A century ago, Taylor published a landmark in the organisational sciences: his Principles of Scientific Management. Many researchers have elaborated on Taylor's principles, or have been influenced otherwise. The authors of the current paper evaluate a century of enterprise development, and conclude that a paradigm shift is needed for dealing adequately with the challenges that modern enterprises face. Three generic goals are identified. The first one, intellectual manageability, is the basis for mastering complexity; current approaches fall short in assisting professionals to master the complexity of enterprises and enterprise changes. The second goal, organisational concinnity, is conditional for making strategic initiatives operational; current approaches do not, or inadequately, address this objective. The third goal, social devotion, is the basis for achieving employee empowerment as well as knowledgeable management and governance; modern employees are highly educated knowledge workers; yet, the mindset of managers has not evolved accordingly. The emerging discipline of Enterprise Engineering, as conceived by the authors, is considered to be a suitable vehicle for achieving these goals. It does so by providing new, powerful theories and effective methodologies. A theoretical framework is presented for positioning the theories, goals, and fundamentals of enterprise engineering in four classes: philosophical, ontological, ideological and technological.

Background Ileus is common after elective colorectal surgery, and is associated with increased adverse events and prolonged hospital stay. The aim was to assess the role of non‐steroidal anti‐inflammatory drugs (NSAIDs) for reducing ileus after surgery. Methods A prospective multicentre cohort study was delivered by an international, student‐ and trainee‐led collaborative group. Adult patients undergoing elective colorectal resection between January and April 2018 were included. The primary outcome was time to gastrointestinal recovery, measured using a composite measure of bowel function and tolerance to oral intake. The impact of NSAIDs was explored using Cox regression analyses, including the results of a centre‐specific survey of compliance to enhanced recovery principles. Secondary safety outcomes included anastomotic leak rate and acute kidney injury. Results A total of 4164 patients were included, with a median age of 68 (i.q.r. 57–75) years (54·9 per cent men). Some 1153 (27·7 per cent) received NSAIDs on postoperative days 1–3, of whom 1061 (92·0 per cent) received non‐selective cyclo‐oxygenase inhibitors. After adjustment for baseline differences, the mean time to gastrointestinal recovery did not differ significantly between patients who received NSAIDs and those who did not (4·6 versus 4·8 days; hazard ratio 1·04, 95 per cent c.i. 0·96 to 1·12; P = 0·360). There were no significant differences in anastomotic leak rate (5·4 versus 4·6 per cent; P = 0·349) or acute kidney injury (14·3 versus 13·8 per cent; P = 0·666) between the groups. Significantly fewer patients receiving NSAIDs required strong opioid analgesia (35·3 versus 56·7 per cent; P < 0·001). Conclusion NSAIDs did not reduce the time for gastrointestinal recovery after colorectal surgery, but they were safe and associated with reduced postoperative opioid requirement.

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