Advanced Lean In Healthcare

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Advanced Lean in Healthcare

Author : Craig Albanese
Publisher :
ISBN 13 : 9781496141897
Total Pages : 272 pages
Book Rating : 4.1/5 (418 download)

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Book Synopsis Advanced Lean in Healthcare by : Craig Albanese

Download or read book Advanced Lean in Healthcare written by Craig Albanese and published by . This book was released on 2014-05-28 with total page 272 pages. Available in PDF, EPUB and Kindle. Book excerpt: Healthcare in the United States is in need of reform. The industry must learn to operate in a fundamentally different way if there is any hope of delivering safer, more reliable, higher quality care with improved patient and staff experience-and accomplish all of this at the lowest possible cost. Advanced Lean in Healthcare is a practical guide for anyone in the healthcare industry. The book presents a novel approach to creating an advanced operating system, breaking it down into simple-to-understand steps. Borrowing from a business system with its roots in manufacturing, Advanced Lean in Healthcare narrates a healthcare industry operational problem through the experience of a patient: a young boy ravaged by terminal illness. By putting a real-world lens on the situation, the book takes the reader through five levels of the increasingly advanced steps of a lean transformation, giving them a bird's-eye view of the required operational and management shifts. By introducing lean strategies one-by-one, the authors provide an easy-to-understand plan for providing higher quality care, improved patient and staff experience, and significant cost savings for healthcare organizations. At its core, lean is a business strategy that aims to increase customer satisfaction and improve staff and corporate productivity by reducing the amount of non-value added work (waste). By engaging everyone in an organization in problem solving to reduce waste, the efficiency and quality of patient care can be optimized. In addition, engaging the entire workforce produces harder-to-quantify results, such as improved morale and greater organizational capability for future problem solving and growth. Advanced Lean in Healthcare introduces the various terms and methodologies of lean and compares them side-by-side with more traditional methods, demonstrating how the five level operating system stacks up against the status quo. In addition, a multitude of colored graphs, photographs, and lists are used to demonstrate and augment the detailed text. By providing specific examples of what works and what doesn't work, the authors make the transformation to a lean system an attainable goal for any organization that is truly committed to change and continuous improvement. The five levels are divided into ten chapters, each building on its predecessor, to provide a clear framework from beginning to end, which healthcare organizations can adapt to their own needs. The end result is a framework that is accessible by anyone in the healthcare industry-including physicians, nurses, technicians, managers, and executives-to create a true transformational shift in their daily operations, making their organization run better, more efficiently, and more affordably, all while maintaining the highest standard of quality and service.

Advanced Lean Thinking

Author :
Publisher : Jcr Publications
ISBN 13 : 9781599402284
Total Pages : 173 pages
Book Rating : 4.4/5 (22 download)

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Book Synopsis Advanced Lean Thinking by :

Download or read book Advanced Lean Thinking written by and published by Jcr Publications. This book was released on 2008 with total page 173 pages. Available in PDF, EPUB and Kindle. Book excerpt: Offers an alternative to traditional health care performance improvement. This book focuses on five specific tools and principles that can eliminate waste, save critical time, and improve the delivery and safety of patient care. It also offers a look at the foundational rules and principles of lean thinking.

Advanced Performance Improvement in Health Care

Author : Donald Lighter
Publisher : Jones & Bartlett Learning
ISBN 13 : 0763764493
Total Pages : 461 pages
Book Rating : 4.7/5 (637 download)

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Book Synopsis Advanced Performance Improvement in Health Care by : Donald Lighter

Download or read book Advanced Performance Improvement in Health Care written by Donald Lighter and published by Jones & Bartlett Learning. This book was released on 2011 with total page 461 pages. Available in PDF, EPUB and Kindle. Book excerpt: Amidst a deepening crisis in U.S. health care, Advanced Performance Improvement in Health Care provides a results-oriented approach to rehabilitating an ailing healthcare system. With his innovative, instructive strategies, Lighter offers a welcome road map to guide meaningful change in the industry and to equip healthcare managers to meet 21st century challenges. Advanced Performance Improvement in Health Care: Principles and Methods provides healthcare educators, leaders, and clinicians with the specific knowledge and tools vital for creating and advocating for quality-centric, next-generation healthcare organizations. This unique compilation of management, analytical, and statistical methods and techniques serves as a comprehensive guide to harnessing todays technology and developing a culture of quality that delivers sustainable, quantifiable value in healthcare organizations.

Dynamic Capacity Management for Healthcare

Author : Pierce Story
Publisher : CRC Press
ISBN 13 : 9781439819760
Total Pages : 226 pages
Book Rating : 4.8/5 (197 download)

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Book Synopsis Dynamic Capacity Management for Healthcare by : Pierce Story

Download or read book Dynamic Capacity Management for Healthcare written by Pierce Story and published by CRC Press. This book was released on 2016-04-19 with total page 226 pages. Available in PDF, EPUB and Kindle. Book excerpt: While hospitals can learn from other industries, they cannot be improved or run like factories. With work that is more individualized than standardized, and limited control over volume and arrivals, even the leanest-minded hospital must recognize that healthcare systems are more dynamic than nearly any work environment. Written with the creativity needed to navigate the rapidly changing landscape of healthcare, Dynamic Capacity Management for Healthcare: Advanced Methods and Tools for Optimization presents the unique new tools, methodologies, and thinking required of healthcare systems that want to survive and thrive in a reduced reimbursement, higher-cost world. Demonstrating his approaches and recommendations through case studies specific to the complex issues of healthcare delivery, Pierce Story, a long-time and passionate healthcare operations expert, shows how hospitals and health systems can make leaps in performance in an environment in which both financial and human resources are shrinking as expectations for clinical perfection continue to rise. Through its unique approach to the dynamic management of complex care systems, this volume raises the bar for what is possible. This text presents an excellent opportunity for healthcare’s change agents to meet the challenges and responsibilities of our day.

Lean Daily Management for Healthcare Field Book

Author : Gerard A. Berlanga
Publisher : CRC Press
ISBN 13 : 1315350890
Total Pages : 207 pages
Book Rating : 4.3/5 (153 download)

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Book Synopsis Lean Daily Management for Healthcare Field Book by : Gerard A. Berlanga

Download or read book Lean Daily Management for Healthcare Field Book written by Gerard A. Berlanga and published by CRC Press. This book was released on 2016-08-05 with total page 207 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book gives healthcare leaders a practical guide to implementing the 4 key components of lean daily management system - 1. LDM boards; 2. Leadership rounds 3. Leader daily disciplines and 4. Lean projects. Although lean is not new to healthcare, effective LDM is just now taking hold with the best lean healthcare organizations in the U.S. and Canada. Leaders are realizing that sustaining their lean projects over time has proven to be a challenge without first addressing the organizations management system/model. LDM gives leaders a straightforward approach to do just that as well as improve their ability to spread and deploy lean to other areas of the organization and tie back to strategy.

The Lean Healthcare Dictionary

Author : Rona Consulting Group
Publisher : CRC Press
ISBN 13 : 1040083277
Total Pages : 216 pages
Book Rating : 4.0/5 (4 download)

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Book Synopsis The Lean Healthcare Dictionary by : Rona Consulting Group

Download or read book The Lean Healthcare Dictionary written by Rona Consulting Group and published by CRC Press. This book was released on 2017-07-27 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: In today's healthcare economy, with reduced reimbursement and closer scrutiny of quality patient care, the concepts and terminology of Lean management are becoming invaluable to nurses, clinicians, administrators, and other healthcare staff involved in improvement. Conversely, a basic grasp of common healthcare terms is essential for process improvement specialists who aren't necessary fluent in healthcare terminology. The Lean Healthcare Dictionary: An Illustrated Guide to Using the Language of Lean Management in Healthcare is designed to bridge the gap between Lean practitioners and healthcare professionals. This comprehensive dictionary defines essential Lean and healthcare terms to help create a common language for anyone involved in Lean healthcare improvement activities. Providing quick reference to the language of Lean management in healthcare, the dictionary includes diagrams and charts that illustrate concepts and aid in understanding. Each entry in Part I provides a succinct description of a Lean term as used in a healthcare setting. Healthcare terms and acronyms that commonly arise in the course of Lean transformations are defined in Part II. The content of this dictionary is firmly rooted in the hands-on experience of Rona Consulting Group, whose principals have designed and led ground-breaking applications of Lean management in emergency rooms, operating rooms, labs, hospitals, and major medical centers

Lean Daily Management for Healthcare

Author : Brad White
Publisher : CRC Press
ISBN 13 : 1315350734
Total Pages : 164 pages
Book Rating : 4.3/5 (153 download)

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Book Synopsis Lean Daily Management for Healthcare by : Brad White

Download or read book Lean Daily Management for Healthcare written by Brad White and published by CRC Press. This book was released on 2016-08-19 with total page 164 pages. Available in PDF, EPUB and Kindle. Book excerpt: You likely don’t need any more tools, programs, or workshops to improve your hospital. What you need is a simple and consistent approach to manage problem-solving. Filling this need, this book presents a Lean management system that can help break down barriers between staff, directors, and administration and empower front-line staff to resolve their own problems. Lean Daily Management for Healthcare: A Strategic Guide to Implementing Lean for Hospital Leaders provides practical, step-by-step guidance on how to roll out Lean daily management in a hospital setting. Ideal for leaders that may feel lost in the transition process, the book supplies a roadmap to help you identify where your hospital currently is in its Lean process, where it’s headed, and how your role will change as you evolve into a Lean leader. Illustrating the entire process of implementing Lean daily management, the book breaks down the cultural progression of units into discreet, objectively measurable phases. It identifies what leaders at all levels of the organization must do to progress units into the next phase of development. Complete with case studies from different service areas in the hospital, the book explains how to link problem-solving boards together to achieve meaningful and measurable improvements in: the emergency department, the operating room, discharge times, clinics, quality, and patient satisfaction. After reading this book you will understand how consistent rounding, a few whiteboards, pen-and-paper data, and a focused effort on working the Plan-Do-Study-Act cycle can help you build a common problem-solving bench strength throughout your organization—establishing the framework upon which future improvement can be built.

Improving Healthcare Using Toyota Lean Production Methods

Author : Robert Chalice
Publisher : Quality Press
ISBN 13 : 0873893719
Total Pages : 317 pages
Book Rating : 4.8/5 (738 download)

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Book Synopsis Improving Healthcare Using Toyota Lean Production Methods by : Robert Chalice

Download or read book Improving Healthcare Using Toyota Lean Production Methods written by Robert Chalice and published by Quality Press. This book was released on 2006-12-14 with total page 317 pages. Available in PDF, EPUB and Kindle. Book excerpt: What differentiates this book from other healthcare improvement books is that it is the only currently available book that presents a simple recipe of 46 lean steps for healthcare providers to reduce cost and improve quality. By taking these straightforward steps, healthcare providers can adopt the same lean methods which have enabled companies like Toyota to become so successful.The first part of the book explains cost and quality issues facing U.S. healthcare. From that understanding, the second part then teaches healthcare providers a 46-step recipe to reduce costs and improve quality by using Toyota Lean Production methods. With industry experts citing that as much as 40% of the total cost of healthcare production is attributed to wasteful processes, it is logical that reducing waste will lower costs. This is the basis of this book.Although other books have presented Toyota's lean methods, this book goes further by showing how to directly apply those successful methods to healthcare, where they are sorely needed. This book is intended to be a practical manual for healthcare providers to use to improve quality and reduce costs. It can be a multi-year strategic plan for healthcare providers to adopt.This second edition includes additional improvement steps and five new appendices of practical examples authored by renowned lean experts.

Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, and Flawless Healthcare

Author : Jay Arthur
Publisher : McGraw Hill Professional
ISBN 13 : 0071753265
Total Pages : 370 pages
Book Rating : 4.0/5 (717 download)

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Book Synopsis Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, and Flawless Healthcare by : Jay Arthur

Download or read book Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, and Flawless Healthcare written by Jay Arthur and published by McGraw Hill Professional. This book was released on 2011-02-22 with total page 370 pages. Available in PDF, EPUB and Kindle. Book excerpt: DELIVER FASTER, BETTER, AND CHEAPER HEALTHCARE IN AS FEW AS FIVE DAYS 4 STAR DOODY'S REVIEW! "The main purpose is to present simple steps to help hospitals start getting faster, better, and cheaper in five days or less while achieving the goal of fast, affordable, and flawless healthcare. Healthcare has many opportunities for improvement and the use of Lean Six Sigma concepts can make a dramatic impact. This book provides the basic information to do that."--Doody's Review Service Lean Six Sigma for Hospitals: Simple Steps to Fast, Affordable, Flawless Healthcare explains how to use tested Lean Six Sigma methods and tools to rapidly improve hospital operations and quality of care and reduce costs. These proven strategies follow the patient from the front door of the hospital or emergency room all the way through discharge, examining key aspects of patient flow and quality. The trail of billing and collections is also followed to discover and eliminate cash flow leaks. This practical guide emphasizes both the clinical and operational sides to reduce the "three demons of quality"--delay, defects, and deviation. Real-world case studies from major hospitals illustrate successful implementations of Lean Six Sigma. Coverage Includes: Achieving a faster, better hospital in five days--emergency department, door-to-balloon time, operating room, medical imaging, lab, nursing unit, clinical staff, pharmacy, order accuracy, diagnosis, ICU Lean for accelerated patient flow Reducing medical errors with Six Sigma Creating a more profitable hospital in five days by reducing denied, rejected, and appealed claims Six Sigma for hospitals Excel power tools for Lean Six Sigma Identifying improvement projects through data mining and analysis Sustaining improvement using control charts Laser-focused process innovation Statistical tools for Lean Six Sigma Implementing Lean Six Sigma

The Lean Healthcare Handbook

Author : Thomas Pyzdek
Publisher : Springer Nature
ISBN 13 : 3030699013
Total Pages : 252 pages
Book Rating : 4.0/5 (36 download)

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Book Synopsis The Lean Healthcare Handbook by : Thomas Pyzdek

Download or read book The Lean Healthcare Handbook written by Thomas Pyzdek and published by Springer Nature. This book was released on 2021-04-28 with total page 252 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book shows readers exactly how to use Lean tools to design healthcare work that is smooth, efficient, error free and focused on patients and patient outcomes. It includes in-depth discussions of every important Lean tool, including value stream maps, takt time, spaghetti diagrams, workcell design, 5S, SMED, A3, Kanban, Kaizen and many more, all presented in the context of healthcare. For example, the book explains the importance of quick operating room or exam room changeovers and shows the reader specific methods for drastically reducing changeover time. Readers will learn to create healthcare value streams where workflows are based on the pull of customer/patient demand. The book also presents a variety of ways to continue improving after initial Lean successes. Methods for finding the root causes of problems and implementing effective solutions are described and demonstrated. The approach taught here is based on the Toyota Production System, which has been adopted worldwide by healthcare organizations for use in clinical, non-clinical and administrative areas.

Lean Behavioral Health

Author : Joseph Merlino
Publisher : Oxford University Press
ISBN 13 : 0199989524
Total Pages : 289 pages
Book Rating : 4.1/5 (999 download)

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Book Synopsis Lean Behavioral Health by : Joseph Merlino

Download or read book Lean Behavioral Health written by Joseph Merlino and published by Oxford University Press. This book was released on 2014 with total page 289 pages. Available in PDF, EPUB and Kindle. Book excerpt: Includes bibliographical references and index.

Taking Improvement from the Assembly Line to Healthcare

Author : Ronald G. Bercaw
Publisher : CRC Press
ISBN 13 : 1000412245
Total Pages : 138 pages
Book Rating : 4.0/5 (4 download)

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Book Synopsis Taking Improvement from the Assembly Line to Healthcare by : Ronald G. Bercaw

Download or read book Taking Improvement from the Assembly Line to Healthcare written by Ronald G. Bercaw and published by CRC Press. This book was released on 2021-07-22 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Quality healthcare is a cornerstone of any healthy society. In the U.S., we have access to sophisticated medical technology, world renowned physicians, highly trained nurses and hospital personnel, advanced pharmaceuticals, and innovations in diagnosis and treatment. But for all of our sophistication, serious problems afflict healthcare systems across the U.S. today – problems that cause severe hardship for families in communities large and small. Considering its impact on society, healthcare is arguably our most important industry. Good health is a key aspect of a productive and fulfilling life no matter what a person’s age, cultural background, social status or career. To live well and provide for ourselves and others, we all depend on a strong healthcare system that can help us prevent illness and access effective treatment when we need it. Needless to say, building and maintaining that robust healthcare system is no easy task. According to a report by the Institute of Medicine, up to 98,000 deaths per year occur in U.S. hospitals as a result of adverse events. In other words, errors in hospitals cause more annual deaths than acceptable and are totally preventable. With the healthcare system in such critical condition, Lean is the best possible treatment as it moves to eliminate waste and improve processes. The revised edition of Taking Improvement from the Assembly Line to Healthcare supplies step-by-step guidance on how to implement Lean methods to achieve world-class improvement with the healthcare industry. The updated edition of this Shingo award winner book provides specific examples of Lean implementation in emergency medicine, diagnostic imaging, orthopedic clinics, general internal medicine, administration, and community care. Highlighting quality, safety, and financial evidence as to why immediate change is both possible and essential, the book provides a firm foundation in Lean improvement and the tools used to deliver sustainable solutions. This revised edition presents new and updated client interviews and how the process has changed or been enhanced, what worked and what didn’t work. New case studies from U.S. and Canada provide readers with the real-world understanding needed to embark and sustain a successful improvement journey.

Lean Healthcare

Author : Dennis R. Delisle
Publisher : Quality Press
ISBN 13 : 1951058453
Total Pages : 275 pages
Book Rating : 4.9/5 (51 download)

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Book Synopsis Lean Healthcare by : Dennis R. Delisle

Download or read book Lean Healthcare written by Dennis R. Delisle and published by Quality Press. This book was released on 2020-12-01 with total page 275 pages. Available in PDF, EPUB and Kindle. Book excerpt: Lean healthcare is not about being better, but rather becoming the best at getting better. Today's challenge in the healthcare environment is your ability to improve at a greater rate than surrounding competitors. This book focuses on the model, strategy, and lessons learned in implementing lean thinking in a practical way. Using real-world case studies, the book provides approaches and tools to facilitate rapid improvements, along with a bonus section on pandemic preparedness. By following this accessible, user-friendly guide, you can achieve meaningful results right away. Dr. Dennis R. Delisle currently serves as the Executive Director for The Ohio State University Wexner Medical Center's flagship University Hospital. Through the Thomas Jefferson University College of Population Health, Dennis founded and oversees the Master of Science degree program in Operational Excellence, one of the first of its kind in the nation. He is the author of two books about streamlining and transforming healthcare.

Lean Daily Management for Healthcare

Author : Brad White
Publisher : CRC Press
ISBN 13 : 1498758991
Total Pages : 216 pages
Book Rating : 4.4/5 (987 download)

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Book Synopsis Lean Daily Management for Healthcare by : Brad White

Download or read book Lean Daily Management for Healthcare written by Brad White and published by CRC Press. This book was released on 2016-08-03 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: You likely don’t need any more tools, programs, or workshops to improve your hospital. What you need is a simple and consistent approach to manage problem-solving. Filling this need, this book presents a Lean management system that can help break down barriers between staff, directors, and administration and empower front-line staff to resolve their own problems. Lean Daily Management for Healthcare: A Strategic Guide to Implementing Lean for Hospital Leaders provides practical, step-by-step guidance on how to roll out Lean daily management in a hospital setting. Ideal for leaders that may feel lost in the transition process, the book supplies a roadmap to help you identify where your hospital currently is in its Lean process, where it’s headed, and how your role will change as you evolve into a Lean leader. Illustrating the entire process of implementing Lean daily management, the book breaks down the cultural progression of units into discreet, objectively measurable phases. It identifies what leaders at all levels of the organization must do to progress units into the next phase of development. Complete with case studies from different service areas in the hospital, the book explains how to link problem-solving boards together to achieve meaningful and measurable improvements in: the emergency department, the operating room, discharge times, clinics, quality, and patient satisfaction. After reading this book you will understand how consistent rounding, a few whiteboards, pen-and-paper data, and a focused effort on working the Plan-Do-Study-Act cycle can help you build a common problem-solving bench strength throughout your organization—establishing the framework upon which future improvement can be built.

Lean Thinking for Healthcare

Author : Nilmini Wickramasinghe
Publisher : Springer Science & Business Media
ISBN 13 : 1461480361
Total Pages : 645 pages
Book Rating : 4.4/5 (614 download)

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Book Synopsis Lean Thinking for Healthcare by : Nilmini Wickramasinghe

Download or read book Lean Thinking for Healthcare written by Nilmini Wickramasinghe and published by Springer Science & Business Media. This book was released on 2013-10-04 with total page 645 pages. Available in PDF, EPUB and Kindle. Book excerpt: A growing, aging population; the rise to epidemic proportions of various chronic diseases; competing, often overlapping medical technologies; and of course, skyrocketing costs compounded by waste and inefficiency - these are just a few of the multifarious challenges currently facing healthcare delivery. An unexpected source of solutions is being imported from the manufacturing sector: lean thinking. Lean Principles for Healthcare presents a conceptual framework, management principles, and practical tools for professionals tasked with designing and implementing modern, streamlined healthcare systems or overhauling faulty ones. Focusing on core components such as knowledge management, e-health, patient-centeredness, and collaborative care, chapters illustrate lean concepts in action across specialties (as diverse as nursing, urology, and emergency care) and around the globe. Extended case examples show health systems responding to consumer needs and provider realities with equal efficiency and effectiveness, and improved quality and patient outcomes. Further, contributors tackle the gamut of technological, medical, cultural, and business issues, among them: Initiatives of service-oriented architecture towards performance improvement Adapted lean thinking for emergency departments Lean thinking in dementia care through smart assistive technology Supporting preventive healthcare with persuasive services Value stream mapping for lean healthcare A technology mediated solution to reduce healthcare disparities Geared toward both how lean ideas can be carried out and how they are being used successfully in the real world, Lean Principles for Healthcare not only brings expert knowledge to healthcare managers and health services researchers but to all who have an interest in superior healthcare delivery.

Basics of Health Care Performance Improvement

Author : Donald Lighter
Publisher : Jones & Bartlett Publishers
ISBN 13 : 1449679838
Total Pages : 352 pages
Book Rating : 4.4/5 (496 download)

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Book Synopsis Basics of Health Care Performance Improvement by : Donald Lighter

Download or read book Basics of Health Care Performance Improvement written by Donald Lighter and published by Jones & Bartlett Publishers. This book was released on 2011-11-15 with total page 352 pages. Available in PDF, EPUB and Kindle. Book excerpt: Basics of Health Care Performance Improvement: A Lean Six Sigma Approach prepares future healthcare administrators to meet the challenges of a changing marketplace through the proven Lean Six Sigma method of quality improvement—straightforward principles and procedures that enhance how healthcare organizations operate. With an eye toward meeting consumers’ increasing demand for value in health care, this new volume provides in-depth information on planning and implementing a “Define-Measure-Analyze-Improve-Control” (DMAIC) initiative to reduce errors and improve performance in healthcare settings, and serves as an essential reference on the basics of Lean Six Sigma and its application in augmenting the quality of care. Key Features: Lean Six Sigma case studies drawn from the industry; A thorough exploration of DMAIC approach to quality improvement; Discussion questions in every chapter Instructor Resources: Instructor's Manual, PowerPoint Presentations, and a TestBank

Applying Lean in Healthcare

Author : Joe Aherne
Publisher : CRC Press
ISBN 13 : 1439827397
Total Pages : 251 pages
Book Rating : 4.4/5 (398 download)

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Book Synopsis Applying Lean in Healthcare by : Joe Aherne

Download or read book Applying Lean in Healthcare written by Joe Aherne and published by CRC Press. This book was released on 2010-04-21 with total page 251 pages. Available in PDF, EPUB and Kindle. Book excerpt: Typically entrenched and systemic, healthcare problems require the sort of comprehensive solutions that can only be addressed by a change in culture and a shift in thinking. Applying Lean in Healthcare: A Collection of International Case Studies demonstrates how honest appraisal, intelligent planning, and vigilant follow-up have led to dramatic improvements in a variety of healthcare settings across the world. It teaches us how innovative organizations can find sustainable solutions to seemingly intractable problems by following a path guided by Lean Thinking. Lean methods may not solve every healthcare problem, but as these cases prove, changing a culture rather than personnel results in more effective sustainable change.