-level screening rate increased by 10%, whilst the district screening rate increased by 7% and new patients initiated to mental health treatment increased by 16%. The CQI approach holds promise in facilitating the attainment of integrated mental health care in resource-scarce contexts. A collaborative relationship between researchers and health system stakeholders is an important strategy for facilitating the uptake of evidence-based innovations. However, the lack of interventions to address healthcare workers' own mental health poses a threat to integrated mental health care at PHC.

Modeling Critical Success Factors of Lean Strategy in the Manufacturing Industry

This article aims to provide valuable new insights into organizations implementing Lean Manufacturing (LM) as a continuous improvement strategy, focusing on those which are reducing waste in order to increase their competitiveness. A statistical approach was used to model the causal relationships between LM Critical Success Factors (CSFs) to achieve this goal. We used an instrument which has been previously validated in the transportation equipment manufacturing sector in the Mexican manufacturing industry. The proposed hypotheses were subjected to empirical tests using the Structural Equation Modeling (SEM) technique. The results indicate that Top Management Involvement and Commitment, with Project Leadership as a mediator, contributes indirectly and significantly to the increase in the benefits of LM projects. In addition, it was observed that Customer Focus, Linking Lean to the Suppliers, and Training and Education directly influence the increase in the benefits of LM projects in the sector. These findings offer a frame of reference for manufacturing industries with similar characteristics to the sector in this study who wish to increase their benefits by developing projects using LM methodology.

B2B supply chain risk measurement systems: a SCOR perspective

PurposeGlobalisation, trade barriers, unprecedented health crises and geo-political crises have forced organisations to revisit their performance measurement systems (PMS) to better prepare their supply chain against the risk and improve performance in times of crisis. This study aims to review the supply chain operation reference (SCOR)-based PMS and propose a dynamic SCOR-based PMS for supply chain risk management (SCRM).Design/methodology/approachDue to the need for multi-stakeholder perspectives on SCOR-based PMS for the SCRM, the authors aimed to develop a theory rather than to elaborate upon or test the theory. Hence, the authors adopted an inductive theory-building approach to build research propositions. The authors also gathered 12 semi-structured interviews with knowledgeable managers from B2B international companies.FindingsThe findings of the study highlight the challenges faced by the organisations during the implementation of the SCOR-based performance indicators and the positive impacts they have on decision-making and on the continuous improvement strategy of organisations to tackle supply chain risks and improve performance. The findings suggest that the effects of these indicators are more felt during risk management and risk monitoring stages.Research limitations/implicationsLike any other study, this study has some rules, and, thus, the authors caution the readers that they must interpret the findings of the research considering these limitations. The study is based on semi-structured qualitative interviews. The interviews were conducted with 12 knowledgeable managers from France; thus, the insights drawn from the study cannot be generalised to other settings. Furthermore, the samples represent something other than small and medium enterprises. In the future, the samples from small and medium firms can offer a nuanced understanding of the performance indicators for SCRM.Originality/valueTo the best of the authors’ knowledge, this is one of the few studies which has attempted to revisit the SCOR-based PMS in the B2B supply chain for risk management. The study’s findings help expand the SCOR-based PMS literature and offer numerous insights to the management and consultants facing challenges in SCOR implementation.

Methodological proposal to assess management practices for incorporating benchmarking into the chilean construction industry

The Chilean construction market has grown considerably in recent years. This progress has generated strong competition among companies, which has forced a constant search for new strategies to generate a continuous improvement of their processes, to achieve better overall results. Among strategies for continuous improvement, it is possible to find tools such as Benchmarking, which involves knowing your own and your competitors’ performance, to meet the gaps. This research is aimed to develop a methodology for evaluating management practices of construction companies based on interviews which could be used as complement of the previous one developed by the Production Management Centre of the Catholic University of Chile at 2014, which was based on questionnaires. Research methodology consists of a literature review, revision of data collected during previous Benchmarking, definition of criteria to be considered in the new methodology and finally developing a questionnaire to interview managers or department heads to visualize how companies manage aspects such as production planning and scheduling, suppliers and innovation, among others. This is related to previous methodologies used to evaluate management practices worldwide in areas such as education, retail, manufacturing and health. A pilot experience was carried out on two construction companies to assess performance of the new tool in terms of application form, evaluation form, practices evaluated, among others. The interviews were conducted with key positions in the management of the company in areas such as production, quality, suppliers and others. The application of the new methodology allowed to observe major organizational differences between both companies and to understand aspects related to the interviews, such as: time of application, validation questions used, selection of respondents, among others. Previous experience will be used to correct and improve possible mistakes to be used in the future.

Study protocol for type II hybrid implementation-effectiveness trial of strategies for depression care task-sharing in community health stations in Vietnam: DEP Project

BackgroundIt is not clear what the most effective implementation strategies are for supporting the enactment and sustainment of depression care services in primary care settings. This type-II Hybrid Implementation-Effectiveness study will compare the effectiveness of three system-level strategies for implementing depression care programs at 36 community health stations (CHSs) across 2 provinces in Vietnam.MethodsIn this cluster-randomized controlled trial, CHSs will be randomly assigned to one of three implementation conditions: (1) Usual Implementation (UI), which consists of training workshops and toolkits; (2) Enhanced Supervision (ES), which includes UI combined with bi-weekly/monthly supervision; and (3) Community-Engaged Learning Collaborative (CELC), which includes all components of ES, combined with bi-monthly province-wide learning collaborative meetings, during which cross-site learning and continuous quality improvement (QI) strategies are implemented to achieve better implementation outcomes. The primary outcome will be measured based on the RE-AIM framework (Reach, Effectiveness, Adoption, Implementation quality, and Maintenance) using indicators on implementation, provider, and client factors. The secondary outcome examines factors associated with barriers and facilitators of quality implementation, while the tertiary outcome evaluates the incremental cost-effectiveness ratio of services provided in the ES and CELC conditions, relative to UI condition for depression care. A total of 1,296 clients receiving depression care at CHSs will be surveyed at baseline and 6-month follow-up to assess mental health and psychosocial outcomes (e.g., depression and anxiety severity, health function, quality of life). Additionally, 180 CHS staff and 180 non-CHS staff will complete pre- and post-training evaluation and surveys at baseline, 6, 12, and 24 months.DiscussionWe hypothesize that the additional implementation supports will make mental health service implementation superior in the ES and CELC arms compared to the UI arm. The findings of this project could identify effective implementation models and assess the added value of specific QI strategies for implementing depression care in primary care settings in Vietnam, with implications and recommendations for other low- and middle-income settings. More importantly, this study will provide evidence for key stakeholders and policymakers to consider policies that disseminate, scale up, and advance quality mental health care in Vietnam.Trial registrationNCT04491045 on Clinicaltrials.gov. Registered July 29, 2020.

Curating a domain ontology for rework in construction: challenges and learnings from practice

Rework remains an ever-present reality in construction projects. How rework data is defined, its format, location, and quantification contribute to the difficulty in managing its risks. This paper examines the challenges and acquired learnings encountered while attempting to create and curate a domain rework ontology in construction. An explanatory case study approach utilizing the lens of pragmatism is used to develop a rework ontology in a real-life transport infrastructure mega-project procured using a program alliancing delivery strategy. As part of an alliance’s continuous improvement strategy, it aims to redress its rework problem by assessing its risk pathways and managing them using a semantic model through an ontology. We use a hybrid approach to develop an ontology. The Correlation Explanation (CorEx) topic modelling approach, a machine learning method, is used to help define our ontology’s scope and generate a rework taxonomy representative of practice. The theoretical and practical implications of developing a domain rework are also discussed. Our paper’s main contribution is the propagation of a knowledge repository that others can learn from when developing an ontology and addressing the problem of rework, which is often embedded in the practice of construction.

Accreditation of nutrition support teams: A new initiative by the Turkish Society of Clinical Enteral & Parenteral Nutrition

ObjectivesAccreditation is a process to evaluate compliance of an institution or organization with predetermined performance standards, focusing on achieving continuous improvement strategies and optimal quality standards and motivating the accredited organization to do so. There is no established accreditation program for nutrition support teams (NSTs) at national and international levels. In order to increase the standards of NSTs, developing an accreditation program is being planned by the Turkish Society of Clinical Enteral & Parenteral Nutrition (KEPAN). MethodsAccreditation standards were developed by a study group under the organization of KEPAN. Minimum standards for composition, qualifications, physical requirements, workflow charts, medical records, and both patient and health care providers’ safety measures in NSTs were specified. These standards were uploaded to a computer program, and the necessary infrastructure for a web-based management of accreditation processes was developed. ResultsAn organization applying for accreditation should fill in the application form on KEPAN website electronically. Eligibility criteria for accreditation include number of NST members, physical environment, patient monitoring requirements, research, and training. A total of 22 standards are surveyed under 13 sections. These standards contain 61 criteria. To be accredited, each of 22 standards must score >70 and each of 13 sections must score >80. ConclusionsIn order to increase the quality of nutritional care and improve patient outcomes, an accreditation program has been developed. This program principally sets the basic standards, organizational scheme, and responsibilities of NSTs.

Implementation of the Lean Manufacturing Concept to Reduce Waste in Spare Part Repair Activities at PT. X

The competition in the manufacturing industry is currently moving very fast. Competitive advantage, increased production effectiveness in operational activities, continuous performance improvement and business strategy Good quality is something that manufacturing companies must pay attention to to be able to compete globally. PT.X is a manufacturing company that specializes in repairing Automated Teller Machine (ATM) machine spare parts. In the process of repairing this spare part, there are problems with the use of the application system, the number of parts that cannot be repaired as before and the performance of employees is lacking, causing waste. This waste has an impact on performance and operational activities being not optimal and hampering the process of repairing spare parts. The lean manufacturing approach aims to identify and eliminate waste that occurs during operational activities in order to be more efficient and effective with the method Value Stream Mapping (VSM) for mapping the flow of spare part repairs and information flow, identifying waste which is divided into 7 categories and conducting analysis. The root cause of waste with fishbone diagrams, the result of which is the cause of waste by humans, is the lack of insight or knowledge of employees, machines that are damaged due to continuous use and the methods used by the company are not appropriate. The results of the identification of waste are waste waiting, transportation, processing, inventory and defective products. 
 Keywords: Lean Manufacturing, Waste, Value Stream Mapping, Fishbone Diagram.

A continuous quality improvement strategy to strengthen screening practices and facilitate the routine use of intravenous iron for treating anaemia in pregnant and postpartum women in Nigeria: a study protocol

BackgroundPregnancy-related anaemia is a public health challenge across Africa. Over 50% of pregnant women in Africa get diagnosed with this condition, and up to 75% of these are caused by iron deficiency. The condition is a significant contributor to the high maternal deaths across the continent and, in particular, Nigeria, which accounts for about 34% of global maternal deaths. Whereas oral iron is the mainstay treatment for pregnancy-related anaemia in Nigeria, this treatment is not very effective given the slow absorption of the medication, and its gastrointestinal adverse effects which lead to poor compliance by women. Intravenous iron is an alternative therapy which can rapidly replenish iron stores, but fears of anaphylactic reactions, as well as several misconceptions, have inhibited its routine use. Newer and safer intravenous iron formulations, such as ferric carboxymaltose, present an opportunity to overcome some concerns relating to adherence. Routine use of this formulation will, however, require addressing misconceptions and systemic barriers to adoption in the continuum of care of obstetric women from screening to treatment. This study aims to test the options to strengthen routine screening for anaemia during and immediately after pregnancy, as well as evaluate and improve conditions necessary to deliver ferric carboxymaltose to pregnant and postpartum women with moderate to severe anaemia.MethodsThis study will be conducted in a cluster of six health facilities in Lagos State, Nigeria. The study will employ continuous quality improvement through the Diagnose-Intervene-Verify-Adjust framework and Tanahashi’s model for health system evaluation to identify and improve systemic bottlenecks to the adoption and implementation of the intervention. Participatory Action Research will be employed to engage health system actors, health services users, and other stakeholders to facilitate change. Evaluation will be guided by the consolidated framework for implementation research and the normalisation process theory.DiscussionWe expect the study to evolve transferable knowledge on barriers and facilitators to the routine use of intravenous iron that will inform scale-up across Nigeria, as well as the adoption of the intervention and strategies in other countries across Africa.