Stakeholder Satisfaction Research Articles

Identification of waste: DOWNTIME in the outpatient prescription services at the pharmacy installation of Rumah Sakit Islam Siti Hajar Mataram

Background: The hospital pharmacy installation is a health service unit that is required to provide professional services and improve quality which is oriented towards achieving patient satisfaction. Waste identification in pharmaceutical services is important because it has an impact on stakeholder satisfaction. Objective: Identifying waste using the DOWNTIME method for the outpatient prescription services at the pharmacy installation of Rumah Sakit Islam Siti Hajar Mataram. Methods: The study used the cross-sectional design, with the population being all outpatients who were provided with pharmaceutical services during February – April 2019 as well as all staff. Data were tabulated and analyzed descriptively. Critical waste was obtained through questionnaires and the root causes of critical waste were obtained through in-depth interviews with 5-why methods. Results: Waste waiting had the highest rate compared to other wastes, reaching 44% or 53 out of 121 respondents, followed by inventory (26%), extra processing (19%), transportation (14%), defects (14%), motion (13%), over production (8%), and non-utilized skills (7%). Meanwhile, from the staff respondents, waiting was also the highest waste (18%), followed by inventory (16%), motion (13%), over production (12%), transportation (12%), non-utilized skills (10%), extra processing (10%), and defects (9%). The root cause of waste waiting was the frequent drug unavailability due to delays in payment of services from the cooperating party to the hospital as well as the narrow service areas. Conclusion:Waste waiting became the critical waste with the highest percentage of dissatisfaction in the patient respondents (44%) and staff respondents (18%). Keywords: Waste, DOWNTIME, outpatient prescription services, pharmacy installation of RSI Siti Hajar Mataram

THE MENAGEMENT MODEL FOR DEVELOPMENT TO QUALITY SCHOOL OF BAN KHONKEANNONSAWAN SCHOOL (SMARTS MODEL) UNDER THE LOEI PRIMARY EDCATIONAL SERVICE AREA OFFICE 2

The objectives of this article were to create to implement and to evaluate the management model for development to quality schools of Ban Khonkeannonsawan school under the Loei Primary Educational Service Area Office 2 by 3 steps of research and developmentmethodology; (1) creating the management model by literature reviewing, the scholars interview, drafting the models suitability and feasibility assessment by 7 the academic experts. The data were collected by interviewing and questionnaires. (2) experimenting the management model in the first semester of academic year 2020 by 20 teachers and 190 students. The research tools were the model manual, questionnaires and summary form. (3) evaluating the management model. The data was collected from 9 teachers by questionnaire. The statistics used for data analysis were mean and standard deviation. The finding showed as follow: (1) The management model for development to quality schools of Ban Khonkeannonsawan school under the Loei Primary Educational Service Area Office 2 consist of 6 elements; (a) Principle, (b) objectives, (c) 7 quality school elements (d) 7 steps of the management process (e) outputs and (f) success factors and the management model’s suitability and feasibility in overall were the highest level. (2) The implement results the management model showed the self-assessment based on the quality school elements was high level, the students had higher academic achievement than academic year 2019 and the stakeholders satisfaction in overall were the highest level (

The Challenge of Participation in Community Development Activities in Rural Ghana: Implications for Effective Development Communication

Despite increasing calls for adequate measures to promote participatory development, stakeholder satisfaction with participation in development projects remains a challenge. This study explored the views of beneficiaries of Cocoa Life Project interventions and local authorities of Wassa East District of Ghana regarding their satisfaction with participation during the planning, implementation and evaluation stages of a development project. The study used sequentialdependence mixed methods design. A total of 410 respondents including farmers, members of Village Savings and Loans Groups, Head of District Agriculture Department, Head of Business Advisory Centre, District Education Planner and Extension Agents were selected for the study. Interview schedule, focus group discussion and interview guides were used for data collection. The study found that, apart from awareness creation on development problems and problem identification, project beneficiaries and local authorities were lowly satisfied with participation in planning activities. Again, satisfaction with participation in evaluation activities of the project was low among beneficiaries and local authorities. Also, no significant difference manifested in the overall satisfaction with participation among project beneficiaries irrespective of differences in sex and marital status

Assessing stakeholder satisfaction in PPP transport projects in developing countries: evidence from Vietnam

PurposePublic-Private Partnership (PPP) model still contains the obstacle in partnership, which can lead to different satisfaction between project participants. Therefore, project managers need to consider stakeholder satisfaction to ensure success in PPP implementation. However, this problem is limited in the previous studies in developing countries. The purpose of this study is to evaluate stakeholder satisfaction of PPP transport projects in developing countries.Design/methodology/approachA total of 15 satisfaction factors were identified and four main groupings were introduced by a review of the literature and expert interview rounds, including satisfaction of general public, satisfaction of private sector, satisfaction of government and satisfaction of end-users. A PPP expressway project in Vietnam was used to illustrate for this analysis. Data were collected through a questionnaire survey with 31 validated responses. The fuzzy synthetic evaluation method was then applied to evaluate satisfaction index for the stakeholder satisfaction of PPP transport projects in Vietnam as a developing country.FindingsThe analyzed result showed that the project participants are basically satisfied with gained outcomes of the experimental project with the satisfaction index = 3.46. Specifically, the general public expressed that they are “satisfied” with satisfaction index = 4.08. Meanwhile, end-users, government and private sector are “basically satisfied” with the project outcome (the satisfaction index of 3.31, 3.16 and 3.04, respectively).Originality/valueThis study provides more depth understanding of the satisfaction factor with transport infrastructure service in developing countries through PPP procurement. In addition, the decision-makers might utilize this evaluation model for rating the stakeholder satisfaction of real PPP projects to ensure project success.

Enhancing primary care psychology services with assistant psychologists in Ireland: An evaluation of output, throughput and stakeholder satisfaction.

Primary care mental health services need to expand to assist the increased number of people reporting mild to moderate mental health difficulties. In Ireland, the primary care mental health service has been recently enhanced through the employment of Assistant Psychologists (AP) in primary care psychology. This paper provides an early and brief evaluation of the impact of the AP-enhanced model through a tripartite approach to evaluation which utilises measures of throughput, output and stakeholder satisfaction. We use data from two sources; Health service key performance indicators, and a routinely gathered minimal dataset of client measures. Results indicate that the numbers of clients seen in the period rose by 16%, that AP-delivered treatments are beneficial for clients with mild to moderate mental health difficulties, and more than 80% of clients reported being 'totally satisfied' with the care received. The data provide early evidence that the AP model is beneficial in meeting clients' needs across a range of presentations within the service admission criteria, and that the AP-enhanced model may offer a satisfactory solution to primary care needs. However, further data collection is required, and additional stakeholder input is necessary for a complete evaluation of the assistant psychologist model in primary care.

Stakeholders em sistemas produto - serviço: uma análise inicial da literatura

Objetivo – Os principais desafios para adoção de sistemas produto-serviço incluem a definição das necessidades, engajamento, coordenação, colaboração e satisfação de diferentes stakeholders envolvidos no ciclo de vida desses sistemas. Nesse contexto, o presente trabalho tem por objetivo responder as seguintes questões de pesquisa: Quais os papeis dos stakeholders nos sistemas produto-serviço? Quais as barreiras à colaboração entre os stakeholders e práticas existentes na literatura para superá-las? O objetivo do presente trabalho é então endereçar as questões de pesquisa com base em uma revisão de literatura.Desenho/metodologia/abordagem - Para desenvolvimento deste trabalho foi realizada uma revisão sistemática da literatura que considera a análise bibliométrica e análise de conteúdo.Resultados - Os resultados encontrados demonstram que este tema ainda é relativamente pouco explorado na literatura de sistema produto-serviço, o que contribui para a formação de uma visão fragmentada do papel dos stakeholders e sua relação com o sucesso desses sistemas.Originalidade/valor - O trabalho identifica os principais stakeholders e seus respectivos papeis, alerta sobre as principais barreiras à colaboração e sugere algumas práticas para evitá-las ou mitigá-las.Palavras-chave - Sistema Produto-Serviço; Stakeholders; Revisão de Literatura.

Allostasis and organizational excellence

Organizational excellence is critical towards the development of organizations and, considering organizations’ role in the modern world, for societies’ economic and social development. The ability of organizations to adapt and adjust to the contingencies of the change and recover the stability of organizational systems through organizations’ own dynamic process is known as allostasis. This research focuses on the relationship between allostasis and organizational excellence. Based on a sample of 205 firms from Portugal and Spain, and resorting to fuzzy-set QCA (fsQCA), this research reveals that there are different combinations (equifinality) of conditions inherent to allostasis (adaptive capacity, feedback capacity, stigmergy capacity and integration intensity) leading to sustainable high outcomes (employee satisfaction, stakeholder satisfaction and organizational performance, jointly selected as proxies for organizational excellence). The analysis also shows that organizations that match those combinations simultaneously achieve high employee satisfaction, stakeholder satisfaction and organizational performance (multifinality), which is aligned with the premises of organizational excellence. Finally, the results reveal that in the different contexts (countries) analyzed, the combinations leading to high outcomes differ, thus supporting the idea that the ability to adapt and adjust that characterizes allostasis is critical towards organizational excellence.

Exploring social impacts of urban rail transit PPP projects: Towards dynamic social change from the stakeholder perspective

While the adoption of public–private partnerships (PPPs) in urban rail transit (URT) has increased in popularity in the past few decades, the participation of private sectors in such developments has generated new effects on society. However, prior studies have prioritised the economic and environmental impacts of URT-PPPs, but lacks a systematic address of its social impacts. Uncovering the evolutionary path of social impacts is critical for project success and societal sustainability. The present study therefore explores the effects of URT-PPPs based on social impact and stakeholder management theories. A conceptual model is proposed and social impacts of URT-PPPs are carried out by studying social change and the satisfaction of stakeholders in URT-PPPs. A social change processes and stakeholders integrated approach helps identify 37 indicators for SIA according to 15 appeals of four major stakeholders (government, end-users, nearby residents and private sectors), which are further examined using a structured questionnaire survey. The varimax rotation used in the factor analysis extracts 26 key indicators, which represents three major social impacts by mixed processes of geographical and economic changes, institutional and sociocultural changes, as well as demographical, resource and environmental changes. Meanwhile, the proposed conceptual model is also verified using a structural equation model, which further demonstrates the dynamic mechanism and evolutionary path of social impacts led by URT-PPPs. This study offered a way to uncover and understand how projects like URT-PPPs generate social impacts, which could help to conduct SIA or strategy selections.

IMPROVEMENT OF HUMAN RESOURCES COMPETENCE WITH ACADEMIC QUALITY POLICY IN THE ECONOMIC SECTOR OF HIGHER EDUCATION PROVIDERS IN EAST JAVA


 This research aims to analyze and obtain a description of the improvement of HR competencies with the Academic Quality Policy in the Economic Sector of Higher Education Providers in East Java. The method used in this research is descriptive method with a qualitative approach. The results showed that the implementation of academic services carried out by all components of higher education including lecturers, staff and academic staff showed a change towards better improvement, in terms of human resource management, as well as supporting facilities that support the implementation of improving the quality of academy services. Higher education institutions need to control the quality of activities carried out at stages in the management process which include input, process, output and stakeholder satisfaction. Improving the quality of service can be carried out by applying in the service quality management process, perfecting and strengthening the curriculum, updating and perfecting learning facilities, increasing the quality qualifications and the number of human resources that are adjusted to the needs in higher education.

Comparative analysis of outcomes under PPP and traditional modes of delivery: a study of schools in Melbourne

Public Private Partnership (PPP) arrangements are perceived as compelling alternatives to traditional infrastructure development to raise finances and improve efficiency. However, with the substantial improvement in the provision of services through traditionally developed infrastructure, the benefits of PPP implementation need to be continually evaluated. This research investigates three categories of outcomes (educational, stakeholder satisfaction, and general outcomes) for schools in Melbourne implemented under PPP arrangement to those implemented under a traditional procurement method. Data Envelopment Analysis is used to assess the efficiency of these outcomes, based on the consumption of teaching, financial and physical resources. The results indicate that there is no substantial difference between the performance of both arrangements. While the schools implemented under the PPP arrangement have provided better education outcomes, the traditional schools perform better in stakeholder satisfaction and general outcomes. The results indicate that the policymakers need to evaluate infrastructure based PPP arrangements more closely and align with the desired outcomes.

Community Participation and Sustainability of Water Flow Project in Rwanda: A Case of Water and Sanitation Corporation in Bugesera District

The communities don’t get the opportunity of fully participating in their projects which is at the core cause of the failure and unsustainability of the most of the project conducted among communities. Thus, the researcher conducted a study to evaluate the role of community participation in sustainability of water flow project in Bugesera of Rwanda. This study used 268 respondents as the primary informants of this study but before actual time of data collection the researcher used 12 respondents to measure validity and reliability of the instrument and it found that CVI is above 0.7 of content validity index. Descriptive research design was used to collect data during actual time of data collection that was presented in a table of frequency, correlation and regression to facilitate the data interpretation process. The findings of the study have revealed that there is a relationship between community participation and water flow project as proven by relationship between joint consultation and stakeholder ownership (r=0.860 and sig=0.00), between joint consultation and effective management (r=0.806 and sig=0.00), between community empowerment and stakeholder satisfaction (r=0.867 and sig=0.00) basing on the calculated p-values which are strong and positive and the calculated level of significance which is under 0.01 results indicate a positive and significant relationship between community participation and water flow project sustainability in WASAC in Bugesera District. The regression analysis results have shown the positive regression coefficients while the calculate significance levels are under 0.05 level of significance implying that community participation and stakeholder ownership is positive and significant. Hence, basing on the research findings, the researcher would like to recommend to the management to formulate policies that favor water flow project. Therefore, the researcher would like to recommend to the government to empower its communities and the community members so that the water flow project would be more sustainable. In conclusion, the findings of the study have proven a positively significant relationship between community participation and water flow project sustainability in Bugesera District, Rwanda.

102 Virtual family-centered rounds: A collaborative necessity during COVID-19 and beyond

Primary Subject areaHospital PaediatricsBackgroundFamily-centered rounds (FCR) are the cornerstone of pediatric hospital care and have many proven benefits including improved patient outcomes, satisfaction, communication and safety. Traditionally, FCR take place in the patient’s room; however, due the COVID-19 pandemic, entering patient rooms was no longer advisable in order to maintain physical distancing and preserve personal protective equipment (PPE). Therefore, it became clear early in our pandemic response that a new process was required to ensure the benefits of FCR were maintained given their paramount importance to safe and quality patient care.ObjectivesThe objective of this study was to virtualize the in-person FCR process used by our pediatric inpatient medicine teams to improve safety and reduce PPE costs during the COVID-19 pandemic.Design/MethodsWe quickly identified available hardware (laptops, tablets) and video conferencing software, assembled a multidisciplinary project team and secured administrative and quality improvement support. Quality improvement methodology and participatory design were used to develop and refine our virtual family-centered rounds (vFCR) standard work, and on April 6, 2020 we launched our first vFCR. Over the next 3 months we engaged in a series of plan-do-study-act (PDSA) cycles to iteratively improve our process: nurse auditors attended vFCR daily then met with our project team to review data and observations, and real-time feedback was sought from patients and caregivers.ResultsData collected on 1792 vFCR between April 6 and July 31, 2020 revealed 74% of nurses, physicians and trainees were satisfied or very satisfied with vFCR and 88% felt they had a good understanding of the patient care plan after vFCR. 79% of patients and caregivers were satisfied or very satisfied with vFCR and 88% of caregivers felt like a valued member of their child’s care team. We met our target of 10 minutes per patient in 74% of vFCR with an average transition time of <3 minutes between patients. Patients and caregivers felt vFCR were collaborative, more private and less intimidating than in-person FCR, and some even preferred the virtual approach.ConclusionDuring this pilot, we achieved a standardized vFCR workflow that is safe, feasible, efficient and confidential, with high levels of stakeholder satisfaction and support. vFCR was highly valued by families and yielded unanticipated benefits. Based on current usage, vFCR are saving ~$36,000 monthly in PPE. The importance of this work during the COVID-19 pandemic is clear, but also has benefits in non-pandemic times, including allowing caregivers to participate in FCR when they cannot be at the bedside, enhancing FCR confidentiality, and improving communication and care for isolated patients. Furthermore, the vFCR process is easily adaptable to other inpatient workflows such as consults and multi-disciplinary meetings. We believe this virtual care model is both highly relevant and transferable to a variety of health care settings across Canada and beyond.

Reward Management Strategies and Employee Satisfaction in the Colleges of Kathmandu Valley

Background: Educational institutions set up a reward management system with the hope that it makes the employees perform their activities to the satisfaction of all concerned stakeholders. However, there are many contradictions and complaints about the performance of employees in colleges, compelling the undertaking the studies. Objectives: This study aims to examine the impact of reward management strategies on employee satisfaction in colleges of Kathmandu valley. Methods: This paper uses a questionnaire survey method of 300 respondents of different 30 colleges/campuses of Kathmandu valley and descriptive statistics and multiple regression models are used to analyze the data. Results: The beta coefficients are positive and significant for promotion, compensation, recognition, learning opportunities, and career development opportunity with employee satisfaction which indicates these variables have a positive impact on employee satisfaction. Conclusion: It is found that reward management is positively related to employee satisfaction and it is a powerful motivational factor that leads to job satisfaction. Implications: College management including universities may focus on identifying better reward management strategies to motivate the employees to enhance better productivity.

Reward Management Strategies and Employee Satisfaction in the Colleges of Kathmandu Valley

Background: Educational institutions set up a reward management system with the hope that it makes the employees perform their activities to the satisfaction of all concerned stakeholders. However, there are many contradictions and complaints about the performance of employees in colleges, compelling the undertaking the studies. Objectives: This study aims to examine the impact of reward management strategies on employee satisfaction in colleges of Kathmandu valley. Methods: This paper uses a questionnaire survey method of 300 respondentsof different 30 colleges/campuses of Kathmandu valley and descriptive statistics and multiple regression models are used to analyze the data. Results: The beta coefficients are positive and significant for promotion, compensation, recognition, learning opportunities, and career development opportunity with employee satisfaction which indicates these variables have a positive impact on employee satisfaction. Conclusion: It is found that reward management is positively related to employee satisfaction and it is a powerful motivational factor that leads to job satisfaction. Implications: College management including universities may focus on identifying better reward management strategies to motivate the employees to enhance better productivity.

Методология совершенствования деятельности санаторно-курортной организации на основе критериев глобальной модели EFQM 2020: представление методики самооценки.

Improving the quality of health resort services through effective management is one of the key tools to increase their competitiveness, which increases the demand, ensures year-round occupancy and increases their financial results. An independent assessment of the management system in a health resort and the publication of the results build the trust of guests as well as authorities and investors, which contributes to attracting investment in the resort and its sustainable development. Purpose of the study. This study develops a methodology for managing changes in accordance with standardized international criteria to improve the results and ensure the development of a health resort. Materials and methods. An express self-assessment of the health resort's management system was carried out by means of a questionnaire, which reveals the development level according to the most effective approaches within each criterion of the global model EFQM 2020. These criteria emphasize consumer priorities, sustainable values, the satisfaction of stakeholder needs, and the environment. The approaches characterizing the health resort’s activity, help to estimate the level of its maturity in accordance with the principles of sustainable development. The results were used to plan improvements in the health resort's operations. In comparison with the results of past self-assessments, these results record the current state of the management system and demonstrate the levels of development and tendencies in work practices, showing possibilities for the development of the resort. To assess the activities of the health resort organization for each element of the model, four options for assessing the levels of maturity were selected. Conclusions. Express self-assessment gives a rapid assessment of the activities of health resorts based on the questionnaire and information supplied verbally. The results can be obtained within one day and can represent graphically the evaluation profile of the health resort. The method can be used in any health resort, regardless of its organization, ownership, or medical specialization. Indirectly, the methodology develops patient- and risk-oriented thinking among management, which forms a culture of quality and innovation in the health resort itself and in the professional community of organizations in order to contribute to the growth and prosperity of the spa industry in Russia as a whole. Improving the methodology of express self-assessment includes clarifying and adding statements to the questionnaire in relation to the best management practices of health resorts, new goals, objectives, and business technologies, as well as challenges at the regional and global levels.

Responding to rural allied health workforce challenges in the public health system: Evaluation of the Allied Health Rural Generalist Pathway pilot in western New South Wales.

The Allied Health Rural Generalist Pathway pilot aimed to improve consistent access to physiotherapy services in rural communities using the "grow own" workforce strategy and existing resources. A summative evaluation of the quality improvement project used to implement the Allied Health Rural Generalist Pathway was completed. A mixed method design was used and included focus groups and a framework analysis. The temporary redesign of specific workforce resources created "development" positions. A shared same-discipline supervisor resource supported five early-career physiotherapists, the participants. The project was undertaken in rural New South Wales in the public health system. The main outcome measures included a number of chronically vacant physiotherapy positions and stakeholder satisfaction. Targeted vacancies were filled, services sustained with minimal service gaps and mean retention rate of 2.9years. A statistically significant increase in service activity to patients in rural locations occurred as a result of the intervention (R-squared 29%, P<.05). Four out of five early career physiotherapists fulfilled terms of their contract and secured senior positions within the region. Whilst participants developed professionally, they did not complete the tertiary education component. The Allied Health Rural Generalist multi-factorial approach supported recruitment, retention and capacity building within the targeted discipline of the allied health workforce. Patient need was met. The rural pipeline capacity was developed. The pathway was complementary of existing NSW Health systems. Systemic change is needed to overcome inefficiencies experienced during implementation and to ensure sustainability. Further research to develop discipline-specific clinical training guidance through the stages of a rural allied health professionals' career may be helpful.

Pengaruh Tingkat Kepuasan Pengguna Lulusan (Stakeholder) Terhadap Kualitas Lulusan Pada Universitas Teknologi Sumbawa

Sumbawa University of Technology (UTS) is an educational institution that produces outputs that match work needs. The curriculum is to develop a number of study programs at UTS, adapted to the developments and demands of today's world of work. This research was conducted to determine the level of satisfaction of Stakeholders on the quality of graduates. Research is using a descriptive method with a quantitative approach. Analysis data method uses the Customer Satisfaction Index (CSI) and Importance Performance Analysis (IPA). Respondents in this study were graduate users (Stakeholders) with a total of 100 respondents. The results of this study, that the quality of graduates from UTS is very good, even though they work not in their field of expertise (non-academic). Even though the quality of the graduates is in the category very good, there are several items/attributes that need to considere. In meeting the satisfaction of Stakeholders, namely Point number 9 regarding the ability of graduates to write activity reports. , such as research and projects. The second point, number 14 is the ability of graduates to use technology related to their field of science. Item number 15 is the graduate's ability to use computers.

Quality management system performance under force majeure risk (COVID-19 pandemic)

Aim.To assess the effectiveness of QMS implemented by Research Institute for Complex Issues of Cardiovascular Diseases (NII KPSSZ) in 2020 and determine the impact of force majeure event (COVID-19 pandemic) on the achievement of the goals and objectives of the organization.Methods.11 QMS processes of the NII KPSSZ in 2020 were analyzed according to 98 performance criteria. The following general scientific methods were used for the assessment of QMS: analysis, synthesis, structural and systems analysis.Results.The overall effectiveness of the QMS in 2020 was 83.5%, for the individual processes it varies from 57% to 100%. Achievement of target indicators in accordance with the criteria reflects the effectiveness of risk management in QMS processes. 27 criteria were added (9 of which were reformulated) as a result of the development of the system and the analysis of work experience in unusual circumstances for year 2021. At the end of 2021, QMS will be analyzed according to 117 criteria for the processes effectiveness.Conclusion.The presented experience of quality management system functioning in 2020 highlights the significant roles of monitoring of the main processes and performance indicators analysis of scientific and medical organization in the ongoing COVID-19 pandemic. Such analysis is a necessary for decision-making because it allows the organization to fulfill the obligations, maintain conditions for increasing stakeholder satisfaction, monitor risks and assess opportunities associated with the environment and objectives of the organization, and ensure compliance with the standard requirements, regulations and legislation.

Enterprise value management based on the stakeholder approach

The need to ensure the growth of enterprise value in the context of strengthening intangible factors’ role in its formation and maintaining sustainable development of society requires the introduction of new value-oriented management models, taking into account the interests of a wide range of stakeholders.The paper aimed to develop an approach to enterprise value management based on the stakeholder approach. Based on the presented conceptual vision of the enterprise as an SRPR system (stakeholders-resources-processes-results), a two-level system of SRPR value indicators for the main stakeholder groups has been developed, as well as an integral indicator of sustainable economic value added (EVA), which allows assessing the potential growth of enterprise value through a sustainable network of stakeholders. The possibility of using SRPR indicators in the process of planning activities has been substantiated: a model for maximizing EVA is formulated subject to a number of restrictions reflecting the standards of relationships with stakeholders, its transformation into a matrix of SRPR indicators.The results of approbation of the proposed approach by questioning processing and wholesale trade enterprises in the B2B segment are presented, confirming the compliance of the proposed system of indicators with the interests of stakeholders and implementation at Europroject Ukraine LLC, which proved its practical value.The need for further empirical studies of the dependence of EVA on changes in indicators of satisfaction of stakeholders’ interests is emphasized.

833 CLINICAL PATHWAY DEVELOPMENT AND IMPLEMENTATION FOR THE MANAGEMENT OF CHYLE LEAK FOLLOWING OESOPHAGECTOMY: THE OXFORD EXPERIENCE

Abstract Thoracic chyle leakage is a major and frequently encountered complication following oesophagectomy. The incidence of chyle leakage depends on the definition used and been reported to be as high as 20% among patients undergoing oesophagectomy. The sequalae can be severe and include hypovolemia, electrolyte disturbance, malnutrition, immune suppression, and increased mortality, thereby making prompt diagnosis and optimum management essential. Nevertheless, controversy remains surrounding the nature and timing of interventions. Methods Retrospective audit was performed of 227 consecutive patients undergoing oesophagectomy between October 2014 and April 2018 at the Oxford Oesophagogastric Centre. Following pathway implementation, data are being prospectively collected along with surveys of the experience and satisfaction of stakeholders. Results Chyle leak was treated in 29 (12.8%) post-operative patients. Females were over twice as likely to be treated for chyle leak (OR 2.31, P = 0.042), while age and length of operation showed no association. Chyle leak was associated with a failure to complete the ERAS pathway (P = 0.005), an increased length of stay (P = 0.0001) with the median length of stay being 4 days greater among the chyle leak group, and increased rates of readmission (P = 0.032). Conclusion Our data highlight the significant morbidity associated with thoracic chyle leakage. Upon review of best available evidence, a clinical pathway was developed for the early diagnosis and standardised management of chyle leak (Figure 1). The goal of the pathway is that patients achieve predetermined outcome within a specified time frame. Here we present our development and experience of the Oxford Oesophagogastric Chyle Leak Pathway and describe the particular challenges and interim outcomes of its implementation.