Pre-implementation Phase Research Articles

Waitlist mortality in pediatric liver transplantation: The goal is zero.

Waitlist mortality in pediatric liver transplantation: The goal is zero.

Waitlist mortality of young patients with biliary atresia: Impact of allocation policy and living donor liver transplantation.

Patients with biliary atresia (BA) below 2 years of age in need of a transplantation largely rely on partial grafts from deceased donors (deceased donor liver transplantation [DDLT]) or living donors (living donor liver transplantation [LDLT]). Because of high waitlist mortality in especially young patients with BA, the Eurotransplant Liver Intestine Advisory Committee (ELIAC) has further prioritized patients with BA listed before their second birthday for allocation of a deceased donor liver since 2014. We evaluated whether this Eurotransplant (ET) allocation prioritization changed the waitlist mortality of young patients with BA. We used a pre-post cohort study design with the implementation of the new allocation rule between the two periods. Participants were patients with BA younger than 2 years who were listed for liver transplantation in the ET database between 2001 and 2018. Competing risk analyses were performed to assess waitlist mortality in the first 2 years after listing. We analyzed a total of 1055 patients with BA, of which 882 had been listed in the preimplementation phase (PRE) and 173 in the postimplementation phase (POST). Waitlist mortality decreased from 6.7% in PRE to 2.3% in POST ( p = 0.03). Interestingly, the proportion of young patients with BA undergoing DDLT decreased from 32% to 18% after ET allocation prioritization ( p = 0.001), whereas LDLT increased from 55% to 74% ( p = 0.001). The proportional increase in LDLT decreased the median waitlist duration of transplanted patients from 1.5 months in PRE to 0.85 months in POST ( p = 0.003). Since 2014, waitlist mortality in young patients with BA has strongly decreased in the ET region. Rather than associated with prioritized allocation of deceased donor organs, the decreased waitlist mortality was related to a higher proportion of patients undergoing LDLT.

The Objectivization of the Living Green Walls Concept as a Tool for Urban Greening (Case Study: LIKO-S a.s., Slavkov u Brna, Czech Republic)

The improvement of human well-being and the urban environment in cities and towns around the world will always be at the forefront of our interests. After all, the resilience of the urban environment to climate change is very important now. For example, the residents’ well-being can be improved in terms of environmental aspects. The opportunities for improving the urban environment are, of course, closely interconnected with other aspects, i.e., economic, technical and social. One of the ways to increase the resilience of cities is by progressive urban greening with small urban greenery elements. Exterior green walls are attractive, often used in urban areas, and are also the key issue of our paper. They represent at first sight (concerning their usual size) only a small instrument, but they can have a significant environmental, techno-economic and socio-cultural impact. Potential stakeholders may not be aware of this consequence. Our research focuses not only on a model exterior green wall (LIKO-S a.s., Czech Republic), where selected environmental aspects were measured for one year to confirm or deny the cooling effect of the exterior green wall on the surrounding environment, but also to objectify the issue of green walls. We also present proposals for tools that consider other aspects (technical-economic and socio-economic aspects): objectivization-decision scheme and guided interview for stakeholders’ motivation. These tools can serve future stakeholders in the pre-implementation phase of the intended exterior green wall. Objectivization of exterior green walls is the main goal of the present paper.

Adaptation process of a culturally congruent parenting intervention for parents of Hispanic adolescents to an online synchronous format.

Adaptations to interventions for specific settings or communities are critical for facilitating successful implementation. The Dynamic Adaptation Process model was applied to systematically assess the adaptation process made to an in-person parenting intervention (FPNG+) prior to its implementation online. This qualitative case study design included meeting notes and interviews completed with project team members. Meeting notes were analyzed using content analysis. Semi-structured interviews regarding project team members' roles on FPNG+ and processes and activities they identified as critical for the adaptation of FPNG+ to an online intervention were analyzed using a deductive-inductive approach. In the formative phase, three primary processes were identified: information gathering to determine if the environment existed for the implementation of an online program; considerations to support the facilitation process of FPNG+ to an online environment, and decision-making to support modifications to FPNG+. The pre-implementation phase consisted of three processes: information shared by the instructional designer to facilitate the delivery of the FPNG+ content online; modifications made to the format of the intervention to meet the cultural needs of Hispanic families and address contextual issues; and iterative efforts to tailor the intervention by the project team. This study used implementation science to distinguish the dynamic processes that occurred across different systems and multiple levels in the project team's effort to modify FPNG+ to an online intervention. The contribution of this study underscores the importance of identifying the processes that facilitate the modifications made to an intervention and the capacity to implement the modified intervention with Hispanic families.

Implementation of Competency Based Medical Education Curriculum in Paediatrics for Phase 2 MBBS UndergraduatesA Descriptive Study

Introduction: Adoption of Competency Based Medical Education-Undergraduate (CBME-UG) curriculum is made mandatory in medical colleges by National Medical Commission (NMC). CBME-UG curriculum enumerates the expected knowledge and skills in detail and it focuses more on observable outcomes that are important in day-to day medical practice. This curriculum holds the teacher as well as learner equally responsible in running the educational programme. Aim: To put forth the approach adopted in implementation of CBME-UG curriculum for phase 2 MBBS students in paediatric subject. Materials and Methods: This article describes the steps applied in transforming the traditional structured teaching method to the CBME method for undergraduate phase 2 MBBS students in the Department of Paediatrics at Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India, during January 2021 to December 2021. The duration of one year was divided into preimplementation phase (three months) and implementation phase (nine months). The faculty of the department, a coordinator to overview the programmeme, the postgraduate residents, and the students of phase 2 MBBS were the stakeholders identified in order to run the CBME-UG educational programmeme. Results: Preimplementation phase consisted of designing the department module and sensitisation of involved stakeholders. The contents of the module were curriculum planner for three years, time-table plan for phase II MBBS students, structuring of teaching sessions, designing the assessment method, and designing the feedback method. Implementation phase during clinical postings for the phase II MBBS students incorporated the strategies designed in preimplementation phase. The teaching sessions, assessment, the feedback sessions, and student-doctor programmeme were implemented with realistic and feasible planning. Conclusion: The CBME curriculum was successfully implemented among undergraduate second year medical students in term of student feedback and performance. It was noted that appropriate planning and sensitisation of students as well as the teachers, helped in running the programme smoothly.

Assessing primary health care readiness for large-scale electronic health record system implementation: Project team perspective.

The introduction of information technology was one of the key priorities for policymakers in healthcare organisations over the last two decades, due to the potential benefits of this technology to improve healthcare services and quality. However, about 50% of those projects failed to achieve their intended aims. This was as a result of several factors and included the level of readiness to the new IT projects. The aim of the study was to assess the readiness of Saudi primary health care centres (PHCCs) readiness for the implementation of an electronic health record system (EHRS) from the project team perspective. Explanatory mixed methods design was used with both qualitative and quantitative methods. Thirty-one members of project team at the ministry of health (MOH) participated in the online-based questionnaire, while 13 participants from the same population took part in the semi-structure interviews. Eight different readiness scales were quantitatively examined. These scales include resources, Knowledge, process, management structure and administrative support, end user, technology and values and goals. Although, very high level of readiness has been recorded at the process, management structure and administrative support levels, readiness was average at the end user, technology and values and goals levels. Moreover, the study findings revealed that primary health care centres readiness for an electronic health record system must be considered in the early stages of implementation (pre-implementation phase), particularly readiness at a technical level, such as preparedness of the infrastructure. A positive significant correlation has been recorded between all readiness scales with centralization of management system and financial resources. Overall, the level of primary health care centres readiness recorded to be high, which indicates that primary health care centres are ready for implementation of the electronic health record system, and in this context, management structure, organizational process, financial recourses and administrative support play significant roles to increase the project success rate.

Reducing burden and building goodwill for practice-embedded trials: Results of rapid qualitative methods in the preimplementation phase of a community paramedic trial to reduce hospitalizations.

Pragmatic trials aim to generate timely evidence while ensuring feasibility, minimizing practice burden, and maintaining real-world conditions. We conducted rapid-cycle qualitative research in the preimplementation period of a trial evaluating a community paramedic program to shorten and prevent hospitalizations. Between December 2021 and March 2022, interviews (n = 30) and presentations/discussions (n = 17) were conducted with clinical and administrative stakeholders. Two investigators analyzed interview and presentation data to identify potential trial challenges, and team reflections were used to develop responsive strategies. Solutions were implemented prior to the commencement of trial enrollment and were aimed at bolstering feasibility and building ongoing practice feedback loops.

Effectiveness Of Multifaceted Care Bundle Approach To Reduce Device Associated Infection (Dai) In Critical Care Unit (Ccu) In A Multi Specialty Hospital, Mangaluru

Device-associated infections (DAI) can cause major medical and economic sequelae. Multifaceted care bundle is considered as an important part of routine nursing activity, not only as a measures DAI prevention, but as a crucial treatment with a profound effect on the patients general health.
 Objectives
 
 To measure the Device associated infection status of CLABSI, CAUTI, and VAP in pre implementation phase according to HAI surveillance guidelines.
 To determine the compliance status of health care workers of care bundles on prevention and care of device associated infections in CCU in Phase III.
 To evaluate the effectiveness of multifaceted care bundle approach on device associated infections status of CLABSI, CAUTI, & VAP in CCU
 To find the risk of DAI in patients in the Post implementation phase (Phase III)
 
 Methods: An experimental approach was adopted to study the effectiveness of multifaceted care bundle approach to reduce device associated infection (DAI) in critical care unit (CCU) in a multispecialty hospital, Mangaluru. Universal sampling technique was adopted to select the 472 sample retrospectively (MRD and HIC records of DAI patients of critically care units) and 409 samples as prospectively (current critically ill patients) then implementation of bundle was done and post implementation evaluation done.
 Results: While comparing pre and post implementation phases, it is found that there was reduction in CAUTI rate /1000 catheter days and CLASBI rate/1000 central line days from Phase I to phase III and increase in VAP rate /1000 ventilator days from Phase I to phase III. Increase in device utilization ratio of CAUTI and CLASBI from Phase I to III and reduction in VAP device utilization ratio from Phase I to III, also observed that during pre-implementation phase, the VAP rate, CLABSI rate and CAUTI rate for all the ICU’s taken together were 134.37/1000 ventilator days, 412/1000 central line days, and 332.92/1000 urinary catheter days, respectively. However, during the post implementation the rates reduced into 133.92, 287.98, and 242 per 1000 device days respectively. There was a month wise decreasing trend of VAP rate, CLABSI rate, and CAUTI rate during the study period.
 In males CAUTI, CLABSI AND VAP rates were reported highest in the both Phases (I and III) and CAUTI, CLABSI and VAP difference in both Phases was not statistically significant according to age and gender (p=0.500) .Highest number of CAUTI was reported in Phase I compared to Phase III .Total number of device days were more (352) for CAUTI whereas 340 ventilator days for VAP, 292 central line days in the Phase I. While comparing both Phases significant difference was found in CAUTI (0.0017) CLASBI (0.002) and VAP (0.0016 ).
 Conclusion: From the findings of the study it can concluded that multifaceted care bundle significantly reduced DAIs in critically ill patients

359. The Clinical Utility of the GenMark Dx ePlex® Fungal Blood Culture Identification Panel

Abstract Background The GenMark ePlex® Fungal Blood Culture Identification (BCID) Panel utilizes electrowetting technology to detect 15 most common causes of fungemia. Rapid identification of fungal species and innate resistance patterns enable improved antifungal stewardship. Methods In this prospective study, aliquots of the initial diagnostic blood culture bottle with fungal organisms detected on Gram Stain (n=61) received standard of care (SOC) fungal identification in two study periods. MALDI-TOF MS was utilized in both phases. BCID-FP results were not reported to treating clinicians during the pre-implementation phase. After 35 isolates, BCID-FP results became part of the SOC for all bloodstream infections (implementation phase) with results available to providers. Chart reviews were performed to assess risk factors for candidemia and evaluate the potential then actual impact of the BCID-FP on the time to organism identification, treatment, and patient outcomes. Results A total of 61 patients were included in the final analysis, 35 in the pre-implementation phase and 26 in the post-implementation phase (Table 1). C. albicans was most common, followed by C. glabrata and C. parapsilosis. The cohort includes two cases of Cryptococcus as well as two rare yeasts unable to be identified by BCID-FP and requiring the state lab identification (Table 2). Overall outcomes and differences between groups are seen in Table 3. The BCID-FP identified species 1.4 days faster compared to SOC methods across all patients, 1.12 days in the pre-implementation phase vs. 1.81 days in the post-implementation phase. In 32 patients (52%), the BCID-FP allowed for an earlier change in antifungal therapy for species with known low risk of fluconazole resistance. Conclusion The BCID-FP enabled earlier fungal identification compared to SOC identification. Earlier identification allows for earlier antifungal stewardship as well as better empiric therapy for non-Candida­ fungal pathogens. Empiric therapy rates were low with high mortality rates, indicative of an ongoing need for improving the care of patients with fungemia. Disclosures Todd P. McCarty, MD, GenMark Dx: Grant/Research Support|GenMark Dx: Honoraria Sixto M. Leal, Jr., MD, PhD, GenMark Dx: Grant/Research Support|GenMark Dx: Honoraria.

‘A priori’ external contextual factors and relationships with process indicators: a mixed methods study of the pre-implementation phase of ‘Communities in Charge of Alcohol’

BackgroundIt is widely recognised that complex public health interventions roll out in distinct phases, within which external contextual factors influence implementation. Less is known about relationships with external contextual factors identified a priori in the pre-implementation phase. We investigated which external contextual factors, prior to the implementation of a community-centred approach to reducing alcohol harm called ‘Communities in Charge of Alcohol’ (CICA), were related to one of the process indicators: numbers of Alcohol Health Champions (AHCs) trained.MethodsA mixed methods design was used in the pre-implementation phase of CICA. We studied ten geographic communities experiencing both high levels of deprivation and alcohol-related harm in the North West of England. Qualitative secondary data were extracted from pre-implementation meeting notes, recorded two to three months before roll-out. Items were coded into 12 content categories using content analysis. To create a baseline ‘infrastructure score’, the number of external contextual factors documented was counted per area to a maximum score of 12. Descriptive data were collected from training registers detailing training numbers in the first 12 months. The relationship between the baseline infrastructure score, external contextual factors, and the number of AHCs trained was assessed using non-parametric univariable statistics.ResultsThere was a positive correlation between baseline infrastructure score and total numbers of AHCs trained (Rs = 0.77, p = 0.01). Four external contextual factors were associated with significantly higher numbers of lay people recruited and trained: having a health care provider to coordinate the intervention (p = 0.02); a pool of other volunteers to recruit from (p = 0.02); a contract in place with a commissioned service (p = 0.02), and; formal volunteer arrangements (p = 0.03).ConclusionsData suggest that there were four key components that significantly influenced establishing an Alcohol Health Champion programme in areas experiencing both high levels of deprivation and alcohol-related harm. There is added value of capturing external contextual factors a priori and then testing relationships with process indicators to inform the effective roll-out of complex interventions. Future research could explore a wider range of process indicators and outcomes, incorporating methods to rate individual factors to derive a mean score.Trial registrationISRCTN81942890, date of registration 12/09/2017.

Development and implementation of a laboratory monitoring dashboard to reduce treatment gaps in inflammatory bowel disease.

Patients receiving biologic therapy for inflammatory bowel disease (IBD) require routine laboratory monitoring to ensure the safety and efficacy of therapy. The purpose of this quality improvement project was to evaluate the implementation of a dashboard to prevent treatment gaps by prospectively identifying patients with IBD and outdated laboratory results receiving biologics. We performed a pre/post analysis of dashboard implementation to assess the number of patients with overdue laboratory work resulting in treatment gaps. The dashboard combined data from the electronic health record (EHR) and pharmacy claims database to identify patients on a biologic with laboratory tests (white blood cell count, liver transaminases, C-reactive protein, and erythrocyte sedimentation rate) completed 5 or more months ago and/or a tuberculosis screen completed 11 or more months ago. After implementation, specialty pharmacists reviewed the dashboard and communicated via EHR if a new prescription and laboratory tests were needed. Messages were sent 4 weeks in advance of the next refill-eligible date. Mixed methods were used for analysis of qualitative data, including surveys, and quantitative data, assessing treatment gap length. A total of 40 patients who had outdated laboratory values and required a new prescription (15 before dashboard implementation and 25 after implementation) were included in the analysis. The frequency of a treatment gap decreased from 80% (n = 12) in the preimplementation phase to 32% (n = 8) in the postimplementation phase. The median gap length was shorter after dashboard implementation, decreasing from 21 days (range, 3-97 days) to 11 days (range, 2-23 days). Utilization of a quality measures dashboard decreased treatment gaps in patients with IBD receiving biologic therapy. Integrated specialty pharmacists are uniquely positioned to monitor adherence to laboratory monitoring parameters for patients on biologics.

Evaluation of Automated Alert and Activation of Medical Emergency Team in Head and Neck Cancer Patients Using Early Warning Score at Tertiary Level Hospital in North India.

Improved patient safety for those undergoing treatment of head and neck cancers depends on prompt identification of warning indicators from severely critical patients and appropriate treatment. As a result, many hospitals all around the world have implemented quick response techniques, including medical emergency teams (MET), which have systems and personnel that are highly trained to deal with patients who are deteriorating. Nowadays, automated activation and alert programs are also being discussed. To compare the patient outcomes in two conditions: one before the application of the automated MET alert and activation program and the other after the application of the automated MET alert and an activation programwas used. There was an examination of clinical data on MET-managed patients before and after the computerized alert and activation approach was put in place. The study comprised all adult head and neck cancer patients who were treated by the MET between March 1, 2017, and December 31, 2021. The physiologic abnormalities of the patient at the moment of the MET initiation were recorded as causes for MET activation when the MET was alerted by the computerized alert, and activation system.From activation through deactivation, the MET intervention lasted. Hospital mortality served as the study's primary outcome. The duration of stay at the hospital and unscheduled ICU hospitalizations were secondary outcomes. Medical records from hospitals were examined retrospectively to get information on clinical outcomes. The percentage of unplanned admissions in ICU was greater in the pre-implementation stage (22.34%) as compared to that in the post-implementation stage (13.56%) (p value<0.001). The duration of stay of patients at the hospital also got reduced in the post-implementation phase (13.23 ±1.47 days) as compared to the pre-implementation stage (24,76± 1.12 days) (p<0.001). The median time of derangement of activation of MET was greater in the pre-implementation stage (62 minutes) as compared to the post-implementation stage (34 minutes) (p-value <0.001). The most common complications leading to MET activation in a pre-implementation phase were neurological and respiratory complications. On the other hand, overall deterioration was the most common cause of MET activation. The mortality rate of patients in the pre-implementation stage was 36.23% as compared to 22.12% in the post-implementation stage (p<0.001). The hospital experienced improved clinical outcomes with the adoption of an automated alarm and activation system using a cumulative weighted scoring methodology, which significantly reduced the time from disruption to MET activation.

Development of Local interventions within JADECARE – Key learnings from two Next Adopters

Abstract In this third presentation, the NA representatives Roberta Papa (Regional Health Agency Marche Region, Italy) and Zdislav Dolecek (University Hospital Olomouc, Czech Republic), will present the Local interventions and action plans they developed during the pre-implementation phase, pre-final results of their implementation phase and preliminary lessons learned from the implementation.

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

406EMF Early Fluid Delivery by Emergency Medical Services for Sepsis Using a Novel Rapid Infusion Device

You have an effective brief intervention (BI) for young adults, now what? Concrete strategies to advance BI implementation in usual care settings.

Objective: Risky drinking remains high among young adults and is associated with negative health-related consequences. Brief interventions (BIs) are an evidence-based practice for risky drinking that are particularly well suited for young adults. However, the widespread implementation of BIs remains challenging. This article highlights guiding principles for researchers and clinicians seeking to implement BI for young adults. Method: Five guiding principles for the implementation of BIs for young adults with risky drinking are introduced as follows: (a) selecting an implementation model; (b) considering contextual factors; (c) specifying an implementation strategy; (d) assessing implementation outcomes; and (e) embracing hybrid effectiveness-implementation designs. Advancing health equity is considered a key crosscutting theme. Results: Multiple implementation models are discussed including process models, determinant frameworks, classic theories, implementation theories, and evaluation frameworks. Contextual factors impacting BI implementation are then considered across multiple levels within an organization. Next, we present methods for selecting implementation strategies and discuss implementation outcomes that can be measured during preimplementation, implementation, and sustainability phases. Finally, we encourage employing hybrid effectiveness-implementation designs to reduce the BI science-practice gap. Guiding principles are illustrated with examples from two National Institute on Alcohol Abuse and Alcoholism-funded studies exploring BI implementation domestically and internationally. Conclusions: This article introduces foundational principles and emerging strategies to nonspecialist researchers, clinicians, and policymakers seeking to enhance the dissemination and implementation of BIs. Advancing the dissemination and implementation of BIs is essential to ensure that investments in BI research are fully realized to equitably improve public health. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

A Spotlight on Adaptation: Preimplementation of Montessori-Based Activity Programming in Long-Term Care Using the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME).

Effectively adapting evidence-based interventions for nursing home (NH) implementation is a critical, yet underexamined, component of improving care quality. Montessori-based activity programming (MAP) is an evidence-based intervention that promotes person-centered care, engages persons living with dementia, and mitigates distress behaviors. Currently, there is sparse evidence of MAP in Department of Veterans Affairs NHs (i.e., community living centers [CLCs]). CLCs differ significantly from community NHs and require adaptations to support MAP use and sustainability. This study uses the Framework for Reporting Adaptations and Modifications-Enhanced (FRAME) to track changes made to MAP as an exemplar for clinicians and implementation scientists. This work fills a gap in adapting interventions through a detailed examination of the adaptation process in NHs. Qualitative and quantitative data were collected across 8 CLCs (e.g., advisory panel, staff interviews, training evaluations, field notes, and fidelity assessments). We used an iterative, rapid content analytic approach to triangulate findings and identify needed adaptations for the CLC setting. Thirty-six adaptations were made. Most adaptions occurred during the preimplementation phase, were reactive, focused on training/evaluation, and involved researchers, intervention developers, and practitioners. All were fidelity-consistent with MAP. The most common goal across adaptations was increased reach/engagement of the intervention. CLCs and community NHs can use findings to support intervention adaptation, and adapt and implement MAP to improve meaningful engagement for persons living with dementia and other residents. Future research should further evaluate and standardize FRAME for diverse users of complex interventions.

Increasing HPV vaccine interest via standardized multimodal education in an underserved patient population (363)

Increasing HPV vaccine interest via standardized multimodal education in an underserved patient population (363)

Blockchain for electronic medical record: assessing stakeholders’ readiness for successful blockchain adoption in health-care

PurposeThis paper aims to provide a helpful tool for those who plan to implement blockchain-based solutions for the governance of the electronic medical record (EMR) in health-care settings. The goals are to identify each type of stakeholders involved in these projects and to clarify the relevance, to achieve success, of their readiness, intended as availability and ability to adopt blockchain.Design/methodology/approachThe chosen methodology is a multiple case study on three initiatives that used blockchain to manage EMRs. This study relied on multiple sources of evidence. The primary data consisted of two rounds of semi-structured interviews with different informants. This study followed a grounded theory approach and performed within- and cross-case analyses.FindingsThis study identified the types of stakeholders – nodes and not-nodes – of the network and how their readiness level affects the implementation of blockchain-based projects applied to EMR. The nodes (e.g. patients and doctors) are pivotal in making the network working once this has been constructed. Out of the four readiness dimensions suggested by literature, motivational readiness, has the higher impact. Not-nodes stakeholders play a pivotal role in the project’s pre-implementation phase. For them, structural readiness is the dimension with the higher relevance.Originality/valueTo the best of the authors’ knowledge, it is the first time that a paper analyses the differences between nodes and not-nodes stakeholders of the blockchain network, in terms not only of type but also of readiness. Identifying the readiness level to implement successful projects is a fundamental step that has never been analysed in the health field.

Critical success factor based resource allocation in ERP implementation: A nonlinear programming model

This research examines how a Constrained Nonlinear programming model for ERP implementation (CNL_ERP) can facilitate Small and medium sized enterprises (SMEs) to deploy resources to address the Critical Success Factors (CSFs) in the pre-implementation phase, and to invest in them during implementation to increase the probability that the implementation will be successful. Applications of CNL_ERP in three case studies demonstrate that the average ERP implementation outcomes outperform the observed results. Using the Generalised Reduced Gradient Method, we developed an ERP implementation strategy realising resource allocation to CSFs. The strategy provides a rich picture of where to concentrate effort in the initial, intermediate and final phases, and is very helpful in enabling an SME to understand the progress of an ERP project and the resources needed. In case there are changes in resources (such as budget, team performance), the model enables SMEs to rank CSFs, and to adjust resources allocations accordingly to achieve the best ERP implementation performance.

Uncovering Readiness Factors Influencing the Lean Six Sigma Pre-Implementation Phase in the Food Industry

The aim of this study is to identify the readiness factors of Lean Six Sigma (LSS) for the food manufacturing industry. A multi-method qualitative approach was used. Semi-structured interviews were conducted with twelve quality practitioners and three case food companies to identify and explore the LSS readiness factors in the food manufacturing industry. Twenty-eight factors were identified and classified into six LSS readiness factors (RF) in the food manufacturing industry context, namely, management support and leadership, organisational culture readiness, process management, project management, employee involvement, and external relations. This study could benefit managers in the food business as a diagnostic tool to evaluate their readiness to implement LSS prior to investing in the programme. The proposed framework identifies LSS readiness dimensions and their attributes to enable food businesses to conduct readiness level self-assessments, thereby contributing to the successful implementation of LSS in the food manufacturing industry. The determined readiness factors will potentially enable an organisational transformation to be better understood, making the implementation of LSS practices in food businesses more successful and sustainable.