Time-related Performance Research Articles

People-centered knowledge management systems and supply chain performance in SMEs

PurposeThe study explores the impact of people-centered Knowledge Management Systems (KMS) on Supply Chain Performance (SCP). It also aims to reinforce the importance of people in an organization’s survival, particularly from a knowledge-based perspective, by empirically assessing the mediating effect of knowledge sharing on people-centered KMS and SCP. The model being assessed incorporates people-centered KMS that promote knowledge sharing and therefore improve SCP within Small and Medium sized Enterprises (SME) in developing countries, leading to their extended life span.Design/methodology/approachThe study developed a knowledge-based SCP model using people-centered KMS as a predictor variable and knowledge sharing as a mediating variable, with SCP as the outcome variable. The data were collected from a sample of 580 SME owners from across Zimbabwe via a questionnaire developed based on validated constructs available in literature that was vetted through a pilot survey before distribution. The dataset was subsequently tested for validity of constructs and scales and analyzed using multiple regression.FindingsThe results of the study showed significant influence of three people-centered KMS, namely, Communities of Practice (CoP), Innovation Management (IM) and Organizational Culture (OC), on knowledge sharing but not from Social Capital. Thereafter, significant influence was also found of knowledge sharing on three process-based measures of SCP, namely, Time-Related Performance (TRP), Cost-Related Performance (CRP) and Responsiveness-Related Performance (RRP), but not on Operational Quality-Related Performance (OQRP). Thus overall, it was confirmed that people-centered KMS has a salutary impact on process-based SCP, with knowledge sharing serving as a significant mediator.Research limitations/implicationsThe study makes a novel contribution to the extant literature by providing insight into how people-centered KMS impacts SCP through knowledge sharing. Additionally, the geographical scope of the study also makes it among the few that have studied supply chain management within the context of developing economies, especially those that face significant economic pressures, such as Zimbabwe. Finally, given the criticality of SMEs to the economic growth in developing economies juxtaposed with the low survival rates of SMEs therein, the study reveals a relatively low-cost strategy of knowledge sharing among supply chain partners as a valid strategy to improve the SCP of these SMEs in an effort to enhance their survival rates. The primary limitation of the study relates to potential difficulty in the generalizability of findings because data were collected from a single country.Originality/valueThe original contributions of the study include: utilizing a people-centered knowledge management perspective, an establishment of the relationship between KMS on SCP and demonstrating the salience of knowledge sharing as a mediator; addressing the dearth of literature on supply chain management in developing economies, especially those with stressed economies; demonstrating the usefulness of knowledge sharing as a relatively low-cost but effective strategy to improve the performance of SMEs in a developing economy and thus lead to higher survival rates, thus providing a tool that can be used by the public and the private sector in developing countries to build structures for successful economic development.

Enhanced cryptographic performance and security using optimized edward-elgamal signature scheme for IoT and blockchain applications

Abstract The rapid proliferation of Internet of Things (IoT) devices and blockchain technology requires robust and efficient cryptographic solutions to ensure secure communication and data integrity. This paper presents an optimized Edward-Elgamal signature algorithm that uses Edward curved signature storage mechanism to improve performance in IoT and blockchain environments to overcome the limitations of schemes, especially Elliptic Curve Digital Signature Algorithm (ECDSA) and Hyper-ECDSA. The proposed method achieved faster signature generation times, with a 33% improvement over ECDSA and a 25% improvement over Hyper-ECDSA, making it more suitable for faster applications. The validation times of the optimized systems were relatively low, with a 32% improvement over ECDSA and a 24% improvement over Hyper-ECDSA. The efficiency of the proposed system was significantly higher, showing a 51% improvement over ECDSA and a 35% improvement over Hyper-ECDSA. The latency was reduced by 33% compared to ECDSA and 26% compared to Hyper-ECDSA, indicating the effectiveness of the optimized system in terms of time-related performance. This paper contributes to the advancement of cryptographic techniques and provides suitable solutions for secure IoT and blockchain applications. The proposed system achieves a highest improvement rate in key performance parameters over existing methods, resulting in a robust solution for modern cryptography requirements.

Do Performance Aspirations Matter for Guiding Software Configuration Tuning? An Empirical Investigation under Dual Performance Objectives

Configurable software systems can be tuned for better performance. Leveraging on some Pareto optimizers, recent work has shifted from tuning for a single, time-related performance objective to two intrinsically different objectives that assess distinct performance aspects of the system, each with varying aspirations to be satisfied, e.g., “ the latency is less than 10s ” while “ the memory usage is no more than 1GB ”. Before we design better optimizers, a crucial engineering decision to make therein is how to handle the performance requirements with clear aspirations in the tuning process. For this, the community takes two alternative optimization models: either quantifying and incorporating the aspirations into the search objectives that guide the tuning, or not considering the aspirations during the search but purely using them in the later decision-making process only. However, despite being a crucial decision that determines how an optimizer can be designed and tailored, there is a rather limited understanding of which optimization model should be chosen under what particular circumstance, and why. In this article, we seek to close this gap. Firstly, we do that through a review of over 426 articles in the literature and 14 real-world requirements datasets, from which we summarize four performance requirement patterns that quantify the aspirations in the configuration tuning. Drawing on these, we then conduct a comprehensive empirical study that covers 15 combinations of the state-of-the-art performance requirement patterns, four types of aspiration space, three Pareto optimizers, and eight real-world systems/environments, leading to 1,296 cases of investigation. Our findings reveal that (1) the realism of aspirations is the key factor that determines whether they should be used to guide the tuning; (2) the given patterns and the position of the realistic aspirations in the objective landscape are less important for the choice, but they do matter to the extents of improvement; (3) the available tuning budget can also influence the choice for unrealistic aspirations but it is insignificant under realistic ones. To promote open science practice, we make our code and dataset publicly available at: https://github.com/ideas-labo/aspiration-study .

Theoretical prediction of time-related performance of GaN-based p–n junction betavoltaic battery

Betavoltaic batteries can meet long-term energy supply needs. However, due to the decay of the radioactive source, the output performance of battery will change over time, and the laws of this change require elucidation to aid the battery engineer. In this study, the influences of time on the apparent power density and β-energy spectrum of the 63 Ni source were clarified. Moreover, the structural parameters, including the p-region, n-region doping concentrations, and junction depth of GaN-based (hexagonal) p–n junction, were optimized, which are 2 × 1017 cm–3, 1014 cm–3, and 0.1 μm, respectively. In particular, the time-related performance trends were analyzed, and a formula for the maximum output power density deterioration was obtained, which can be used to evaluate the performance of 63 Ni GaN-based p–n junction betavoltaic battery within 200 years. The simulation results showed that the maximum output power density of battery after 50 years is 0.243 μW cm−2, which is only 60% of the initial value. In addition, the other output performances, namely, the short-circuit current density, open-circuit voltage, fill factor, and conversion efficiency are 0.096 μA cm−2, 2.67 V, 94.3%, and 20.5%, respectively.

Associations between Force-Time Related Single-Leg Counter Movement Jump Variables, Agility, and Linear Sprint in Competitive Youth Male Basketball Players

Previous research has reported a strong relationship between vertical jumping, sprinting, and agility, as a reflection of lower-limb power. Unilateral analysis of this relationship has not yet been explored. This study primarily investigated the associations between single-leg countermovement jump (CMJ), sprint, and agility performances in youth basketball players. Thirty-five male basketball players from the youth category (age 15.06 ± 2.62 years, n = 32 right-limb dominant; n = 3 left-limb dominant) performed single-leg CMJ, 20 m sprint, and T-drill agility tests over two sessions. Force-time-related performance variables were measured using a single-leg CMJ test on a Kistler force plate. Significant moderate to large negative correlations were observed between single-leg CMJ variables, 20 m sprint, and T-drill agility, except for mean force for both dominant and non-dominant leg measures (r = -0.384 to -0.705). Mean power and mean force were correlated with the physical characteristics of the athletes for both legs (r = -0.389 to -0.843). Flight time and jump height were identified as the best predictor variables for both sprint and agility time in the stepwise model (R2 = 0.608 to 0.660). No statistical inter-limb differences were found during the single-leg CMJ test (p > 0.05). The study findings suggest that youth basketball players with greater single-leg jump output most likely have better sprint and agility performances. Thus, trainers and athletic performance coaches may include unilateral limb exercises in their training programs to enhance lower-limb explosive performance and reduce limb asymmetries.

Time-related performance characteristics of high-sensitivity troponin I assay using manufacturer’s controls and reagents

BackgroundTroponin is a widely used cardiac protein biomarker for acute coronary syndrome. Its increasing importance drives an increasing need to assess, in real-world conditions, the performance of the tests to measure it. We evaluated the performance characteristics of high-sensitivity troponin I assay reagents and ancillary agents on the Abbott ARCHITECT ci4100, ARCHITECT i2000SR and Alinity ci using historical quality control data spanning 5 years. Design and methodRetrospective diagnostic hs-TnI quality control data were collected between 2015 and 2019 from the Abbott ARCHITECT ci4100, ARCHITECT i2000SR and Alinity ci located in the University College Dublin Clinical Research Centre Core Lab facility. Descriptive statistics for bias and variability were generated. Linear regression models were used to calculate the mean hs-TnI concentrations over Abbott quality control or reagent lot age and over time from the last calibration of the analysers. ResultsMeasurement bias on all three systems ranged between -2.49% and 3.98%. The total CV was ≤8.80%, with a within-lot variability for the reagents and controls of ≤5.45% and ≤7.13%, respectively. The between-lot CVs for reagents and controls were ≤7.16% and 6.19%, respectively. The effect of control or reagent age did not greatly affect stability over time. Results were also stable over different times from the last calibration of the analysers. ConclusionThe results of this study show that the Abbott hs-TnI assay on the ARCHITECT i2000sr and ARCHITECT ci4000 systems is quite stable in a core laboratory environment. The Alinity ci system exhibits similar performance characteristics.

Use of a Novel Patient-Flow Model to Optimize Hospital Bed Capacity for Medical Patients

There is no known method for determining the minimum number of beds in hospital inpatient units (IPs) to achieve patient waiting-time targets. This study aims to determine the relationship between patient waiting time-related performance measures and bed utilization, so as to optimize IP capacity decisions. The researchers simulated a novel queueing model specifically developed for the IPs. The model takes into account salient features of patient-flow dynamics and was validated against hospital census data. The team used the model to evaluate inpatient capacity decisions against multiple waiting time outcomes: (1) daily average, peak-hour average, and daily maximum waiting times; and (2) proportion of patients waiting strictly more than 0, 1, and 2 hours. The results were published in a simple Microsoft Excel toolbox to allow administrators to conduct sensitivity analysis. To achieve the hospital's goal of rooming patients within 30 to 60 minutes of IP bed requests, the model predicted that the optimal daily average occupancy levels should be 89%-92% (182-188 beds) in the Medicine cohort, 74%-79% (41-43 beds) in the Cardiology cohort, and 72%-78% (23-25 beds) in the Observation cohort. Larger IP cohorts can achieve the same queueing-related performance measure as smaller ones, while tolerating a higher occupancy level. Moreover, patient waiting time increases rapidly as the occupancy level approaches 100%. No universal optimal IP occupancy level exists. Capacity decisions should therefore be made on a cohort-by-cohort basis, incorporating the comprehensive patient-flow characteristics of each cohort. To this end, patient-flow queueing models tailored to the IPs are needed.

Analyses of time-related performance of betavoltaic batteries using TiT2

The time effect of tritium silicon p–n junction betavoltaic batteries is considered in this work. For a titanium tritium (TiT2) source, the processes of decaying, tritium leaking, swelling and 3He releasing are contained in the calculation, and expressions of component and density changes are obtained. As time goes by, the self-absorption rate has a downward trend, while all electrical performances decrease, especially the short-circuit current (ISC) and the maximum output power (Pmax). At about 3.5 a, the battery begins to release gaseous 3He, and the expiry date of the battery is about 10.7 a, shorter than the half-life of tritium. The result indicated that for a tritium source, the time leads to a significant reduction in the electrical performance of the battery, which cannot be ignored in simulations and experiments.

The impact of information sharing on installation processes of offshore wind farms - process modelling and simulation-based analysis

The installation of offshore wind energy turbines is accompanied by great challenges arising from the dynamic environment, which influences logistics processes. Communication plays a major role for cost-efficient installation processes, due to the coordination needed between different partners involved in the offshore wind energy supply chain. A detailed process analysis revealed the importance of shared information about weather conditions, storage capacities and vessel availabilities. By applying a simulation study, which evaluates eight information sharing scenarios, the influence of the following execution time-related performance measures is investigated: average time in manufacturer storage, average time in port, total installation time and average vessel usage time. As a result, the simulation study verifies that sharing information between supply chain partners can contribute to more efficient logistics processes. However, the achievable prediction accuracy and the interdependencies between the information items have a major influence on the quality of results.

On the state liveness of some classes of guidepath-based transport systems and its computational complexity

Guidepath-based transport systems is a pertinent abstraction for the traffic that is generated in many contemporary applications, ranging from industrial material handling and robotics, to computer game animations and the qubit transport systems employed in quantum computing. A particular problem that must be effectively addressed for the systematic operation of these systems, is the preservation of their “liveness”, i.e., the preservation of the ability of the system agents to complete their current assignments and engage successfully in similar assignments in the future operation of the system. This paper provides a systematic and comprehensive characterization of the notion of “liveness” for the entire spectrum of the aforementioned transport systems, and it further investigates the implications of this characterization for the deployment of maximally permissive liveness-enforcing supervision for the underlying traffic. It is shown that the computational complexity of the sought supervisors is contingent upon certain structural and operational attributes of the considered transport systems, that define, thus, a useful taxonomy for these environments. The paper proposes effective and efficient liveness-enforcing supervisors for each member of this taxonomy. Furthermore, the concluding part of the paper indicates how the obtained results can be integrated in a broader control framework for the considered transport systems that will also address time-related performance considerations for these environments, like the maximization of their throughput.

72. Operation timing affects outcomes after adult spinal deformity surgery

BACKGROUND CONTEXT Adult spinal deformity (ASD) surgery can entail complex reconstructive procedures in patients with multiple comorbidities. Postoperative complications can range from minor complications such as ileus, to significant neurologic injury. ASD surgery is commonly scheduled for weekdays, with first start times. It is unclear if there is any effect of time-related performance impairment on the surgical team. PURPOSE To investigate the rate of complications based on day of the week, or time of day, that ASD surgeries are performed. STUDY DESIGN/SETTING Retrospective review of prospectively collected single center database. PATIENT SAMPLE 1040 ASD patients (Age: 46 ± 23; BMI 25 ± 7, ASA 2.5 ± 0.6, Levels fused 10 ± 4, Revision procedure: 9%, 3CO: 13%) were included in the analysis. OUTCOME MEASURES Overall complication rate, and 90-day readmission and reoperation rates. METHODS We collected start times and day of the week for ASD cases occurring at our institution from 2011-2018. First start was designated as any case starting at 7:30 AM; late start was designated as any case starting 11 am and after. Day of week was modelled as a categorical variable, with Monday as the reference group. RESULTS 1040 ASD patients (Age: 46 ± 23; BMI 25 ± 7, ASA 2.5 ± 0.6, Levels fused 10 ± 4, Revision procedure: 9%, 3CO: 13%) were included. After controlling for patient and case characteristics, there was no association between day of week and length of stay, or 90-day complication, readmission, or reoperation rates in the adjusted analyses. Late start cases (n=269) had higher rates of 90-day readmission (10.4% vs 6.0%, p=0.02), reoperation (11.9% vs 6.6%, p=0.008), and neurologic injury (5.2% vs 2.3%, 0.019). Sub-analysis of types of neurologic complications encountered demonstrated that in late start cases, there was a higher rate of postoperative radiculopathy (3.3% vs 0.9%, p=0.007), and residual central or foraminal stenosis (2.2% vs 0.6%, p=0.029). Late start cases were predictive of increased risk for 90-day readmission (OR 1.8, CI: 1.1-3.0, p=0.02), unplanned reoperation (OR 1.9, CI:1.2-3.1, p=0.009), and neurologic complication (OR 2.1, CI: 1.0-4.3, p=0.046). CONCLUSIONS Risk of morbidity after elective ASD surgery is not associated with day of the week, in an analysis of over 1000 cases. A late OR start time was predictive of increased risk for neurologic complication, and 90-day readmission and unplanned reoperation. Well-established protocols for first start OR times for elective ASD surgery may decrease outcome risk and reduce variability in complication rates. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Multi-Dimensional Indexes in DBMSs

Multi-dimensional data is present across multimedia, data mining and other data-driven applications. The R-Tree is a popular index structure that DBMSs are implementing as core for efficient retrieval of such data. The gap between the best and worst-case performance is very wide in an R-tree. Thus, building quality R-trees quickly is desirable. Variations differ in how node overflow are approached during the building process. This article studies the R-Tree technique that the open-source PostgreSQL DBMS uses. Focus is on a specific parameter controlling node overflows as an optimisation target, and improved configurations are proposed. This parameter is hard-wired into the DBMS, and therefore, an implementation is presented to allow this parameter to become accessible through an SQL construct. The access method designer can resort to configuring this parameter when trying to meet specific storage or time-related performance targets. With this study, the reader can gain an insight into the effects of changing the parameter by considering the spatial indexes on well-known workloads.

MILP models to minimise makespan in additive manufacturing machine scheduling problems

Additive manufacturing (AM), also known as 3D printing, is gaining enormous importance in the production of highly customised quality and lightweight products in low quantities. In addition to AM's use in producing fully functional industrial components, it is also seen as a technology of the future that will enable civilisation in space. Although the cost structures for AM facilities have been sufficiently studied in the literature, no effort has been made to investigate the scheduling problem of AM machines with the aim of optimising processing time-related performance measures. This paper focuses on the scheduling problem of single and multiple AM machines and proposes mathematical models for optimisation. Mixed-integer linear programming models allocate parts into jobs to be produced on AM machines to minimise makespan. The problem was handled by considering different machine configurations (i.e. single machine, parallel identical machines, and parallel non-identical machines). The models were coded in IBM ILOG CPLEX Optimization Studio (v12.8.0) and solved through the CPLEX solver. This paper presents detailed solutions for numerical examples. A comprehensive computational study was also conducted, and the results are presented. The optimum solutions are reported for most problems. The best solutions obtained within the time limit (i.e. 1800 and 2400 s) are reported for the parallel identical and non-identical AM machine scheduling problems if optimum solution could not be verified.

An operation sequence-based temporal multilayer networks model for production process in flexible manufacturing systems

This paper focuses on flexible manufacturing systems, which is a typical discrete event system. Different from traditional approaches for the system, this paper provides a multidimensional, ordinal, temporal topology structure to depict the dynamic production process from the perspective of complex networks. Firstly, the factors of real manufacturing environment are mapped to the multilayer networks and the frameworks of the model are given. The proposed temporal multilayer networks model includes intra-layers and inter-layers, involving two aspects of task and resource nodes and time-depending graphs respectively. Secondly, the generation rules to construct the networks are presented. A novel approach for evaluating bottleneck resources in time blocks is presented to evolve the networks model. Finally, the temporal multilayer networks model is generated based on theory of constraints. The proposed model based on operation sequence is superior in measurement of time-dependent performance of the system. Moreover, an application case for energy consumption evaluation is confirmed that the proposed model can support exploratory analysis of the time-related performance criterion in discrete manufacturing.

Delay Estimation of Industrial IoT Applications Based on Messaging Protocols

Information and operational technologies merge into the so-called industrial Internet of Things, which is one of the basic pillars of the Industry 4.0 paradigm. Roughly speaking, yet-to-come services will be offered in the automation scenario by industrial devices having an internet connection for sharing data in the cloud. Currently, most efforts are in the development of protocols able to ensure horizontal interoperability among heterogeneous applications. Consequently, poor attention is devoted to time-related performance. In this paper, a new, full software, platform-independent approach is proposed for experimentally evaluating the delay in transferring information across local and intercontinental routes by applications leveraging on messaging middleware. The application is realized using the node-RED web-based framework, due to its availability on different platforms; the widely accepted message queue telemetry transport protocol has been chosen thanks to its low overhead and complexity. For sake of completeness, five different, private and public, brokers are used. The adopted industrial-grade hardware, complemented by global positioning system time reference, permits an overall synchronization and timestamping accuracy of a few milliseconds. The vast measurement campaign highlighted that, generally, quality of service (QoS) type 1 offers low end-to-end delay (average value less than 0.5 s) with reduced variability (0.1 s). However, the maximum end-to-end one-way delay ranges from 1 s for QoS 0 to less than 1.5 s for fully acknowledged QoS 2.

Evaluation of the IoT LoRaWAN Solution for Distributed Measurement Applications

Internet of Things (IoT) is based on data collection, where billions of sensors sample the real world; in other words, the IoT includes a giant distributed measurement system (DMS). A question still requiring an answer is: Are the IoT technologies usable to enhance traditional measurement systems, since they have been developed for a very similar objective? In this paper, the use of a long-range (LoRa) technology, originally developed for IoT, is investigated with the aim of implementing DMSs. After the conclusion that LoRa and LoRa wide area network architectures show a good match with measurement systems, this paper focuses on the characterization of time-related performance indicators that are important for distributed systems. The experimental results show the capability of low-cost transceiver to schedule the transmission of frames with a standard uncertainty less than $3~\mu \text{s}$ ; and an acceptable long-term clock stability (Allan Deviation) of commercial available devices (nodes and packet forwarders) for application such as smart metering, smart building, and process industry.

Time Optimal Synthesis Based Upon Sequential Abstraction and Its Application to Cluster Tools

The Ramadge–Wonham supervisory control paradigm has been shown effective in dealing with logic control. Nevertheless, time-related performance is always one of the major concerns in industry. Current methods for synthesizing time optimal supervisors are incapable of dealing with large discrete-event systems (DESs) with massive state spaces. This paper proposes an approach for finding a time optimal accepting trace for large DESs based upon sequential language projection, and pruning. The algorithms are tested on a linear cluster tool to show their effectiveness.

Study on using design patterns to implement a simulation system for WiMAX network

A network simulator always is an important tool to observe and evaluate the study concept for wireless networks. Considering the restriction of the limited budget, the non-commercial open-source simulation software often becomes the top choice of academia. Since the natures of academic study are innovation and excellence, a simulator frequently encounters that the existing modular functions are inadequate and need to be appended or modified. If a selected simulator inherently has poor architecture, the maintenance, recondition, and expansion of functions will become more difficult and more time-consuming in the future, while it is difficult to understand and reuse by the successors. Therefore, how to select a most suitable simulator is an important issue. In order to make a simulator have flexible architecture and believable results, design patterns are proposed as the norms to design system architecture. To realize this idea, we surveyed six most used simulators, i.e., J-Sim, NS-2, NS-3, OMNet++, OPNET, and QualNet, to ponder their system architectures and design concepts from the source codes and the related literatures of the modular function expansion. We propose a network simulator architecture, named as CCGns, which is a discrete-event virtual network simulator and follows the IEEE 802.16-2009 standard. CCGns obeys the object-oriented design principles and is coded by the Java language. CCGns comprises eight packages for physical layer, medium access control layer, network layer, devices, topologies, events, scheduler, and reports, respectively. The main contribution includes three aspects which propose a scalable MAC messages management and the corresponding architecture, an applicable for multi-hop relay network topology architecture, and a two-stage minimum variance bandwidth allocation algorithm. To the best of our knowledge, this article is not the first one to apply the design patterns for the simulator architectures of wireless network, but we use more design patterns and types than the others and also provide the unified modeling language figures to explain the system architectures. We particularly focus on how the management procedure of control messages influences the time-related performance evaluation metrics, e.g., how the amount and processing time of different control messages affect throughput, packet delay, and packet drop ratio. By using mathematic calculation to verify the simulation results, the proposed system architecture has been proven to possess excellent fidelity.

A Strong Preemptive Relaxation for Weighted Tardiness and Earliness/Tardiness Problems on Unrelated Parallel Machines

Research on due date-oriented objectives in the parallel machine environment is at best scarce compared to objectives such as minimizing the makespan or the completion time-related performance measures. Moreover, almost all existing work in this area is focused on the identical parallel machine environment. In this study, we leverage on our previous work on the single machine total weighted tardiness (TWT) and total weighted earliness/tardiness (TWET) problems and develop a new preemptive relaxation for both problems on a bank of unrelated parallel machines. The key contribution of this paper is devising a computationally effective Benders decomposition algorithm to solve the preemptive relaxation formulated as a mixed-integer linear program. The optimal solution of the preemptive relaxation provides a tight lower bound. Moreover, it offers a near-optimal partition of the jobs to the machines. We then exploit recent advances in solving the nonpreemptive single-machine TWT and TWET problems for constructing nonpreemptive solutions of high quality to the original problem. We demonstrate the effectiveness of our approach with instances of up to five machines and 200 jobs.

Managing competing organizational priorities in clinical handover across organizational boundaries.

Handover across care boundaries poses additional challenges due to the different professional, organizational and cultural backgrounds of the participants involved. This paper provides a qualitative account of how practitioners in emergency care attempt to align their different individual and organizational priorities and backgrounds when handing over patients across care boundaries (ambulance service to emergency department (ED), and ED to acute medicine). A total of 270 clinical handovers were observed in three emergency care pathways involving five participating NHS organizations (two ambulance services and three hospitals). Half-day process mapping sessions were conducted for each pathway. Semi-structured interviews were carried out with 39 participants and analysed thematically. The management of patient flow and the fulfilment of time-related performance targets can create conflicting priorities for practitioners during handover. Practitioners involved in handover manage such competing organizational priorities through additional coordination effort and dynamic trade-offs. Practitioners perceive greater collaboration across departments and organizations, and mutual awareness of each other's goals and constraints as possible ways towards more sustainable improvement. Sustainable improvement in handover across boundaries in emergency care might require commitment by leaders from all parts of the local health economy to work as partners to establish a culture of integrated, patient-centred care.