We examine the content of continuous improvement strategies and identify infrastructure decision areas that are important for continuous improvement initiatives. We present a framework of infrastructure based on the idea that continuous improvement can serve as a dynamic capability when it includes a comprehensive organizational context. Further, we study continuous improvement initiatives in five companies to investigate the practices used by them in each of the decision areas of our framework. This research adds to the conceptual understanding of continuous improvement and results in grounded propositions about critical areas of infrastructure for continuous improvement.

Objective Bladder cancer (BC) has the highest lifetime treatment costs per patient of all cancers. The high recurrence rate and ongoing invasive monitoring requirement are the key contributors to the economic and human toll of this disease. The purpose of this paper was to utilize the recent literature to identify opportunities for improving the beneWts and costs of BC care. Methods A PubMed search was performed of recent publications concerning (BC) cost-eVectiveness. We reviewed studies, reviews, opinion papers and cost-eVectiveness analyses, focusing primarily on non-muscle-invasive bladder cancer (Ta/T1; NMIBC). Results New diagnostic tools such as urine markers may assist in more cost-eVectively detecting BC at an earlier stage, however, these markers cannot replace the cystoscopy, which is the current standard of care. A photodynamic diagnostic tool (PDD) using hexylaminolevulinate (Hexvix ® ) enhances tumor visibility and improves transurethral resection of bladder cancer (TURB) results, potentially reducing recurrence rates and lowering treatment costs. While the importance of BC research has been acknowledged, research investment has been continuously reduced during the last 5 years. Conclusions The economic burden of BC is well-characterized in the literature. This study suggests that new technologies (i.e., urine-based tests, PDD) and therapeutic regimes (intravesical chemotherapy, adjuvant immunotherapy) have signiWcant potential to improve the diagnosis, treatment and on-going monitoring of BC patients, with potential improvements in clinical outcomes and concurrent cost-savings. A renewed interest and investment in BC research are required to ensure future advancements.

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