Deborah Nightingale

Bio: Deborah Nightingale is an academic researcher from Massachusetts Institute of Technology. The author has contributed to research in topics: Lean enterprise & Enterprise architecture. The author has an hindex of 19, co-authored 52 publications receiving 1459 citations.

Development of a Lean Enterprise Transformation Maturity Model

Abstract: The Lean Enterprise Self-Assessment Tool (LESAT) was developed by an industry/govern-ment/ academia team under the auspices of the Lean Aerospace Initiative (LAI) at the Massachusetts Institute of Technology in 2000 and 2001. Based upon a user needs determination, a Capability Maturity Model format was selected. The current version of LESAT, released in August 2001, is the result of a joint effort between the U.S. LAI and the United Kingdom LAI. Extensive field-testing in more than 20 companies in both countries demonstrated the tool's utility, effectiveness and ease of use. Further refinements are planned for the future.

Enabling systems thinking to accelerate the development of senior systems engineers

Abstract: As systems become more complex, the roles involved in developing and managing such systems also become more complex. Thus, there is increasing interest in educating and training engineering professionals to think more systemically. In particular, there is an increasing need to accelerate the development of senior systems engineers. As new educational degree programs in systems rapidly emerge and as companies scurry to establish systems training programs to meet this need, fundamental questions still remain about how systems thinking develops in engineers. Increased understanding of the mechanisms that develop systems thinking will enable effective and efficient development of senior systems professionals. After reviewing related literature, an exploratory and inductive study was designed to gather data on enablers, barriers, and precursors to systems thinking development in engineers. In a field study conducted primarily in the United States aerospace sector, 205 interviews were conducted in 10 host companies. Senior systems engineers were studied to better understand how they developed systems thinking, and information was collected on company procedures for developing systems engineers. Using interview and survey data, comparisons were made of two control groups and senior systems engineers. Proven stellar systems thinkers were also interviewed. To summarize the results, even though systems thinking definitions diverge, there is consensus on primary mechanisms that enable or obstruct systems thinking development in engineers. In order to reconcile the divergent definitions observed, a systems thinking framework and definition are given. The data show that the primary mechanisms that enable systems thinking development include experiential learning, specific individual characteristics, and a supporting environment. This document defines the research space on this topic and suggests applications for the results. Better understanding of systems thinking development provides a foundation for educational interventions and employee development in systems thinking for engineering professionals across industry, government, and academia. © 2007 Wiley Periodicals, Inc. Syst Eng The Massachusetts Institute of Technology (M.I.T.) is the copyright owner of the original dissertation work on which this paper is based. Permission has been granted to the authors to reproduce this work for publication in the Systems Engineering journal by Wiley. The research was sponsored by the Lean Aerospace Initiative at MIT. For more information, contact the corresponding author Heidi L. Davidz.

Predicting Emergency Department Inpatient Admissions to Improve Same‐day Patient Flow

Abstract: Objectives: The objectives were to evaluate three models that use information gathered during triage to predict, in real time, the number of emergency department (ED) patients who subsequently will be admitted to a hospital inpatient unit (IU) and to introduce a new methodology for implementing these predictions in the hospital setting. Methods: Three simple methods were compared for predicting hospital admission at ED triage: expert opinion, naive Bayes conditional probability, and a generalized linear regression model with a logit link function (logit-linear). Two months of data were gathered from the Boston VA Healthcare System‘s 13-bed ED, which receives approximately 1,100 patients per month. Triage nurses were asked to estimate the likelihood that each of 767 triaged patients from that 2-month period would be admitted after their ED treatment, by placing them into one of six categories ranging from low to high likelihood. Logit-linear regression and naive Bayes models also were developed using retrospective data and used to estimate admission probabilities for each patient who entered the ED within a 2-month time frame, during triage hours (1,160 patients). Predictors considered included patient age, primary complaint, provider, designation (ED or fast track), arrival mode, and urgency level (emergency severity index assigned at triage). Results: Of the three methods considered, logit-linear regression performed the best in predicting total bed need, with a receiver operating characteristic (ROC) area under the curve (AUC) of 0.887, an R 2 of 0.58, an average estimation error of 0.19 beds per day, and on average roughly 3.5 hours before peak demand occurred. Significant predictors were patient age, primary complaint, bed type designation, and arrival mode (p < 0.0001 for all factors). The naive Bayesian model had similar positive predictive value, with an AUC of 0.841 and an R 2 of 0.58, but with average difference in total bed need of approximately 2.08 per day. Triage nurse expert opinion also had some predictive capability, with an R 2 of 0.52 and an average difference in total bed need of 1.87 per day. Conclusions: Simple probability models can reasonably predict ED-to-IU patient volumes based on basic data gathered at triage. This predictive information could be used for improved real-time bed management, patient flow, and discharge processes. Both statistical models were reasonably accurate, using only a minimal number of readily available independent variables.

Teledermatology: Key factors associated with reducing face-to-face dermatology visits

Abstract: Teledermatology makes 3 promises: better, cheaper, and faster dermatologic care. It is "better" because, although it cannot offer as much to the patient as a traditional visit, it extends the dermatologist's reach to places and in ways not previously possible as a result of time and place limitations; it is "cheaper and faster" because it has the potential to reduce costs and increase efficiency for both patients and providers. For teledermatology to fulfill these promises, it must enable dermatologists to improve access by increasing the number of patients evaluated and treated. Increased patient access depends on maximizing a scarce resource–dermatologists' time–in part by avoiding unnecessary and time-consuming face-to-face appointments. We examined the literature to date to determine which teledermatology programs have greater or lesser success in reducing face-to-face visits. Our review highlights 4 factors that are associated with a higher number of face-to-face appointments avoided by teledermatology programs: (1) effective preselection of patients for teleconsultation, (2) high-quality photographic images, (3) dermoscopy if pigmented lesions are evaluated, and (4) effective infrastructure and culture in place to implement teleconsultation recommendations.

Out of the Crisis

Abstract: According to W. Edwards Deming, American companies require nothing less than a transformation of management style and of governmental relations with industry. In Out of the Crisis, originally published in 1982, Deming offers a theory of management based on his famous 14 Points for Management. Management's failure to plan for the future, he claims, brings about loss of market, which brings about loss of jobs. Management must be judged not only by the quarterly dividend, but by innovative plans to stay in business, protect investment, ensure future dividends, and provide more jobs through improved product and service. In simple, direct language, he explains the principles of management transformation and how to apply them.

Toyota production system : beyond large-scale production

Abstract: * Starting from Need* Evolution of the Toyota Production System* Further Development* Genealogy of the Toyota Production System* The True Intention of the Ford System* Surviving the Low-Growth Period

Critical success factors for lean implementation within SMEs

Abstract: Purpose – The aim of this research paper is to present the critical factors that constitute a successful implementation of lean manufacturing within manufacturing SMEs.Design/methodology/approach – A combination of comprehensive literature review and visits to ten SMEs based in the East of the UK were employed in the study. The companies' practices were observed to highlight the degree of lean manufacturing utilisation within these companies. This was followed by interviewing of the relevant and key personnel involved in lean implementation. Results were analysed and validated through workshops, case studies and Delphi techniques.Findings – Several critical factors that determine the success of implementing the concept of lean manufacturing within SMEs are identified. Leadership, management, finance organisational culture and skills and expertise, amongst other factors; are classified as the most pertinent issues critical for the successful adoption of lean manufacturing within SMEs environment.Research l...