My current domain of interest is the implementation and deployment of ongoing efficiency and effectiveness improvement in NHS processes and their management over time. Lean has been extensively employed in hospitals to improve efficiency, (reduction of time and waste, in processes), as has Six Sigma to improve effectiveness (adjustment of processes to eliminate error), and the research literature has a lot to say on the difficulties of leadership during deployment. Much of the literature also alleges that Lean deployments have not always been successful and foregrounds both the vulnerabilities to change among clinical staff and the formidable difficulties facing the NHS trusts? In view of such claims, the topics of value to my research are: -

• the articulation of authority and the methods of communication over time to instil a supportive culture, a desire for change, and a sense of urgency among frontline clinical and administrative staff to accompany such
improvement; I would like to evaluate, for example, how the chain of command functions in trusts and hospitals to effectively interact with frontline-staff values and behaviour in times of change;

• the feelings of fear and of resistance among clinical staff, which can make questions of efficiency improvement emotionally charged and difficult to implement; this question searches to understand reflexivity among senior
staff concerning managerial and clinical role models and to discover how teamwork might be developed in repairing 'broken' processes;

• the perception or not of healthcare within hospitals as being a series of processes amenable to process science; for example, some literature claims that the 4-hour A&E limit has sometimes been met with coping strategies rather than with efficiency improvement; I seek to understand how staff could be heartened and helped to use process-improvement techniques, where coping has been the case;

• the debate between holistic and iterative implementation of continuous improvement initiatives within hospitals seems to polarise across these two different lines of thought; I wish to find how to reconcile them in the minds both of trust management and of NHS staff:

• experience in various areas, notably pharmaceuticals and medical equipment manufacture, shows that successful continuous improvement using Lean and Six Sigma typically takes between three and five years to
achieve, and this within a deployment framework enlisting extensive support from the constellation of stakeholders and from all within the organisational structure; I wish ultimately to find such a model which equably accommodates the use of Lean Six Sigma process-improvement science to the culture, values and behaviour of NHS staff.

I have in the past researched: European and American poetic Modernism in Charles Baudelaire, T.S. Eliot and Wallace Stevens and the influence of French symbolisme (various essays 2016-2018); and comparative European national behaviour and values by country as a function of monarchical or republican constitutions and of national protestant/catholic christian influence. ( Machiavelli and The Mayflower ISBN 9782953386707 UoS library reference: CB 203 GIL)