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9. Tratamiento de la obesidad en niños y en adolescentes

9.2 Estrategia terapéutica de los programas de tratamiento

9.2.4 Establecimiento de objetivos

The project, which is the setting for the first development and instantiation (1A) of the LCM model, involved the construction of a block of 32 residential apartments situated in a small town in south-east Germany in July 2007. During this time (2007-currently), the researcher was employed as consultant by a company focusing on the project management and optimisation of real estate projects. The project was managed by a construction management company, which is a sister company of the firm where the researcher was then employed. Five main subcontractors were responsible for the majority of the construction work. It was hoped that through better coordination between the planners and the construction companies, the project could be completed without additional amendments, quality problems and ultimately,

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with a reduction in cost for the customer through an optimised planning and building process. The researcher, together with a consultant from an external company (which was working together with the researcher’s company on this project), was given the task of conducting an analysis at the building site in question, to determine any potential to reduce waste as defined in the Toyota Production System and to optimise the building process.

Case study 1 represents the first stage of the research, beginning where a solution had been developed in practice (by the researcher) and the researcher starts by “working backwards” to apply rigor to this process (Peffers et al., 2007). The initial development of the model is analysed and reflected upon by building a description and explanation of the process by applying the following steps:

3.8.1.1 Step 1: Definition of problem

The research process began with an initial solution to a problem perceived in practice which was a lack of transparency in the construction process onsite leading to difficulties in communication, decision-making and general progress in daily operations. Part of this step of the research was to gain a deeper understanding of the practical problem in case study 1 and to clarify the problem from a theoretical perspective. A synthesis of the literature was carried out to gain this deeper understanding of the problem and of the theoretical background that could provide basis for addressing it. The literature review focused on the principle of transparency, Visual Management, Lean Production, Lean Construction and the deficiencies of Project Management.

In addition to the literature review, an important activity of this step was reviewing and analysing data gathered (Chapter 4, Table 4.1) on the practical problem by the researcher during the initial development stage in her role as a consultant. Data from a report from the subcontractors on problems onsite was reviewed. Data gathered on site such as photos, information on inventory and problems experienced in the flow of daily work were also reviewed. The literature findings helped to established that the problems onsite were related to a lack of transparency in daily operations.

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3.8.1.2 Step 2: Defining objectives for the solution

An important part of step 2 was the definition of the objectives of a solution that addressed the problem identified in step 1. This step involved the review and analysis of data gathered (Chapter, 4, Table 4.1) to explain how the objectives for a solution were defined based on the problems observed in practice, a review of important concepts in the literature and the researchers practical experience of the application of Lean tools and Visual Management previously (prior to LCMs development in 2007).

Seven objectives of the Visual Management Model were defined at this step which had not been formally clarified during the development in practice (Chapter 4, Section 4.4).

3.8.1.3 Step 3: Design and development

Based on the objectives for a solution and a knowledge of visual tools used in practice when optimising processes i.e.: process maps, Kanban systems, Andon, Poke-Yoke, the researcher in her role as a consultant developed the first concept of the LCM model. An important part of this step was to clarify the steps to be taken to achieve the defined objectives and to clarify which visual tools should be used.

3.8.1.4 Step 4: Demonstration

An important part of this step was to explain, based on the data collected (Chapter, 4, Table 4.1), how the model (and its individual elements) was applied for the first time in practice. The main data was drawn from the researchers personal experience of the application process and all information gathered during that process (i.e: photos, descriptions of process, examples of visual tools used, templates for visual tools, notes from discussions with foreman and companies during implementation, KPI information gathered etc.). The different visual elements making up the model are described and their relationship to each other and use in practice explained. This step was important to determine the different elements of the model.

3.8.1.5 Step 5: Evaluation

An important outcome of the evaluation stage of Design Science is to establish whether a real- world problem has been solved (and to what extent) by the implementation of a new artefact

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and what are the practical and theoretical contributions of this solution (Lukka, 2003). Kasanen (1986) proposes weak, semi-strong and strong market tests to validate the utility of new artefacts which are viewed as products competing in the market of solution ideas (Kasenan, 1993, p. 253). A weak market test is based on the willingness of any manager responsible for the results of his or her business unit or project to apply the artefact; a semi- strong market test is based on how widely the artefact has been adopted by companies and a strong market test is based on how results have been improved by those companies systematically applying the artefact, compared to those who are not. The evaluation of the model during each part of this research serves two main purposes: to contribute to the models overall further development and to establish the applicability and effectiveness of the model, i.e: the market testing of the artefact. In this way both formative and summative evaluation is used. The main concern of formative evaluation is to “form” or develop a program or solution to help achieve a specific goal and summative evaluation intends to provide an “end-of-term report” indicating what the program or solution has achieved (Robson, 2004, p.51).

In evaluating what a solution has achieved, a difficulty often lies in determining when a solution is complete. Henver et al., (2004) states that a solution is complete and effective when it satisfies the requirements and constraints of the problem it was meant to solve. An important part of the evaluation of the LCM model is to establish whether it contributed to an improvement in transparency in the planning and control of daily operations and to clarify its contribution to knowledge and practice. In order to carry out the summative evaluation, it was first of all necessary to develop an evaluation framework. The development of the evaluation framework and the evaluation process is a significant part of the overall research design.

3.8.1.5.1 Evaluation framework

Three important steps were taken to develop a suitable framework for the evaluation:

Step 1: definition of evaluation criteria

The first step involved the definition of evaluation criteria. In the literature, a number of important criteria can be found that should be considered when evaluating an artefact using the Design Science approach. Hevner et al., (2004)

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point out that utility, quality, and efficacy are parameters for evaluating a solution. March & Smith et al., (1997), state that research in the build activity should be judged based on value or utility to a community of users. Likewise, Kasanen argues that artefacts should be validated based on their utility and applicability in the market (Kasenen, 1993). Van Aken (2004) refers to evaluating the effectiveness of a certain rule in the original context while Lukka (2000) emphasises the need to “ponder the scope of applicability of the solution” or translating the rule to other contexts. Lukka (2003) also emphasises the need for the researcher to explicate the theoretical contribution of the artefact during the evaluation by reflecting the findings back to prior theory. From these ideas, high level criteria were identified as basis for the evaluation framework. They are: usefulness, applicability and theoretical importance (Figures 3.4 and 3.5).

While the applicability of the model could be evaluated based on its adaptability to different types of construction scenarios, in order to establish criteria for evaluating utility a deeper understanding of the aims of the model and its outcomes according to Design Science was needed.

Step 2: classification of LCM elements

The LCM model was analysed and its elements classified according to the outcomes of Design Science: concepts, models, methods and instantiations (Section 3.5). This is an important step, to fully understand the artefact and its aims to determine what is understood by utility of the LCM model. The foundational concepts of the LCM model are based on the idea behind the Lean principles of value, value stream, flow, pull and perfection (Womack & Jones, 1996) and a need to improve transparency in the construction process onsite. A total of 16 different elements as part of the LCM model were identified which are based on these concepts (see Figure 3.3). Five of the elements (1. Overall Process Map 2. Process Planning tool 3. Overall Process Analysis action list 4. Process Planning action list and 5. The Stability of Process Planning Metric PP metric) aim to focus on the principle of value by ensuring that the optimal process

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is fully understood and that there is a common understanding of what the value of the process is. Six further elements of the model (6. The Planning board 7. The construction cards 8. The problem cards 9. The logistic board 10. Logistic cards 11. Visualised colour-coded site layout and 12. Material database (power plant) aim to implement flow and pull in the construction process onsite and in the wider processes. Finally, four elements of the model (13. Apartment clock / colour- coded plans 14. Visualised action plans in LCM area 15. Metric for On-Time- Performance and 16 metric for quality) aim promote continuous improvement and the principle of perfection in the process. How these elements are applied together in a specified way is the method. Each application of LCM represents an instantiation.

Figure 3.3: The outcomes of LCM

Step 3: definition of low level evaluation criteria based on aims of model Ultimately by applying the LCM model the aim was to improve the process of planning and control in construction, to enable the early identification of constraints, to reduce waste and to measure performance through increased transparency (Figures 3.4 and 3.5). Low level criteria were established according to the aim of the model (ie.: the effectiveness of the model in stabilising daily

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planning, identifying constraints, reducing waste, measuring improvements and performance and improving transparency). Questions were defined that were used as a basis for the semi-structured interviews with the LCM manager and the client. The data gathered from these interviews would help determine whether the criteria were fulfilled.

Figure 3.4: Evaluation framework for the LCM model (elements 1-8)

Figure 3.5: Evaluation framework for the LCM model (elements 9-16)

During part 1 of the research, the researcher used these questions as basis for reflection on the first application of the model to the construction project in case study 1 (instantiation 1A). An

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initial evaluation of instantiation 1A of version 1 was carried out to access if an improvement in transparency was achieved. In addition, recommendations are made regarding future application of the model and improvements to the model are proposed. This evaluation was carried out as part of the research, approximately four years after the instantiation took place. For this reason, there were limitations in the data available for the evaluation such as the incompleteness of KPI data and inability to carry out formal interviews.

3.8.1.6 Step 6: Communication

Finally an important part of this step of the research was the communication of the initial findings of the research, the importance of the research problem and the artefact to improve this problem. This included two papers published in 2011 and 2012 at the IGLC conferences and various presentations of the research work that were held for fellow PhD students, academics and practitioners.

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