PurposeIndustry 4.0 is predicted to be a game-changer, revolutionizing commercial and manufacturing practices through improved knowledge utilization and efficiencies. The barriers however, are significant, and the construction industry remains notoriously slow to take up innovations. This study reviews the research work in Industry 4.0 as it relates to construction, and examines a leading UK-based construction firm to ascertain the prognosis for Industry 4.0 roll-out in terms of the impediments and opportunities.Design/methodology/approachA multistage mixed philosophies and methods approach was adopted for this study. First, an interpretivist epistemological lens was used to synthesise extant literature as a means of contextualizing the present study. Second, an empirical case study using a post-positivist stance and inductive reasoning was conducted to explore practitioner acceptance of Industry 4.0 in the UK construction context.FindingsFindings from the literature review indicate studies in Industry 4.0 to be a relatively new phenomenon, with developed countries and Germany in particular leading in the field. The range of opportunities are many, but so too are the barriers to enablement. Findings from the case study provide real-world corroboration of the review; practitioners are sanguine about Industry 4.0's potential to reinvigorate the construction industry, but also note that implementation remains curtailed by residual managerial practices dependent on ‘human interaction’. At present, much of the focus of industry practitioners is on the implementation of building information modelling (BIM), often at the expense of other more advanced technologies within Industry 4.0.Originality/valueResearch in Industry 4.0 is limited, with the emphasis being on technology application. This paper, by contrast, maps the totality of work carried out so far and presents an assessment of Industry 4.0's progression, potential and degree of uptake within the UK construction industry.

Objectives: Paramedics routinely make critical decisions about the most appropriate care to deliver in a complex system characterized by significant variation in patient case-mix, care pathways and linked service providers. There has been little research carried out in the ambulance service to identify areas of risk associated with decisions about patient care. The aim of this study was to explore systemic influences on decision making by paramedics relating to care transitions to identify potential risk factors. Methods: An exploratory multi-method qualitative study was conducted in three English National Health Service (NHS) Ambulance Service Trusts, focusing on decision making by paramedic and specialist paramedic staff. Researchers observed 57 staff across 34 shifts. Ten staff completed digital diaries and three focus groups were conducted with 21 staff. Results: Nine types of decision were identified, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. Seven overarching systemic influences and risk factors potentially influencing decision making were identified: demand; performance priorities; access to care options; risk tolerance; training and development; communication and feedback and resources. Conclusions: Use of multiple methods provided a consistent picture of key systemic influences and potential risk factors. The study highlighted the increased complexity of paramedic decisions and multi-level system influences that may exacerbate risk. The findings have implications at the level of individual NHS Ambulance Service Trusts (e.g. ensuring an appropriately skilled workforce to manage diverse patient needs and reduce emergency department conveyance) and at the wider prehospital emergency care system level (e.g. ensuring access to appropriate patient care options as alternatives to the emergency department).

Background: Decisions made by front-line ambulance staff are often time critical and based on limited information, but wrong decisions in this context could have serious consequences for patients. There has been little research carried out in the ambulance service setting to identify areas of risk associated with decisions about patient care.\ud Aim: The aim of this study was to qualitatively examine potential system-wide influences on decision-making in the ambulance service setting and to identify useful areas for future research and intervention.\ud Methods: We used a multisite, multimethod qualitative approach across three ambulance service trusts. In phase 1 we carried out 16 interviews to contextualise the study and provide discussion points for phase 2. For phase 2, university and ambulance service researchers observed paramedics on 34 shifts and 10 paramedics completed ‘digital diaries’ that reported challenges to decision-making or to patient safety. Six focus groups were held, three with staff (n = 21) and three with service users (n = 23). From observation and diary data we developed a typology of decisions made at the scene. Data from these and other sources were also coded within a human factors framework and then thematically analysed to identify influences on those decisions. In phase 3, workshops were held at each site to allow participants and stakeholders (n = 45) to comment on the study findings. Participants were asked to rank influences on decisions using a ‘paired comparison’ method.\ud Results: Interviews provided the context for further qualitative exploration. Nine types of decision were identified from observations and digital diaries, ranging from emergency department conveyance and specialist emergency pathways to non-conveyance. A synthesis of findings from the observations, diaries and staff focus groups revealed seven overarching system influences on decision-making and potential risk factors: meeting increasing demand for emergency care; impacts of performance regime and priorities on service delivery; access to appropriate care options; disproportionate risk aversion; education, training and professional development for crews; communication and feedback to crews; and ambulance service resources. Safety culture issues were also identified. Data from the service user focus groups reflected similar issues to those identified from the staff focus groups. Service user concerns included call handling and communication, triage, patient involvement in decisions, balancing demand, resources, access to care, risk aversion, geographical location and vulnerable patients. Group discussions highlighted a lack of awareness by the public of how best to use emergency and urgent care services. Workshop attendees were satisfied that the findings reflected relevant issues. The two issues ranked highest for warranting attention were staff training and development and access to alternative care.\ud Conclusions: Multiple qualitative methods allowed a range of perspectives to be accessed and validation o...

BackgroundThe contribution of service users to identifying and prioritising research issues is vital to make practice and policy more relevant to their needs. Their experiences and knowledge can complement those of clinicians, health professionals and researchers. The aim of this research was to explore service-user perceptions of ambulance service care and patient safety.MethodsThree service-users focus groups (n=23) were conducted in three different Ambulance Service Trust regions and enabled participants to discuss their respective perceptions, experiences and concerns. Discussions were audio-recorded, transcribed and thematically analysed.FindingsService-users identified a number of concerns. The skills of call handlers in managing two-way communication at the initial call stage was perceived as critical to informing appropriate triage decisions; the risk at this stage was considered to be higher where callers have communication difficulties. Participants emphasised the importance of patient involvement in decisions made at-scene, and carers/advocates where appropriate; however, different levels of understanding in relation to their rights were apparent. Awareness of new ambulance service roles and alternatives to ED conveyance also varied. Non-conveyance was viewed as an acceptable option and even preferable where appropriate, and where alternative care options are assured. Participants were aware of the demands facing front-line staff and the impact of 24/7 accessibility, while other services were perceived as more difficult to access, in part due to limited awareness. Risk aversion amongst the public and health professionals was also perceived as a potential contributor to the increased demand for emergency care.ConclusionsDespite the relatively small number of participants, the findings provide useful service-user perspectives relevant to pre-hospital emergency care policy and practice, as well as the wider urgent and emergency care context. It is important that such views can be represented through public/patient involvement in decision making at organisational and service commissioning level.

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BackgroundAs part of a study examining systemic influences on conveyance decisions by paramedics and potential threats to patient safety, stakeholder workshops were conducted with three Ambulance Service Trusts in England. The study identified seven overarching systemic influences: demand; priorities; access to care; risk tolerance; training, communication and resources. The aim of the workshops was to elicit feedback on the findings and identify perceived areas for future intervention and research. Attendees were also asked to rank the seven threats to patient safety in terms of their perceived importance for future attention.MethodsA total of 45 individuals attended across all the workshops, 28 ambulance service staff and 17 service user representatives. Discussions were audio-recorded, transcribed and thematically analysed. A paper based paired comparison approach was used to produce an ordinal ranking to illustrate the relative prioritisation of issues. Analysis included testing for internal consistency and between-rater agreement for this relatively small sample.FindingsThe two highest ranking priorities were training and development, as well as access to care. The areas for intervention identified represent what attendees perceived as feasible to undertake and relate to: care options; cross boundary working; managing demand; staff development; information and feedback; and commissioning decisions. Perceived areas for research specifically address conveyance decisions and potential threats to patient safety. 17 areas for research were proposed that directly relate to six of the systemic threats to patient safety.ConclusionsFeedback workshops were effective in the validation of findings as well as providing an opportunity to identify priorities for future interventions and research. They also facilitated discussion between a variety of Ambulance Service staff and service user representatives. Ongoing collaboration between members of the research team has enabled some of the research recommendations to be explored as part of a mutually agreed research agenda.