Activating clinical trials: a process improvement approach.

PubMed

Martinez, Diego A; Tsalatsanis, Athanasios; Yalcin, Ali; Zayas-Castro, José L; Djulbegovic, Benjamin

2016-02-24

The administrative process associated with clinical trial activation has been criticized as costly, complex, and time-consuming. Prior research has concentrated on identifying administrative barriers and proposing various solutions to reduce activation time, and consequently associated costs. Here, we expand on previous research by incorporating social network analysis and discrete-event simulation to support process improvement decision-making. We searched for all operational data associated with the administrative process of activating industry-sponsored clinical trials at the Office of Clinical Research of the University of South Florida in Tampa, Florida. We limited the search to those trials initiated and activated between July 2011 and June 2012. We described the process using value stream mapping, studied the interactions of the various process participants using social network analysis, and modeled potential process modifications using discrete-event simulation. The administrative process comprised 5 sub-processes, 30 activities, 11 decision points, 5 loops, and 8 participants. The mean activation time was 76.6 days. Rate-limiting sub-processes were those of contract and budget development. Key participants during contract and budget development were the Office of Clinical Research, sponsors, and the principal investigator. Simulation results indicate that slight increments on the number of trials, arriving to the Office of Clinical Research, would increase activation time by 11 %. Also, incrementing the efficiency of contract and budget development would reduce the activation time by 28 %. Finally, better synchronization between contract and budget development would reduce time spent on batching documentation; however, no improvements would be attained in total activation time. The presented process improvement analytic framework not only identifies administrative barriers, but also helps to devise and evaluate potential improvement scenarios. The strength

Identifying pathogenic processes by integrating microarray data with prior knowledge

PubMed Central

2014-01-01

Background It is of great importance to identify molecular processes and pathways that are involved in disease etiology. Although there has been an extensive use of various high-throughput methods for this task, pathogenic pathways are still not completely understood. Often the set of genes or proteins identified as altered in genome-wide screens show a poor overlap with canonical disease pathways. These findings are difficult to interpret, yet crucial in order to improve the understanding of the molecular processes underlying the disease progression. We present a novel method for identifying groups of connected molecules from a set of differentially expressed genes. These groups represent functional modules sharing common cellular function and involve signaling and regulatory events. Specifically, our method makes use of Bayesian statistics to identify groups of co-regulated genes based on the microarray data, where external information about molecular interactions and connections are used as priors in the group assignments. Markov chain Monte Carlo sampling is used to search for the most reliable grouping. Results Simulation results showed that the method improved the ability of identifying correct groups compared to traditional clustering, especially for small sample sizes. Applied to a microarray heart failure dataset the method found one large cluster with several genes important for the structure of the extracellular matrix and a smaller group with many genes involved in carbohydrate metabolism. The method was also applied to a microarray dataset on melanoma cancer patients with or without metastasis, where the main cluster was dominated by genes related to keratinocyte differentiation. Conclusion Our method found clusters overlapping with known pathogenic processes, but also pointed to new connections extending beyond the classical pathways. PMID:24758699

Environmental Data Flow Six Sigma Process Improvement Savings Overview

DOE Office of Scientific and Technical Information (OSTI.GOV)

Paige, Karen S

An overview of the Environmental Data Flow Six Sigma improvement project covers LANL’s environmental data processing following receipt from the analytical laboratories. The Six Sigma project identified thirty-three process improvements, many of which focused on cutting costs or reducing the time it took to deliver data to clients.

Design of launch systems using continuous improvement process

NASA Technical Reports Server (NTRS)

Brown, Richard W.

1995-01-01

The purpose of this paper is to identify a systematic process for improving ground operations for future launch systems. This approach is based on the Total Quality Management (TQM) continuous improvement process. While the continuous improvement process is normally identified with making incremental changes to an existing system, it can be used on new systems if they use past experience as a knowledge base. In the case of the Reusable Launch Vehicle (RLV), the Space Shuttle operations provide many lessons. The TQM methodology used for this paper will be borrowed from the United States Air Force 'Quality Air Force' Program. There is a general overview of the continuous improvement process, with concentration on the formulation phase. During this phase critical analyses are conducted to determine the strategy and goals for the remaining development process. These analyses include analyzing the mission from the customers point of view, developing an operations concept for the future, assessing current capabilities and determining the gap to be closed between current capabilities and future needs and requirements. A brief analyses of the RLV, relative to the Space Shuttle, will be used to illustrate the concept. Using the continuous improvement design concept has many advantages. These include a customer oriented process which will develop a more marketable product and a better integration of operations and systems during the design phase. But, the use of TQM techniques will require changes, including more discipline in the design process and more emphasis on data gathering for operational systems. The benefits will far outweigh the additional effort.

Mobile Phone Apps to Improve Medication Adherence: A Systematic Stepwise Process to Identify High-Quality Apps.

PubMed

Santo, Karla; Richtering, Sarah S; Chalmers, John; Thiagalingam, Aravinda; Chow, Clara K; Redfern, Julie

2016-12-02

There are a growing number of mobile phone apps available to support people in taking their medications and to improve medication adherence. However, little is known about how these apps differ in terms of features, quality, and effectiveness. We aimed to systematically review the medication reminder apps available in the Australian iTunes store and Google Play to assess their features and their quality in order to identify high-quality apps. This review was conducted in a similar manner to a systematic review by using a stepwise approach that included (1) a search strategy; (2) eligibility assessment; (3) app selection process through an initial screening of all retrieved apps and full app review of the included apps; (4) data extraction using a predefined set of features considered important or desirable in medication reminder apps; (5) analysis by classifying the apps as basic and advanced medication reminder apps and scoring and ranking them; and (6) a quality assessment by using the Mobile App Rating Scale (MARS), a reliable tool to assess mobile health apps. We identified 272 medication reminder apps, of which 152 were found only in Google Play, 87 only in iTunes, and 33 in both app stores. Apps found in Google Play had more customer reviews, higher star ratings, and lower cost compared with apps in iTunes. Only 109 apps were available for free and 124 were recently updated in 2015 or 2016. Overall, the median number of features per app was 3.0 (interquartile range 4.0) and only 18 apps had ≥9 of the 17 desirable features. The most common features were flexible scheduling that was present in 56.3% (153/272) of the included apps, medication tracking history in 54.8% (149/272), snooze option in 34.9% (95/272), and visual aids in 32.4% (88/272). We classified 54.8% (149/272) of the included apps as advanced medication reminder apps and 45.2% (123/272) as basic medication reminder apps. The advanced apps had a higher number of features per app compared with the

A DMAIC approach for process capability improvement an engine crankshaft manufacturing process

NASA Astrophysics Data System (ADS)

Sharma, G. V. S. S.; Rao, P. Srinivasa

2014-05-01

The define-measure-analyze-improve-control (DMAIC) approach is a five-strata approach, namely DMAIC. This approach is the scientific approach for reducing the deviations and improving the capability levels of the manufacturing processes. The present work elaborates on DMAIC approach applied in reducing the process variations of the stub-end-hole boring operation of the manufacture of crankshaft. This statistical process control study starts with selection of the critical-to-quality (CTQ) characteristic in the define stratum. The next stratum constitutes the collection of dimensional measurement data of the CTQ characteristic identified. This is followed by the analysis and improvement strata where the various quality control tools like Ishikawa diagram, physical mechanism analysis, failure modes effects analysis and analysis of variance are applied. Finally, the process monitoring charts are deployed at the workplace for regular monitoring and control of the concerned CTQ characteristic. By adopting DMAIC approach, standard deviation is reduced from 0.003 to 0.002. The process potential capability index ( C P) values improved from 1.29 to 2.02 and the process performance capability index ( C PK) values improved from 0.32 to 1.45, respectively.

Process mapping as a framework for performance improvement in emergency general surgery.

PubMed

DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

2017-12-01

Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

Process mapping as a framework for performance improvement in emergency general surgery.

PubMed

DeGirolamo, Kristin; D'Souza, Karan; Hall, William; Joos, Emilie; Garraway, Naisan; Sing, Chad Kim; McLaughlin, Patrick; Hameed, Morad

2018-02-01

Emergency general surgery conditions are often thought of as being too acute for the development of standardized approaches to quality improvement. However, process mapping, a concept that has been applied extensively in manufacturing quality improvement, is now being used in health care. The objective of this study was to create process maps for small bowel obstruction in an effort to identify potential areas for quality improvement. We used the American College of Surgeons Emergency General Surgery Quality Improvement Program pilot database to identify patients who received nonoperative or operative management of small bowel obstruction between March 2015 and March 2016. This database, patient charts and electronic health records were used to create process maps from the time of presentation to discharge. Eighty-eight patients with small bowel obstruction (33 operative; 55 nonoperative) were identified. Patients who received surgery had a complication rate of 32%. The processes of care from the time of presentation to the time of follow-up were highly elaborate and variable in terms of duration; however, the sequences of care were found to be consistent. We used data visualization strategies to identify bottlenecks in care, and they showed substantial variability in terms of operating room access. Variability in the operative care of small bowel obstruction is high and represents an important improvement opportunity in general surgery. Process mapping can identify common themes, even in acute care, and suggest specific performance improvement measures.

Anesthesiology leadership rounding: identifying opportunities for improvement.

PubMed

Gravenstein, Dietrich; Ford, Susan; Enneking, F Kayser

2012-01-01

Rounding that includes participation of individuals with authority to implement changes has been advocated as important to the transformation of an institution into a high-quality and safe organization. We describe a Department of Anesthesiology's experience with leadership rounding. The Department Chair or other senior faculty designate, a quality coordinator, up to four residents, the ward charge nurse, and patient nurses participated in rounds at bedsides. During a 23-month period, 14 significant opportunities to improve care were identified. Nurses identified 5 of these opportunities, primary team physicians 2, the rounding team 4, and patients or their family members another 3. The anesthesiology service had sole or shared responsibility for 10 improvements. A variety of organizations track specific measures across all phases of the patient experience to gauge quality of care. Chart auditing tools for detecting threats to safety are often used. These measures and tools missed opportunities for improvement that were discovered only through rounding. We conclude that the introduction of leadership rounding by an anesthesiology service can identify opportunities for improving quality that are not captured by conventional efforts.

Making process improvement 'stick'.

PubMed

Studer, Quint

2014-06-01

To sustain gains from a process improvement initiative, healthcare organizations should: Explain to staff why a process improvement initiative is needed. Encourage leaders within the organization to champion the process improvement, and tie their evaluations to its outcomes. Ensure that both leaders and employees have the skills to help sustain the sought-after process improvements.

Process capability improvement through DMAIC for aluminum alloy wheel machining

NASA Astrophysics Data System (ADS)

Sharma, G. V. S. S.; Rao, P. Srinivasa; Babu, B. Surendra

2017-07-01

This paper first enlists the generic problems of alloy wheel machining and subsequently details on the process improvement of the identified critical-to-quality machining characteristic of A356 aluminum alloy wheel machining process. The causal factors are traced using the Ishikawa diagram and prioritization of corrective actions is done through process failure modes and effects analysis. Process monitoring charts are employed for improving the process capability index of the process, at the industrial benchmark of four sigma level, which is equal to the value of 1.33. The procedure adopted for improving the process capability levels is the define-measure-analyze-improve-control (DMAIC) approach. By following the DMAIC approach, the C p, C pk and C pm showed signs of improvement from an initial value of 0.66, -0.24 and 0.27, to a final value of 4.19, 3.24 and 1.41, respectively.

A new process sensitivity index to identify important system processes under process model and parametric uncertainty

DOE PAGES

Dai, Heng; Ye, Ming; Walker, Anthony P.; ...

2017-03-28

A hydrological model consists of multiple process level submodels, and each submodel represents a process key to the operation of the simulated system. Global sensitivity analysis methods have been widely used to identify important processes for system model development and improvement. The existing methods of global sensitivity analysis only consider parametric uncertainty, and are not capable of handling model uncertainty caused by multiple process models that arise from competing hypotheses about one or more processes. To address this problem, this study develops a new method to probe model output sensitivity to competing process models by integrating model averaging methods withmore » variance-based global sensitivity analysis. A process sensitivity index is derived as a single summary measure of relative process importance, and the index includes variance in model outputs caused by uncertainty in both process models and their parameters. Here, for demonstration, the new index is used to assign importance to the processes of recharge and geology in a synthetic study of groundwater reactive transport modeling. The recharge process is simulated by two models that convert precipitation to recharge, and the geology process is simulated by two models of hydraulic conductivity. Each process model has its own random parameters. Finally, the new process sensitivity index is mathematically general, and can be applied to a wide range of problems in hydrology and beyond.« less

A new process sensitivity index to identify important system processes under process model and parametric uncertainty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dai, Heng; Ye, Ming; Walker, Anthony P.

A hydrological model consists of multiple process level submodels, and each submodel represents a process key to the operation of the simulated system. Global sensitivity analysis methods have been widely used to identify important processes for system model development and improvement. The existing methods of global sensitivity analysis only consider parametric uncertainty, and are not capable of handling model uncertainty caused by multiple process models that arise from competing hypotheses about one or more processes. To address this problem, this study develops a new method to probe model output sensitivity to competing process models by integrating model averaging methods withmore » variance-based global sensitivity analysis. A process sensitivity index is derived as a single summary measure of relative process importance, and the index includes variance in model outputs caused by uncertainty in both process models and their parameters. Here, for demonstration, the new index is used to assign importance to the processes of recharge and geology in a synthetic study of groundwater reactive transport modeling. The recharge process is simulated by two models that convert precipitation to recharge, and the geology process is simulated by two models of hydraulic conductivity. Each process model has its own random parameters. Finally, the new process sensitivity index is mathematically general, and can be applied to a wide range of problems in hydrology and beyond.« less

The RISE Framework: Using Learning Analytics to Automatically Identify Open Educational Resources for Continuous Improvement

ERIC Educational Resources Information Center

Bodily, Robert; Nyland, Rob; Wiley, David

2017-01-01

The RISE (Resource Inspection, Selection, and Enhancement) Framework is a framework supporting the continuous improvement of open educational resources (OER). The framework is an automated process that identifies learning resources that should be evaluated and either eliminated or improved. This is particularly useful in OER contexts where the…

Software process improvement in the NASA software engineering laboratory

NASA Technical Reports Server (NTRS)

Mcgarry, Frank; Pajerski, Rose; Page, Gerald; Waligora, Sharon; Basili, Victor; Zelkowitz, Marvin

1994-01-01

The Software Engineering Laboratory (SEL) was established in 1976 for the purpose of studying and measuring software processes with the intent of identifying improvements that could be applied to the production of ground support software within the Flight Dynamics Division (FDD) at the National Aeronautics and Space Administration (NASA)/Goddard Space Flight Center (GSFC). The SEL has three member organizations: NASA/GSFC, the University of Maryland, and Computer Sciences Corporation (CSC). The concept of process improvement within the SEL focuses on the continual understanding of both process and product as well as goal-driven experimentation and analysis of process change within a production environment.

Improving operational anodising process performance using simulation approach

NASA Astrophysics Data System (ADS)

Liong, Choong-Yeun; Ghazali, Syarah Syahidah

2015-10-01

The use of aluminium is very widespread, especially in transportation, electrical and electronics, architectural, automotive and engineering applications sectors. Therefore, the anodizing process is an important process for aluminium in order to make the aluminium durable, attractive and weather resistant. This research is focused on the anodizing process operations in manufacturing and supplying of aluminium extrusion. The data required for the development of the model is collected from the observations and interviews conducted in the study. To study the current system, the processes involved in the anodizing process are modeled by using Arena 14.5 simulation software. Those processes consist of five main processes, namely the degreasing process, the etching process, the desmut process, the anodizing process, the sealing process and 16 other processes. The results obtained were analyzed to identify the problems or bottlenecks that occurred and to propose improvement methods that can be implemented on the original model. Based on the comparisons that have been done between the improvement methods, the productivity could be increased by reallocating the workers and reducing loading time.

Improving operational anodising process performance using simulation approach

DOE Office of Scientific and Technical Information (OSTI.GOV)

Liong, Choong-Yeun, E-mail: lg@ukm.edu.my; Ghazali, Syarah Syahidah, E-mail: syarah@gapps.kptm.edu.my

The use of aluminium is very widespread, especially in transportation, electrical and electronics, architectural, automotive and engineering applications sectors. Therefore, the anodizing process is an important process for aluminium in order to make the aluminium durable, attractive and weather resistant. This research is focused on the anodizing process operations in manufacturing and supplying of aluminium extrusion. The data required for the development of the model is collected from the observations and interviews conducted in the study. To study the current system, the processes involved in the anodizing process are modeled by using Arena 14.5 simulation software. Those processes consist ofmore » five main processes, namely the degreasing process, the etching process, the desmut process, the anodizing process, the sealing process and 16 other processes. The results obtained were analyzed to identify the problems or bottlenecks that occurred and to propose improvement methods that can be implemented on the original model. Based on the comparisons that have been done between the improvement methods, the productivity could be increased by reallocating the workers and reducing loading time.« less

Development of Six Sigma methodology for CNC milling process improvements

NASA Astrophysics Data System (ADS)

Ismail, M. N.; Rose, A. N. M.; Mohammed, N. Z.; Rashid, M. F. F. Ab

2017-10-01

Quality and productivity have been identified as an important role in any organization, especially for manufacturing sectors to gain more profit that leads to success of a company. This paper reports a work improvement project in Kolej Kemahiran Tinggi MARA Kuantan. It involves problem identification in production of “Khufi” product and proposing an effective framework to improve the current situation effectively. Based on the observation and data collection on the work in progress (WIP) product, the major problem has been identified related to function of the product which is the parts can’t assemble properly due to dimension of the product is out of specification. The six sigma has been used as a methodology to study and improve of the problems identified. Six Sigma is a highly statistical and data driven approach to solving complex business problems. It uses a methodical five phase approach define, measure, analysis, improve and control (DMAIC) to help understand the process and the variables that affect it so that can be optimized the processes. Finally, the root cause and solution for the production of “Khufi” problem has been identified and implemented then the result for this product was successfully followed the specification of fitting.

Using patients’ experiences to identify priorities for quality improvement in breast cancer care: patient narratives, surveys or both?

PubMed Central

2012-01-01

Background Patients’ experiences have become central to assessing the performance of healthcare systems worldwide and are increasingly being used to inform quality improvement processes. This paper explores the relative value of surveys and detailed patient narratives in identifying priorities for improving breast cancer services as part of a quality improvement process. Methods One dataset was collected using a narrative interview approach, (n = 13) and the other using a postal survey (n = 82). Datasets were analyzed separately and then compared to determine whether similar priorities for improving patient experiences were identified. Results There were both similarities and differences in the improvement priorities arising from each approach. Day surgery was specifically identified as a priority in the narrative dataset but included in the survey recommendations only as part of a broader priority around improving inpatient experience. Both datasets identified appointment systems, patients spending enough time with staff, information about treatment and side effects and more information at the end of treatment as priorities. The specific priorities identified by the narrative interviews commonly related to ‘relational’ aspects of patient experience. Those identified by the survey typically related to more ‘functional’ aspects and were not always sufficiently detailed to identify specific improvement actions. Conclusions Our analysis suggests that whilst local survey data may act as a screening tool to identify potential problems within the breast cancer service, they do not always provide sufficient detail of what to do to improve that service. These findings may have wider applicability in other services. We recommend using an initial preliminary survey, with better use of survey open comments, followed by an in-depth qualitative analysis to help deliver improvements to relational and functional aspects of patient experience. PMID:22913525

The use of process mapping in healthcare quality improvement projects.

PubMed

Antonacci, Grazia; Reed, Julie E; Lennox, Laura; Barlow, James

2018-05-01

Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

A process improvement model for software verification and validation

NASA Technical Reports Server (NTRS)

Callahan, John; Sabolish, George

1994-01-01

We describe ongoing work at the NASA Independent Verification and Validation (IV&V) Facility to establish a process improvement model for software verification and validation (V&V) organizations. This model, similar to those used by some software development organizations, uses measurement-based techniques to identify problem areas and introduce incremental improvements. We seek to replicate this model for organizations involved in V&V on large-scale software development projects such as EOS and space station. At the IV&V Facility, a university research group and V&V contractors are working together to collect metrics across projects in order to determine the effectiveness of V&V and improve its application. Since V&V processes are intimately tied to development processes, this paper also examines the repercussions for development organizations in large-scale efforts.

A process improvement model for software verification and validation

NASA Technical Reports Server (NTRS)

Callahan, John; Sabolish, George

1994-01-01

We describe ongoing work at the NASA Independent Verification and Validation (IV&V) Facility to establish a process improvement model for software verification and validation (V&V) organizations. This model, similar to those used by some software development organizations, uses measurement-based techniques to identify problem areas and introduce incremental improvements. We seek to replicate this model for organizations involved in V&V on large-scale software development projects such as EOS and Space Station. At the IV&V Facility, a university research group and V&V contractors are working together to collect metrics across projects in order to determine the effectiveness of V&V and improve its application. Since V&V processes are intimately tied to development processes, this paper also examines the repercussions for development organizations in large-scale efforts.

Improving Earth/Prediction Models to Improve Network Processing

NASA Astrophysics Data System (ADS)

Wagner, G. S.

2017-12-01

The United States Atomic Energy Detection System (USAEDS) primaryseismic network consists of a relatively small number of arrays andthree-component stations. The relatively small number of stationsin the USAEDS primary network make it both necessary and feasibleto optimize both station and network processing.Station processing improvements include detector tuning effortsthat use Receiver Operator Characteristic (ROC) curves to helpjudiciously set acceptable Type 1 (false) vs. Type 2 (miss) errorrates. Other station processing improvements include the use ofempirical/historical observations and continuous background noisemeasurements to compute time-varying, maximum likelihood probabilityof detection thresholds.The USAEDS network processing software makes extensive use of theazimuth and slowness information provided by frequency-wavenumberanalysis at array sites, and polarization analysis at three-componentsites. Most of the improvements in USAEDS network processing aredue to improvements in the models used to predict azimuth, slowness,and probability of detection. Kriged travel-time, azimuth andslowness corrections-and associated uncertainties-are computedusing a ground truth database. Improvements in station processingand the use of improved models for azimuth, slowness, and probabilityof detection have led to significant improvements in USADES networkprocessing.

The role of the PIRT process in identifying code improvements and executing code development

DOE Office of Scientific and Technical Information (OSTI.GOV)

Wilson, G.E.; Boyack, B.E.

1997-07-01

In September 1988, the USNRC issued a revised ECCS rule for light water reactors that allows, as an option, the use of best estimate (BE) plus uncertainty methods in safety analysis. The key feature of this licensing option relates to quantification of the uncertainty in the determination that an NPP has a {open_quotes}low{close_quotes} probability of violating the safety criteria specified in 10 CFR 50. To support the 1988 licensing revision, the USNRC and its contractors developed the CSAU evaluation methodology to demonstrate the feasibility of the BE plus uncertainty approach. The PIRT process, Step 3 in the CSAU methodology, wasmore » originally formulated to support the BE plus uncertainty licensing option as executed in the CSAU approach to safety analysis. Subsequent work has shown the PIRT process to be a much more powerful tool than conceived in its original form. Through further development and application, the PIRT process has shown itself to be a robust means to establish safety analysis computer code phenomenological requirements in their order of importance to such analyses. Used early in research directed toward these objectives, PIRT results also provide the technical basis and cost effective organization for new experimental programs needed to improve the safety analysis codes for new applications. The primary purpose of this paper is to describe the generic PIRT process, including typical and common illustrations from prior applications. The secondary objective is to provide guidance to future applications of the process to help them focus, in a graded approach, on systems, components, processes and phenomena that have been common in several prior applications.« less

Use of Failure Mode and Effects Analysis to Improve Emergency Department Handoff Processes.

PubMed

Sorrentino, Patricia

2016-01-01

The purpose of this article is to describe a quality improvement process using failure mode and effects analysis (FMEA) to evaluate systems handoff communication processes, improve emergency department (ED) throughput and reduce crowding through development of a standardized handoff, and, ultimately, improve patient safety. Risk of patient harm through ineffective communication during handoff transitions is a major reason for breakdown of systems. Complexities of ED processes put patient safety at risk. An increased incidence of submitted patient safety event reports for handoff communication failures between the ED and inpatient units solidified a decision to implement the use of FMEA to identify handoff failures to mitigate patient harm through redesign. The clinical nurse specialist implemented an FMEA. Handoff failure themes were created from deidentified retrospective reviews. Weekly meetings were held over a 3-month period to identify failure modes and determine cause and effect on the process. A functional block diagram process map tool was used to illustrate handoff processes. An FMEA grid was used to list failure modes and assign a risk priority number to quantify results. Multiple areas with actionable failures were identified. A majority of causes for high-priority failure modes were specific to communications. Findings demonstrate the complexity of transition and handoff processes. The FMEA served to identify and evaluate risk of handoff failures and provide a framework for process improvement. A focus on mentoring nurses to quality handoff processes so that it becomes habitual practice is crucial to safe patient transitions. Standardizing content and hardwiring within the system are best practice. The clinical nurse specialist is prepared to provide strong leadership to drive and implement system-wide quality projects.

Quality initiatives: planning, setting up, and carrying out radiology process improvement projects.

PubMed

Tamm, Eric P; Szklaruk, Janio; Puthooran, Leejo; Stone, Danna; Stevens, Brian L; Modaro, Cathy

2012-01-01

In the coming decades, those who provide radiologic imaging services will be increasingly challenged by the economic, demographic, and political forces affecting healthcare to improve their efficiency, enhance the value of their services, and achieve greater customer satisfaction. It is essential that radiologists master and consistently apply basic process improvement skills that have allowed professionals in many other fields to thrive in a competitive environment. The authors provide a step-by-step overview of process improvement from the perspective of a radiologic imaging practice by describing their experience in conducting a process improvement project: to increase the daily volume of body magnetic resonance imaging examinations performed at their institution. The first step in any process improvement project is to identify and prioritize opportunities for improvement in the work process. Next, an effective project team must be formed that includes representatives of all participants in the process. An achievable aim must be formulated, appropriate measures selected, and baseline data collected to determine the effects of subsequent efforts to achieve the aim. Each aspect of the process in question is then analyzed by using appropriate tools (eg, flowcharts, fishbone diagrams, Pareto diagrams) to identify opportunities for beneficial change. Plans for change are then established and implemented with regular measurements and review followed by necessary adjustments in course. These so-called PDSA (planning, doing, studying, and acting) cycles are repeated until the aim is achieved or modified and the project closed.

Improving Work Processes by Making the Invisible Visible

ERIC Educational Resources Information Center

Bakker, Arthur; Hoyles, Celia; Kent, Phillip; Noss, Richard

2006-01-01

Increasingly, companies are taking part in process improvement programmes, which brings about a growing need for employees to interpret and act on data representations. We have carried out case studies in a range of companies to identify the existence and need of what we call "techno-mathematical literacies" (TmL): functional mathematical…

Design of production process main shaft process with lean manufacturing to improve productivity

NASA Astrophysics Data System (ADS)

Siregar, I.; Nasution, A. A.; Andayani, U.; Anizar; Syahputri, K.

2018-02-01

This object research is one of manufacturing companies that produce oil palm machinery parts. In the production process there is delay in the completion of the Main shaft order. Delays in the completion of the order indicate the low productivity of the company in terms of resource utilization. This study aimed to obtain a draft improvement of production processes that can improve productivity by identifying and eliminating activities that do not add value (non-value added activity). One approach that can be used to reduce and eliminate non-value added activity is Lean Manufacturing. This study focuses on the identification of non-value added activity with value stream mapping analysis tools, while the elimination of non-value added activity is done with tools 5 whys and implementation of pull demand system. Based on the research known that non-value added activity on the production process of the main shaft is 9,509.51 minutes of total lead time 10,804.59 minutes. This shows the level of efficiency (Process Cycle Efficiency) in the production process of the main shaft is still very low by 11.89%. Estimation results of improvement showed a decrease in total lead time became 4,355.08 minutes and greater process cycle efficiency that is equal to 29.73%, which indicates that the process was nearing the concept of lean production.

Process for improving metal production in steelmaking processes

DOEpatents

Pal, Uday B.; Gazula, Gopala K. M.; Hasham, Ali

1996-01-01

A process and apparatus for improving metal production in ironmaking and steelmaking processes is disclosed. The use of an inert metallic conductor in the slag containing crucible and the addition of a transition metal oxide to the slag are the disclosed process improvements.

Process for improving metal production in steelmaking processes

DOEpatents

Pal, U.B.; Gazula, G.K.M.; Hasham, A.

1996-06-18

A process and apparatus for improving metal production in ironmaking and steelmaking processes is disclosed. The use of an inert metallic conductor in the slag containing crucible and the addition of a transition metal oxide to the slag are the disclosed process improvements. 6 figs.

Initiating statistical process control to improve quality outcomes in colorectal surgery.

PubMed

Keller, Deborah S; Stulberg, Jonah J; Lawrence, Justin K; Samia, Hoda; Delaney, Conor P

2015-12-01

Unexpected variations in postoperative length of stay (LOS) negatively impact resources and patient outcomes. Statistical process control (SPC) measures performance, evaluates productivity, and modifies processes for optimal performance. The goal of this study was to initiate SPC to identify LOS outliers and evaluate its feasibility to improve outcomes in colorectal surgery. Review of a prospective database identified colorectal procedures performed by a single surgeon. Patients were grouped into elective and emergent categories and then stratified by laparoscopic and open approaches. All followed a standardized enhanced recovery protocol. SPC was applied to identify outliers and evaluate causes within each group. A total of 1294 cases were analyzed--83% elective (n = 1074) and 17% emergent (n = 220). Emergent cases were 70.5% open and 29.5% laparoscopic; elective cases were 36.8% open and 63.2% laparoscopic. All groups had a wide range in LOS. LOS outliers ranged from 8.6% (elective laparoscopic) to 10.8% (emergent laparoscopic). Evaluation of outliers demonstrated patient characteristics of higher ASA scores, longer operating times, ICU requirement, and temporary nursing at discharge. Outliers had higher postoperative complication rates in elective open (57.1 vs. 20.0%) and elective lap groups (77.6 vs. 26.1%). Outliers also had higher readmission rates for emergent open (11.4 vs. 5.4%), emergent lap (14.3 vs. 9.2%), and elective lap (32.8 vs. 6.9%). Elective open outliers did not follow trends of longer LOS or higher reoperation rates. SPC is feasible and promising for improving colorectal surgery outcomes. SPC identified patient and process characteristics associated with increased LOS. SPC may allow real-time outlier identification, during quality improvement efforts, and reevaluation of outcomes after introducing process change. SPC has clinical implications for improving patient outcomes and resource utilization.

Model-based software process improvement

NASA Technical Reports Server (NTRS)

Zettervall, Brenda T.

1994-01-01

The activities of a field test site for the Software Engineering Institute's software process definition project are discussed. Products tested included the improvement model itself, descriptive modeling techniques, the CMM level 2 framework document, and the use of process definition guidelines and templates. The software process improvement model represents a five stage cyclic approach for organizational process improvement. The cycles consist of the initiating, diagnosing, establishing, acting, and leveraging phases.

Improving Video Game Development: Facilitating Heterogeneous Team Collaboration through Flexible Software Processes

NASA Astrophysics Data System (ADS)

Musil, Juergen; Schweda, Angelika; Winkler, Dietmar; Biffl, Stefan

Based on our observations of Austrian video game software development (VGSD) practices we identified a lack of systematic processes/method support and inefficient collaboration between various involved disciplines, i.e. engineers and artists. VGSD includes heterogeneous disciplines, e.g. creative arts, game/content design, and software. Nevertheless, improving team collaboration and process support is an ongoing challenge to enable a comprehensive view on game development projects. Lessons learned from software engineering practices can help game developers to increase game development processes within a heterogeneous environment. Based on a state of the practice survey in the Austrian games industry, this paper presents (a) first results with focus on process/method support and (b) suggests a candidate flexible process approach based on Scrum to improve VGSD and team collaboration. Results showed (a) a trend to highly flexible software processes involving various disciplines and (b) identified the suggested flexible process approach as feasible and useful for project application.

[Process management in the hospital pharmacy for the improvement of the patient safety].

PubMed

Govindarajan, R; Perelló-Juncá, A; Parès-Marimòn, R M; Serrais-Benavente, J; Ferrandez-Martí, D; Sala-Robinat, R; Camacho-Calvente, A; Campabanal-Prats, C; Solà-Anderiu, I; Sanchez-Caparrós, S; Gonzalez-Estrada, J; Martinez-Olalla, P; Colomer-Palomo, J; Perez-Mañosas, R; Rodríguez-Gallego, D

2013-01-01

To define a process management model for a hospital pharmacy in order to measure, analyse and make continuous improvements in patient safety and healthcare quality. In order to implement process management, Igualada Hospital was divided into different processes, one of which was the Hospital Pharmacy. A multidisciplinary management team was given responsibility for each process. For each sub-process one person was identified to be responsible, and a working group was formed under his/her leadership. With the help of each working group, a risk analysis using failure modes and effects analysis (FMEA) was performed, and the corresponding improvement actions were implemented. Sub-process indicators were also identified, and different process management mechanisms were introduced. The first risk analysis with FMEA produced more than thirty preventive actions to improve patient safety. Later, the weekly analysis of errors, as well as the monthly analysis of key process indicators, permitted us to monitor process results and, as each sub-process manager participated in these meetings, also to assume accountability and responsibility, thus consolidating the culture of excellence. The introduction of different process management mechanisms, with the participation of people responsible for each sub-process, introduces a participative management tool for the continuous improvement of patient safety and healthcare quality. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

AFSO 21: Identifying Potential Failure Points in Sustaining Continuous Process Improvement Across the Air Force

DTIC Science & Technology

2007-04-01

Michael W. Wynne, and the Air Force Chief of Staff, General T. Michael Moseley, “our strategy will be a comprehensive effort to improve our work processes...5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT NUMBER 5e. TASK NUMBER 5f. WORK UNIT NUMBER 7...property of the United States government. ii AU/ACSC/2307/AY07 Preface I have always been a proponent of working smarter and not harder. I

The use of discrete-event simulation modelling to improve radiation therapy planning processes.

PubMed

Werker, Greg; Sauré, Antoine; French, John; Shechter, Steven

2009-07-01

The planning portion of the radiation therapy treatment process at the British Columbia Cancer Agency is efficient but nevertheless contains room for improvement. The purpose of this study is to show how a discrete-event simulation (DES) model can be used to represent this complex process and to suggest improvements that may reduce the planning time and ultimately reduce overall waiting times. A simulation model of the radiation therapy (RT) planning process was constructed using the Arena simulation software, representing the complexities of the system. Several types of inputs feed into the model; these inputs come from historical data, a staff survey, and interviews with planners. The simulation model was validated against historical data and then used to test various scenarios to identify and quantify potential improvements to the RT planning process. Simulation modelling is an attractive tool for describing complex systems, and can be used to identify improvements to the processes involved. It is possible to use this technique in the area of radiation therapy planning with the intent of reducing process times and subsequent delays for patient treatment. In this particular system, reducing the variability and length of oncologist-related delays contributes most to improving the planning time.

Interchange. Program Improvement Products Identified through Networking.

ERIC Educational Resources Information Center

Ohio State Univ., Columbus. National Center for Research in Vocational Education.

This catalog lists exemplary field-based program improvement products identified by the Dissemination and Utilization Products and Services Program (D&U) at the National Center for Research in Vocational Education. It is designed to increase awareness of these products among vocational educators and to provide information about them that…

Why Process Improvement Training Fails

ERIC Educational Resources Information Center

Lu, Dawei; Betts, Alan

2011-01-01

Purpose: The purpose of this paper is to explore the underlying reasons why providing process improvement training, by itself, may not be sufficient to achieve the desired outcome of improved processes; and to attempt a conceptual framework of management training for more effective improvement. Design/methodology/approach: Two similar units within…

Microfluidic screening and whole-genome sequencing identifies mutations associated with improved protein secretion by yeast.

PubMed

Huang, Mingtao; Bai, Yunpeng; Sjostrom, Staffan L; Hallström, Björn M; Liu, Zihe; Petranovic, Dina; Uhlén, Mathias; Joensson, Haakan N; Andersson-Svahn, Helene; Nielsen, Jens

2015-08-25

There is an increasing demand for biotech-based production of recombinant proteins for use as pharmaceuticals in the food and feed industry and in industrial applications. Yeast Saccharomyces cerevisiae is among preferred cell factories for recombinant protein production, and there is increasing interest in improving its protein secretion capacity. Due to the complexity of the secretory machinery in eukaryotic cells, it is difficult to apply rational engineering for construction of improved strains. Here we used high-throughput microfluidics for the screening of yeast libraries, generated by UV mutagenesis. Several screening and sorting rounds resulted in the selection of eight yeast clones with significantly improved secretion of recombinant α-amylase. Efficient secretion was genetically stable in the selected clones. We performed whole-genome sequencing of the eight clones and identified 330 mutations in total. Gene ontology analysis of mutated genes revealed many biological processes, including some that have not been identified before in the context of protein secretion. Mutated genes identified in this study can be potentially used for reverse metabolic engineering, with the objective to construct efficient cell factories for protein secretion. The combined use of microfluidics screening and whole-genome sequencing to map the mutations associated with the improved phenotype can easily be adapted for other products and cell types to identify novel engineering targets, and this approach could broadly facilitate design of novel cell factories.

Improvement of hospital processes through business process management in Qaem Teaching Hospital: A work in progress.

PubMed

Yarmohammadian, Mohammad H; Ebrahimipour, Hossein; Doosty, Farzaneh

2014-01-01

In a world of continuously changing business environments, organizations have no option; however, to deal with such a big level of transformation in order to adjust the consequential demands. Therefore, many companies need to continually improve and review their processes to maintain their competitive advantages in an uncertain environment. Meeting these challenges requires implementing the most efficient possible business processes, geared to the needs of the industry and market segments that the organization serves globally. In the last 10 years, total quality management, business process reengineering, and business process management (BPM) have been some of the management tools applied by organizations to increase business competiveness. This paper is an original article that presents implementation of "BPM" approach in the healthcare domain that allows an organization to improve and review its critical business processes. This project was performed in "Qaem Teaching Hospital" in Mashhad city, Iran and consists of four distinct steps; (1) identify business processes, (2) document the process, (3) analyze and measure the process, and (4) improve the process. Implementing BPM in Qaem Teaching Hospital changed the nature of management by allowing the organization to avoid the complexity of disparate, soloed systems. BPM instead enabled the organization to focus on business processes at a higher level.

Ventilation equations for improved exothermic process control.

PubMed

McKernan, John L; Ellenbecker, Michael J

2007-04-01

Exothermic or heated processes create potentially unsafe work environments for an estimated 5-10 million American workers each year. Excessive heat and process contaminants have the potential to cause acute health effects such as heat stroke, and chronic effects such as manganism in welders. Although millions of workers are exposed to exothermic processes, insufficient attention has been given to continuously improving engineering technologies for these processes to provide effective and efficient control. Currently there is no specific occupational standard established by OSHA regarding exposure to heat from exothermic processes, therefore it is important to investigate techniques that can mitigate known and potential adverse occupational health effects. The current understanding of engineering controls for exothermic processes is primarily based on a book chapter written by W. C. L. Hemeon in 1955. Improvements in heat transfer and meteorological theory necessary to design improved process controls have occurred since this time. The research presented involved a review of the physical properties, heat transfer and meteorological theories governing buoyant air flow created by exothermic processes. These properties and theories were used to identify parameters and develop equations required for the determination of buoyant volumetric flow to assist in improving ventilation controls. Goals of this research were to develop and describe a new (i.e. proposed) flow equation, and compare it to currently accepted ones by Hemeon and the American Conference of Governmental Industrial Hygienists (ACGIH). Numerical assessments were conducted to compare solutions from the proposed equations for plume area, mean velocity and flow to those from the ACGIH and Hemeon. Parameters were varied for the dependent variables and solutions from the proposed, ACGIH, and Hemeon equations for plume area, mean velocity and flow were analyzed using a randomized complete block statistical

SEL's Software Process-Improvement Program

NASA Technical Reports Server (NTRS)

Basili, Victor; Zelkowitz, Marvin; McGarry, Frank; Page, Jerry; Waligora, Sharon; Pajerski, Rose

1995-01-01

The goals and operations of the Software Engineering Laboratory (SEL) is reviewed. For nearly 20 years the SEL has worked to understand, assess, and improve software and the development process within the production environment of the Flight Dynamics Division (FDD) of NASA's Goddard Space Flight Center. The SEL was established in 1976 with the goals of reducing: (1) the defect rate of delivered software, (2) the cost of software to support flight projects, and (3) the average time to produce mission-support software. After studying over 125 projects of FDD, the results have guided the standards, management practices, technologies, and the training within the division. The results of the studies have been a 75 percent reduction in defects, a 50 percent reduction in cost, and a 25 percent reduction in development time. Over time the goals of SEL have been clarified. The goals are now stated as: (1) Understand baseline processes and product characteristics, (2) Assess improvements that have been incorporated into the development projects, (3) Package and infuse improvements into the standard SEL process. The SEL improvement goal is to demonstrate continual improvement of the software process by carrying out analysis, measurement and feedback to projects with in the FDD environment. The SEL supports the understanding of the process by study of several processes including, the effort distribution, and error detection rates. The SEL assesses and refines the processes. Once the assessment and refinement of a process is completed, the SEL packages the process by capturing the process in standards, tools and training.

Process Architecture for Managing Digital Object Identifiers

NASA Astrophysics Data System (ADS)

Wanchoo, L.; James, N.; Stolte, E.

2014-12-01

In 2010, NASA's Earth Science Data and Information System (ESDIS) Project implemented a process for registering Digital Object Identifiers (DOIs) for data products distributed by Earth Observing System Data and Information System (EOSDIS). For the first 3 years, ESDIS evolved the process involving the data provider community in the development of processes for creating and assigning DOIs, and guidelines for the landing page. To accomplish this, ESDIS established two DOI User Working Groups: one for reviewing the DOI process whose recommendations were submitted to ESDIS in February 2014; and the other recently tasked to review and further develop DOI landing page guidelines for ESDIS approval by end of 2014. ESDIS has recently upgraded the DOI system from a manually-driven system to one that largely automates the DOI process. The new automated feature include: a) reviewing the DOI metadata, b) assigning of opaque DOI name if data provider chooses, and c) reserving, registering, and updating the DOIs. The flexibility of reserving the DOI allows data providers to embed and test the DOI in the data product metadata before formally registering with EZID. The DOI update process allows the changing of any DOI metadata except the DOI name unless the name has not been registered. Currently, ESDIS has processed a total of 557 DOIs of which 379 DOIs are registered with EZID and 178 are reserved with ESDIS. The DOI incorporates several metadata elements that effectively identify the data product and the source of availability. Of these elements, the Uniform Resource Locator (URL) attribute has the very important function of identifying the landing page which describes the data product. ESDIS in consultation with data providers in the Earth Science community is currently developing landing page guidelines that specify the key data product descriptive elements to be included on each data product's landing page. This poster will describe in detail the unique automated process and

Developing a Quality Improvement Process to Optimize Faculty Success

ERIC Educational Resources Information Center

Merillat, Linda; Scheibmeir, Monica

2016-01-01

As part of a major shift to embed quality improvement processes within a School of Nursing at a medium-sized Midwestern university, a faculty enrichment program using a Plan-Do-Act-Study design was implemented. A central focus for the program was the development and maintenance of an online faculty resource center identified as "My Faculty…

Identifying priorities for improving rear seat occupant protection.

DOT National Transportation Integrated Search

2009-03-01

This project helped to identify priorities for improving the safety of rear seat occupants through a literature review and NASS-CDS injury analysis. The literature review covers injury patterns of rear seat occupants, new safety technologies intended...

Ontario's emergency department process improvement program: the experience of implementation.

PubMed

Rotteau, Leahora; Webster, Fiona; Salkeld, Erin; Hellings, Chelsea; Guttmann, Astrid; Vermeulen, Marian J; Bell, Robert S; Zwarenstein, Merrick; Rowe, Brian H; Nigam, Amit; Schull, Michael J

2015-06-01

In recent years, Lean manufacturing principles have been applied to health care quality improvement efforts to improve wait times. In Ontario, an emergency department (ED) process improvement program based on Lean principles was introduced by the Ministry of Health and Long-Term Care as part of a strategy to reduce ED length of stay (LOS) and to improve patient flow. This article aims to describe the hospital-based teams' experiences during the ED process improvement program implementation and the teams' perceptions of the key factors that influenced the program's success or failure. A qualitative evaluation was conducted based on semistructured interviews with hospital implementation team members, such as team leads, medical leads, and executive sponsors, at 10 purposively selected hospitals in Ontario, Canada. Sites were selected based, in part, on their changes in median ED LOS following the implementation period. A thematic framework approach as used for interviews, and a standard thematic coding framework was developed. Twenty-four interviews were coded and analyzed. The results are organized according to participants' experience and are grouped into four themes that were identified as significantly affecting the implementation experience: local contextual factors, relationship between improvement team and support players, staff engagement, and success and sustainability. The results demonstrate the importance of the context of implementation, establishing strong relationships and communication strategies, and preparing for implementation and sustainability prior to the start of the project. Several key factors were identified as important to the success of the program, such as preparing for implementation, ensuring strong executive support, creation of implementation teams based on the tasks and outcomes of the initiative, and using multiple communication strategies throughout the implementation process. Explicit incorporation of these factors into the

How to improve patient satisfaction when patients are already satisfied: a continuous process-improvement approach.

PubMed

Friesner, Dan; Neufelder, Donna; Raisor, Janet; Bozman, Carl S

2009-01-01

The authors present a methodology that measures improvement in customer satisfaction scores when those scores are already high and the production process is slow and thus does not generate a large amount of useful data in any given time period. The authors used these techniques with data from a midsized rehabilitation institute affiliated with a regional, nonprofit medical center. Thus, this article functions as a case study, the findings of which may be applicable to a large number of other healthcare providers that share both the mission and challenges faced by this facility. The methodology focused on 2 factors: use of the unique characteristics of panel data to overcome the paucity of observations and a dynamic benchmarking approach to track process variability over time. By focusing on these factors, the authors identify some additional areas for process improvement despite the institute's past operational success.

Improving a Dental School's Clinic Operations Using Lean Process Improvement.

PubMed

Robinson, Fonda G; Cunningham, Larry L; Turner, Sharon P; Lindroth, John; Ray, Deborah; Khan, Talib; Yates, Audrey

2016-10-01

The term "lean production," also known as "Lean," describes a process of operations management pioneered at the Toyota Motor Company that contributed significantly to the success of the company. Although developed by Toyota, the Lean process has been implemented at many other organizations, including those in health care, and should be considered by dental schools in evaluating their clinical operations. Lean combines engineering principles with operations management and improvement tools to optimize business and operating processes. One of the core concepts is relentless elimination of waste (non-value-added components of a process). Another key concept is utilization of individuals closest to the actual work to analyze and improve the process. When the medical center of the University of Kentucky adopted the Lean process for improving clinical operations, members of the College of Dentistry trained in the process applied the techniques to improve inefficient operations at the Walk-In Dental Clinic. The purpose of this project was to reduce patients' average in-the-door-to-out-the-door time from over four hours to three hours within 90 days. Achievement of this goal was realized by streamlining patient flow and strategically relocating key phases of the process. This initiative resulted in patient benefits such as shortening average in-the-door-to-out-the-door time by over an hour, improving satisfaction by 21%, and reducing negative comments by 24%, as well as providing opportunity to implement the electronic health record, improving teamwork, and enhancing educational experiences for students. These benefits were achieved while maintaining high-quality patient care with zero adverse outcomes during and two years following the process improvement project.

Case Studies in Continuous Process Improvement

NASA Technical Reports Server (NTRS)

Mehta, A.

1997-01-01

This study focuses on improving the SMT assembly process in a low-volume, high-reliability environment with emphasis on fine pitch and BGA packages. Before a process improvement is carried out, it is important to evaluate where the process stands in terms of process capability.

PROCESS IMPROVEMENT STUDIES ON THE BATTELLE HYDROTHERMAL COAL PROCESS

EPA Science Inventory

The report gives results of a study to improve the economic viability of the Battelle Hydrothermal (HT) Coal Process by reducing the costs associated with liquid/solid separation and leachant regeneration. Laboratory experiments were conducted to evaluate process improvements for...

Improving participant comprehension in the informed consent process.

PubMed

Cohn, Elizabeth; Larson, Elaine

2007-01-01

To critically analyze studies published within the past decade about participants' comprehension of informed consent in clinical research and to identify promising intervention strategies. Integrative review of literature. The Cumulative Index of Nursing and Allied Health Literature (CINAHL), PubMed, and the Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials were searched. Inclusion criteria included studies (a) published between January 1, 1996 and January 1, 2007, (b) designed as descriptive or interventional studies of comprehension of informed consent for clinical research, (c) conducted in nonpsychiatric adult populations who were either patients or volunteer participants, (d) written in English, and (e) published in peer-reviewed journals. Of the 980 studies identified, 319 abstracts were screened, 154 studies were reviewed, and 23 met the inclusion criteria. Thirteen studies (57%) were descriptive, and 10 (43%) were interventional. Interventions tested included simplified written consent documents, multimedia approaches, and the use of a trained professional (consent educator) to assist in the consent process. Collectively, no single intervention strategy was consistently associated with improved comprehension. Studies also varied in regard to the definition of comprehension and the tools used to measure it. Despite increasing regulatory scrutiny, deficiencies still exist in participant comprehension of the research in which they participate, as well as differences in how comprehension is measured and assessed. No single intervention was identified as consistently successful for improving participant comprehension, and results indicated that any successful consent process should at a minimum include various communication modes and is likely to require one-to-one interaction with someone knowledgeable about the study.

Developing Process Maps as a Tool for a Surgical Infection Prevention Quality Improvement Initiative in Resource-Constrained Settings.

PubMed

Forrester, Jared A; Koritsanszky, Luca A; Amenu, Demisew; Haynes, Alex B; Berry, William R; Alemu, Seifu; Jiru, Fekadu; Weiser, Thomas G

2018-06-01

Surgical infections cause substantial morbidity and mortality in low-and middle-income countries (LMICs). To improve adherence to critical perioperative infection prevention standards, we developed Clean Cut, a checklist-based quality improvement program to improve compliance with best practices. We hypothesized that process mapping infection prevention activities can help clinicians identify strategies for improving surgical safety. We introduced Clean Cut at a tertiary hospital in Ethiopia. Infection prevention standards included skin antisepsis, ensuring a sterile field, instrument decontamination/sterilization, prophylactic antibiotic administration, routine swab/gauze counting, and use of a surgical safety checklist. Processes were mapped by a visiting surgical fellow and local operating theater staff to facilitate the development of contextually relevant solutions; processes were reassessed for improvements. Process mapping helped identify barriers to using alcohol-based hand solution due to skin irritation, inconsistent administration of prophylactic antibiotics due to variable delivery outside of the operating theater, inefficiencies in assuring sterility of surgical instruments through lack of confirmatory measures, and occurrences of retained surgical items through inappropriate guidelines, staffing, and training in proper routine gauze counting. Compliance with most processes improved significantly following organizational changes to align tasks with specific process goals. Enumerating the steps involved in surgical infection prevention using a process mapping technique helped identify opportunities for improving adherence and plotting contextually relevant solutions, resulting in superior compliance with antiseptic standards. Simplifying these process maps into an adaptable tool could be a powerful strategy for improving safe surgery delivery in LMICs. Copyright © 2018 American College of Surgeons. Published by Elsevier Inc. All rights reserved.

Value-driven process management: using value to improve processes.

PubMed

Melnyk, S A; Christensen, R T

2000-08-01

Every firm can be viewed as consisting of various processes. These processes affect everything that the firm does from accepting orders and designing products to scheduling production. In many firms, the management of processes often reflects considerations of efficiency (cost) rather than effectiveness (value). In this article, we introduce a well-structured process for managing processes that begins not with the process, but rather with the customer and the product and the concept of value. This process progresses through a number of steps which include issues such as defining value, generating the appropriate metrics, identifying the critical processes, mapping and assessing the performance of these processes, and identifying long- and short-term areas for action. What makes the approach presented in this article so powerful is that it explicitly links the customer to the process and that the process is evaluated in term of its ability to effectively serve the customers.

Process safety improvement--quality and target zero.

PubMed

Van Scyoc, Karl

2008-11-15

Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given.

Autoverification process improvement by Six Sigma approach: Clinical chemistry & immunoassay.

PubMed

Randell, Edward W; Short, Garry; Lee, Natasha; Beresford, Allison; Spencer, Margaret; Kennell, Marina; Moores, Zoë; Parry, David

2018-05-01

This study examines effectiveness of a project to enhance an autoverification (AV) system through application of Six Sigma (DMAIC) process improvement strategies. Similar AV systems set up at three sites underwent examination and modification to produce improved systems while monitoring proportions of samples autoverified, the time required for manual review and verification, sample processing time, and examining characteristics of tests not autoverified. This information was used to identify areas for improvement and monitor the impact of changes. Use of reference range based criteria had the greatest impact on the proportion of tests autoverified. To improve AV process, reference range based criteria was replaced with extreme value limits based on a 99.5% test result interval, delta check criteria were broadened, and new specimen consistency rules were implemented. Decision guidance tools were also developed to assist staff using the AV system. The mean proportion of tests and samples autoverified improved from <62% for samples and <80% for tests, to >90% for samples and >95% for tests across all three sites. The new AV system significantly decreased turn-around time and total sample review time (to about a third), however, time spent for manual review of held samples almost tripled. There was no evidence of compromise to the quality of testing process and <1% of samples held for exceeding delta check or extreme limits required corrective action. The Six Sigma (DMAIC) process improvement methodology was successfully applied to AV systems resulting in an increase in overall test and sample AV by >90%, improved turn-around time, reduced time for manual verification, and with no obvious compromise to quality or error detection. Copyright © 2018 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

Applications of process improvement techniques to improve workflow in abdominal imaging.

PubMed

Tamm, Eric Peter

2016-03-01

Major changes in the management and funding of healthcare are underway that will markedly change the way radiology studies will be reimbursed. The result will be the need to deliver radiology services in a highly efficient manner while maintaining quality. The science of process improvement provides a practical approach to improve the processes utilized in radiology. This article will address in a step-by-step manner how to implement process improvement techniques to improve workflow in abdominal imaging.

IRQN award paper: Operational rounds: a practical administrative process to improve safety and clinical services in radiology.

PubMed

Donnelly, Lane F; Dickerson, Julie M; Lehkamp, Todd W; Gessner, Kevin E; Moskovitz, Jay; Hutchinson, Sally

2008-11-01

As part of a patient safety program in the authors' department of radiology, operational rounds have been instituted. This process consists of radiology leaders' visiting imaging divisions at the site of imaging and discussing frontline employees' concerns about patient safety, the quality of care, and patient and family satisfaction. Operational rounds are executed at a time to optimize the number of attendees. Minutes that describe the issues identified, persons responsible for improvement, and updated improvement plan status are available to employees online. Via this process, multiple patient safety and other issues have been identified and remedied. The authors believe that the process has improved patient safety, the quality of care, and the efficiency of operations. Since the inception of the safety program, the mean number of days between serious safety events involving radiology has doubled. The authors review the background around such walk rounds, describe their particular program, and give multiple illustrative examples of issues identified and improvement plans put in place.

Realization of process improvement at a diagnostic radiology department with aid of simulation modeling.

PubMed

Oh, Hong-Choon; Toh, Hong-Guan; Giap Cheong, Eddy Seng

2011-11-01

Using the classical process improvement framework of Plan-Do-Study-Act (PDSA), the diagnostic radiology department of a tertiary hospital identified several patient cycle time reduction strategies. Experimentation of these strategies (which included procurement of new machines, hiring of new staff, redesign of queue system, etc.) through pilot scale implementation was impractical because it might incur substantial expenditure or be operationally disruptive. With this in mind, simulation modeling was used to test these strategies via performance of "what if" analyses. Using the output generated by the simulation model, the team was able to identify a cost-free cycle time reduction strategy, which subsequently led to a reduction of patient cycle time and achievement of a management-defined performance target. As healthcare professionals work continually to improve healthcare operational efficiency in response to rising healthcare costs and patient expectation, simulation modeling offers an effective scientific framework that can complement established process improvement framework like PDSA to realize healthcare process enhancement. © 2011 National Association for Healthcare Quality.

76 FR 41246 - Pesticide Program Dialogue Committee, Pesticide Registration Improvement Act Process Improvement...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-13

... Committee, Pesticide Registration Improvement Act Process Improvement Workgroup; Notice of Public Meeting...) Process Improvement Work Group. EPA plans to meet its ESA consultation obligations through the pesticide... a pesticide during the registration review process. This meeting of the PRIA Process Improvement...

Process Improvements in Training Device Acceptance Testing: A Study in Total Quality Management

DTIC Science & Technology

1990-12-12

Quality Management , a small group of Government and industry specialists examined the existing training device acceptance test process for potential improvements. The agreed-to mission of the Air Force/Industry partnership was to continuously identify and promote implementable approaches to minimize the cost and time required for acceptance testing while ensuring that validated performance supports the user training requirements. Application of a Total Quality process improvement model focused on the customers and their requirements, analyzed how work was accomplished, and

Identifying Core Concepts of Cybersecurity: Results of Two Delphi Processes

ERIC Educational Resources Information Center

Parekh, Geet; DeLatte, David; Herman, Geoffrey L.; Oliva, Linda; Phatak, Dhananjay; Scheponik, Travis; Sherman, Alan T.

2018-01-01

This paper presents and analyzes results of two Delphi processes that polled cybersecurity experts to rate cybersecurity topics based on importance, difficulty, and timelessness. These ratings can be used to identify core concepts--cross-cutting ideas that connect knowledge in the discipline. The first Delphi process identified core concepts that…

Using A3 thinking to improve the STAT medication process.

PubMed

Manojlovich, Milisa; Chase, Valerie J; Mack, Megan; Conroy, Meghan K; Belanger, Karen; Zawol, Debbie; Corr, Karen M; Fowler, Karen E; Viglianti, Elizabeth

2014-08-01

Although the term STAT conveys a sense of urgency, it is sometimes used to circumvent a system that may be too slow to accomplish tasks in a timely manner. We describe a quality-improvement project undertaken by a US Department of Veterans Affairs (VA) hospital to improve the STAT medication process. We adapted A3 Thinking, a problem-solving process common in Lean organizations, to our problem. In the discovery phase, a color-coded flow map of the existing process was constructed, and a real-time STAT order was followed in a modified "Go to the Gemba" exercise. In the envisioning phase, the team brainstormed to come up with as many improvement ideas as possible, which were then prioritized based on the anticipated effort and impact. The team then identified initial experiments to be carried out in the experimentation phase; each experiment followed a standard Plan-Do-Study-Act cycle. On average, the number of STAT medications ordered per month decreased by 9.5%. The average time from STAT order entry to administration decreased by 21%, and time from medication delivery to administration decreased by 26%. Improvements were also made in technician awareness of STAT medications and nurse notification of STAT medication delivery. Adapting A3 Thinking for process improvement was a low-cost/low-tech option for a VA facility. The A3 Thinking process led to a better understanding of the meaning of STAT across disciplines, and promoted a collaborative culture in which other hospital-wide problems may be addressed in the future. Published 2014. This article is a U.S. Government work and is in the public domain in the USA.

Use of failure mode effect analysis (FMEA) to improve medication management process.

PubMed

Jain, Khushboo

2017-03-13

Purpose Medication management is a complex process, at high risk of error with life threatening consequences. The focus should be on devising strategies to avoid errors and make the process self-reliable by ensuring prevention of errors and/or error detection at subsequent stages. The purpose of this paper is to use failure mode effect analysis (FMEA), a systematic proactive tool, to identify the likelihood and the causes for the process to fail at various steps and prioritise them to devise risk reduction strategies to improve patient safety. Design/methodology/approach The study was designed as an observational analytical study of medication management process in the inpatient area of a multi-speciality hospital in Gurgaon, Haryana, India. A team was made to study the complex process of medication management in the hospital. FMEA tool was used. Corrective actions were developed based on the prioritised failure modes which were implemented and monitored. Findings The percentage distribution of medication errors as per the observation made by the team was found to be maximum of transcription errors (37 per cent) followed by administration errors (29 per cent) indicating the need to identify the causes and effects of their occurrence. In all, 11 failure modes were identified out of which major five were prioritised based on the risk priority number (RPN). The process was repeated after corrective actions were taken which resulted in about 40 per cent (average) and around 60 per cent reduction in the RPN of prioritised failure modes. Research limitations/implications FMEA is a time consuming process and requires a multidisciplinary team which has good understanding of the process being analysed. FMEA only helps in identifying the possibilities of a process to fail, it does not eliminate them, additional efforts are required to develop action plans and implement them. Frank discussion and agreement among the team members is required not only for successfully conducing

Application of agent-based system for bioprocess description and process improvement.

PubMed

Gao, Ying; Kipling, Katie; Glassey, Jarka; Willis, Mark; Montague, Gary; Zhou, Yuhong; Titchener-Hooker, Nigel J

2010-01-01

Modeling plays an important role in bioprocess development for design and scale-up. Predictive models can also be used in biopharmaceutical manufacturing to assist decision-making either to maintain process consistency or to identify optimal operating conditions. To predict the whole bioprocess performance, the strong interactions present in a processing sequence must be adequately modeled. Traditionally, bioprocess modeling considers process units separately, which makes it difficult to capture the interactions between units. In this work, a systematic framework is developed to analyze the bioprocesses based on a whole process understanding and considering the interactions between process operations. An agent-based approach is adopted to provide a flexible infrastructure for the necessary integration of process models. This enables the prediction of overall process behavior, which can then be applied during process development or once manufacturing has commenced, in both cases leading to the capacity for fast evaluation of process improvement options. The multi-agent system comprises a process knowledge base, process models, and a group of functional agents. In this system, agent components co-operate with each other in performing their tasks. These include the description of the whole process behavior, evaluating process operating conditions, monitoring of the operating processes, predicting critical process performance, and providing guidance to decision-making when coping with process deviations. During process development, the system can be used to evaluate the design space for process operation. During manufacture, the system can be applied to identify abnormal process operation events and then to provide suggestions as to how best to cope with the deviations. In all cases, the function of the system is to ensure an efficient manufacturing process. The implementation of the agent-based approach is illustrated via selected application scenarios, which

A combined disease management and process modeling approach for assessing and improving care processes: a fall management case-study.

PubMed

Askari, Marjan; Westerhof, Richard; Eslami, Saied; Medlock, Stephanie; de Rooij, Sophia E; Abu-Hanna, Ameen

2013-10-01

To propose a combined disease management and process modeling approach for evaluating and improving care processes, and demonstrate its usability and usefulness in a real-world fall management case study. We identified essential disease management related concepts and mapped them into explicit questions meant to expose areas for improvement in the respective care processes. We applied the disease management oriented questions to a process model of a comprehensive real world fall prevention and treatment program covering primary and secondary care. We relied on interviews and observations to complete the process models, which were captured in UML activity diagrams. A preliminary evaluation of the usability of our approach by gauging the experience of the modeler and an external validator was conducted, and the usefulness of the method was evaluated by gathering feedback from stakeholders at an invitational conference of 75 attendees. The process model of the fall management program was organized around the clinical tasks of case finding, risk profiling, decision making, coordination and interventions. Applying the disease management questions to the process models exposed weaknesses in the process including: absence of program ownership, under-detection of falls in primary care, and lack of efficient communication among stakeholders due to missing awareness about other stakeholders' workflow. The modelers experienced the approach as usable and the attendees of the invitational conference found the analysis results to be valid. The proposed disease management view of process modeling was usable and useful for systematically identifying areas of improvement in a fall management program. Although specifically applied to fall management, we believe our case study is characteristic of various disease management settings, suggesting the wider applicability of the approach. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Homeless Veterans: Management Improvements Could Help VA Better Identify Supportive Housing Projects

DTIC Science & Technology

2016-12-01

HOMELESS VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects Report to...VETERANS Management Improvements Could Help VA Better Identify Supportive-Housing Projects What GAO Found As of September 2016, for veterans who...disabled veterans. These supportive-housing EULs receive project -based HUD-VASH vouchers, which provide housing subsidies, on-site case management

Enhancing patient safety: improving the patient handoff process through appreciative inquiry.

PubMed

Shendell-Falik, Nancy; Feinson, Michael; Mohr, Bernard J

2007-02-01

Patient transfers from one care giver to another are an area of high safety consequence, as is evident by many studies and the Joint Commission on Accreditation of Healthcare Organization's Patient Safety Goals. The authors describe how one hospital made measurable improvements in a patient handoff process by using an unconventional approach to change called appreciative inquiry. Rather than identifying the root causes of ineffective handoffs, appreciative inquiry was used to engage staff in identifying and building on their most effective handoff experiences.

Process Improvement for Interinstitutional Research Contracting.

PubMed

Varner, Michael; Logan, Jennifer; Bjorklund, Todd; Whitfield, Jesse; Reed, Peggy; Lesher, Laurie; Sikalis, Amy; Brown, Brent; Drollinger, Sandy; Larrabee, Kristine; Thompson, Kristie; Clark, Erin; Workman, Michael; Boi, Luca

2015-08-01

Sponsored research increasingly requires multiinstitutional collaboration. However, research contracting procedures have become more complicated and time consuming. The perinatal research units of two colocated healthcare systems sought to improve their research contracting processes. The Lean Process, a management practice that iteratively involves team members in root cause analyses and process improvement, was applied to the research contracting process, initially using Process Mapping and then developing Problem Solving Reports. Root cause analyses revealed that the longest delays were the individual contract legal negotiations. In addition, the "business entity" was the research support personnel of both healthcare systems whose "customers" were investigators attempting to conduct interinstitutional research. Development of mutually acceptable research contract templates and language, chain of custody templates, and process development and refinement formats decreased the Notice of Grant Award to Purchase Order time from a mean of 103.5 days in the year prior to Lean Process implementation to 45.8 days in the year after implementation (p = 0.004). The Lean Process can be applied to interinstitutional research contracting with significant improvement in contract implementation. © 2015 Wiley Periodicals, Inc.

Identifying influential factors of business process performance using dependency analysis

NASA Astrophysics Data System (ADS)

Wetzstein, Branimir; Leitner, Philipp; Rosenberg, Florian; Dustdar, Schahram; Leymann, Frank

2011-02-01

We present a comprehensive framework for identifying influential factors of business process performance. In particular, our approach combines monitoring of process events and Quality of Service (QoS) measurements with dependency analysis to effectively identify influential factors. The framework uses data mining techniques to construct tree structures to represent dependencies of a key performance indicator (KPI) on process and QoS metrics. These dependency trees allow business analysts to determine how process KPIs depend on lower-level process metrics and QoS characteristics of the IT infrastructure. The structure of the dependencies enables a drill-down analysis of single factors of influence to gain a deeper knowledge why certain KPI targets are not met.

Improving Histopathology Laboratory Productivity: Process Consultancy and A3 Problem Solving.

PubMed

Yörükoğlu, Kutsal; Özer, Erdener; Alptekin, Birsen; Öcal, Cem

2017-01-01

The ISO 17020 quality program has been run in our pathology laboratory for four years to establish an action plan for correction and prevention of identified errors. In this study, we aimed to evaluate the errors that we could not identify through ISO 17020 and/or solve by means of process consulting. Process consulting is carefully intervening in a group or team to help it to accomplish its goals. The A3 problem solving process was run under the leadership of a 'workflow, IT and consultancy manager'. An action team was established consisting of technical staff. A root cause analysis was applied for target conditions, and the 6-S method was implemented for solution proposals. Applicable proposals were activated and the results were rated by six-sigma analysis. Non-applicable proposals were reported to the laboratory administrator. A mislabelling error was the most complained issue triggering all pre-analytical errors. There were 21 non-value added steps grouped in 8 main targets on the fish bone graphic (transporting, recording, moving, individual, waiting, over-processing, over-transaction and errors). Unnecessary redundant requests, missing slides, archiving issues, redundant activities, and mislabelling errors were proposed to be solved by improving visibility and fixing spaghetti problems. Spatial re-organization, organizational marking, re-defining some operations, and labeling activities raised the six sigma score from 24% to 68% for all phases. Operational transactions such as implementation of a pathology laboratory system was suggested for long-term improvement. Laboratory management is a complex process. Quality control is an effective method to improve productivity. Systematic checking in a quality program may not always find and/or solve the problems. External observation may reveal crucial indicators about the system failures providing very simple solutions.

Performance Improvement Processes.

ERIC Educational Resources Information Center

1997

This document contains four papers from a symposium on performance improvement processes. In "Never the Twain Shall Meet?: A Glimpse into High Performance Work Practices and Downsizing" (Laurie J. Bassi, Mark E. Van Buren) evidence from a national cross-industry of more than 200 establishments is used to demonstrate that high-performance…

Process improvement methodologies uncover unexpected gaps in stroke care.

PubMed

Kuner, Anthony D; Schemmel, Andrew J; Pooler, B Dustin; Yu, John-Paul J

2018-01-01

Background The diagnosis and treatment of acute stroke requires timed and coordinated effort across multiple clinical teams. Purpose To analyze the frequency and temporal distribution of emergent stroke evaluations (ESEs) to identify potential contributory workflow factors that may delay the initiation and subsequent evaluation of emergency department stroke patients. Material and Methods A total of 719 sentinel ESEs with concurrent neuroimaging were identified over a 22-month retrospective time period. Frequency data were tabulated and odds ratios calculated. Results Of all ESEs, 5% occur between 01:00 and 07:00. ESEs were most frequent during the late morning and early afternoon hours (10:00-14:00). Unexpectedly, there was a statistically significant decline in the frequency of ESEs that occur at the 14:00 time point. Conclusion Temporal analysis of ESEs in the emergency department allowed us to identify an unexpected decrease in ESEs and through process improvement methodologies (Lean and Six Sigma) and identify potential workflow elements contributing to this observation.

Software Engineering Program: Software Process Improvement Guidebook

NASA Technical Reports Server (NTRS)

1996-01-01

The purpose of this document is to provide experience-based guidance in implementing a software process improvement program in any NASA software development or maintenance community. This guidebook details how to define, operate, and implement a working software process improvement program. It describes the concept of the software process improvement program and its basic organizational components. It then describes the structure, organization, and operation of the software process improvement program, illustrating all these concepts with specific NASA examples. The information presented in the document is derived from the experiences of several NASA software organizations, including the SEL, the SEAL, and the SORCE. Their experiences reflect many of the elements of software process improvement within NASA. This guidebook presents lessons learned in a form usable by anyone considering establishing a software process improvement program within his or her own environment. This guidebook attempts to balance general and detailed information. It provides material general enough to be usable by NASA organizations whose characteristics do not directly match those of the sources of the information and models presented herein. It also keeps the ideas sufficiently close to the sources of the practical experiences that have generated the models and information.

Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people

PubMed Central

Sutton, Elizabeth; Dixon-Woods, Mary; Tarrant, Carolyn

2016-01-01

Objectives Quality improvement projects to address transitions of care across care boundaries are increasingly common but meet with mixed success for reasons that are poorly understood. We aimed to characterise challenges in a project to improve transitions for older people between hospital and care homes. Design Independent process evaluation, using ethnographic observations and interviews, of a quality improvement project. Setting and participants An English hospital and two residential care homes for older people. Data 32 hours of non-participant observations and 12 semistructured interviews with project members, hospital and care home staff. Results A hospital-based improvement team sought to reduce unplanned readmissions from residential care homes using interventions including a community-based geriatric team that could be accessed directly by care homes and a communication tool intended to facilitate transfer of information between homes and hospital. Only very modest (if any) impacts of these interventions on readmission rates could be detected. The process evaluation identified multiple challenges in implementing interventions and securing improvement. Many of these arose because of lack of consensus on the nature of the problem and the proper solutions: while the hospital team was keen to reduce readmissions and saw the problems as lying in poor communication and lack of community-based support for care homes, the care home staff had different priorities. Care home staff were unconvinced that the improvement interventions were aligned with their needs or addressed their concerns, resulting in compromised implementation. Conclusions Process evaluations have a valuable role in quality improvement. Our study suggests that a key task for quality improvement projects aimed at transitions of care is that of developing a shared view of the problem to be addressed. A more participatory approach could help to surface assumptions, interpretations and interests

Process Improvement for Interinstitutional Research Contracting

PubMed Central

Logan, Jennifer; Bjorklund, Todd; Whitfield, Jesse; Reed, Peggy; Lesher, Laurie; Sikalis, Amy; Brown, Brent; Drollinger, Sandy; Larrabee, Kristine; Thompson, Kristie; Clark, Erin; Workman, Michael; Boi, Luca

2015-01-01

Abstract Introduction Sponsored research increasingly requires multiinstitutional collaboration. However, research contracting procedures have become more complicated and time consuming. The perinatal research units of two colocated healthcare systems sought to improve their research contracting processes. Methods The Lean Process, a management practice that iteratively involves team members in root cause analyses and process improvement, was applied to the research contracting process, initially using Process Mapping and then developing Problem Solving Reports. Results Root cause analyses revealed that the longest delays were the individual contract legal negotiations. In addition, the “business entity” was the research support personnel of both healthcare systems whose “customers” were investigators attempting to conduct interinstitutional research. Development of mutually acceptable research contract templates and language, chain of custody templates, and process development and refinement formats decreased the Notice of Grant Award to Purchase Order time from a mean of 103.5 days in the year prior to Lean Process implementation to 45.8 days in the year after implementation (p = 0.004). Conclusions The Lean Process can be applied to interinstitutional research contracting with significant improvement in contract implementation. PMID:26083433

A primer on the cost of quality for improvement of laboratory and pathology specimen processes.

PubMed

Carlson, Richard O; Amirahmadi, Fazlollaah; Hernandez, James S

2012-09-01

In today's environment, many laboratories and pathology practices are challenged to maintain or increase their quality while simultaneously lowering their overall costs. The cost of improving specimen processes is related to quality, and we demonstrate that actual costs can be reduced by designing "quality at the source" into the processes. Various costs are hidden along the total testing process, and we suggest ways to identify opportunities to reduce cost by improving quality in laboratories and pathology practices through the use of Lean, Six Sigma, and industrial engineering.

NCCDS configuration management process improvement

NASA Technical Reports Server (NTRS)

Shay, Kathy

1993-01-01

By concentrating on defining and improving specific Configuration Management (CM) functions, processes, procedures, personnel selection/development, and tools, internal and external customers received improved CM services. Job performance within the section increased in both satisfaction and output. Participation in achieving major improvements has led to the delivery of consistent quality CM products as well as significant decreases in every measured CM metrics category.

Improvement of Processing Speed in Executive Function Immediately following an Increase in Cardiovascular Activity.

PubMed

Tam, Nicoladie D

2013-01-01

This study aims to identify the acute effects of physical exercise on specific cognitive functions immediately following an increase in cardiovascular activity. Stair-climbing exercise is used to increase the cardiovascular output of human subjects. The color-naming Stroop Test was used to identify the cognitive improvements in executive function with respect to processing speed and error rate. The study compared the Stroop results before and immediately after exercise and before and after nonexercise, as a control. The results show that there is a significant increase in processing speed and a reduction in errors immediately after less than 30 min of aerobic exercise. The improvements are greater for the incongruent than for the congruent color tests. This suggests that physical exercise induces a better performance in a task that requires resolving conflict (or interference) than a task that does not. There is no significant improvement for the nonexercise control trials. This demonstrates that an increase in cardiovascular activity has significant acute effects on improving the executive function that requires conflict resolution (for the incongruent color tests) immediately following aerobic exercise more than similar executive functions that do not require conflict resolution or involve the attention-inhibition process (for the congruent color tests).

[Sustainable process improvement with application of 'lean philosophy'].

PubMed

Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

2013-01-01

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

Inpatient preanalytic process improvements.

PubMed

Wagar, Elizabeth A; Phipps, Ron; Del Guidice, Robert; Middleton, Lavinia P; Bingham, John; Prejean, Cheryl; Johnson-Hamilton, Martha; Philip, Pheba; Le, Ngoc Han; Muses, Waheed

2013-12-01

Phlebotomy services are a common target for preanalytic improvements. Many new, quality engineering tools have recently been applied in clinical laboratories. However, data on relatively few projects have been published. This example describes a complete application of current, quality engineering tools to improve preanalytic phlebotomy services. To decrease the response time in the preanalytic inpatient laboratory by 25%, to reduce the number of incident reports related to preanalytic phlebotomy, and to make systematic process changes that satisfied the stakeholders. The Department of Laboratory Medicine, General Services Section, at the University of Texas MD Anderson Cancer Center (Houston) is responsible for inpatient phlebotomy in a 24-hour operation, which serves 689 inpatient beds. The study director was project director of the Division of Pathology and Laboratory Medicine's Quality Improvement Section and was assisted by 2 quality technologists and an industrial engineer from MD Anderson Office of Performance Improvement. After implementing each solution, using well-recognized, quality tools and metrics, the response time for blood collection decreased by 23%, which was close to meeting the original responsiveness goal of 25%. The response time between collection and arrival in the laboratory decreased by 8%. Applicable laboratory-related incident reports were reduced by 43%. Comprehensive application of quality tools, such as statistical control charts, Pareto diagrams, value-stream maps, process failure modes and effects analyses, fishbone diagrams, solution prioritization matrices, and customer satisfaction surveys can significantly improve preset goals for inpatient phlebotomy.

Using Neuropsychological Process Scores to Identify Subtle Cognitive Decline and Predict Progression to Mild Cognitive Impairment.

PubMed

Thomas, Kelsey R; Edmonds, Emily C; Eppig, Joel; Salmon, David P; Bondi, Mark W

2018-05-26

We previously operationally-defined subtle cognitive decline (SCD) in preclinical Alzheimer's disease (AD) using total scores on neuropsychological (NP) tests. NP process scores (i.e., provide information about how a total NP score was achieved) may be a useful tool for identifying early cognitive inefficiencies prior to objective impairment seen in mild cognitive impairment (MCI) and dementia. We aimed to integrate process scores into the SCD definition to identify stages of SCD and improve early detection of those at risk for decline. Cognitively "normal" participants from the Alzheimer's Disease Neuroimaging Initiative were classified as "early" SCD (E-SCD; >1 SD below mean on 2 process scores or on 1 process score plus 1 NP total score), "late" SCD (L-SCD; existing SCD criteria of >1 SD below norm-adjusted mean on 2 NP total scores in different domains), or "no SCD" (NC). Process scores considered in the SCD criteria were word-list intrusion errors, retroactive interference, and learning slope. Cerebrospinal fluid AD biomarkers were used to examine pathologic burden across groups. E-SCD and L-SCD progressed to MCI 2.5-3.4 times faster than the NC group. Survival curves for E-SCD and L-SCD converged at 7-8 years after baseline. The combined (E-SCD+L-SCD) group had improved sensitivity to detect progression to MCI relative to L-SCD only. AD biomarker positivity increased across NC, SCD, and MCI groups. Process scores can be integrated into the SCD criteria to allow for increased sensitivity and earlier identification of cognitively normal older adults at risk for decline prior to frank impairment on NP total scores.

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery.

PubMed

Wei, A C; Devitt, K S; Wiebe, M; Bathe, O F; McLeod, R S; Urbach, D R

2014-04-01

Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery.

Identifying geochemical processes using End Member Mixing Analysis to decouple chemical components for mixing ratio calculations

NASA Astrophysics Data System (ADS)

Pelizardi, Flavia; Bea, Sergio A.; Carrera, Jesús; Vives, Luis

2017-07-01

Mixing calculations (i.e., the calculation of the proportions in which end-members are mixed in a sample) are essential for hydrological research and water management. However, they typically require the use of conservative species, a condition that may be difficult to meet due to chemical reactions. Mixing calculation also require identifying end-member waters, which is usually achieved through End Member Mixing Analysis (EMMA). We present a methodology to help in the identification of both end-members and such reactions, so as to improve mixing ratio calculations. The proposed approach consists of: (1) identifying the potential chemical reactions with the help of EMMA; (2) defining decoupled conservative chemical components consistent with those reactions; (3) repeat EMMA with the decoupled (i.e., conservative) components, so as to identify end-members waters; and (4) computing mixing ratios using the new set of components and end-members. The approach is illustrated by application to two synthetic mixing examples involving mineral dissolution and cation exchange reactions. Results confirm that the methodology can be successfully used to identify geochemical processes affecting the mixtures, thus improving the accuracy of mixing ratios calculations and relaxing the need for conservative species.

Fermentation process improvement of a Chinese traditional food: soybean residue cake.

PubMed

Yao, Yingzheng; Pan, Siyi; Wang, Kexing; Xu, Xiaoyun

2010-09-01

Fermentation process improvement of soybean residue cake, a Chinese traditional fermented food, and its physicochemical analysis during fermentation were studied. One of the dominant strains in the fermentation was isolated and identified as Mucor racemosus Fresenius. The fermentation process was improved by subsection fermentation. The crude protein content decreased from 19.95 ± 0.03% in the raw soybean residue to 16.85 ± 0.10% in the fermented products, and the formaldehyde nitrogen content increased from 0.068 ± 0.004% to 0.461 ± 0.022% in final fermented cakes. Hardness of samples significantly (P < 0.05) increased whereas springiness, cohesiveness, and resilience significantly (P < 0.05) decreased with increasing fermentation time, respectively. Microstructure observations showed obvious change of the surface of cake samples during the fermentation process. During the soybean processing, it will produce plenty of by-products, and the most part of them is soybean residue. The discarded soybean residue causes economic loss. Fortunately, we can obtain nutritious and delicious fermented soybean residue cakes by fermenting soybean residue as raw material.

Process Improvement: Customer Service.

PubMed

Cull, Donald

2015-01-01

Utilizing the comment section of patient satisfaction surveys, Clark Memorial Hospital in Jeffersonville, IN went through a thoughtful process to arrive at an experience that patients said they wanted. Two Lean Six Sigma tools were used--the Voice of the Customer (VoC) and the Affinity Diagram. Even when using these tools, a facility will not be able to accomplish everything the patient may want. Guidelines were set and rules were established for the Process Improvement Team in order to lessen frustration, increase focus, and ultimately be successful. The project's success is driven by the team members carrying its message back to their areas. It's about ensuring that everyone is striving to improve the patients' experience by listening to what they say is being done right and what they say can be done better. And then acting on it.

Preparing systems engineering and computing science students in disciplined methods, quantitative, and advanced statistical techniques to improve process performance

NASA Astrophysics Data System (ADS)

McCray, Wilmon Wil L., Jr.

The research was prompted by a need to conduct a study that assesses process improvement, quality management and analytical techniques taught to students in U.S. colleges and universities undergraduate and graduate systems engineering and the computing science discipline (e.g., software engineering, computer science, and information technology) degree programs during their academic training that can be applied to quantitatively manage processes for performance. Everyone involved in executing repeatable processes in the software and systems development lifecycle processes needs to become familiar with the concepts of quantitative management, statistical thinking, process improvement methods and how they relate to process-performance. Organizations are starting to embrace the de facto Software Engineering Institute (SEI) Capability Maturity Model Integration (CMMI RTM) Models as process improvement frameworks to improve business processes performance. High maturity process areas in the CMMI model imply the use of analytical, statistical, quantitative management techniques, and process performance modeling to identify and eliminate sources of variation, continually improve process-performance; reduce cost and predict future outcomes. The research study identifies and provides a detail discussion of the gap analysis findings of process improvement and quantitative analysis techniques taught in U.S. universities systems engineering and computing science degree programs, gaps that exist in the literature, and a comparison analysis which identifies the gaps that exist between the SEI's "healthy ingredients " of a process performance model and courses taught in U.S. universities degree program. The research also heightens awareness that academicians have conducted little research on applicable statistics and quantitative techniques that can be used to demonstrate high maturity as implied in the CMMI models. The research also includes a Monte Carlo simulation optimization

Improving Working Memory and Processing Speed of Students with Dyslexia in Nigeria

ERIC Educational Resources Information Center

Adubasim, Ijeoma

2018-01-01

This study investigated effective strategies for improving working memory and processing speed of students identified with dyslexia in Nigeria. The study adopted a quasi-experimental research design with the population made up of twenty four thousand seven hundred and twenty seven (24,727) senior secondary school students (S.S.2) in all the public…

Application Process Improvement Yields Results.

ERIC Educational Resources Information Center

Holesovsky, Jan Paul

1995-01-01

After a continuing effort to improve its grant application process, the department of medical microbiology and immunology at the University of Wisconsin-Madison is submitting many more applications and realizing increased funding. The methods and strategy used to make the process more efficient and effective are outlined. (Author/MSE)

Development of procedures for identifying high-crash locations and prioritizing safety improvements

DOT National Transportation Integrated Search

2003-06-01

The objectives of this study were to review and analyze the current procedures for identifying high-crash locations and evaluating and prioritizing roadway safety improvements at high-crash locations, and to recommend improved methods. Several tasks ...

Development of procedures for identifying high-crash locations and prioritizing safety improvements.

DOT National Transportation Integrated Search

2003-06-01

The objectives of this study were to review and analyze the current procedures for identifying high-crash locations and evaluating and prioritizing roadway safety improvements at high-crash locations, and to recommend improved methods. Several tasks ...

Ethnographic process evaluation of a quality improvement project to improve transitions of care for older people.

PubMed

Sutton, Elizabeth; Dixon-Woods, Mary; Tarrant, Carolyn

2016-08-04

Quality improvement projects to address transitions of care across care boundaries are increasingly common but meet with mixed success for reasons that are poorly understood. We aimed to characterise challenges in a project to improve transitions for older people between hospital and care homes. Independent process evaluation, using ethnographic observations and interviews, of a quality improvement project. An English hospital and two residential care homes for older people. 32 hours of non-participant observations and 12 semistructured interviews with project members, hospital and care home staff. A hospital-based improvement team sought to reduce unplanned readmissions from residential care homes using interventions including a community-based geriatric team that could be accessed directly by care homes and a communication tool intended to facilitate transfer of information between homes and hospital. Only very modest (if any) impacts of these interventions on readmission rates could be detected. The process evaluation identified multiple challenges in implementing interventions and securing improvement. Many of these arose because of lack of consensus on the nature of the problem and the proper solutions: while the hospital team was keen to reduce readmissions and saw the problems as lying in poor communication and lack of community-based support for care homes, the care home staff had different priorities. Care home staff were unconvinced that the improvement interventions were aligned with their needs or addressed their concerns, resulting in compromised implementation. Process evaluations have a valuable role in quality improvement. Our study suggests that a key task for quality improvement projects aimed at transitions of care is that of developing a shared view of the problem to be addressed. A more participatory approach could help to surface assumptions, interpretations and interests and could facilitate the coproduction of solutions. This finding is

Teacher Research as Continuous Process Improvement

ERIC Educational Resources Information Center

Ellis, Charles; Castle, Kathryn

2010-01-01

Purpose: Teacher research (inquiry) has been characterized as practice improvement, professional development and action research, among numerous names and descriptions. The purpose of this paper is to support the case that teacher research is also a form of quality improvement known as continuous process improvement (CPI).…

Surgical process improvement tools: defining quality gaps and priority areas in gastrointestinal cancer surgery

PubMed Central

Wei, A.C.; Devitt, K.S.; Wiebe, M.; Bathe, O.F.; McLeod, R.S.; Urbach, D.R.

2014-01-01

Background Surgery is a cornerstone of cancer treatment, but significant differences in the quality of surgery have been reported. Surgical process improvement tools (spits) modify the processes of care as a means to quality improvement (qi). We were interested in developing spits in the area of gastrointestinal (gi) cancer surgery. We report the recommendations of an expert panel held to define quality gaps and establish priority areas that would benefit from spits. Methods The present study used the knowledge-to-action cycle was as a framework. Canadian experts in qi and in gi cancer surgery were assembled in a nominal group workshop. Participants evaluated the merits of spits, described gaps in current knowledge, and identified and ranked processes of care that would benefit from qi. A qualitative analysis of the workshop deliberations using modified grounded theory methods identified major themes. Results The expert panel consisted of 22 participants. Experts confirmed that spits were an important strategy for qi. The top-rated spits included clinical pathways, electronic information technology, and patient safety tools. The preferred settings for use of spits included preoperative and intraoperative settings and multidisciplinary contexts. Outcomes of interest were cancer-related outcomes, process, and the technical quality of surgery measures. Conclusions Surgical process improvement tools were confirmed as an important strategy. Expert panel recommendations will be used to guide future research efforts for spits in gi cancer surgery. PMID:24764704

Identifying strategies to improve the effectiveness of booster seat laws

DOT National Transportation Integrated Search

2008-05-01

The objective of this project was to identify strategies to improve the effectiveness of booster seat laws. The project explored the possible factors that relate to the use and nonuse of booster seats, and examined the attitudes of law enforcement of...

Harnessing Biomedical Natural Language Processing Tools to Identify Medicinal Plant Knowledge from Historical Texts.

PubMed

Sharma, Vivekanand; Law, Wayne; Balick, Michael J; Sarkar, Indra Neil

2017-01-01

The growing amount of data describing historical medicinal uses of plants from digitization efforts provides the opportunity to develop systematic approaches for identifying potential plant-based therapies. However, the task of cataloguing plant use information from natural language text is a challenging task for ethnobotanists. To date, there have been only limited adoption of informatics approaches used for supporting the identification of ethnobotanical information associated with medicinal uses. This study explored the feasibility of using biomedical terminologies and natural language processing approaches for extracting relevant plant-associated therapeutic use information from historical biodiversity literature collection available from the Biodiversity Heritage Library. The results from this preliminary study suggest that there is potential utility of informatics methods to identify medicinal plant knowledge from digitized resources as well as highlight opportunities for improvement.

Harnessing Biomedical Natural Language Processing Tools to Identify Medicinal Plant Knowledge from Historical Texts

PubMed Central

Sharma, Vivekanand; Law, Wayne; Balick, Michael J.; Sarkar, Indra Neil

2017-01-01

The growing amount of data describing historical medicinal uses of plants from digitization efforts provides the opportunity to develop systematic approaches for identifying potential plant-based therapies. However, the task of cataloguing plant use information from natural language text is a challenging task for ethnobotanists. To date, there have been only limited adoption of informatics approaches used for supporting the identification of ethnobotanical information associated with medicinal uses. This study explored the feasibility of using biomedical terminologies and natural language processing approaches for extracting relevant plant-associated therapeutic use information from historical biodiversity literature collection available from the Biodiversity Heritage Library. The results from this preliminary study suggest that there is potential utility of informatics methods to identify medicinal plant knowledge from digitized resources as well as highlight opportunities for improvement. PMID:29854223

Advanced Practice Nursing Committee on Process Improvement in Trauma: An Innovative Application of the Strong Model.

PubMed

West, Sarah Katherine

2016-01-01

This article aims to summarize the successes and future implications for a nurse practitioner-driven committee on process improvement in trauma. The trauma nurse practitioner is uniquely positioned to recognize the need for clinical process improvement and enact change within the clinical setting. Application of the Strong Model of Advanced Practice proves to actively engage the trauma nurse practitioner in process improvement initiatives. Through enhancing nurse practitioner professional engagement, the committee aims to improve health care delivery to the traumatically injured patient. A retrospective review of the committee's first year reveals trauma nurse practitioner success in the domains of direct comprehensive care, support of systems, education, and leadership. The need for increased trauma nurse practitioner involvement has been identified for the domains of research and publication.

Improving performances of the knee replacement surgery process by applying DMAIC principles.

PubMed

Improta, Giovanni; Balato, Giovanni; Romano, Maria; Ponsiglione, Alfonso Maria; Raiola, Eliana; Russo, Mario Alessandro; Cuccaro, Patrizia; Santillo, Liberatina Carmela; Cesarelli, Mario

2017-12-01

The work is a part of a project about the application of the Lean Six Sigma to improve health care processes. A previously published work regarding the hip replacement surgery has shown promising results. Here, we propose an application of the DMAIC (Define, Measure, Analyse, Improve, and Control) cycle to improve quality and reduce costs related to the prosthetic knee replacement surgery by decreasing patients' length of hospital stay (LOS) METHODS: The DMAIC cycle has been adopted to decrease the patients' LOS. The University Hospital "Federico II" of Naples, one of the most important university hospitals in Southern Italy, participated in this study. Data on 148 patients who underwent prosthetic knee replacement between 2010 and 2013 were used. Process mapping, statistical measures, brainstorming activities, and comparative analysis were performed to identify factors influencing LOS and improvement strategies. The study allowed the identification of variables influencing the prolongation of the LOS and the implementation of corrective actions to improve the process of care. The adopted actions reduced the LOS by 42%, from a mean value of 14.2 to 8.3 days (standard deviation also decreased from 5.2 to 2.3 days). The DMAIC approach has proven to be a helpful strategy ensuring a significant decreasing of the LOS. Furthermore, through its implementation, a significant reduction of the average costs of hospital stay can be achieved. Such a versatile approach could be applied to improve a wide range of health care processes. © 2017 John Wiley & Sons, Ltd.

[Applying healthcare failure mode and effect analysis to improve the surgical specimen transportation process and rejection rate].

PubMed

Hu, Pao-Hsueh; Hu, Hsiao-Chen; Huang, Hui-Ju; Chao, Hui-Lin; Lei, Ei-Fang

2014-04-01

Because surgical pathology specimens are crucial to the diagnosis and treatment of disease, it is critical that they be collected and transported safely and securely. Due to recent near-miss events in our department, we used the healthcare failure model and effect analysis to identify 14 potential perils in the specimen collection and transportation process. Improvement and prevention strategies were developed accordingly to improve quality of care. Using health care failure mode and effect analysis (HFMEA) may improve the surgical specimen transportation process and reduce the rate of surgical specimen rejection. Rectify standard operating procedures for surgical pathology specimen collection and transportation. Create educational videos and posters. Rectify methods of specimen verification. Organize and create an online and instantaneous management system for specimen tracking and specimen rejection. Implementation of the new surgical specimen transportation process effectively eliminated the 14 identified potential perils. In addition, the specimen rejection fell from 0.86% to 0.03%. This project was applied to improve the specimen transportation process, enhance interdisciplinary cooperation, and improve the patient-centered healthcare system. The creation and implementation of an online information system significantly facilitates specimen tracking, hospital cost reductions, and patient safety improvements. The success in our department is currently being replicated across all departments in our hospital that transport specimens. Our experience and strategy may be applied to inter-hospital specimen transportation in the future.

An Ontology for Identifying Cyber Intrusion Induced Faults in Process Control Systems

NASA Astrophysics Data System (ADS)

Hieb, Jeffrey; Graham, James; Guan, Jian

This paper presents an ontological framework that permits formal representations of process control systems, including elements of the process being controlled and the control system itself. A fault diagnosis algorithm based on the ontological model is also presented. The algorithm can identify traditional process elements as well as control system elements (e.g., IP network and SCADA protocol) as fault sources. When these elements are identified as a likely fault source, the possibility exists that the process fault is induced by a cyber intrusion. A laboratory-scale distillation column is used to illustrate the model and the algorithm. Coupled with a well-defined statistical process model, this fault diagnosis approach provides cyber security enhanced fault diagnosis information to plant operators and can help identify that a cyber attack is underway before a major process failure is experienced.

Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin.

PubMed

Borchert, Matthias; Goufodji, Sourou; Alihonou, Eusèbe; Delvaux, Thérèse; Saizonou, Jacques; Kanhonou, Lydie; Filippi, Véronique

2012-10-11

Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. We analysed case summaries, women's interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established.

Can hospital audit teams identify case management problems, analyse their causes, identify and implement improvements? A cross-sectional process evaluation of obstetric near-miss case reviews in Benin

PubMed Central

2012-01-01

Background Obstetric near-miss case reviews are being promoted as a quality assurance intervention suitable for hospitals in low income countries. We introduced such reviews in five district, regional and national hospitals in Benin, West Africa. In a cross-sectional study we analysed the extent to which the hospital audit teams were able to identify case management problems (CMPs), analyse their causes, agree on solutions and put these solutions into practice. Methods We analysed case summaries, women’s interview transcripts and audit minutes produced by the audit teams for 67 meetings concerning one woman with near-miss complications each. We compared the proportion of CMPs identified by an external assessment team to the number found by the audit teams. For the latter, we described the CMP causes identified, solutions proposed and implemented by the audit teams. Results Audit meetings were conducted regularly and were well attended. Audit teams identified half of the 714 CMPs; they were more likely to find managerial ones (71%) than the ones relating to treatment (30%). Most identified CMPs were valid. Almost all causes of CMPs were plausible, but often too superficial to be of great value for directing remedial action. Audit teams suggested solutions, most of them promising ones, for 38% of the CMPs they had identified, but recorded their implementation only for a minority (8.5%). Conclusions The importance of following-up and documenting the implementation of solutions should be stressed in future audit interventions. Tools facilitating the follow-up should be made available. Near-miss case reviews hold promise, but their effectiveness to improve the quality of care sustainably and on a large scale still needs to be established. PMID:23057707

Improving Students’ Science Process Skills through Simple Computer Simulations on Linear Motion Conceptions

NASA Astrophysics Data System (ADS)

Siahaan, P.; Suryani, A.; Kaniawati, I.; Suhendi, E.; Samsudin, A.

2017-02-01

The purpose of this research is to identify the development of students’ science process skills (SPS) on linear motion concept by utilizing simple computer simulation. In order to simplify the learning process, the concept is able to be divided into three sub-concepts: 1) the definition of motion, 2) the uniform linear motion and 3) the uniformly accelerated motion. This research was administered via pre-experimental method with one group pretest-posttest design. The respondents which were involved in this research were 23 students of seventh grade in one of junior high schools in Bandung City. The improving process of students’ science process skill is examined based on normalized gain analysis from pretest and posttest scores for all sub-concepts. The result of this research shows that students’ science process skills are dramatically improved by 47% (moderate) on observation skill; 43% (moderate) on summarizing skill, 70% (high) on prediction skill, 44% (moderate) on communication skill and 49% (moderate) on classification skill. These results clarify that the utilizing simple computer simulations in physics learning is be able to improve overall science skills at moderate level.

Improving the preparticipation exam process.

PubMed

Reed, F E

2001-08-01

The Preparticipation Exam for too long has been a mandatory yearly athletic exam and not the base from which a process of continuous athletic care took place. The purpose of this article is not only to introduce improvements in the exam itself but to also describe some extensions of the process that allow us to improve athletic care in South Carolina. It is hoped that a software scanning program will allow compiling of demographic data from individual and group examinations and thus support the method of exam preferred by all physicians in our state. Standard forms will also facilitate communication within the Athletic Care Unit and between physicians involved in athletic care.

Report: Agency-Wide Application of Region 7 NPDES Program Process Improvements Could Increase EPA Efficiency

EPA Pesticide Factsheets

Report #11-P-0315, July 6, 2011. Although Region 7 NPDES Kaizen event participants continued to follow up on the commitments and action items identified, no single authority was responsible for tracking the process improvement outcomes.

Improved compression molding process

NASA Technical Reports Server (NTRS)

Heier, W. C.

1967-01-01

Modified compression molding process produces plastic molding compounds that are strong, homogeneous, free of residual stresses, and have improved ablative characteristics. The conventional method is modified by applying a vacuum to the mold during the molding cycle, using a volatile sink, and exercising precise control of the mold closure limits.

Capability Maturity Model (CMM) for Software Process Improvements

NASA Technical Reports Server (NTRS)

Ling, Robert Y.

2000-01-01

This slide presentation reviews the Avionic Systems Division's implementation of the Capability Maturity Model (CMM) for improvements in the software development process. The presentation reviews the process involved in implementing the model and the benefits of using CMM to improve the software development process.

Improving Science Pedagogic Quality in Elementary School Using Process Skill Approach Can Motivate Student to Be Active in Learning

ERIC Educational Resources Information Center

Sukiniarti

2016-01-01

On global era todays, as the professional teacher should be improving their pedagogic competency, including to improve their science pedagogy quality. This study is aimed to identify: (1) Process skill approach which has been used by Elementary School Teacher in science learning; (2) Teacher's opinion that process skill can motivate the student to…

[Improving the continuous care process in primary care during weekends and holidays: redesigning and FMEA].

PubMed

Cañada Dorado, A; Cárdenas Valladolid, J; Espejo Matorrales, F; García Ferradal, I; Sastre Páez, S; Vicente Martín, I

2010-01-01

To describe a project carried out in order to improve the process of Continuous Health Care (CHC) on Saturdays and bank holidays in Primary Care, area number 4, Madrid. The aim of this project was to guarantee a safe and error-free service to patients receiving home health care on weekends. The urgent need for improving CHC process was identified by the Risk Management Functional Unit (RMFU) of the area. In addition, some complaints had been received from the nurses involved in the process as well as from their patients. A SWOT (Strengths, Weaknesses, Opportunities and Threats) analysis performed in 2009 highlighted a number of problems with the process. As a result, a project for improvement was drawn up, to be implemented in the following stages: 1. Redesigning and improving the existing process. 2. Application of failure mode and effect analysis (FMEA) to the new process. 3. Follow up, managing and leading the project. 4. Nurse training. 5. Implementing the process in the whole area. 6. CHC nurse satisfaction surveys. After carrying out this project, the efficiency and level of automation improved considerably. Since implementation of the process enhancement measures, no complaints have been received from patients and surveys show that CHC nurse satisfaction has improved. By using FMEA, errors were given priority and enhancement steps were taken in order to: Inform professionals, back-up personnel and patients about the process. Improve the specialist follow-up report. Provide training in ulcer patient care. The process enhancement, and especially its automation, has resulted in a significant step forward toward achieving greater patient safety. FMEA was a useful tool, which helped in taking some important actions. Finally, CHC nurse satisfaction has clearly improved. Copyright © 2009 SECA. Published by Elsevier Espana. All rights reserved.

Identifying improvements to complex pathways: evidence synthesis and stakeholder engagement in infant congenital heart disease

PubMed Central

Crowe, Sonya; Knowles, Rachel; Wray, Jo; Tregay, Jenifer; Ridout, Deborah A; Utley, Martin; Franklin, Rodney; Bull, Catherine L; Brown, Katherine L

2016-01-01

Objectives Many infants die in the year following discharge from hospital after surgical or catheter intervention for congenital heart disease (3–5% of discharged infants). There is considerable variability in the provision of care and support in this period, and some families experience barriers to care. We aimed to identify ways to improve discharge and postdischarge care for this patient group. Design A systematic evidence synthesis aligned with a process of eliciting the perspectives of families and professionals from community, primary, secondary and tertiary care. Setting UK. Results A set of evidence-informed recommendations for improving the discharge and postdischarge care of infants following intervention for congenital heart disease was produced. These address known challenges with current care processes and, recognising current resource constraints, are targeted at patient groups based on the number of patients affected and the level and nature of their risk of adverse 1-year outcome. The recommendations include: structured discharge documentation, discharging certain high-risk patients via their local hospital, enhanced surveillance for patients with certain (high-risk) cardiac diagnoses and an early warning tool for parents and community health professionals. Conclusions Our recommendations set out a comprehensive, system-wide approach for improving discharge and postdischarge services. This approach could be used to address challenges in delivering care for other patient populations that can fall through gaps between sectors and organisations. PMID:27266768

Use of Process Improvement Tools in Radiology.

PubMed

Rawson, James V; Kannan, Amogha; Furman, Melissa

2016-01-01

Process improvement techniques are common in manufacturing and industry. Over the past few decades these principles have been slowly introduced in select health care settings. This article reviews the Plan, Do, Study, and Act cycle, Six Sigma, the System of Profound Knowledge, Lean, and the theory of constraints. Specific process improvement tools in health care and radiology are presented in the order the radiologist is likely to encounter them in an improvement project. Copyright © 2015 Mosby, Inc. All rights reserved.

Reducing Bottlenecks to Improve the Efficiency of the Lung Cancer Care Delivery Process: A Process Engineering Modeling Approach to Patient-Centered Care.

PubMed

Ju, Feng; Lee, Hyo Kyung; Yu, Xinhua; Faris, Nicholas R; Rugless, Fedoria; Jiang, Shan; Li, Jingshan; Osarogiagbon, Raymond U

2017-12-01

The process of lung cancer care from initial lesion detection to treatment is complex, involving multiple steps, each introducing the potential for substantial delays. Identifying the steps with the greatest delays enables a focused effort to improve the timeliness of care-delivery, without sacrificing quality. We retrospectively reviewed clinical events from initial detection, through histologic diagnosis, radiologic and invasive staging, and medical clearance, to surgery for all patients who had an attempted resection of a suspected lung cancer in a community healthcare system. We used a computer process modeling approach to evaluate delays in care delivery, in order to identify potential 'bottlenecks' in waiting time, the reduction of which could produce greater care efficiency. We also conducted 'what-if' analyses to predict the relative impact of simulated changes in the care delivery process to determine the most efficient pathways to surgery. The waiting time between radiologic lesion detection and diagnostic biopsy, and the waiting time from radiologic staging to surgery were the two most critical bottlenecks impeding efficient care delivery (more than 3 times larger compared to reducing other waiting times). Additionally, instituting surgical consultation prior to cardiac consultation for medical clearance and decreasing the waiting time between CT scans and diagnostic biopsies, were potentially the most impactful measures to reduce care delays before surgery. Rigorous computer simulation modeling, using clinical data, can provide useful information to identify areas for improving the efficiency of care delivery by process engineering, for patients who receive surgery for lung cancer.

Selecting Health Care Improvement Projects: A Methodology Integrating Cause-and-Effect Diagram and Analytical Hierarchy Process.

PubMed

Testik, Özlem Müge; Shaygan, Amir; Dasdemir, Erdi; Soydan, Guray

It is often vital to identify, prioritize, and select quality improvement projects in a hospital. Yet, a methodology, which utilizes experts' opinions with different points of view, is needed for better decision making. The proposed methodology utilizes the cause-and-effect diagram to identify improvement projects and construct a project hierarchy for a problem. The right improvement projects are then prioritized and selected using a weighting scheme of analytical hierarchy process by aggregating experts' opinions. An approach for collecting data from experts and a graphical display for summarizing the obtained information are also provided. The methodology is implemented for improving a hospital appointment system. The top-ranked 2 major project categories for improvements were identified to be system- and accessibility-related causes (45%) and capacity-related causes (28%), respectively. For each of the major project category, subprojects were then ranked for selecting the improvement needs. The methodology is useful in cases where an aggregate decision based on experts' opinions is expected. Some suggestions for practical implementations are provided.

Audit filters for improving processes of care and clinical outcomes in trauma systems.

PubMed

Evans, Christopher; Howes, Daniel; Pickett, William; Dagnone, Luigi

2009-10-07

intervention for improving processes of care, morbidity, or mortality for severely injured patients. Two authors independently screened the search results, applied inclusion criteria, and extracted data. There were no studies identified that met the inclusion criteria for this review. We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.

A new process sensitivity index to identify important system processes under process model and parametric uncertainty

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dai, Heng; Ye, Ming; Walker, Anthony P.

Hydrological models are always composed of multiple components that represent processes key to intended model applications. When a process can be simulated by multiple conceptual-mathematical models (process models), model uncertainty in representing the process arises. While global sensitivity analysis methods have been widely used for identifying important processes in hydrologic modeling, the existing methods consider only parametric uncertainty but ignore the model uncertainty for process representation. To address this problem, this study develops a new method to probe multimodel process sensitivity by integrating the model averaging methods into the framework of variance-based global sensitivity analysis, given that the model averagingmore » methods quantify both parametric and model uncertainty. A new process sensitivity index is derived as a metric of relative process importance, and the index includes variance in model outputs caused by uncertainty in both process models and model parameters. For demonstration, the new index is used to evaluate the processes of recharge and geology in a synthetic study of groundwater reactive transport modeling. The recharge process is simulated by two models that converting precipitation to recharge, and the geology process is also simulated by two models of different parameterizations of hydraulic conductivity; each process model has its own random parameters. The new process sensitivity index is mathematically general, and can be applied to a wide range of problems in hydrology and beyond.« less

Improving Metal Casting Process

NASA Technical Reports Server (NTRS)

1998-01-01

Don Sirois, an Auburn University research associate, and Bruce Strom, a mechanical engineering Co-Op Student, are evaluating the dimensional characteristics of an aluminum automobile engine casting. More accurate metal casting processes may reduce the weight of some cast metal products used in automobiles, such as engines. Research in low gravity has taken an important first step toward making metal products used in homes, automobiles, and aircraft less expensive, safer, and more durable. Auburn University and industry are partnering with NASA to develop one of the first accurate computer model predictions of molten metals and molding materials used in a manufacturing process called casting. Ford Motor Company's casting plant in Cleveland, Ohio is using NASA-sponsored computer modeling information to improve the casting process of automobile and light-truck engine blocks.

Pilot Guidelines for Improving Instructional Materials Through the Process of Learner Verification and Revision.

ERIC Educational Resources Information Center

Educational Products Information Exchange Inst., Stony Brook, NY.

Learner Verification and Revision (LVR) Process of Instructional Materials is an ongoing effort for the improvement of instructional materials based on systematic feedback from learners who have used the materials. This evaluation gives publishers a method of identifying instructional strengths and weaknesses of a product and provides an…

Systematic donor selection review process improves cardiac transplant volumes and outcomes.

PubMed

Smith, Jason W; O'Brien, Kevin D; Dardas, Todd; Pal, Jay D; Fishbein, Daniel P; Levy, Wayne C; Mahr, Claudius; Masri, Sofia C; Cheng, Richard K; Stempien-Otero, April; Mokadam, Nahush A

2016-01-01

Heart transplant remains the definitive therapy for advanced heart failure patients but is limited by organ availability. We identified a large number of donor hearts from our organ procurement organization (OPO) being exported to other regions. We engaged a multidisciplinary team including transplant surgeons, cardiologists, and our OPO colleagues to identify opportunities to improve our center-specific organ utilization rate. We performed a retrospective analysis of donor offers before and after institution of a novel review process. Each donor offer made to our program was reviewed on a monthly basis from July 2013 to June 2014 and compared with the previous year. This review process resulted in a transplant utilization rate of 28% for period 1 versus 49% for period 2 (P = .007). Limiting the analysis to offers from our local OPO changed our utilization rate from 46% to 75% (P = .02). Transplant volume increased from 22 to 35 between the 2 study periods. Thirty-day and 1-year mortality were unchanged over the 2 periods. A total of 58 hearts were refused by our center and transplanted at other centers. During period 1, the 30-day and 1-year survival rates for recipients of those organs were 98% and 90%, respectively, comparable with our historical survival data. The simple process of systematically reviewing donor turndown events as a group tended to reduce variability, increase confidence in expanded criteria for donors, and resulted in improved donor organ utilization and transplant volumes. Copyright © 2016 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Developing an Interdisciplinary, Team-Based Quality Improvement Leadership Training Program for Clinicians: The Partners Clinical Process Improvement Leadership Program.

PubMed

Rao, Sandhya K; Carballo, Victoria; Cummings, Brian M; Millham, Frederick; Jacobson, Joseph O

Although there has been tremendous progress in quality improvement (QI) education for students and trainees in recent years, much less has been published regarding the training of active clinicians in QI. The Partners Clinical Process Improvement Leadership Program (CPIP) is a 6-day experiential program. Interdisciplinary teams complete a QI project framed by didactic sessions, interactive exercises, case-based problem sessions, and a final presentation. A total of 239 teams composed of 516 individuals have graduated CPIP. On completion, participant satisfaction scores average 4.52 (scale 1-5) and self-reported understanding of QI concepts improved. At 6 months after graduation, 66% of survey respondents reported sustained QI activity. Three opportunities to improve the program have been identified: (1) increasing faculty participation through online and tiered course offerings, (2) integrating the faculty-focused program with the trainee curriculum, and (3) developing a postgraduate curriculum to address the challenges of sustained improvement.

Health-care process improvement decisions: a systems perspective.

PubMed

Walley, Paul; Silvester, Kate; Mountford, Shaun

2006-01-01

The paper seeks to investigate decision-making processes within hospital improvement activity, to understand how performance measurement systems influence decisions and potentially lead to unsuccessful or unsustainable process changes. A longitudinal study over a 33-month period investigates key events, decisions and outcomes at one medium-sized hospital in the UK. Process improvement events are monitored using process control methods and by direct observation. The authors took a systems perspective of the health-care processes, ensuring that the impacts of decisions across the health-care supply chain were appropriately interpreted. The research uncovers the ways in which measurement systems disguise failed decisions and encourage managers to take a low-risk approach of "symptomatic relief" when trying to improve performance metrics. This prevents many managers from trying higher risk, sustainable process improvement changes. The behaviour of the health-care system is not understood by many managers and this leads to poor analysis of problem situations. Measurement using time-series methodologies, such as statistical process control are vital for a better understanding of the systems impact of changes. Senior managers must also be aware of the behavioural influence of similar performance measurement systems that discourage sustainable improvement. There is a risk that such experiences will tarnish the reputation of performance management as a discipline. Recommends process control measures as a way of creating an organization memory of how decisions affect performance--something that is currently lacking.

An Aspect-Oriented Framework for Business Process Improvement

NASA Astrophysics Data System (ADS)

Pourshahid, Alireza; Mussbacher, Gunter; Amyot, Daniel; Weiss, Michael

Recently, many organizations invested in Business Process Management Systems (BPMSs) in order to automate and monitor their processes. Business Activity Monitoring is one of the essential modules of a BPMS as it provides the core monitoring capabilities. Although the natural step after process monitoring is process improvement, most of the existing systems do not provide the means to help users with the improvement step. In this paper, we address this issue by proposing an aspect-oriented framework that allows the impact of changes to business processes to be explored with what-if scenarios based on the most appropriate process redesign patterns among several possibilities. As the four cornerstones of a BPMS are process, goal, performance and validation views, these views need to be aligned automatically by any approach that intends to support automated improvement of business processes. Our framework therefore provides means to reflect process changes also in the other views of the business process. A health care case study presented as a proof of concept suggests that this novel approach is feasible.

Improving the treatment planning and delivery process of Xoft electronic skin brachytherapy.

PubMed

Manger, Ryan; Rahn, Douglas; Hoisak, Jeremy; Dragojević, Irena

2018-05-14

To develop an improved Xoft electronic skin brachytherapy process and identify areas of further improvement. A multidisciplinary team conducted a failure modes and effects analysis (FMEA) by developing a process map and a corresponding list of failure modes. The failure modes were scored for their occurrence, severity, and detectability, and a risk priority number (RPN) was calculated for each failure mode as the product of occurrence, severity, and detectability. Corrective actions were implemented to address the higher risk failure modes, and a revised process was generated. The RPNs of the failure modes were compared between the initial process and final process to assess the perceived benefits of the corrective actions. The final treatment process consists of 100 steps and 114 failure modes. The FMEA took approximately 20 person-hours (one physician, three physicists, and two therapists) to complete. The 10 most dangerous failure modes had RPNs ranging from 336 to 630. Corrective actions were effective at addressing most failure modes (10 riskiest RPNs ranging from 189 to 310), yet the RPNs were higher than those published for alternative systems. Many of these high-risk failure modes remained due to hardware design limitations. FMEA helps guide process improvement efforts by emphasizing the riskiest steps. Significant risks are apparent when using a Xoft treatment unit for skin brachytherapy due to hardware limitations such as the lack of several interlocks, a short source lifespan, and variability in source output. The process presented in this article is expected to reduce but not eliminate these risks. Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

EUV process improvement with novel litho track hardware

NASA Astrophysics Data System (ADS)

Stokes, Harold; Harumoto, Masahiko; Tanaka, Yuji; Kaneyama, Koji; Pieczulewski, Charles; Asai, Masaya

2017-03-01

Currently, there are many developments in the field of EUV lithography that are helping to move it towards increased HVM feasibility. Targeted improvements in hardware design for advanced lithography are of interest to our group specifically for metrics such as CD uniformity, LWR, and defect density. Of course, our work is focused on EUV process steps that are specifically affected by litho track performance, and consequently, can be improved by litho track design improvement and optimization. In this study we are building on our experience to provide continual improvement for LWR, CDU, and Defects as applied to a standard EUV process by employing novel hardware solutions on our SOKUDO DUO coat develop track system. Although it is preferable to achieve such improvements post-etch process we feel, as many do, that improvements after patterning are a precursor to improvements after etching. We hereby present our work utilizing the SOKUDO DUO coat develop track system with an ASML NXE:3300 in the IMEC (Leuven, Belgium) cleanroom environment to improve aggressive dense L/S patterns.

Identifying Hydrologic Processes in Agricultural Watersheds Using Precipitation-Runoff Models

USGS Publications Warehouse

Linard, Joshua I.; Wolock, David M.; Webb, Richard M.T.; Wieczorek, Michael

2009-01-01

Understanding the fate and transport of agricultural chemicals applied to agricultural fields will assist in designing the most effective strategies to prevent water-quality impairments. At a watershed scale, the processes controlling the fate and transport of agricultural chemicals are generally understood only conceptually. To examine the applicability of conceptual models to the processes actually occurring, two precipitation-runoff models - the Soil and Water Assessment Tool (SWAT) and the Water, Energy, and Biogeochemical Model (WEBMOD) - were applied in different agricultural settings of the contiguous United States. Each model, through different physical processes, simulated the transport of water to a stream from the surface, the unsaturated zone, and the saturated zone. Models were calibrated for watersheds in Maryland, Indiana, and Nebraska. The calibrated sets of input parameters for each model at each watershed are discussed, and the criteria used to validate the models are explained. The SWAT and WEBMOD model results at each watershed conformed to each other and to the processes identified in each watershed's conceptual hydrology. In Maryland the conceptual understanding of the hydrology indicated groundwater flow was the largest annual source of streamflow; the simulation results for the validation period confirm this. The dominant source of water to the Indiana watershed was thought to be tile drains. Although tile drains were not explicitly simulated in the SWAT model, a large component of streamflow was received from lateral flow, which could be attributed to tile drains. Being able to explicitly account for tile drains, WEBMOD indicated water from tile drains constituted most of the annual streamflow in the Indiana watershed. The Nebraska models indicated annual streamflow was composed primarily of perennial groundwater flow and infiltration-excess runoff, which conformed to the conceptual hydrology developed for that watershed. The hydrologic

Using IT to improve quality at NewYork-Presybterian Hospital: a requirements-driven strategic planning process.

PubMed

Kuperman, Gilad J; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D; Cooper, Mary

2006-01-01

At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality.

Using IT to Improve Quality at NewYork-Presybterian Hospital: A Requirements-Driven Strategic Planning Process

PubMed Central

Kuperman, Gilad J.; Boyer, Aurelia; Cole, Curt; Forman, Bruce; Stetson, Peter D.; Cooper, Mary

2006-01-01

At NewYork-Presbyterian Hospital, we are committed to the delivery of high quality care. We have implemented a strategic planning process to determine the information technology initiatives that will best help us improve quality. The process began with the creation of a Clinical Quality and IT Committee. The Committee identified 2 high priority goals that would enable demonstrably high quality care: 1) excellence at data warehousing, and 2) optimal use of automated clinical documentation to capture encounter-related quality and safety data. For each high priority goal, a working group was created to develop specific recommendations. The Data Warehousing subgroup has recommended the implementation of an architecture management process and an improved ability for users to get access to aggregate data. The Structured Documentation subgroup is establishing recommendations for a documentation template creation process. The strategic planning process at times is slow, but assures that the organization is focusing on the information technology activities most likely to lead to improved quality. PMID:17238381

The Self in Movement: Being Identified and Identifying Oneself in the Process of Migration and Asylum Seeking.

PubMed

Watzlawik, Meike; Brescó de Luna, Ignacio

2017-06-01

How migration influences the processes of identity development has been under longstanding scrutiny in the social sciences. Usually, stage models have been suggested, and different strategies for acculturation (e.g., integration, assimilation, separation, and marginalization) have been considered as ways to make sense of the psychological transformations of migrants as a group. On an individual level, however, identity development is a more complex endeavor: Identity does not just develop by itself, but is constructed as an ongoing process. To capture these processes, we will look at different aspects of migration and asylum seeking; for example, the cultural-specific values and expectations of the hosting (European) countries (e.g., as identifier), but also of the arriving individuals/groups (e.g., identified as refugees). Since the two may contradict each other, negotiations between identities claims and identity assignments become necessary. Ways to solve these contradictions are discussed, with a special focus on the experienced (and often missing) agency in different settings upon arrival in a new country. In addition, it will be shown how sudden events (e.g., 9/11, the Charlie Hebdo attack) may challenge identity processes in different ways.

A Case Study on Improving Intensive Care Unit (ICU) Services Reliability: By Using Process Failure Mode and Effects Analysis (PFMEA)

PubMed Central

Yousefinezhadi, Taraneh; Jannesar Nobari, Farnaz Attar; Goodari, Faranak Behzadi; Arab, Mohammad

2016-01-01

Introduction: In any complex human system, human error is inevitable and shows that can’t be eliminated by blaming wrong doers. So with the aim of improving Intensive Care Units (ICU) reliability in hospitals, this research tries to identify and analyze ICU’s process failure modes at the point of systematic approach to errors. Methods: In this descriptive research, data was gathered qualitatively by observations, document reviews, and Focus Group Discussions (FGDs) with the process owners in two selected ICUs in Tehran in 2014. But, data analysis was quantitative, based on failures’ Risk Priority Number (RPN) at the base of Failure Modes and Effects Analysis (FMEA) method used. Besides, some causes of failures were analyzed by qualitative Eindhoven Classification Model (ECM). Results: Through FMEA methodology, 378 potential failure modes from 180 ICU activities in hospital A and 184 potential failures from 99 ICU activities in hospital B were identified and evaluated. Then with 90% reliability (RPN≥100), totally 18 failures in hospital A and 42 ones in hospital B were identified as non-acceptable risks and then their causes were analyzed by ECM. Conclusions: Applying of modified PFMEA for improving two selected ICUs’ processes reliability in two different kinds of hospitals shows that this method empowers staff to identify, evaluate, prioritize and analyze all potential failure modes and also make them eager to identify their causes, recommend corrective actions and even participate in improving process without feeling blamed by top management. Moreover, by combining FMEA and ECM, team members can easily identify failure causes at the point of health care perspectives. PMID:27157162

The utilization of six sigma and statistical process control techniques in surgical quality improvement.

PubMed

Sedlack, Jeffrey D

2010-01-01

Surgeons have been slow to incorporate industrial reliability techniques. Process control methods were applied to surgeon waiting time between cases, and to length of stay (LOS) after colon surgery. Waiting times between surgeries were evaluated by auditing the operating room records of a single hospital over a 1-month period. The medical records of 628 patients undergoing colon surgery over a 5-year period were reviewed. The average surgeon wait time between cases was 53 min, and the busiest surgeon spent 291/2 hr in 1 month waiting between surgeries. Process control charting demonstrated poor overall control of the room turnover process. Average LOS after colon resection also demonstrated very poor control. Mean LOS was 10 days. Weibull's conditional analysis revealed a conditional LOS of 9.83 days. Serious process management problems were identified in both analyses. These process issues are both expensive and adversely affect the quality of service offered by the institution. Process control mechanisms were suggested or implemented to improve these surgical processes. Industrial reliability and quality management tools can easily and effectively identify process control problems that occur on surgical services. © 2010 National Association for Healthcare Quality.

Improving the claims process with EDI.

PubMed

Moynihan, J J

1993-01-01

Electronic data interchange (EDI) is redefining the healthcare claims process. The traditional managerial approach to claims processing emphasizes information flow within the patient accounting department and between patient accounting and other departments. EDI enlarges the scope of the claims process to include information exchange between providers and payers. Using EDI to improve both external and internal information exchange makes the claims process more efficient and less expensive. This article is excerpted from "The Healthcare Financial Manager's Guide to Healthcare EDI," by James J. Moynihan, published by the Healthcare Financial Management Association.

Identifying Information Focuses in Listening Comprehension

ERIC Educational Resources Information Center

Zhang, Hong-yan

2011-01-01

The study explains the process of learners' listening comprehension within Halliday's information theory in functional grammar, including the skills of identifying focuses while listening in college English teaching. Identifying information focuses in listening is proved to improve the students' communicative listening ability by the means of a…

Improved Newborn Hearing Screening Follow-up Results in More Infants Identified

PubMed Central

Alam, Suhana; Gaffney, Marcus; Eichwald, John

2015-01-01

Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed. PMID:23803975

Improved newborn hearing screening follow-up results in more infants identified.

PubMed

Alam, Suhana; Gaffney, Marcus; Eichwald, John

2014-01-01

Longitudinal research suggests that efforts at the national, state, and local levels are leading to improved follow-up and data reporting. Data now support the assumption that the number of deaf or hard-of-hearing infants identified through newborn hearing screening increases with a reduction in the number of infants lost to follow-up. Documenting the receipt of services has made a noticeable impact on reducing lost to follow-up rates and early identification of infants with hearing loss; however, continued improvement and monitoring of services are still needed.

Using Statistical Process Control to Drive Improvement in Neonatal Care: A Practical Introduction to Control Charts.

PubMed

Gupta, Munish; Kaplan, Heather C

2017-09-01

Quality improvement (QI) is based on measuring performance over time, and variation in data measured over time must be understood to guide change and make optimal improvements. Common cause variation is natural variation owing to factors inherent to any process; special cause variation is unnatural variation owing to external factors. Statistical process control methods, and particularly control charts, are robust tools for understanding data over time and identifying common and special cause variation. This review provides a practical introduction to the use of control charts in health care QI, with a focus on neonatology. Copyright © 2017 Elsevier Inc. All rights reserved.

Process improvement as an investment: Measuring its worth

NASA Technical Reports Server (NTRS)

Mcgarry, Frank; Jeletic, Kellyann

1993-01-01

This paper discusses return on investment (ROI) generated from software process improvement programs. It details the steps needed to compute ROI and compares these steps from the perspective of two process improvement approaches: the widely known Software Engineering Institute's capability maturity model and the approach employed by NASA's Software Engineering Laboratory (SEL). The paper then describes the specific investments made in the SEL over the past 18 years and discusses the improvements gained from this investment by the production organization in the SEL.

Process improvement for regulatory analyses of custom-blend fertilizers.

PubMed

Wegner, Keith A

2014-01-01

Chemical testing of custom-blend fertilizers is essential to ensure that the products meet the formulation requirements. For purposes of proper crop nutrition and consumer protection, regulatory oversight promotes compliance and particular attention to blending and formulation specifications. Analyses of custom-blend fertilizer products must be performed and reported within a very narrow window in order to be effective. The Colorado Department of Agriculture's Biochemistry Laboratory is an ISO 17025 accredited facility and conducts analyses of custom-blend fertilizer products primarily during the spring planting season. Using the Lean Six Sigma (LSS) process, the Biochemistry Laboratory has reduced turnaround times from as much as 45 days to as little as 3 days. The LSS methodology focuses on waste reduction through identifying: non-value-added steps, unneeded process reviews, optimization of screening and confirmatory analyses, equipment utilization, nonessential reporting requirements, and inefficient personnel deployment. Eliminating these non-value-added activities helped the laboratory significantly shorten turnaround time and reduce costs. Key improvement elements discovered during the LSS process included: focused sample tracking, equipment redundancy, strategic supply stocking, batch size optimization, critical sample paths, elimination of nonessential QC reviews, and more efficient personnel deployment.

A Mixed-Methods Research Framework for Healthcare Process Improvement.

PubMed

Bastian, Nathaniel D; Munoz, David; Ventura, Marta

2016-01-01

The healthcare system in the United States is spiraling out of control due to ever-increasing costs without significant improvements in quality, access to care, satisfaction, and efficiency. Efficient workflow is paramount to improving healthcare value while maintaining the utmost standards of patient care and provider satisfaction in high stress environments. This article provides healthcare managers and quality engineers with a practical healthcare process improvement framework to assess, measure and improve clinical workflow processes. The proposed mixed-methods research framework integrates qualitative and quantitative tools to foster the improvement of processes and workflow in a systematic way. The framework consists of three distinct phases: 1) stakeholder analysis, 2a) survey design, 2b) time-motion study, and 3) process improvement. The proposed framework is applied to the pediatric intensive care unit of the Penn State Hershey Children's Hospital. The implementation of this methodology led to identification and categorization of different workflow tasks and activities into both value-added and non-value added in an effort to provide more valuable and higher quality patient care. Based upon the lessons learned from the case study, the three-phase methodology provides a better, broader, leaner, and holistic assessment of clinical workflow. The proposed framework can be implemented in various healthcare settings to support continuous improvement efforts in which complexity is a daily element that impacts workflow. We proffer a general methodology for process improvement in a healthcare setting, providing decision makers and stakeholders with a useful framework to help their organizations improve efficiency. Published by Elsevier Inc.

Image processing for improved eye-tracking accuracy

NASA Technical Reports Server (NTRS)

Mulligan, J. B.; Watson, A. B. (Principal Investigator)

1997-01-01

Video cameras provide a simple, noninvasive method for monitoring a subject's eye movements. An important concept is that of the resolution of the system, which is the smallest eye movement that can be reliably detected. While hardware systems are available that estimate direction of gaze in real-time from a video image of the pupil, such systems must limit image processing to attain real-time performance and are limited to a resolution of about 10 arc minutes. Two ways to improve resolution are discussed. The first is to improve the image processing algorithms that are used to derive an estimate. Off-line analysis of the data can improve resolution by at least one order of magnitude for images of the pupil. A second avenue by which to improve resolution is to increase the optical gain of the imaging setup (i.e., the amount of image motion produced by a given eye rotation). Ophthalmoscopic imaging of retinal blood vessels provides increased optical gain and improved immunity to small head movements but requires a highly sensitive camera. The large number of images involved in a typical experiment imposes great demands on the storage, handling, and processing of data. A major bottleneck had been the real-time digitization and storage of large amounts of video imagery, but recent developments in video compression hardware have made this problem tractable at a reasonable cost. Images of both the retina and the pupil can be analyzed successfully using a basic toolbox of image-processing routines (filtering, correlation, thresholding, etc.), which are, for the most part, well suited to implementation on vectorizing supercomputers.

Use of failure mode, effect and criticality analysis to improve safety in the medication administration process.

PubMed

Rodriguez-Gonzalez, Carmen Guadalupe; Martin-Barbero, Maria Luisa; Herranz-Alonso, Ana; Durango-Limarquez, Maria Isabel; Hernandez-Sampelayo, Paloma; Sanjurjo-Saez, Maria

2015-08-01

To critically evaluate the causes of preventable adverse drug events during the nurse medication administration process in inpatient units with computerized prescription order entry and profiled automated dispensing cabinets in order to prioritize interventions that need to be implemented and to evaluate the impact of specific interventions on the criticality index. This is a failure mode, effects and criticality analysis (FMECA) study. A multidisciplinary consensus committee composed of pharmacists, nurses and doctors evaluated the process of administering medications in a hospital setting in Spain. By analysing the process, all failure modes were identified and criticality was determined by rating severity, frequency and likelihood of failure detection on a scale of 1 to 10, using adapted versions of already published scales. Safety strategies were identified and prioritized. Through consensus, the committee identified eight processes and 40 failure modes, of which 20 were classified as high risk. The sum of the criticality indices was 5254. For the potential high-risk failure modes, 21 different potential causes were found resulting in 24 recommendations. Thirteen recommendations were prioritized and developed over a 24-month period, reducing total criticality from 5254 to 3572 (a 32.0% reduction). The recommendations with a greater impact on criticality were the development of an electronic medication administration record (-582) and the standardization of intravenous drug compounding in the unit (-168). Other improvements, such as barcode medication administration technology (-1033), were scheduled for a longer period of time because of lower feasibility. FMECA is a useful approach that can improve the medication administration process. © 2015 John Wiley & Sons, Ltd.

Evaluation of process excellence tools in improving donor flow management in a tertiary care hospital in South India

PubMed Central

Venugopal, Divya; Rafi, Aboobacker Mohamed; Innah, Susheela Jacob; Puthayath, Bibin T.

2017-01-01

BACKGROUND: Process Excellence is a value based approach and focuses on standardizing work processes by eliminating the non-value added processes, identify process improving methodologies and maximize capacity and expertise of the staff. AIM AND OBJECTIVES: To Evaluate the utility of Process Excellence Tools in improving Donor Flow Management in a Tertiary care Hospital by studying the current state of donor movement within the blood bank and providing recommendations for eliminating the wait times and to improve the process and workflow. MATERIALS AND METHODS: The work was done in two phases; The First Phase comprised of on-site observations with the help of an expert trained in Process Excellence Methodology who observed and documented various aspects of donor flow, donor turn around time, total staff details and operator process flow. The Second Phase comprised of constitution of a Team to analyse the data collected. The analyzed data along with the recommendations were presented before an expert hospital committee and the management. RESULTS: Our analysis put forward our strengths and identified potential problems. Donor wait time was reduced by 50% after lean due to better donor management with reorganization of the infrastructure of the donor area. Receptionist tracking showed that 62% of the total time the staff wastes in walking and 22% in other non-value added activities. Defining Duties for each staff reduced the time spent by them in non-value added activities. Implementation of the token system, generation of unique identification code for donors and bar code labeling of the tubes and bags are among the other recommendations. CONCLUSION: Process Excellence is not a programme; it's a culture that transforms an organization and improves its Quality and Efficiency through new attitudes, elimination of wastes and reduction in costs. PMID:28970681

Evaluation of process excellence tools in improving donor flow management in a tertiary care hospital in South India.

PubMed

Venugopal, Divya; Rafi, Aboobacker Mohamed; Innah, Susheela Jacob; Puthayath, Bibin T

2017-01-01

Process Excellence is a value based approach and focuses on standardizing work processes by eliminating the non-value added processes, identify process improving methodologies and maximize capacity and expertise of the staff. To Evaluate the utility of Process Excellence Tools in improving Donor Flow Management in a Tertiary care Hospital by studying the current state of donor movement within the blood bank and providing recommendations for eliminating the wait times and to improve the process and workflow. The work was done in two phases; The First Phase comprised of on-site observations with the help of an expert trained in Process Excellence Methodology who observed and documented various aspects of donor flow, donor turn around time, total staff details and operator process flow. The Second Phase comprised of constitution of a Team to analyse the data collected. The analyzed data along with the recommendations were presented before an expert hospital committee and the management. Our analysis put forward our strengths and identified potential problems. Donor wait time was reduced by 50% after lean due to better donor management with reorganization of the infrastructure of the donor area. Receptionist tracking showed that 62% of the total time the staff wastes in walking and 22% in other non-value added activities. Defining Duties for each staff reduced the time spent by them in non-value added activities. Implementation of the token system, generation of unique identification code for donors and bar code labeling of the tubes and bags are among the other recommendations. Process Excellence is not a programme; it's a culture that transforms an organization and improves its Quality and Efficiency through new attitudes, elimination of wastes and reduction in costs.

Process Improvement to Enhance Quality in a Large Volume Labor and Birth Unit.

PubMed

Bell, Ashley M; Bohannon, Jessica; Porthouse, Lisa; Thompson, Heather; Vago, Tony

using the Lean process, frontline clinicians identified areas that needed improvement, developed and implemented successful strategies that addressed each gap, and enhanced the quality and safety of care for a large volume perinatal service.

Optimization and Improvement of Test Processes on a Production Line

NASA Astrophysics Data System (ADS)

Sujová, Erika; Čierna, Helena

2018-06-01

The paper deals with increasing processes efficiency at a production line of cylinder heads of engines in a production company operating in the automotive industry. The goal is to achieve improvement and optimization of test processes on a production line. It analyzes options for improving capacity, availability and productivity of processes of an output test by using modern technology available on the market. We have focused on analysis of operation times before and after optimization of test processes at specific production sections. By analyzing measured results we have determined differences in time before and after improvement of the process. We have determined a coefficient of efficiency OEE and by comparing outputs we have confirmed real improvement of the process of the output test of cylinder heads.

A Total Quality Leadership Process Improvement Model

DTIC Science & Technology

1993-12-01

Leadership Process Improvement Model by Archester Houston, Ph.D. and Steven L. Dockstader, Ph.D. DTICS ELECTE tleaese oand sale itsFeat ben proe 94-12058...tTl ’AND SIATE COVERID0 Z lits Z40 uerI’Ll12/93 IFinalS.FNR IM F A Total Quality Leadership Process Improvement Model M ARRhOW~ Archester Houston, Ph.D...and Steven L. Dockstader, Ph.D. ?. 7PEJORMING ORG-AN1:AION NAMEIS) AND 00-RESS(ES) L PERFORMIN4 ORAINIZATION Total Quality Leadership OfficeREOTNMR

Instituting organizational learning for quality improvement through strategic planning nominal group processes.

PubMed

White, D B

2000-01-01

Healthcare managers are faced with unprecedented challenges as characterized by managed care constraints, downsizing, increased client needs, and a society demanding more responsive services. Managers must initiate change for quality, efficiency, and survival. This article provides information and strategies for (a) assessing the change readiness of an organization, (b) conducting an organizational diagnosis, (c) instituting a team culture, (d) developing a change strategy, (e) integrating the strategy with a quality improvement process, and (f) identifying the leadership skills to implement organization renewal. Nominal group processes, namely, SWOT and the Search Conference, are described, and case examples are provided. The implementation strategies have been used successfully in a variety of milieus; practical advice for success is described in detail.

Enhancement of MS Signal Processing For Improved Cancer Biomarker Discovery

NASA Astrophysics Data System (ADS)

Si, Qian

Technological advances in proteomics have shown great potential in detecting cancer at the earliest stages. One way is to use the time of flight mass spectroscopy to identify biomarkers, or early disease indicators related to the cancer. Pattern analysis of time of flight mass spectra data from blood and tissue samples gives great hope for the identification of potential biomarkers among the complex mixture of biological and chemical samples for the early cancer detection. One of the keys issues is the pre-processing of raw mass spectra data. A lot of challenges need to be addressed: unknown noise character associated with the large volume of data, high variability in the mass spectroscopy measurements, and poorly understood signal background and so on. This dissertation focuses on developing statistical algorithms and creating data mining tools for computationally improved signal processing for mass spectrometry data. I have introduced an advanced accurate estimate of the noise model and a half-supervised method of mass spectrum data processing which requires little knowledge about the data.

Engaging communication experts in a Delphi process to identify patient behaviors that could enhance communication in medical encounters

PubMed Central

2010-01-01

Background The communication literature currently focuses primarily on improving physicians' verbal and non-verbal behaviors during the medical interview. The Four Habits Model is a teaching and research framework for physician communication that is based on evidence linking specific communication behaviors with processes and outcomes of care. The Model conceptualizes basic communication tasks as "Habits" and describes the sequence of physician communication behaviors during the clinical encounter associated with improved outcomes. Using the Four Habits Model as a starting point, we asked communication experts to identify the verbal communication behaviors of patients that are important in outpatient encounters. Methods We conducted a 4-round Delphi process with 17 international experts in communication research, medical education, and health care delivery. All rounds were conducted via the internet. In round 1, experts reviewed a list of proposed patient verbal communication behaviors within the Four Habits Model framework. The proposed patient verbal communication behaviors were identified based on a review of the communication literature. The experts could: approve the proposed list; add new behaviors; or modify behaviors. In rounds 2, 3, and 4, they rated each behavior for its fit (agree or disagree) with a particular habit. After each round, we calculated the percent agreement for each behavior and provided these data in the next round. Behaviors receiving more than 70% of experts' votes (either agree or disagree) were considered as achieving consensus. Results Of the 14 originally-proposed patient verbal communication behaviors, the experts modified all but 2, and they added 20 behaviors to the Model in round 1. In round 2, they were presented with 59 behaviors and 14 options to remove specific behaviors for rating. After 3 rounds of rating, the experts retained 22 behaviors. This set included behaviors such as asking questions, expressing preferences, and

Post discharge issues identified by a call-back program: identifying improvement opportunities.

PubMed

Ojeda, Patricia I; Kara, Areeba

2017-12-01

The period following discharge from the hospital is one of heightened vulnerability. Discharge instructions serve as a guide during this transition. Yet, clinicians receive little feedback on the quality of this document that ties into the patients' experience. We reviewed the issues voiced by discharged patients via a call-back program and compared them to the discharge instructions they had received. At our institution, patients receive an automated call forty-eight hours following discharge inquiring about progress. If indicated by the response to the call, they are directed to a nurse who assists with problem solving. We reviewed the nursing documentation of these encounters for a period of nine months. The issues voiced were grouped into five categories: communication, medications, durable medical equipment/therapies, follow up and new or ongoing symptoms. The discharge instructions given to each patient were reviewed. We retrieved data on the number of discharges from each specialty from the hospital over the same period. A total of 592 patients voiced 685 issues. The numbers of patients discharged from medical or surgical services identified as having issues via the call-back line paralleled the proportions discharged from medical and surgical services from the hospital during the same period. Nearly a quarter of the issues discussed had been addressed in the discharge instructions. The most common category of issues was related to communication deficits including missing or incomplete information which made it difficult for the patient to enact or understand the plan of care. Medication prescription related issues were the next most common. Resource barriers and questions surrounding medications were often unaddressed. Post discharge issues affect patients discharged from all services equally. Data from call back programs may provide actionable targets for improvement, identify the inpatient team's 'blind spots' and be used to provide feedback to clinicians.

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Using the cognitive interviewing process to improve survey design by allied health: A qualitative study.

PubMed

Howlett, Owen; McKinstry, Carol; Lannin, Natasha A

2018-04-01

Allied health professionals frequently use surveys to collect data for clinical practice and service improvement projects. Careful development and piloting of purpose-designed surveys is important to ensure intended measuring (that respondents correctly interpret survey items when responding). Cognitive interviewing is a specific technique that can improve the design of self-administered surveys. The aim of this study was to describe the use of the cognitive interviewing process to improve survey design, which involved a purpose-designed, online survey evaluating staff use of functional electrical stimulation. A qualitative study involving one round of cognitive interviewing with three occupational therapists and three physiotherapists. The cognitive interviewing process identified 11 issues with the draft survey, which could potentially influence the validity and quality of responses. The raised issues included difficulties with: processing the question to be able to respond, determining a response to the question, retrieving relevant information from memory and comprehending the written question. Twelve survey amendments were made following the cognitive interviewing process, comprising four additions, seven revisions and one correction. The cognitive interviewing process applied during the development of a purpose-designed survey enabled the identification of potential problems and informed revisions to the survey prior to its use. © 2017 Occupational Therapy Australia.

Development and Processing Improvement of Aerospace Aluminum Alloys

NASA Technical Reports Server (NTRS)

Lisagor, W. Barry; Bales, Thomas T.

2007-01-01

This final report, in multiple presentation format, describes a comprehensive multi-tasked contract study to improve the overall property response of selected aerospace alloys, explore further a newly-developed and registered alloy, and correlate the processing, metallurgical structure, and subsequent properties achieved with particular emphasis on the crystallographic orientation texture developed. Modifications to plate processing, specifically hot rolling practices, were evaluated for Al-Li alloys 2195 and 2297, for the recently registered Al-Cu-Ag alloy, 2139, and for the Al-Zn-Mg-Cu alloy, 7050. For all of the alloys evaluated, the processing modifications resulted in significant improvements in mechanical properties. Analyses also resulted in an enhanced understanding of the correlation of processing, crystallographic texture, and mechanical properties.

Process mapping evaluation of medication reconciliation in academic teaching hospitals: a critical step in quality improvement.

PubMed

Holbrook, Anne; Bowen, James M; Patel, Harsit; O'Brien, Chris; You, John J; Tahavori, Roshan; Doleweerd, Jeff; Berezny, Tim; Perri, Dan; Nieuwstraten, Carmine; Troyan, Sue; Patel, Ameen

2016-12-30

Medication reconciliation (MedRec) has been a mandated or recommended activity in Canada, the USA and the UK for nearly 10 years. Accreditation bodies in North America will soon require MedRec for every admission, transfer and discharge of every patient. Studies of MedRec have revealed unintentional discrepancies in prescriptions but no clear evidence that clinically important outcomes are improved, leading to widely variable practices. Our objective was to apply process mapping methodology to MedRec to clarify current processes and resource usage, identify potential efficiencies and gaps in care, and make recommendations for improvement in the light of current literature evidence of effectiveness. Process engineers observed and recorded all MedRec activities at 3 academic teaching hospitals, from initial emergency department triage to patient discharge, for general internal medicine patients. Process maps were validated with frontline staff, then with the study team, managers and patient safety leads to summarise current problems and discuss solutions. Across all of the 3 hospitals, 5 general problem themes were identified: lack of use of all available medication sources, duplication of effort creating inefficiency, lack of timeliness of completion of the Best Possible Medication History, lack of standardisation of the MedRec process, and suboptimal communication of MedRec issues between physicians, pharmacists and nurses. MedRec as practised in this environment requires improvements in quality, timeliness, consistency and dissemination. Further research exploring efficient use of resources, in terms of personnel and costs, is required. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

20 CFR 1010.300 - What processes are to be implemented to identify covered persons?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 20 Employees' Benefits 3 2010-04-01 2010-04-01 false What processes are to be implemented to identify covered persons? 1010.300 Section 1010.300 Employees' Benefits OFFICE OF THE ASSISTANT SECRETARY... processes to identify covered persons who physically access service delivery points or who access virtual...

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities.

PubMed

Pankow, Jennifer; Willett, Jennifer; Yang, Yang; Swan, Holly; Dembo, Richard; Burdon, William M; Patterson, Yvonne; Pearson, Frank S; Belenko, Steven; Frisman, Linda K

2018-04-01

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

Improving reliability of a residency interview process.

PubMed

Peeters, Michael J; Serres, Michelle L; Gundrum, Todd E

2013-10-14

To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station-impact of content specificity was greatly reduced with more interview stations. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity.

Improving Reliability of a Residency Interview Process

PubMed Central

Serres, Michelle L.; Gundrum, Todd E.

2013-01-01

Objective. To improve the reliability and discrimination of a pharmacy resident interview evaluation form, and thereby improve the reliability of the interview process. Methods. In phase 1 of the study, authors used a Many-Facet Rasch Measurement model to optimize an existing evaluation form for reliability and discrimination. In phase 2, interviewer pairs used the modified evaluation form within 4 separate interview stations. In phase 3, 8 interviewers individually-evaluated each candidate in one-on-one interviews. Results. In phase 1, the evaluation form had a reliability of 0.98 with person separation of 6.56; reproducibly, the form separated applicants into 6 distinct groups. Using that form in phase 2 and 3, our largest variation source was candidates, while content specificity was the next largest variation source. The phase 2 g-coefficient was 0.787, while confirmatory phase 3 was 0.922. Process reliability improved with more stations despite fewer interviewers per station—impact of content specificity was greatly reduced with more interview stations. Conclusion. A more reliable, discriminating evaluation form was developed to evaluate candidates during resident interviews, and a process was designed that reduced the impact from content specificity. PMID:24159209

IMPROVED PROCESS OF PLUTONIUM CARRIER PRECIPITATION

DOEpatents

Faris, B.F.

1959-06-30

This patent relates to an improvement in the bismuth phosphate process for separating and recovering plutonium from neutron irradiated uranium, resulting in improved decontamination even without the use of scavenging precipitates in the by-product precipitation step and subsequently more complete recovery of the plutonium in the product precipitation step. This improvement is achieved by addition of fluomolybdic acid, or a water soluble fluomolybdate, such as the ammonium, sodium, or potassium salt thereof, to the aqueous nitric acid solution containing tetravalent plutonium ions and contaminating fission products, so as to establish a fluomolybdate ion concentration of about 0.05 M. The solution is then treated to form the bismuth phosphate plutonium carrying precipitate.

Evaluating and improving a model of nursing care delivery: a process of partnership.

PubMed

Hall, Catherine; McCutcheon, Helen; Deuter, Kate; Matricciani, Lisa

2012-01-01

Evaluating and improving a model of nursing care is a fundamental part of clinical practice improvement. While Australian nurses are showing increasing interest in improving models of care delivery, more research is needed that addresses and articulates the processes attendant upon evaluating, re-designing and implementing improvements to the provision of nursing care. Providing nurses with an open opportunity to plan, act, observe and reflect on their practice promotes successful partnerships between academics and clinicians. The aim of this study was to evaluate and improve the model of nursing care delivery to patients in a general surgical ward using participatory action research. Researchers conducted non-participant observations (n = 9) of two hours duration across the 24 h period. Focus groups (n = 3) were used to share non-participant observation data with staff, providing them with an opportunity to reflect on their practice and explore possible solutions. Data was collected in 2008-2009. Two main problem areas were identified as impeding the nurses' ability to provide care to patients: (i) practices and behaviours of nurses and (ii) infrastructure and physical layout of the ward. An overview of issues within each problem area is presented. Shifting the focus of task-centred care towards a more patient-centred care approach, results directly in improvements in resource utilisation, improved cost-effectiveness and job satisfaction for nursing staff. New ways of thinking about nursing processes and systems, workflow design and skill allocation will guide hospital administrators and managers in the effective and efficient allocation of nursing work in similar settings.

Process Improvement in a Radically Changing Organization

NASA Technical Reports Server (NTRS)

Varga, Denise M.; Wilson, Barbara M.

2007-01-01

This presentation describes how the NASA Glenn Research Center planned and implemented a process improvement effort in response to a radically changing environment. As a result of a presidential decision to redefine the Agency's mission, many ongoing projects were canceled and future workload would be awarded based on relevance to the Exploration Initiative. NASA imposed a new Procedural Requirements standard on all future software development, and the Center needed to redesign its processes from CMM Level 2 objectives to meet the new standard and position itself for CMMI. The intended audience for this presentation is systems/software developers and managers in a large, research-oriented organization that may need to respond to imposed standards while also pursuing CMMI Maturity Level goals. A set of internally developed tools will be presented, including an overall Process Improvement Action Item database, a formal inspection/peer review tool, metrics collection spreadsheet, and other related technologies. The Center also found a need to charter Technical Working Groups (TWGs) to address particular Process Areas. In addition, a Marketing TWG was needed to communicate the process changes to the development community, including an innovative web site portal.

Positive affect improves working memory: implications for controlled cognitive processing.

PubMed

Yang, Hwajin; Yang, Sujin; Isen, Alice M

2013-01-01

This study examined the effects of positive affect on working memory (WM) and short-term memory (STM). Given that WM involves both storage and controlled processing and that STM primarily involves storage processing, we hypothesised that if positive affect facilitates controlled processing, it should improve WM more than STM. The results demonstrated that positive affect, compared with neutral affect, significantly enhanced WM, as measured by the operation span task. The influence of positive affect on STM, however, was weaker. These results suggest that positive affect enhances WM, a task that involves controlled processing, not just storage processing. Additional analyses of recall and processing times and accuracy further suggest that improved WM under positive affect is not attributable to motivational differences, but results instead from improved controlled cognitive processing.

Measuring and improving the quality of postoperative epidural analgesia for major abdominal surgery using statistical process control charts.

PubMed

Duncan, Fiona; Haigh, Carol

2013-10-01

To explore and improve the quality of continuous epidural analgesia for pain relief using Statistical Process Control tools. Measuring the quality of pain management interventions is complex. Intermittent audits do not accurately capture the results of quality improvement initiatives. The failure rate for one intervention, epidural analgesia, is approximately 30% in everyday practice, so it is an important area for improvement. Continuous measurement and analysis are required to understand the multiple factors involved in providing effective pain relief. Process control and quality improvement Routine prospectively acquired data collection started in 2006. Patients were asked about their pain and side effects of treatment. Statistical Process Control methods were applied for continuous data analysis. A multidisciplinary group worked together to identify reasons for variation in the data and instigated ideas for improvement. The key measure for improvement was a reduction in the percentage of patients with an epidural in severe pain. The baseline control charts illustrated the recorded variation in the rate of several processes and outcomes for 293 surgical patients. The mean visual analogue pain score (VNRS) was four. There was no special cause variation when data were stratified by surgeons, clinical area or patients who had experienced pain before surgery. Fifty-seven per cent of patients were hypotensive on the first day after surgery. We were able to demonstrate a significant improvement in the failure rate of epidurals as the project continued with quality improvement interventions. Statistical Process Control is a useful tool for measuring and improving the quality of pain management. The applications of Statistical Process Control methods offer the potential to learn more about the process of change and outcomes in an Acute Pain Service both locally and nationally. We have been able to develop measures for improvement and benchmarking in routine care that

Value stream mapping of the Pap test processing procedure: a lean approach to improve quality and efficiency.

PubMed

Michael, Claire W; Naik, Kalyani; McVicker, Michael

2013-05-01

We developed a value stream map (VSM) of the Papanicolaou test procedure to identify opportunities to reduce waste and errors, created a new VSM, and implemented a new process emphasizing Lean tools. Preimplementation data revealed the following: (1) processing time (PT) for 1,140 samples averaged 54 hours; (2) 27 accessioning errors were detected on review of 357 random requisitions (7.6%); (3) 5 of the 20,060 tests had labeling errors that had gone undetected in the processing stage. Four were detected later during specimen processing but 1 reached the reporting stage. Postimplementation data were as follows: (1) PT for 1,355 samples averaged 31 hours; (2) 17 accessioning errors were detected on review of 385 random requisitions (4.4%); and (3) no labeling errors were undetected. Our results demonstrate that implementation of Lean methods, such as first-in first-out processes and minimizing batch size by staff actively participating in the improvement process, allows for higher quality, greater patient safety, and improved efficiency.

Improving cell mixture deconvolution by identifying optimal DNA methylation libraries (IDOL).

PubMed

Koestler, Devin C; Jones, Meaghan J; Usset, Joseph; Christensen, Brock C; Butler, Rondi A; Kobor, Michael S; Wiencke, John K; Kelsey, Karl T

2016-03-08

Confounding due to cellular heterogeneity represents one of the foremost challenges currently facing Epigenome-Wide Association Studies (EWAS). Statistical methods leveraging the tissue-specificity of DNA methylation for deconvoluting the cellular mixture of heterogenous biospecimens offer a promising solution, however the performance of such methods depends entirely on the library of methylation markers being used for deconvolution. Here, we introduce a novel algorithm for Identifying Optimal Libraries (IDOL) that dynamically scans a candidate set of cell-specific methylation markers to find libraries that optimize the accuracy of cell fraction estimates obtained from cell mixture deconvolution. Application of IDOL to training set consisting of samples with both whole-blood DNA methylation data (Illumina HumanMethylation450 BeadArray (HM450)) and flow cytometry measurements of cell composition revealed an optimized library comprised of 300 CpG sites. When compared existing libraries, the library identified by IDOL demonstrated significantly better overall discrimination of the entire immune cell landscape (p = 0.038), and resulted in improved discrimination of 14 out of the 15 pairs of leukocyte subtypes. Estimates of cell composition across the samples in the training set using the IDOL library were highly correlated with their respective flow cytometry measurements, with all cell-specific R (2)>0.99 and root mean square errors (RMSEs) ranging from [0.97 % to 1.33 %] across leukocyte subtypes. Independent validation of the optimized IDOL library using two additional HM450 data sets showed similarly strong prediction performance, with all cell-specific R (2)>0.90 and R M S E<4.00 %. In simulation studies, adjustments for cell composition using the IDOL library resulted in uniformly lower false positive rates compared to competing libraries, while also demonstrating an improved capacity to explain epigenome-wide variation in DNA methylation within two large

Organizational management practices for achieving software process improvement

NASA Technical Reports Server (NTRS)

Kandt, Ronald Kirk

2004-01-01

The crisis in developing software has been known for over thirty years. Problems that existed in developing software in the early days of computing still exist today. These problems include the delivery of low-quality products, actual development costs that exceed expected development costs, and actual development time that exceeds expected development time. Several solutions have been offered to overcome out inability to deliver high-quality software, on-time and within budget. One of these solutions involves software process improvement. However, such efforts often fail because of organizational management issues. This paper discusses business practices that organizations should follow to improve their chances of initiating and sustaining successful software process improvement efforts.

Distributed collaborative team effectiveness: measurement and process improvement

NASA Technical Reports Server (NTRS)

Wheeler, R.; Hihn, J.; Wilkinson, B.

2002-01-01

This paper describes a measurement methodology developed for assessing the readiness, and identifying opportunities for improving the effectiveness, of distributed collaborative design teams preparing to conduct a coccurent design session.

Process-Improvement Cost Model for the Emergency Department.

PubMed

Dyas, Sheila R; Greenfield, Eric; Messimer, Sherri; Thotakura, Swati; Gholston, Sampson; Doughty, Tracy; Hays, Mary; Ivey, Richard; Spalding, Joseph; Phillips, Robin

2015-01-01

The objective of this report is to present a simplified, activity-based costing approach for hospital emergency departments (EDs) to use with Lean Six Sigma cost-benefit analyses. The cost model complexity is reduced by removing diagnostic and condition-specific costs, thereby revealing the underlying process activities' cost inefficiencies. Examples are provided for evaluating the cost savings from reducing discharge delays and the cost impact of keeping patients in the ED (boarding) after the decision to admit has been made. The process-improvement cost model provides a needed tool in selecting, prioritizing, and validating Lean process-improvement projects in the ED and other areas of patient care that involve multiple dissimilar diagnoses.

Identifying critical issues in recreation planning and management: improving the management-research partnership

Treesearch

John H. Schomaker; David W. Lime

1988-01-01

The "nominal group" process is a proven technique to systematically arrive at a consensus about critical information needs in recreation planning and management. Using this process, 41 managers who attended a 1983 conference on river management identified 114 specific information needs grouped under 11 general questions. Clearly, some concerns of...

Improving program documentation quality through the application of continuous improvement processes.

PubMed

Lovlien, Cheryl A; Johansen, Martha; Timm, Sandra; Eversman, Shari; Gusa, Dorothy; Twedell, Diane

2007-01-01

Maintaining the integrity of record keeping and retrievable information related to the provision of continuing education credit creates challenges for a large organization. Accurate educational program documentation is vital to support the knowledge and professional development of nursing staff. Quality review and accurate documentation of programs for nursing staff development occurred at one institution through the use of continuous improvement principles. Integration of the new process into the current system maintains the process of providing quality record keeping.

Improved cancer diagnostics by different image processing techniques on OCT images

NASA Astrophysics Data System (ADS)

Kanawade, Rajesh; Lengenfelder, Benjamin; Marini Menezes, Tassiana; Hohmann, Martin; Kopfinger, Stefan; Hohmann, Tim; Grabiec, Urszula; Klämpfl, Florian; Gonzales Menezes, Jean; Waldner, Maximilian; Schmidt, Michael

2015-07-01

Optical-coherence tomography (OCT) is a promising non-invasive, high-resolution imaging modality which can be used for cancer diagnosis and its therapeutic assessment. However, speckle noise makes detection of cancer boundaries and image segmentation problematic and unreliable. Therefore, to improve the image analysis for a precise cancer border detection, the performance of different image processing algorithms such as mean, median, hybrid median filter and rotational kernel transformation (RKT) for this task is investigated. This is done on OCT images acquired from an ex-vivo human cancerous mucosa and in vitro by using cultivated tumour applied on organotypical hippocampal slice cultures. The preliminary results confirm that the border between the healthy and the cancer lesions can be identified precisely. The obtained results are verified with fluorescence microscopy. This research can improve cancer diagnosis and the detection of borders between healthy and cancerous tissue. Thus, it could also reduce the number of biopsies required during screening endoscopy by providing better guidance to the physician.

Cetane improvement via the DIESEL-B process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dawson, F.N. Jr.

1987-01-01

The DIESEL-B Process is a new process offered by Calsyn which is targeted toward significant cost savings - up to half the cost of conventional cetane improvers. Pay out of the low capital investments - perhaps $0.5 million - may be obtained in some cases in less than one year. The process involves on-site treating of a small slip stream - about 3% of the diesel pool. Refiners have developed quality fuels for diesel engines which would be suitable for the many diverse applications of these engines. Over the years a fair consensus of required quality specifications has evolved, mostmore » importantly those of the major pipeline operators. Ignition characteristics, as defined by cetane number or cetane index have been the most important, but other controls designed to insure stability, color, carbon content and the like are also essential constraints for the refiner. Refiners have historically been able to meet demand for motor diesel fuels by blending the higher quality virgin and hydrotreated materials with a variety of lesser quality stocks, such as cat cracker light cycle oils, coker cycle oils, thermal cycle oils and the like. But because of the typically poor engine performance properties of these latter materials, refiners have had to employ a variety of additives, most importantly cetane improvement additives, cost for which can be substantial. Calsyn is pleased to announce the development of the DIESEL-B Process for improvement of diesel fuel ignition characteristics in response to the growing need for cost cutting methods for the bread and butter portions of our business.« less

Significant improvement in the thermal annealing process of optical resonators

NASA Astrophysics Data System (ADS)

Salzenstein, Patrice; Zarubin, Mikhail

2017-05-01

Thermal annealing performed during process improves the quality of the roughness of optical resonators reducing stresses at the periphery of their surface thus allowing higher Q-factors. After a preliminary realization, the design of the oven and the electronic method were significantly improved thanks to nichrome resistant alloy wires and chopped basalt fibers for thermal isolation during the annealing process. Q-factors can then be improved.

Applying process mapping and analysis as a quality improvement strategy to increase the adoption of fruit, vegetable, and water breaks in Australian primary schools.

PubMed

Biggs, Janice S; Farrell, Louise; Lawrence, Glenda; Johnson, Julie K

2014-03-01

Over the past decade, public health policy in Australia has prioritized the prevention and control of obesity and invested in programs that promote healthy eating-related behaviors, which includes increasing fruit and vegetable consumption in children. This article reports on a study that used process mapping and analysis as a quality improvement strategy to improve the delivery of a nutrition primary prevention program delivered in primary schools in New South Wales, Australia. Crunch&Sip® has been delivered since 2008. To date, adoption is low with only 25% of schools implementing the program. We investigated the cause of low adoption and propose actions to increase school participation. We conducted semistructured interviews with key stakeholders and analyzed the process of delivering Crunch&Sip to schools. Interviews and process mapping and analysis identified a number of barriers to schools adopting the program. The analyses identified the need to simplify and streamline the process of delivering the program to schools and introduce monitoring and feedback loops to track ongoing participation. The combination of stakeholder interviews and process mapping and analysis provided important practical solutions to improving program delivery and also contributed to building an understanding of factors that help and hinder program adoption. The insight provided by this analysis helped identify usable routine measures of adoption, which were an improvement over those used in the existing program plan. This study contributed toward improving the quality and efficiency of delivering a health promoting program to work toward achieving healthy eating behaviors in children.

Identifying risk event in Indonesian fresh meat supply chain

NASA Astrophysics Data System (ADS)

Wahyuni, H. C.; Vanany, I.; Ciptomulyono, U.

2018-04-01

The aim of this paper is to identify risk issues in Indonesian fresh meat supply chain from the farm until to the “plate”. The critical points for food safety in physical fresh meat product flow are also identified. The paper employed one case study in the Indonesian fresh meat company by conducting observations and in-depth three stages of interviews. At the first interview, the players, process, and activities in the fresh meat industry were identified. In the second interview, critical points for food safety were recognized. The risk events in each player and process were identified in the last interview. The research will be conducted in three stages, but this article focuses on risk identification process (first stage) only. The second stage is measuring risk and the third stage focuses on determining the value of risk priority. The results showed that there were four players in the fresh meat supply chain: livestock (source), slaughter (make), distributor and retail (deliver). Each player has different activities and identified 16 risk events in the fresh meat supply chain. Some of the strategies that can be used to reduce the occurrence of such risks include improving the ability of laborers on food safety systems, improving cutting equipment and distribution processes

Identifying determinants of medication adherence following myocardial infarction using the Theoretical Domains Framework and the Health Action Process Approach.

PubMed

Presseau, Justin; Schwalm, J D; Grimshaw, Jeremy M; Witteman, Holly O; Natarajan, Madhu K; Linklater, Stefanie; Sullivan, Katrina; Ivers, Noah M

2017-10-01

Despite evidence-based recommendations, adherence with secondary prevention medications post-myocardial infarction (MI) remains low. Taking medication requires behaviour change, and using behavioural theories to identify what factors determine adherence could help to develop novel adherence interventions. Compare the utility of different behaviour theory-based approaches for identifying modifiable determinants of medication adherence post-MI that could be targeted by interventions. Two studies were conducted with patients 0-2, 3-12, 13-24 or 25-36 weeks post-MI. Study 1: 24 patients were interviewed about barriers and facilitators to medication adherence. Interviews were conducted and coded using the Theoretical Domains Framework. Study 2: 201 patients answered a telephone questionnaire assessing Health Action Process Approach constructs to predict intention and medication adherence (MMAS-8). Study 1: domains identified: Beliefs about Consequences, Memory/Attention/Decision Processes, Behavioural Regulation, Social Influences and Social Identity. Study 2: 64, 59, 42 and 58% reported high adherence at 0-2, 3-12, 13-24 and 25-36 weeks. Social Support and Action Planning predicted adherence at all time points, though the relationship between Action Planning and adherence decreased over time. Using two behaviour theory-based approaches provided complimentary findings and identified modifiable factors that could be targeted to help translate Intention into action to improve medication adherence post-MI.

Parameter prediction based on Improved Process neural network and ARMA error compensation in Evaporation Process

NASA Astrophysics Data System (ADS)

Qian, Xiaoshan

2018-01-01

The traditional model of evaporation process parameters have continuity and cumulative characteristics of the prediction error larger issues, based on the basis of the process proposed an adaptive particle swarm neural network forecasting method parameters established on the autoregressive moving average (ARMA) error correction procedure compensated prediction model to predict the results of the neural network to improve prediction accuracy. Taking a alumina plant evaporation process to analyze production data validation, and compared with the traditional model, the new model prediction accuracy greatly improved, can be used to predict the dynamic process of evaporation of sodium aluminate solution components.

The gynecologic oncology fellowship interview process: Challenges and potential areas for improvement.

PubMed

Gressel, Gregory M; Van Arsdale, Anne; Dioun, Shayan M; Goldberg, Gary L; Nevadunsky, Nicole S

2017-05-01

The application and interview process for gynecologic oncology fellowship is highly competitive, time-consuming and expensive for applicants. We conducted a survey of successfully matched gynecologic oncology fellowship applicants to assess problems associated with the interview process and identify areas for improvement. All Society of Gynecologic Oncology (SGO) list-serve members who have participated in the match program for gynecologic oncology fellowship were asked to complete an online survey regarding the interview process. Linear regression modeling was used to examine association between year of match, number of programs applied to, cost incurred, and overall satisfaction. Two hundred and sixty-nine eligible participants reported applying to a mean of 20 programs [range 1-45] and were offered a mean of 14 interviews [range 1-43]. They spent an average of $6000 [$0-25,000], using personal savings (54%), credit cards (50%), family support (12%) or personal loans (3%). Seventy percent of respondents identified the match as fair, and 93% were satisfied. Interviewees spent a mean of 15 [0-45] days away from work and 37% reported difficulty arranging coverage. Linear regression showed an increase in number of programs applied to and cost per applicant over time ( p  < 0.001) between 1993 and 2016. Applicants who applied to all available programs spent more ( p  < 0.001) than those who applied to programs based on their location or quality. The current fellowship match was identified as fair and satisfying by most respondents despite being time consuming and expensive. Suggested alternative options included clustering interviews geographically or conducting preliminary interviews at the SGO Annual Meeting.

Reducing RN Vacancy Rate: A Nursing Recruitment Office Process Improvement Project.

PubMed

Hisgen, Stephanie A; Page, Nancy E; Thornlow, Deirdre K; Merwin, Elizabeth I

2018-06-01

The aim of this study was to reduce the RN vacancy rate at an academic medical center by improving the hiring process in the Nursing Recruitment Office. Inability to fill RN positions can lead to higher vacancy rates and negatively impact staff and patient satisfaction, quality outcomes, and the organization's bottom line. The Model for Improvement was used to design and implement a process improvement project to improve the hiring process from time of interview through the position being filled. Number of days to interview and check references decreased significantly, but no change in overall time to hire and time to fill positions was noted. RN vacancy rate also decreased significantly. Nurse manager satisfaction with the hiring process increased significantly. Redesigning the recruitment process supported operational efficiencies of the organization related to RN recruitment.

The theory, practice, and future of process improvement in general thoracic surgery.

PubMed

Freeman, Richard K

2014-01-01

Process improvement, in its broadest sense, is the analysis of a given set of actions with the aim of elevating quality and reducing costs. The tenets of process improvement have been applied to medicine in increasing frequency for at least the last quarter century including thoracic surgery. This review outlines the theory underlying process improvement, the currently available data sources for process improvement and possible future directions of research. Copyright © 2015 Elsevier Inc. All rights reserved.

Advanced Hydrogen Liquefaction Process

DOE Office of Scientific and Technical Information (OSTI.GOV)

Schwartz, Joseph; Kromer, Brian; Neu, Ben

2011-09-28

The project identified and quantified ways to reduce the cost of hydrogen liquefaction, and reduce the cost of hydrogen distribution. The goal was to reduce the power consumption by 20% and then to reduce the capital cost. Optimizing the process, improving process equipment, and improving ortho-para conversion significantly reduced the power consumption of liquefaction, but by less than 20%. Because the efficiency improvement was less than the target, the program was stopped before the capital cost was addressed. These efficiency improvements could provide a benefit to the public to improve the design of future hydrogen liquefiers. The project increased themore » understanding of hydrogen liquefaction by modeling different processes and thoroughly examining ortho-para separation and conversion. The process modeling provided a benefit to the public because the project incorporated para hydrogen into the process modeling software, so liquefaction processes can be modeled more accurately than using only normal hydrogen. Adding catalyst to the first heat exchanger, a simple method to reduce liquefaction power, was identified, analyzed, and quantified. The demonstrated performance of ortho-para separation is sufficient for at least one identified process concept to show reduced power cost when compared to hydrogen liquefaction processes using conventional ortho-para conversion. The impact of improved ortho-para conversion can be significant because ortho para conversion uses about 20-25% of the total liquefaction power, but performance improvement is necessary to realize a substantial benefit. Most of the energy used in liquefaction is for gas compression. Improvements in hydrogen compression will have a significant impact on overall liquefier efficiency. Improvements to turbines, heat exchangers, and other process equipment will have less impact.« less

‘In the Moment’: An Analysis of Facilitator Impact During a Quality Improvement Process

PubMed Central

Shaw, Erik; Looney, Anna; Chase, Sabrina; Navalekar, Rohini; Stello, Brian; Lontok, Oliver; Crabtree, Benjamin

2010-01-01

Facilitators frequently act ‘in the moment’ – deciding if, when and how to intervene into group process discussions. This paper offers a unique look at how facilitators impacted eleven primary care teams engaged in a 12-week quality improvement (QI) process. Participating in a federally funded QI trial, primary care practices in New Jersey and Pennsylvania formed practice-based teams comprised of physicians, nurses, administrative staff, and patients. External facilitators met with each team to help them identify and implement changes aimed at improving the organization, work relationships, office functions, and patient care. Audio-recordings of the meetings and descriptive field notes were collected. These qualitative data provided information on how facilitators acted ‘in the moment’ and how their interventions impacted group processes over time. Our findings reveal that facilitators impacted groups in multiple ways throughout the QI process, rather than through a linear progression of stages or events. We present five case examples that show what acting ‘in the moment’ looked like during the QI meetings and how these facilitator actions/interventions impacted the primary care teams. These accounts provide practical lessons learned and insights into effective facilitation that may encourage others in their own facilitation work and offer beneficial strategies to facilitators in other contexts. PMID:22557936

Improving performance on core processes of care.

PubMed

Austin, John Matthew; Pronovost, Peter J

2016-06-01

This article describes the recent literature on using extrinsic and intrinsic motivators to improve performance on core processes of care, highlighting literature that describes general frameworks for quality improvement work. The literature supporting the effectiveness of extrinsic motivators to improve quality is generally positive for public reporting of performance, with mixed results for pay-for-performance. A four-element quality improvement framework developed by The Armstrong Institute at Johns Hopkins Medicine was developed with intrinsic motivation in mind. The clear definition and communication of goals are important for quality improvement work. Training clinicians in improvement science, such as lean sigma, teamwork, or culture change provides clinicians with the skills they need to drive the improvement work. Peer learning communities offer the opportunity for clinicians to engage with each other and offer support in their work. The transparent reporting of performance helps ensure accountability of performance ranging from individual clinicians to governance. Quality improvement work that is led by and engages clinicians offers the opportunity for the work to be both meaningful and sustainable. The literature supports approaching quality improvement work in a systematic way, including the key elements of communication, infrastructure building, training, transparency, and accountability.

Genome-wide transcriptome study in wheat identified candidate genes related to processing quality, majority of them showing interaction (quality x development) and having temporal and spatial distributions.

PubMed

Singh, Anuradha; Mantri, Shrikant; Sharma, Monica; Chaudhury, Ashok; Tuli, Rakesh; Roy, Joy

2014-01-16

The cultivated bread wheat (Triticum aestivum L.) possesses unique flour quality, which can be processed into many end-use food products such as bread, pasta, chapatti (unleavened flat bread), biscuit, etc. The present wheat varieties require improvement in processing quality to meet the increasing demand of better quality food products. However, processing quality is very complex and controlled by many genes, which have not been completely explored. To identify the candidate genes whose expressions changed due to variation in processing quality and interaction (quality x development), genome-wide transcriptome studies were performed in two sets of diverse Indian wheat varieties differing for chapatti quality. It is also important to understand the temporal and spatial distributions of their expressions for designing tissue and growth specific functional genomics experiments. Gene-specific two-way ANOVA analysis of expression of about 55 K transcripts in two diverse sets of Indian wheat varieties for chapatti quality at three seed developmental stages identified 236 differentially expressed probe sets (10-fold). Out of 236, 110 probe sets were identified for chapatti quality. Many processing quality related key genes such as glutenin and gliadins, puroindolines, grain softness protein, alpha and beta amylases, proteases, were identified, and many other candidate genes related to cellular and molecular functions were also identified. The ANOVA analysis revealed that the expression of 56 of 110 probe sets was involved in interaction (quality x development). Majority of the probe sets showed differential expression at early stage of seed development i.e. temporal expression. Meta-analysis revealed that the majority of the genes expressed in one or a few growth stages indicating spatial distribution of their expressions. The differential expressions of a few candidate genes such as pre-alpha/beta-gliadin and gamma gliadin were validated by RT-PCR. Therefore, this study

Genome-wide transcriptome study in wheat identified candidate genes related to processing quality, majority of them showing interaction (quality x development) and having temporal and spatial distributions

PubMed Central

2014-01-01

Background The cultivated bread wheat (Triticum aestivum L.) possesses unique flour quality, which can be processed into many end-use food products such as bread, pasta, chapatti (unleavened flat bread), biscuit, etc. The present wheat varieties require improvement in processing quality to meet the increasing demand of better quality food products. However, processing quality is very complex and controlled by many genes, which have not been completely explored. To identify the candidate genes whose expressions changed due to variation in processing quality and interaction (quality x development), genome-wide transcriptome studies were performed in two sets of diverse Indian wheat varieties differing for chapatti quality. It is also important to understand the temporal and spatial distributions of their expressions for designing tissue and growth specific functional genomics experiments. Results Gene-specific two-way ANOVA analysis of expression of about 55 K transcripts in two diverse sets of Indian wheat varieties for chapatti quality at three seed developmental stages identified 236 differentially expressed probe sets (10-fold). Out of 236, 110 probe sets were identified for chapatti quality. Many processing quality related key genes such as glutenin and gliadins, puroindolines, grain softness protein, alpha and beta amylases, proteases, were identified, and many other candidate genes related to cellular and molecular functions were also identified. The ANOVA analysis revealed that the expression of 56 of 110 probe sets was involved in interaction (quality x development). Majority of the probe sets showed differential expression at early stage of seed development i.e. temporal expression. Meta-analysis revealed that the majority of the genes expressed in one or a few growth stages indicating spatial distribution of their expressions. The differential expressions of a few candidate genes such as pre-alpha/beta-gliadin and gamma gliadin were validated by RT

Process for preparing improved silvered glass mirrors

DOEpatents

Buckwalter, Jr., Charles Q.

1981-01-01

Glass mirrors having improved weathering properties are prepared by an improvement in the process for making the mirrors. The glass surface after it has been cleaned but before it is silvered, is contacted with a solution of lanthanide rare earths in addition to a sensitization solution of tin or palladium. The addition of the rare earths produces a mirror which has increased resistance to delamination of the silver from the glass surface in the presence of water.

Process for preparing improved silvered glass mirrors

DOEpatents

Buckwalter, C.Q. Jr.

1980-01-28

Glass mirrors having improved weathering properties are prepared by an improvement in the process for making the mirrors. The glass surface after it has been cleaned but before it is silvered, is contacted with a solution of lanthanide rare earths in addition to a sensitization solution of tin or palladium. The addition of the rare earths produces a mirror which has increased resistance to delamination of the silver from the glass surface in the presence of water.

Improving Process Heating System Performance v3

DOE Office of Scientific and Technical Information (OSTI.GOV)

None

2016-04-11

Improving Process Heating System Performance: A Sourcebook for Industry is a development of the U.S. Department of Energy (DOE) Advanced Manufacturing Office (AMO) and the Industrial Heating Equipment Association (IHEA). The AMO and IHEA undertook this project as part of an series of sourcebook publications developed by AMO on energy-consuming industrial systems, and opportunities to improve performance. Other topics in this series include compressed air systems, pumping systems, fan systems, steam systems, and motors and drives

UMI-tools: modeling sequencing errors in Unique Molecular Identifiers to improve quantification accuracy

PubMed Central

2017-01-01

Unique Molecular Identifiers (UMIs) are random oligonucleotide barcodes that are increasingly used in high-throughput sequencing experiments. Through a UMI, identical copies arising from distinct molecules can be distinguished from those arising through PCR amplification of the same molecule. However, bioinformatic methods to leverage the information from UMIs have yet to be formalized. In particular, sequencing errors in the UMI sequence are often ignored or else resolved in an ad hoc manner. We show that errors in the UMI sequence are common and introduce network-based methods to account for these errors when identifying PCR duplicates. Using these methods, we demonstrate improved quantification accuracy both under simulated conditions and real iCLIP and single-cell RNA-seq data sets. Reproducibility between iCLIP replicates and single-cell RNA-seq clustering are both improved using our proposed network-based method, demonstrating the value of properly accounting for errors in UMIs. These methods are implemented in the open source UMI-tools software package. PMID:28100584

Information Technology Process Improvement Decision-Making: An Exploratory Study from the Perspective of Process Owners and Process Managers

ERIC Educational Resources Information Center

Lamp, Sandra A.

2012-01-01

There is information available in the literature that discusses information technology (IT) governance and investment decision making from an executive-level perception, yet there is little information available that offers the perspective of process owners and process managers pertaining to their role in IT process improvement and investment…

The process of managerial control in quality improvement initiatives.

PubMed

Slovensky, D J; Fottler, M D

1994-11-01

The fundamental intent of strategic management is to position an organization with in its market to exploit organizational competencies and strengths to gain competitive advantage. Competitive advantage may be achieved through such strategies as low cost, high quality, or unique services or products. For health care organizations accredited by the Joint Commission on Accreditation of Healthcare Organizations, continually improving both processes and outcomes of organizational performance--quality improvement--in all operational areas of the organization is a mandated strategy. Defining and measuring quality and controlling the quality improvement strategy remain problematic. The article discusses the nature and processes of managerial control, some potential measures of quality, and related information needs.

Paths of Adoption: Routes to Continuous Process Improvement

DTIC Science & Technology

2014-07-01

To obtain a process the team will use: The Team Lead has worked on teams with good processes and wants their new team to start out on the right foot ...eventually going to have to eat the entire process-improvement elephant . So, how do you get the “Never- Adopters” to undertake the effort? The key is to...Air Warfare Center Abstract. This paper covers the different types of teams the authors have en- countered as NAVAIR Internal Process Coaches and how

A data mining paradigm for identifying key factors in biological processes using gene expression data.

PubMed

Li, Jin; Zheng, Le; Uchiyama, Akihiko; Bin, Lianghua; Mauro, Theodora M; Elias, Peter M; Pawelczyk, Tadeusz; Sakowicz-Burkiewicz, Monika; Trzeciak, Magdalena; Leung, Donald Y M; Morasso, Maria I; Yu, Peng

2018-06-13

A large volume of biological data is being generated for studying mechanisms of various biological processes. These precious data enable large-scale computational analyses to gain biological insights. However, it remains a challenge to mine the data efficiently for knowledge discovery. The heterogeneity of these data makes it difficult to consistently integrate them, slowing down the process of biological discovery. We introduce a data processing paradigm to identify key factors in biological processes via systematic collection of gene expression datasets, primary analysis of data, and evaluation of consistent signals. To demonstrate its effectiveness, our paradigm was applied to epidermal development and identified many genes that play a potential role in this process. Besides the known epidermal development genes, a substantial proportion of the identified genes are still not supported by gain- or loss-of-function studies, yielding many novel genes for future studies. Among them, we selected a top gene for loss-of-function experimental validation and confirmed its function in epidermal differentiation, proving the ability of this paradigm to identify new factors in biological processes. In addition, this paradigm revealed many key genes in cold-induced thermogenesis using data from cold-challenged tissues, demonstrating its generalizability. This paradigm can lead to fruitful results for studying molecular mechanisms in an era of explosive accumulation of publicly available biological data.

Improved Process for Fabricating Carbon Nanotube Probes

NASA Technical Reports Server (NTRS)

Stevens, R.; Nguyen, C.; Cassell, A.; Delzeit, L.; Meyyappan, M.; Han, Jie

2003-01-01

An improved process has been developed for the efficient fabrication of carbon nanotube probes for use in atomic-force microscopes (AFMs) and nanomanipulators. Relative to prior nanotube tip production processes, this process offers advantages in alignment of the nanotube on the cantilever and stability of the nanotube's attachment. A procedure has also been developed at Ames that effectively sharpens the multiwalled nanotube, which improves the resolution of the multiwalled nanotube probes and, combined with the greater stability of multiwalled nanotube probes, increases the effective resolution of these probes, making them comparable in resolution to single-walled carbon nanotube probes. The robust attachment derived from this improved fabrication method and the natural strength and resiliency of the nanotube itself produces an AFM probe with an extremely long imaging lifetime. In a longevity test, a nanotube tip imaged a silicon nitride surface for 15 hours without measurable loss of resolution. In contrast, the resolution of conventional silicon probes noticeably begins to degrade within minutes. These carbon nanotube probes have many possible applications in the semiconductor industry, particularly as devices are approaching the nanometer scale and new atomic layer deposition techniques necessitate a higher resolution characterization technique. Previously at Ames, the use of nanotube probes has been demonstrated for imaging photoresist patterns with high aspect ratio. In addition, these tips have been used to analyze Mars simulant dust grains, extremophile protein crystals, and DNA structure.

Process improvement of pap smear tracking in a women's medicine center clinic in residency training.

PubMed

Calhoun, Byron C; Goode, Jeff; Simmons, Kathy

2011-11-01

Application of Six-Sigma methodology and Change Acceleration Process (CAP)/Work Out (WO) tools to track pap smear results in an outpatient clinic in a hospital-based residency-training program. Observational study of impact of changes obtained through application of Six-Sigma principles in clinic process with particular attention to prevention of sentinel events. Using cohort analysis and applying Six-Sigma principles to an interactive electronic medical record Soarian workflow engine, we designed a system of timely accession and reporting of pap smear and pathology results. We compared manual processes from January 1, 2007 to February 28, 2008 to automated processes from March 1, 2008 to December 31, 2009. Using the Six-Sigma principles, CAP/WO tools, including "voice of the customer" and team focused approach, no outlier events went untracked. Applying the Soarian workflow engine to track prescribed 7 day turnaround time for completion, we identified 148 pap results in 3,936, 3 non-gynecological results in 15, and 41 surgical results in 246. We applied Six-Sigma principles to an outpatient clinic facilitating an interdisciplinary team approach to improve the clinic's reporting system. Through focused problem assessment, verification of process, and validation of outcomes, we improved patient care for pap smears and critical pathology. © 2011 National Association for Healthcare Quality.

Enhanced Time Out: An Improved Communication Process.

PubMed

Nelson, Patricia E

2017-06-01

An enhanced time out is an improved communication process initiated to prevent such surgical errors as wrong-site, wrong-procedure, or wrong-patient surgery. The enhanced time out at my facility mandates participation from all members of the surgical team and requires designated members to respond to specified time out elements on the surgical safety checklist. The enhanced time out incorporated at my facility expands upon the safety measures from the World Health Organization's surgical safety checklist and ensures that all personnel involved in a surgical intervention perform a final check of relevant information. Initiating the enhanced time out at my facility was intended to improve communication and teamwork among surgical team members and provide a highly reliable safety process to prevent wrong-site, wrong-procedure, and wrong-patient surgery. Copyright © 2017 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Development and pilot test of a process to identify research needs from a systematic review.

PubMed

Saldanha, Ian J; Wilson, Lisa M; Bennett, Wendy L; Nicholson, Wanda K; Robinson, Karen A

2013-05-01

To ensure appropriate allocation of research funds, we need methods for identifying high-priority research needs. We developed and pilot tested a process to identify needs for primary clinical research using a systematic review in gestational diabetes mellitus. We conducted eight steps: abstract research gaps from a systematic review using the Population, Intervention, Comparison, Outcomes, and Settings (PICOS) framework; solicit feedback from the review authors; translate gaps into researchable questions using the PICOS framework; solicit feedback from multidisciplinary stakeholders at our institution; establish consensus among multidisciplinary external stakeholders on the importance of the research questions using the Delphi method; prioritize outcomes; develop conceptual models to highlight research needs; and evaluate the process. We identified 19 research questions. During the Delphi method, external stakeholders established consensus for 16 of these 19 questions (15 with "high" and 1 with "medium" clinical benefit/importance). We pilot tested an eight-step process to identify clinically important research needs. Before wider application of this process, it should be tested using systematic reviews of other diseases. Further evaluation should include assessment of the usefulness of the research needs generated using this process for primary researchers and funders. Copyright © 2013 Elsevier Inc. All rights reserved.

Process Evaluation of a Quality Improvement Project to Decrease Hospital Readmissions From Skilled Nursing Facilities.

PubMed

Meehan, Thomas P; Qazi, Daniel J; Van Hoof, Thomas J; Ho, Shih-Yieh; Eckenrode, Sheila; Spenard, Ann; Pandolfi, Michelle; Johnson, Florence; Quetti, Deborah

2015-08-01

To describe and evaluate the impact of quality improvement (QI) support provided to skilled nursing facilities (SNFs) by a Quality Improvement Organization (QIO). Retrospective, mixed-method, process evaluation of a QI project intended to decrease preventable hospital readmissions from SNFs. Five SNFs in Connecticut. SNF Administrators, Directors of Nursing, Assistant Directors of Nursing, Admissions Coordinators, Registered Nurses, Certified Nursing Assistants, Receptionists, QIO Quality Improvement Consultant. QIO staff provided training and technical assistance to SNF administrative and clinical staff to establish or enhance QI infrastructure and implement an established set of QI tools [Interventions to Reduce Acute Care Transfers (INTERACT) tools]. Baseline SNF demographic, staffing, and hospital readmission data; baseline and follow-up SNF QI structure (QI Committee), processes (general and use of INTERACT tools), and outcome (30-day all-cause hospital readmission rates); details of QIO-provided training and technical assistance; QIO-perceived barriers to quality improvement; SNF leadership-perceived barriers, accomplishments, and suggestions for improvement of QIO support. Success occurred in establishing QI Committees and targeting preventable hospital readmissions, as well as implementing INTERACT tools in all SNFs; however, hospital readmission rates decreased in only 2 facilities. QIO staff and SNF leaders noted the ongoing challenge of engaging already busy SNF staff and leadership in QI activities. SNF leaders reported that they appreciated the training and technical assistance that their institutions received, although most noted that additional support was needed to bring about improvement in readmission rates. This process evaluation documented mixed clinical results but successfully identified opportunities to improve recruitment of and provision of technical support to participating SNFs. Recommendations are offered for others who wish to conduct

Identifying and processing the gap between perceived and actual agreement in breast pathology interpretation.

PubMed

Carney, Patricia A; Allison, Kimberly H; Oster, Natalia V; Frederick, Paul D; Morgan, Thomas R; Geller, Berta M; Weaver, Donald L; Elmore, Joann G

2016-07-01

We examined how pathologists' process their perceptions of how their interpretations on diagnoses for breast pathology cases agree with a reference standard. To accomplish this, we created an individualized self-directed continuing medical education program that showed pathologists interpreting breast specimens how their interpretations on a test set compared with a reference diagnosis developed by a consensus panel of experienced breast pathologists. After interpreting a test set of 60 cases, 92 participating pathologists were asked to estimate how their interpretations compared with the standard for benign without atypia, atypia, ductal carcinoma in situ and invasive cancer. We then asked pathologists their thoughts about learning about differences in their perceptions compared with actual agreement. Overall, participants tended to overestimate their agreement with the reference standard, with a mean difference of 5.5% (75.9% actual agreement; 81.4% estimated agreement), especially for atypia and were least likely to overestimate it for invasive breast cancer. Non-academic affiliated pathologists were more likely to more closely estimate their performance relative to academic affiliated pathologists (77.6 vs 48%; P=0.001), whereas participants affiliated with an academic medical center were more likely to underestimate agreement with their diagnoses compared with non-academic affiliated pathologists (40 vs 6%). Before the continuing medical education program, nearly 55% (54.9%) of participants could not estimate whether they would overinterpret the cases or underinterpret them relative to the reference diagnosis. Nearly 80% (79.8%) reported learning new information from this individualized web-based continuing medical education program, and 23.9% of pathologists identified strategies they would change their practice to improve. In conclusion, when evaluating breast pathology specimens, pathologists do a good job of estimating their diagnostic agreement with a

Linking the Teacher Appraisal Process to the School Improvement Plan

ERIC Educational Resources Information Center

Reddekopp, Therese

2007-01-01

If a school improvement plan includes input from all stakeholders and focuses on data-driven processes that are linked to teacher appraisal, it can be powerful in leading the school toward the common mission of achieving student success. Linking the school improvement plan to the teacher appraisal process creates a system whereby all individuals…

Ergonomics improvements of the visual inspection process in a printed circuit assembly factory.

PubMed

Yeow, Paul H P; Sen, Rabindra Nath

2004-01-01

An ergonomics improvement study was conducted on the visual inspection process of a printed circuit assembly (PCA) factory. The process was studied through subjective assessment and direct observation. Three problems were identified: operators' eye problems, insufficient time for inspection and ineffective visual inspection. These problems caused a huge yearly rejection cost of US 298,240 dollars, poor quality, customer dissatisfaction and poor occupational health and safety. Ergonomics interventions were made to rectify the problems: reduced usage of a magnifying glass, the use of less glaring inspection templates, inspection of only electrically non-tested components and introduction of a visual inspection sequence. The interventions produced savings in rejection cost, reduced operators' eye strain, headaches and watery eyes, lowered the defect percentage at customers' sites and increased the factory's productivity and customer satisfaction.

Development of a framework to improve the process of recruitment to randomised controlled trials (RCTs): the SEAR (Screened, Eligible, Approached, Randomised) framework.

PubMed

Wilson, Caroline; Rooshenas, Leila; Paramasivan, Sangeetha; Elliott, Daisy; Jepson, Marcus; Strong, Sean; Birtle, Alison; Beard, David J; Halliday, Alison; Hamdy, Freddie C; Lewis, Rebecca; Metcalfe, Chris; Rogers, Chris A; Stein, Robert C; Blazeby, Jane M; Donovan, Jenny L

2018-01-19

Research has shown that recruitment to trials is a process that stretches from identifying potentially eligible patients, through eligibility assessment, to obtaining informed consent. The length and complexity of this pathway means that many patients do not have the opportunity to consider participation. This article presents the development of a simple framework to document, understand and improve the process of trial recruitment. Eight RCTs integrated a QuinteT Recruitment Intervention (QRI) into the main trial, feasibility or pilot study. Part of the QRI required mapping the patient recruitment pathway using trial-specific screening and recruitment logs. A content analysis compared the logs to identify aspects of the recruitment pathway and process that were useful in monitoring and improving recruitment. Findings were synthesised to develop an optimised simple framework that can be used in a wide range of RCTs. The eight trials recorded basic information about patients screened for trial participation and randomisation outcome. Three trials systematically recorded reasons why an individual was not enrolled in the trial, and further details why they were not eligible or approached, or declined randomisation. A framework to facilitate clearer recording of the recruitment process and reasons for non-participation was developed: SEAR - Screening, to identify potentially eligible trial participants; Eligibility, assessed against the trial protocol inclusion/exclusion criteria; Approach, the provision of oral and written information and invitation to participate in the trial, and Randomised or not, with the outcome of randomisation or treatment received. The SEAR framework encourages the collection of information to identify recruitment obstacles and facilitate improvements to the recruitment process. SEAR can be adapted to monitor recruitment to most RCTs, but is likely to add most value in trials where recruitment problems are anticipated or evident. Further work

Understanding identifiability as a crucial step in uncertainty assessment

NASA Astrophysics Data System (ADS)

Jakeman, A. J.; Guillaume, J. H. A.; Hill, M. C.; Seo, L.

2016-12-01

The topic of identifiability analysis offers concepts and approaches to identify why unique model parameter values cannot be identified, and can suggest possible responses that either increase uniqueness or help to understand the effect of non-uniqueness on predictions. Identifiability analysis typically involves evaluation of the model equations and the parameter estimation process. Non-identifiability can have a number of undesirable effects. In terms of model parameters these effects include: parameters not being estimated uniquely even with ideal data; wildly different values being returned for different initialisations of a parameter optimisation algorithm; and parameters not being physically meaningful in a model attempting to represent a process. This presentation illustrates some of the drastic consequences of ignoring model identifiability analysis. It argues for a more cogent framework and use of identifiability analysis as a way of understanding model limitations and systematically learning about sources of uncertainty and their importance. The presentation specifically distinguishes between five sources of parameter non-uniqueness (and hence uncertainty) within the modelling process, pragmatically capturing key distinctions within existing identifiability literature. It enumerates many of the various approaches discussed in the literature. Admittedly, improving identifiability is often non-trivial. It requires thorough understanding of the cause of non-identifiability, and the time, knowledge and resources to collect or select new data, modify model structures or objective functions, or improve conditioning. But ignoring these problems is not a viable solution. Even simple approaches such as fixing parameter values or naively using a different model structure may have significant impacts on results which are too often overlooked because identifiability analysis is neglected.

Co-optimization of lithographic and patterning processes for improved EPE performance

NASA Astrophysics Data System (ADS)

Maslow, Mark J.; Timoshkov, Vadim; Kiers, Ton; Jee, Tae Kwon; de Loijer, Peter; Morikita, Shinya; Demand, Marc; Metz, Andrew W.; Okada, Soichiro; Kumar, Kaushik A.; Biesemans, Serge; Yaegashi, Hidetami; Di Lorenzo, Paolo; Bekaert, Joost P.; Mao, Ming; Beral, Christophe; Larivière, Stephane

2017-03-01

Complimentary lithography is already being used for advanced logic patterns. The tight pitches for 1D Metal layers are expected to be created using spacer based multiple patterning ArF-i exposures and the more complex cut/block patterns are made using EUV exposures. At the same time, control requirements of CDU, pattern shift and pitch-walk are approaching sub-nanometer levels to meet edge placement error (EPE) requirements. Local variability, such as Line Edge Roughness (LER), Local CDU, and Local Placement Error (LPE), are dominant factors in the total Edge Placement error budget. In the lithography process, improving the imaging contrast when printing the core pattern has been shown to improve the local variability. In the etch process, it has been shown that the fusion of atomic level etching and deposition can also improve these local variations. Co-optimization of lithography and etch processing is expected to further improve the performance over individual optimizations alone. To meet the scaling requirements and keep process complexity to a minimum, EUV is increasingly seen as the platform for delivering the exposures for both the grating and the cut/block patterns beyond N7. In this work, we evaluated the overlay and pattern fidelity of an EUV block printed in a negative tone resist on an ArF-i SAQP grating. High-order Overlay modeling and corrections during the exposure can reduce overlay error after development, a significant component of the total EPE. During etch, additional degrees of freedom are available to improve the pattern placement error in single layer processes. Process control of advanced pitch nanoscale-multi-patterning techniques as described above is exceedingly complicated in a high volume manufacturing environment. Incorporating potential patterning optimizations into both design and HVM controls for the lithography process is expected to bring a combined benefit over individual optimizations. In this work we will show the EPE

GOCI Level-2 Processing Improvements and Cloud Motion Analysis

NASA Technical Reports Server (NTRS)

Robinson, Wayne D.

2015-01-01

The Ocean Biology Processing Group has been working with the Korean Institute of Ocean Science and Technology (KIOST) to process geosynchronous ocean color data from the GOCI (Geostationary Ocean Color Instrument) aboard the COMS (Communications, Ocean and Meteorological Satellite). The level-2 processing program, l2gen has GOCI processing as an option. Improvements made to that processing are discussed here as well as a discussion about cloud motion effects.

Characteristics of Volunteer Coaches in a Clinical Process Improvement Program.

PubMed

Morley, Katharine E; Barysauskas, Constance M; Carballo, Victoria; Kalibatas, Orinta; Rao, Sandhya K; Jacobson, Joseph O; Cummings, Brian M

The Partners Clinical Process Improvement Leadership Program provides quality improvement training for clinicians and administrators, utilizing graduates as volunteer peer coaches for mentorship. We sought to understand the factors associated with volunteer coach participation and gain insight into how to improve and sustain this program. Review of coach characteristics from course database and survey of frequent coaches. Out of 516 Partners Clinical Process Improvement Leadership Program graduates from March 2010 to June 2015, 117 (23%) individuals volunteered as coaches. Sixty-one (52%) individuals coached once, 31 (27%) coached twice, and 25 (21%) coached 3 or more times. There were statistically significant associations between coaching and occupation (P = .005), Partners Clinical Process Improvement Leadership Program course taken (P = .001), and course location (P = .007). Administrators were more likely to coach than physicians (odds ratio: 1.75, P = .04). Reasons for volunteering as a coach included further development of skills, desire to stay involved with program, and enjoying mentoring. Reasons for repeated coaching included maintaining quality improvement skills, expanding skills to a wider variety of projects, and networking. A peer graduate volunteer coach model is a viable strategy for interprofessional quality improvement mentorship. Strategies that support repeat coaching and engage clinicians should be promoted to ensure an experienced and diversified group of coaches.

Westinghouse modular grinding process - improvement for follow on processes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Fehrmann, Henning

2013-07-01

In nuclear power plants (NPP) ion exchange (IX) resins are used in several systems for water treatment. The resins can be in bead or powdered form. For waste treatment of spent IX resins, two methods are basically used: Direct immobilization (e.g. with cement, bitumen, polymer or High Integrity Container (HIC)); Thermal treatment (e.g. drying, oxidation or pyrolysis). Bead resins have some properties (e.g. particle size and density) that can have negative impacts on following waste treatment processes. Negative impacts could be: Floatation of bead resins in cementation process; Sedimentation in pipeline during transportation; Poor compaction properties for Hot Resin Supercompactionmore » (HRSC). Reducing the particle size of the bead resins can have beneficial effects enhancing further treatment processes and overcoming prior mentioned effects. Westinghouse Electric Company has developed a modular grinding process to crush/grind the bead resins. This modular process is designed for flexible use and enables a selective adjustment of particle size to tailor the grinding system to the customer needs. The system can be equipped with a crusher integrated in the process tank and if necessary a colloid mill. The crusher reduces the bead resins particle size and converts the bead resins to a pump able suspension with lower sedimentation properties. With the colloid mill the resins can be ground to a powder. Compared to existing grinding systems this equipment is designed to minimize radiation exposure of the worker during operation and maintenance. Using the crushed and/or ground bead resins has several beneficial effects like facilitating cementation process and recipe development, enhancing oxidation of resins, improving the Hot Resin Supercompaction volume reduction performance. (authors)« less

Failure mode and effect analysis: improving intensive care unit risk management processes.

PubMed

Askari, Roohollah; Shafii, Milad; Rafiei, Sima; Abolhassani, Mohammad Sadegh; Salarikhah, Elaheh

2017-04-18

Purpose Failure modes and effects analysis (FMEA) is a practical tool to evaluate risks, discover failures in a proactive manner and propose corrective actions to reduce or eliminate potential risks. The purpose of this paper is to apply FMEA technique to examine the hazards associated with the process of service delivery in intensive care unit (ICU) of a tertiary hospital in Yazd, Iran. Design/methodology/approach This was a before-after study conducted between March 2013 and December 2014. By forming a FMEA team, all potential hazards associated with ICU services - their frequency and severity - were identified. Then risk priority number was calculated for each activity as an indicator representing high priority areas that need special attention and resource allocation. Findings Eight failure modes with highest priority scores including endotracheal tube defect, wrong placement of endotracheal tube, EVD interface, aspiration failure during suctioning, chest tube failure, tissue injury and deep vein thrombosis were selected for improvement. Findings affirmed that improvement strategies were generally satisfying and significantly decreased total failures. Practical implications Application of FMEA in ICUs proved to be effective in proactively decreasing the risk of failures and corrected the control measures up to acceptable levels in all eight areas of function. Originality/value Using a prospective risk assessment approach, such as FMEA, could be beneficial in dealing with potential failures through proposing preventive actions in a proactive manner. The method could be used as a tool for healthcare continuous quality improvement so that the method identifies both systemic and human errors, and offers practical advice to deal effectively with them.

Hydrologic-Process-Based Soil Texture Classifications for Improved Visualization of Landscape Function

PubMed Central

Groenendyk, Derek G.; Ferré, Ty P.A.; Thorp, Kelly R.; Rice, Amy K.

2015-01-01

Soils lie at the interface between the atmosphere and the subsurface and are a key component that control ecosystem services, food production, and many other processes at the Earth’s surface. There is a long-established convention for identifying and mapping soils by texture. These readily available, georeferenced soil maps and databases are used widely in environmental sciences. Here, we show that these traditional soil classifications can be inappropriate, contributing to bias and uncertainty in applications from slope stability to water resource management. We suggest a new approach to soil classification, with a detailed example from the science of hydrology. Hydrologic simulations based on common meteorological conditions were performed using HYDRUS-1D, spanning textures identified by the United States Department of Agriculture soil texture triangle. We consider these common conditions to be: drainage from saturation, infiltration onto a drained soil, and combined infiltration and drainage events. Using a k-means clustering algorithm, we created soil classifications based on the modeled hydrologic responses of these soils. The hydrologic-process-based classifications were compared to those based on soil texture and a single hydraulic property, Ks. Differences in classifications based on hydrologic response versus soil texture demonstrate that traditional soil texture classification is a poor predictor of hydrologic response. We then developed a QGIS plugin to construct soil maps combining a classification with georeferenced soil data from the Natural Resource Conservation Service. The spatial patterns of hydrologic response were more immediately informative, much simpler, and less ambiguous, for use in applications ranging from trafficability to irrigation management to flood control. The ease with which hydrologic-process-based classifications can be made, along with the improved quantitative predictions of soil responses and visualization of landscape

Hydrologic-Process-Based Soil Texture Classifications for Improved Visualization of Landscape Function.

PubMed

Groenendyk, Derek G; Ferré, Ty P A; Thorp, Kelly R; Rice, Amy K

2015-01-01

Soils lie at the interface between the atmosphere and the subsurface and are a key component that control ecosystem services, food production, and many other processes at the Earth's surface. There is a long-established convention for identifying and mapping soils by texture. These readily available, georeferenced soil maps and databases are used widely in environmental sciences. Here, we show that these traditional soil classifications can be inappropriate, contributing to bias and uncertainty in applications from slope stability to water resource management. We suggest a new approach to soil classification, with a detailed example from the science of hydrology. Hydrologic simulations based on common meteorological conditions were performed using HYDRUS-1D, spanning textures identified by the United States Department of Agriculture soil texture triangle. We consider these common conditions to be: drainage from saturation, infiltration onto a drained soil, and combined infiltration and drainage events. Using a k-means clustering algorithm, we created soil classifications based on the modeled hydrologic responses of these soils. The hydrologic-process-based classifications were compared to those based on soil texture and a single hydraulic property, Ks. Differences in classifications based on hydrologic response versus soil texture demonstrate that traditional soil texture classification is a poor predictor of hydrologic response. We then developed a QGIS plugin to construct soil maps combining a classification with georeferenced soil data from the Natural Resource Conservation Service. The spatial patterns of hydrologic response were more immediately informative, much simpler, and less ambiguous, for use in applications ranging from trafficability to irrigation management to flood control. The ease with which hydrologic-process-based classifications can be made, along with the improved quantitative predictions of soil responses and visualization of landscape

Design Process Improvement for Electric CAR Harness

NASA Astrophysics Data System (ADS)

Sawatdee, Thiwarat; Chutima, Parames

2017-06-01

In an automobile parts design company, the customer satisfaction is one of the most important factors for product design. Therefore, the company employs all means to focus its product design process based on the various requirements of customers resulting in high number of design changes. The objective of this research is to improve the design process of the electric car harness that effects the production scheduling by using Fault Tree Analysis (FTA) and Failure Mode and Effect Analysis (FMEA) as the main tools. FTA is employed for root cause analysis and FMEA is used to ranking a High Risk Priority Number (RPN) which is shows the priority of factors in the electric car harness that have high impact to the design of the electric car harness. After the implementation, the improvements are realized significantly since the number of design change is reduced from 0.26% to 0.08%.

Using continuous process improvement methodology to standardize nursing handoff communication.

PubMed

Klee, Kristi; Latta, Linda; Davis-Kirsch, Sallie; Pecchia, Maria

2012-04-01

The purpose of this article was to describe the use of continuous performance improvement (CPI) methodology to standardize nurse shift-to-shift handoff communication. The goals of the process were to standardize the content and process of shift handoff, improve patient safety, increase patient and family involvement in the handoff process, and decrease end-of-shift overtime. This article will describe process changes made over a 4-year period as result of application of the plan-do-check-act procedure, which is an integral part of the CPI methodology, and discuss further work needed to continue to refine this critical nursing care process. Copyright © 2012 Elsevier Inc. All rights reserved.

Improving preanalytic processes using the principles of lean production (Toyota Production System).

PubMed

Persoon, Thomas J; Zaleski, Sue; Frerichs, Janice

2006-01-01

The basic technologies used in preanalytic processes for chemistry tests have been mature for a long time, and improvements in preanalytic processes have lagged behind improvements in analytic and postanalytic processes. We describe our successful efforts to improve chemistry test turnaround time from a central laboratory by improving preanalytic processes, using existing resources and the principles of lean production. Our goal is to report 80% of chemistry tests in less than 1 hour and to no longer recognize a distinction between expedited and routine testing. We used principles of lean production (the Toyota Production System) to redesign preanalytic processes. The redesigned preanalytic process has fewer steps and uses 1-piece flow to move blood samples through the accessioning, centrifugation, and aliquoting processes. Median preanalytic processing time was reduced from 29 to 19 minutes, and the laboratory met the goal of reporting 80% of chemistry results in less than 1 hour for 11 consecutive months.

A Qualitative Study of Multidisciplinary Providers' Experiences With the Transfer Process for Injured Children and Ideas for Improvement.

PubMed

Gawel, Marcie; Emerson, Beth; Giuliano, John S; Rosenberg, Alana; Minges, Karl E; Feder, Shelli; Violano, Pina; Morrell, Patricia; Petersen, Judy; Christison-Lagay, Emily; Auerbach, Marc

2018-02-01

Most injured children initially present to a community hospital, and many will require transfer to a regional pediatric trauma center. The purpose of this study was 1) to explore multidisciplinary providers' experiences with the process of transferring injured children and 2) to describe proposed ideas for process improvement. This qualitative study involved 26 semistructured interviews. Subjects were recruited from 6 community hospital emergency departments and the trauma and transport teams of a level I pediatric trauma center in New Haven, Conn. Participants (n = 34) included interprofessional providers from sending facilities, transport teams, and receiving facilities. Using the constant comparative method, a multidisciplinary team coded transcripts and collectively refined codes to generate recurrent themes across interviews until theoretical saturation was achieved. Participants reported that the transfer process for injured children is complex, stressful, and necessitates collaboration. The transfer process was perceived to involve numerous interrelated components, including professions, disciplines, and institutions. The 5 themes identified as areas to improve this transfer process included 1) Creation of a unified standard operating procedure that crosses institutions/teams, 2) Enhancing 'shared sense making' of all providers, 3) Improving provider confidence, expertise, and skills in caring for pediatric trauma transfer cases, 4) Addressing organization and environmental factors that may impede/delay transfer, and 5) Fostering institutional and personal relationships. Efforts to improve the transfer process for injured children should be guided by the experiences of and input from multidisciplinary frontline emergency providers.

Optimisation of multiplet identifier processing on a PLAYSTATION® 3

NASA Astrophysics Data System (ADS)

Hattori, Masami; Mizuno, Takashi

2010-02-01

To enable high-performance computing (HPC) for applications with large datasets using a Sony® PLAYSTATION® 3 (PS3™) video game console, we configured a hybrid system consisting of a Windows® PC and a PS3™. To validate this system, we implemented the real-time multiplet identifier (RTMI) application, which identifies multiplets of microearthquakes in terms of the similarity of their waveforms. The cross-correlation computation, which is a core algorithm of the RTMI application, was optimised for the PS3™ platform, while the rest of the computation, including data input and output remained on the PC. With this configuration, the core part of the algorithm ran 69 times faster than the original program, accelerating total computation speed more than five times. As a result, the system processed up to 2100 total microseismic events, whereas the original implementation had a limit of 400 events. These results indicate that this system enables high-performance computing for large datasets using the PS3™, as long as data transfer time is negligible compared with computation time.

Improving quality of care in substance abuse treatment using five key process improvement principles

PubMed Central

Hoffman, Kim A.; Green, Carla A.; Ford, James H.; Wisdom, Jennifer P.; Gustafson, David H.; McCarty, Dennis

2012-01-01

Process and quality improvement techniques have been successfully applied in health care arenas, but efforts to institute these strategies in alcohol and drug treatment are underdeveloped. The Network for the Improvement of Addiction Treatment (NIATx) teaches participating substance abuse treatment agencies to use process improvement strategies to increase client access to, and retention in, treatment. NIATx recommends five principles to promote organizational change: 1) Understand and involve the customer; 2) Fix key problems; 3) Pick a powerful change leader; 4) Get ideas from outside the organization; and 5) Use rapid-cycle testing. Using case studies, supplemented with cross-agency analyses of interview data, this paper profiles participating NIATx treatment agencies that illustrate application of each principle. Results suggest that the most successful organizations integrate and apply most, if not all, of the five principles as they develop and test change strategies. PMID:22282129

Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project

PubMed Central

Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti

2013-01-01

Background Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. Methods We designed and implemented a structured curriculum in which interdisciplinary teams acquired knowledge on quality improvement and teamwork, while focusing on a specific clinical project: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. Results The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. Conclusions This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team

Improving Immunization Rates Using Lean Six Sigma Processes: Alliance of Independent Academic Medical Centers National Initiative III Project.

PubMed

Hina-Syeda, Hussaini; Kimbrough, Christina; Murdoch, William; Markova, Tsveti

2013-01-01

Quality improvement education and work in interdisciplinary teams is a healthcare priority. Healthcare systems are trying to meet core measures and provide excellent patient care, thus improving their Hospital Consumer Assessment of Healthcare Providers & Systems scores. Crittenton Hospital Medical Center in Rochester Hills, MI, aligned educational and clinical objectives, focusing on improving immunization rates against pneumonia and influenza prior to the rates being implemented as core measures. Improving immunization rates prevents infections, minimizes hospitalizations, and results in overall improved patient care. Teaching hospitals offer an effective way to work on clinical projects by bringing together the skill sets of residents, faculty, and hospital staff to achieve superior results. WE DESIGNED AND IMPLEMENTED A STRUCTURED CURRICULUM IN WHICH INTERDISCIPLINARY TEAMS ACQUIRED KNOWLEDGE ON QUALITY IMPROVEMENT AND TEAMWORK, WHILE FOCUSING ON A SPECIFIC CLINICAL PROJECT: improving global immunization rates. We used the Lean Six Sigma process tools to quantify the initial process capability to immunize against pneumococcus and influenza. The hospital's process to vaccinate against pneumonia overall was operating at a Z score of 3.13, and the influenza vaccination Z score was 2.53. However, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 1.96. Improvement in immunization rates of high-risk patients became the focus of the project. After the implementation of solutions, the process to vaccinate high-risk patients against pneumonia operated at a Z score of 3.9 with a defects/million opportunities rate of 9,346 and a yield of 93.5%. Revisions to the adult assessment form fixed 80% of the problems identified. This process improvement project was not only beneficial in terms of improved quality of patient care but was also a positive learning experience for the interdisciplinary team, particularly for the residents. The

Process Improvement for Next Generation Space Flight Vehicles: MSFC Lessons Learned

NASA Technical Reports Server (NTRS)

Housch, Helen

2008-01-01

This viewgraph presentation reviews the lessons learned from process improvement for Next Generation Space Flight Vehicles. The contents include: 1) Organizational profile; 2) Process Improvement History; 3) Appraisal Preparation; 4) The Appraisal Experience; 5) Useful Tools; and 6) Is CMMI working?

Identifying target processes for microbial electrosynthesis by elementary mode analysis.

PubMed

Kracke, Frauke; Krömer, Jens O

2014-12-30

Microbial electrosynthesis and electro fermentation are techniques that aim to optimize microbial production of chemicals and fuels by regulating the cellular redox balance via interaction with electrodes. While the concept is known for decades major knowledge gaps remain, which make it hard to evaluate its biotechnological potential. Here we present an in silico approach to identify beneficial production processes for electro fermentation by elementary mode analysis. Since the fundamentals of electron transport between electrodes and microbes have not been fully uncovered yet, we propose different options and discuss their impact on biomass and product yields. For the first time 20 different valuable products were screened for their potential to show increased yields during anaerobic electrically enhanced fermentation. Surprisingly we found that an increase in product formation by electrical enhancement is not necessarily dependent on the degree of reduction of the product but rather the metabolic pathway it is derived from. We present a variety of beneficial processes with product yield increases of maximal 36% in reductive and 84% in oxidative fermentations and final theoretical product yields up to 100%. This includes compounds that are already produced at industrial scale such as succinic acid, lysine and diaminopentane as well as potential novel bio-commodities such as isoprene, para-hydroxybenzoic acid and para-aminobenzoic acid. Furthermore, it is shown that the way of electron transport has major impact on achievable biomass and product yields. The coupling of electron transport to energy conservation could be identified as crucial for most processes. This study introduces a powerful tool to determine beneficial substrate and product combinations for electro-fermentation. It also highlights that the maximal yield achievable by bio electrochemical techniques depends strongly on the actual electron transport mechanisms. Therefore it is of great importance to

Food safety management systems performance in African food processing companies: a review of deficiencies and possible improvement strategies.

PubMed

Kussaga, Jamal B; Jacxsens, Liesbeth; Tiisekwa, Bendantunguka Pm; Luning, Pieternel A

2014-08-01

This study seeks to provide insight into current deficiencies in food safety management systems (FSMS) in African food-processing companies and to identify possible strategies for improvement so as to contribute to African countries' efforts to provide safe food to both local and international markets. This study found that most African food products had high microbiological and chemical contamination levels exceeding the set (legal) limits. Relative to industrialized countries, the study identified various deficiencies at government, sector/branch, retail and company levels which affect performance of FSMS in Africa. For instance, very few companies (except exporting and large companies) have implemented HACCP and ISO 22000:2005. Various measures were proposed to be taken at government (e.g. construction of risk-based legislative frameworks, strengthening of food safety authorities, recommend use of ISO 22000:2005, and consumers' food safety training), branch/sector (e.g. sector-specific guidelines and third-party certification), retail (develop stringent certification standards and impose product specifications) and company levels (improving hygiene, strict raw material control, production process efficacy, and enhancing monitoring systems, assurance activities and supportive administrative structures). By working on those four levels, FSMS of African food-processing companies could be better designed and tailored towards their production processes and specific needs to ensure food safety. © 2014 Society of Chemical Industry.

Bootstrapping Process Improvement Metrics: CMMI Level 4 Process Improvement Metrics in a Level 3 World

NASA Technical Reports Server (NTRS)

Hihn, Jairus; Lewicki, Scott; Morgan, Scott

2011-01-01

The measurement techniques for organizations which have achieved the Software Engineering Institutes CMMI Maturity Levels 4 and 5 are well documented. On the other hand, how to effectively measure when an organization is Maturity Level 3 is less well understood, especially when there is no consistency in tool use and there is extensive tailoring of the organizational software processes. Most organizations fail in their attempts to generate, collect, and analyze standard process improvement metrics under these conditions. But at JPL, NASA's prime center for deep space robotic exploration, we have a long history of proving there is always a solution: It just may not be what you expected. In this paper we describe the wide variety of qualitative and quantitative techniques we have been implementing over the last few years, including the various approaches used to communicate the results to both software technical managers and senior managers.

Upward appraisal as a means for improving supervisory performance and promoting process improvement, with long-term implications for organizational change

NASA Technical Reports Server (NTRS)

Siegfeldt, Denise V.

1994-01-01

This study represents the implementation phase of an organizational development project which was initiated last year in the Management Support Division (MSD) at Langley Research Center to diagnose organizational functioning. As a result of MSD survey data from last year's effort, a Quality Action Team was created to address the responses compiled from the MSD Organizational Assessment Questionnaire and Follow-Up Questionnaire. The team was officially named the MSD Employee Relations Improvement Team (MERIT). MERIT's goal was to analyze major concerns generated by the questionnaires and to present feasible solutions to management which would improve supervisory performance, promote process improvement; and ultimately, lead to a better organization. The team met weekly and was very disciplined in following guidelines needed to ensure a fully functioning team. Several TQM tools were used during the team process, including brainstorming and the cause and effect diagram. One of the products produced by MERIT was a 'report card', more formally known as an upward appraisal system, to evaluate supervisory performance in the division office, its three branches, and in teams. Major areas of emphasis on the 47 item report card were those identified by employees through the previously administered questionnaires as needing to be improved; specifically, training, recognition, teamwork, supervision and leadership, and communication. MERIT created an enlarged and modified version of the report card which enabled scores for each individual supervisor to be recorded on a separate form, along with summary results and employee comments. Report card results have been compiled and fed back to the Division Chief and Assistant Division Chief. These individuals will in turn, feed the results back to the remaining supervisors and the team leaders. Although results differ among supervisors, some similarities exist. Communication generally appears to be adequate, which represents an

Deployment of lean six sigma in care coordination: an improved discharge process.

PubMed

Breslin, Susan Ellen; Hamilton, Karen Marie; Paynter, Jacquelyn

2014-01-01

This article presents a quality improvement project to reduce readmissions in the Medicare population related to heart failure, acute myocardial infarction, and pneumonia. The article describes a systematic approach to the discharge process aimed at improving transitions of care from hospital to post-acute care, utilizing Lean Six Sigma methodology. Inpatient acute care hospital. A coordinated discharge process, which includes postdischarge follow-up, can reduce avoidable readmissions. Implications for The quality improvement project demonstrated the significant role case management plays in preventing costly readmissions and improving outcomes for patients through better transitions of care from the hospital to the community. By utilizing Lean Six Sigma methodology, hospitals can focus on eliminating waste in their current processes and build more sustainable improvements to deliver a safe, quality, discharge process for their patients. Case managers are leading this effort to improve care transitions and assure a smoother transition into the community postdischarge..

Improving Competition: Reforming the Requirements Process

DTIC Science & Technology

2016-07-01

45 Defense AT&L: July-August 2016 Improving Competition Reforming the Requirements Process Roy Wood, Ph.D. Wood is the Acting Vice President...professional. T ypical acquisition reform efforts have been focused in the margins, achiev­ ing marginal results. The evidence of decades of...acquisition reform indicates that the marginal reforms typically taken are not making the funda­ mental changes needed by the Department of Defense (DoD

Ten steps to successful software process improvement

NASA Technical Reports Server (NTRS)

Kandt, R. K.

2003-01-01

This paper identifies ten steps for managing change that address organizational and cultural issues. Four of these steps are critical, that if not done, will almost guarantee failure. This ten-step program emphasizes the alignment of business goals, change process goals, and the work performed by the employees of an organization.

Improving healthcare using Lean processes.

PubMed

Baker, G Ross

2014-01-01

For more than a decade, healthcare organizations across Canada have been using Lean management tools to improve care processes, reduce preventable adverse events, increase patient satisfaction and create better work environments. The largest system-wide effort in Canada, and perhaps anywhere, is currently under way in Saskatchewan. The jury is still out on whether Lean efforts in that province, or elsewhere in Canada, are robust enough to transform current delivery systems and sustain new levels of performance. This issue of Healthcare Quarterly features several articles that provide a perspective on Lean methods in healthcare. Copyright © 2014 Longwoods Publishing.

Focused process improvement events: sustainability of impact on process and performance in an academic radiology department.

PubMed

Rosenkrantz, Andrew B; Lawson, Kirk; Ally, Rosina; Chen, David; Donno, Frank; Rittberg, Steven; Rodriguez, Joan; Recht, Michael P

2015-01-01

To evaluate sustainability of impact of rapid, focused process improvement (PI) events on process and performance within an academic radiology department. Our department conducted PI during 2011 and 2012 in CT, MRI, ultrasound, breast imaging, and research billing. PI entailed participation by all stakeholders, facilitation by the department chair, collection of baseline data, meetings during several weeks, definition of performance metrics, creation of an improvement plan, and prompt implementation. We explore common themes among PI events regarding initial impact and durability of changes. We also assess performance in each area pre-PI, immediately post-PI, and at the time of the current study. All PI events achieved an immediate improvement in performance metrics, often entailing both examination volumes and on-time performance. IT-based solutions, process standardization, and redefinition of staff responsibilities were often central in these changes, and participants consistently expressed improved internal leadership and problem-solving ability. Major environmental changes commonly occurred after PI, including a natural disaster with equipment loss, a change in location or services offered, and new enterprise-wide electronic medical record system incorporating new billing and radiology informatics systems, requiring flexibility in the PI implementation plan. Only one PI team conducted regular post-PI follow-up meetings. Sustained improvement was frequently, but not universally, observed: in the long-term following initial PI, measures of examination volume showed continued progressive improvements, whereas measures of operational efficiency remained stable or occasionally declined. Focused PI is generally effective in achieving performance improvement, although a changing environment influences the sustainability of impact. Thus, continued process evaluation and ongoing workflow modifications are warranted. Copyright © 2015 American College of Radiology

Improved process for forming a three-dimensional undersurface on a printed cantilever

NASA Astrophysics Data System (ADS)

Kanazawa, Shusuke; Kusaka, Yasuyuki; Yamamoto, Noritaka; Ushijima, Hirobumi

2018-05-01

An improvement in the lift-on offset printing process is reported as a means of enabling the structural customization of hollow structures used as moving parts of sensors and actuators. The improved process can add structures to the underside of a hollow structure by modifying the preparation of the pre-structure. As a demonstration, the mechanical displacement of a cantilever in a gravitational acceleration sensor was enhanced by the addition of a proof mass. The improved process can be expected to further produce functionalized hollow structures by an efficient manufacturing process.

Stakeholder Engagement to Identify Priorities for Improving the Quality and Value of Critical Care.

PubMed

Stelfox, Henry T; Niven, Daniel J; Clement, Fiona M; Bagshaw, Sean M; Cook, Deborah J; McKenzie, Emily; Potestio, Melissa L; Doig, Christopher J; O'Neill, Barbara; Zygun, David

2015-01-01

Large amounts of scientific evidence are generated, but not implemented into patient care (the 'knowledge-to-care' gap). We identified and prioritized knowledge-to-care gaps in critical care as opportunities to improve the quality and value of healthcare. We used a multi-method community-based participatory research approach to engage a Network of all adult (n = 14) and pediatric (n = 2) medical-surgical intensive care units (ICUs) in a fully integrated geographically defined healthcare system serving 4 million residents. Participants included Network oversight committee members (n = 38) and frontline providers (n = 1,790). Network committee members used a modified RAND/University of California Appropriateness Methodology, to serially propose, rate (validated 9 point scale) and revise potential knowledge-to-care gaps as priorities for improvement. The priorities were sent to frontline providers for evaluation. Results were relayed back to all frontline providers for feedback. Initially, 68 knowledge-to-care gaps were proposed, rated and revised by the committee (n = 32 participants) over 3 rounds of review and resulted in 13 proposed priorities for improvement. Then, 1,103 providers (62% response rate) evaluated the priorities, and rated 9 as 'necessary' (median score 7-9). Several factors were associated with rating priorities as necessary in multivariable logistic regression, related to the provider (experience, teaching status of ICU) and topic (strength of supporting evidence, potential to benefit the patient, potential to improve patient/family experience, potential to decrease costs). A community-based participatory research approach engaged a diverse group of stakeholders to identify 9 priorities for improving the quality and value of critical care. The approach was time and cost efficient and could serve as a model to prioritize areas for research quality improvement across other settings.

Improvement of radiology services based on the process management approach.

PubMed

Amaral, Creusa Sayuri Tahara; Rozenfeld, Henrique; Costa, Janaina Mascarenhas Hornos; Magon, Maria de Fátima de Andrade; Mascarenhas, Yvone Maria

2011-06-01

The health sector requires continuous investments to ensure the improvement of products and services from a technological standpoint, the use of new materials, equipment and tools, and the application of process management methods. Methods associated with the process management approach, such as the development of reference models of business processes, can provide significant innovations in the health sector and respond to the current market trend for modern management in this sector (Gunderman et al. (2008) [4]). This article proposes a process model for diagnostic medical X-ray imaging, from which it derives a primary reference model and describes how this information leads to gains in quality and improvements. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

Electronic Timekeeping: North Dakota State University Improves Payroll Processing.

ERIC Educational Resources Information Center

Vetter, Ronald J.; And Others

1993-01-01

North Dakota State University has adopted automated timekeeping to improve the efficiency and effectiveness of payroll processing. The microcomputer-based system accurately records and computes employee time, tracks labor distribution, accommodates complex labor policies and company pay practices, provides automatic data processing and reporting,…

[Improving inpatient pharmacoterapeutic process by Lean Six Sigma methodology].

PubMed

Font Noguera, I; Fernández Megía, M J; Ferrer Riquelme, A J; Balasch I Parisi, S; Edo Solsona, M D; Poveda Andres, J L

2013-01-01

Lean Six Sigma methodology has been used to improve care processes, eliminate waste, reduce costs, and increase patient satisfaction. To analyse the results obtained with Lean Six Sigma methodology in the diagnosis and improvement of the inpatient pharmacotherapy process during structural and organisational changes in a tertiary hospital. 1.000 beds tertiary hospital. prospective observational study. The define, measure, analyse, improve and control (DMAIC), were deployed from March to September 2011. An Initial Project Charter was updated as results were obtained. 131 patients with treatments prescribed within 24h after admission and with 4 drugs. safety indicators (medication errors), and efficiency indicators (complaints and time delays). Proportion of patients with a medication error was reduced from 61.0% (25/41 patients) to 55.7% (39/70 patients) in four months. Percentage of errors (regarding the opportunities for error) decreased in the different phases of the process: Prescription: from 5.1% (19/372 opportunities) to 3.3% (19/572 opportunities); Preparation: from 2.7% (14/525 opportunities) to 1.3% (11/847 opportunities); and administration: from 4.9% (16/329 opportunities) to 3.0% (13/433 opportunities). Nursing complaints decreased from 10.0% (2119/21038 patients) to 5.7% (1779/31097 patients). The estimated economic impact was 76,800 euros saved. An improvement in the pharmacotherapeutic process and a positive economic impact was observed, as well as enhancing patient safety and efficiency of the organization. Standardisation and professional training are future Lean Six Sigma candidate projects. Copyright © 2012 SECA. Published by Elsevier Espana. All rights reserved.

Model of areas for identifying risks influencing the compliance of technological processes and products

NASA Astrophysics Data System (ADS)

Misztal, A.; Belu, N.

2016-08-01

Operation of every company is associated with the risk of interfering with proper performance of its fundamental processes. This risk is associated with various internal areas of the company, as well as the environment in which it operates. From the point of view of ensuring compliance of the course of specific technological processes and, consequently, product conformity with requirements, it is important to identify these threats and eliminate or reduce the risk of their occurrence. The purpose of this article is to present a model of areas of identifying risk affecting the compliance of processes and products, which is based on multiregional targeted monitoring of typical places of interference and risk management methods. The model is based on the verification of risk analyses carried out in small and medium-sized manufacturing companies in various industries..

CORROSION PROCESS IN REINFORCED CONCRETE IDENTIFIED BY ACOUSTIC EMISSION

NASA Astrophysics Data System (ADS)

Kawasaki, Yuma; Kitaura, Misuzu; Tomoda, Yuichi; Ohtsu, Masayasu

Deterioration of Reinforced Concrete (RC) due to salt attack is known as one of serious problems. Thus, development of non-destructive evaluation (NDE) techniques is important to assess the corrosion process. Reinforcement in concrete normally does not corrode because of a passive film on the surface of reinforcement. When chloride concentration at reinfo rcement exceeds the threshold level, the passive film is destroyed. Thus maintenance is desirable at an early stage. In this study, to identify the onset of corrosion and the nucleation of corrosion-induced cracking in concrete due to expansion of corrosion products, continuous acoustic emission (AE) monitoring is applied. Accelerated corrosion and cyclic wet and dry tests are performed in a laboratory. The SiGMA (Simplified Green's functions for Moment tensor Analysis) proce dure is applied to AE waveforms to clarify source kinematics of micro-cracks locations, types and orientations. Results show that the onset of corrosion and the nu cleation of corrosion-induced cracking in concrete are successfully identified. Additionally, cross-sections inside the reinforcement are observed by a scanning electron microscope (SEM). From these results, a great promise for AE techniques to monitor salt damage at an early stage in RC structures is demonstrated.

The hepatitis C cascade of care: identifying priorities to improve clinical outcomes.

PubMed

Linas, Benjamin P; Barter, Devra M; Leff, Jared A; Assoumou, Sabrina A; Salomon, Joshua A; Weinstein, Milton C; Kim, Arthur Y; Schackman, Bruce R

2014-01-01

As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost-effective. Priority should be given to developing and

Pre-processing by data augmentation for improved ellipse fitting.

PubMed

Kumar, Pankaj; Belchamber, Erika R; Miklavcic, Stanley J

2018-01-01

Ellipse fitting is a highly researched and mature topic. Surprisingly, however, no existing method has thus far considered the data point eccentricity in its ellipse fitting procedure. Here, we introduce the concept of eccentricity of a data point, in analogy with the idea of ellipse eccentricity. We then show empirically that, irrespective of ellipse fitting method used, the root mean square error (RMSE) of a fit increases with the eccentricity of the data point set. The main contribution of the paper is based on the hypothesis that if the data point set were pre-processed to strategically add additional data points in regions of high eccentricity, then the quality of a fit could be improved. Conditional validity of this hypothesis is demonstrated mathematically using a model scenario. Based on this confirmation we propose an algorithm that pre-processes the data so that data points with high eccentricity are replicated. The improvement of ellipse fitting is then demonstrated empirically in real-world application of 3D reconstruction of a plant root system for phenotypic analysis. The degree of improvement for different underlying ellipse fitting methods as a function of data noise level is also analysed. We show that almost every method tested, irrespective of whether it minimizes algebraic error or geometric error, shows improvement in the fit following data augmentation using the proposed pre-processing algorithm.

Redesigning the ICU nursing discharge process: a quality improvement study.

PubMed

Chaboyer, Wendy; Lin, Frances; Foster, Michelle; Retallick, Lorraine; Panuwatwanich, Kriengsak; Richards, Brent

2012-02-01

To evaluate the impact of a redesigned intensive care unit (ICU) nursing discharge process on ICU discharge delay, hospital mortality, and ICU readmission within 72 hours. A quality improvement study using a time series design and statistical process control analysis was conducted in one Australian general ICU. The primary outcome measure was hours of discharge delay per patient discharged alive per month, measured for 15 months prior to, and for 12 months after the redesigned process was implemented. The redesign process included appointing a change agent to facilitate process improvement, developing a patient handover sheet, requesting ward staff to nominate an estimated transfer time, and designing a daily ICU discharge alert sheet that included an expected date of discharge. A total of 1,787 ICU discharges were included in this study, 1,001 in the 15 months before and 786 in the 12 months after the implementation of the new discharge processes. There was no difference in in-hospital mortality after discharge from ICU or ICU readmission within 72 hours during the study period. However, process improvement was demonstrated by a reduction in the average patient discharge delay time of 3.2 hours (from 4.6 hour baseline to 1.0 hours post-intervention). Involving both ward and ICU staff in the redesign process may have contributed to a shared situational awareness of the problems, which led to more timely and effective ICU discharge processes. The use of a change agent, whose ongoing role involved follow-up of patients discharged from ICU, may have helped to embed the new process into practice. ©2011 Sigma Theta Tau International.

Unconscious decisional learning improves unconscious information processing.

PubMed

Vlassova, Alexandra; Pearson, Joel

2018-07-01

The idea that unconscious input can result in long-term learning or task improvement has been debated for decades, yet there is still little evidence to suggest that learning outside of awareness can produce meaningful changes to decision-making. Here we trained participants using noisy motion stimuli, which require the gradual accumulation of information until a decision can be reached. These stimuli were suppressed from conscious awareness by simultaneously presenting a dynamic dichoptic mask. We show that a short period of training on either a partially or fully suppressed motion stimulus resulted in improved accuracy when tested on a partially suppressed motion stimulus traveling in the orthogonal direction. We found this improvement occurred even when performance on the training task was at chance. Performance gains generalized across motion directions, suggesting that the improvement was the result of changes to the decisional mechanisms rather than perceptual. Interestingly, unconscious learning had a stronger effect on unconscious, compared to conscious decisional accumulation. We further show that a conscious coherent percept is necessary to reap the benefits of unconscious learning. Together, these data suggest that unconscious decisional processing can be improved via training. Copyright © 2018 Elsevier B.V. All rights reserved.

An anticipatory quality improvement process for curricular reform.

PubMed

Hollander, Harry; Loeser, Helen; Irby, David

2002-09-01

standardized set of questions; and examined course schedules, cases, and detailed learning objectives for particular sessions. In July 2001, the committee reported back to the deans with specific recommendations for coordinating the block courses, and about the success in creating integration and the overall balance of topics students would learn. Specific recommendations included increasing the use of pediatric and geriatric cases across courses, creating a case database, developing explicit plans to relocate uncovered material in the four-year curriculum, and bolstering participation of clinical faculty during the first-year blocks. These recommendations were then presented to and endorsed by the Essential Core Steering Committee, which implemented an action plan prior to the September 2001 start date. This proactive approach to quality improvement added an evaluation point before the new curriculum was actually unveiled. The anticipatory planning process substantially aided the interdisciplinary developmental process, increased input into the first-year curriculum by clerkship directors, and identified problems that would have otherwise become apparent after implementation. We believe this model adds value to the curriculum planning process.

Challenges and potential improvements in the admission process of patients with spinal cord injury in a specialized rehabilitation clinic - an interview based qualitative study of an interdisciplinary team.

PubMed

Röthlisberger, Fabian; Boes, Stefan; Rubinelli, Sara; Schmitt, Klaus; Scheel-Sailer, Anke

2017-06-26

The admission process of patients to a hospital is the starting point for inpatient services. In order to optimize the quality of the health services provision, one needs a good understanding of the patient admission workflow in a clinic. The aim of this study was to identify challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic from the perspective of an interdisciplinary team of health professionals. Semi-structured interviews with eight health professionals (medical doctors, physical therapists, occupational therapists, nurses) at the Swiss Paraplegic Centre (acute and rehabilitation clinic) were conducted based on a maximum variety purposive sampling strategy. The interviews were analyzed using a thematic analysis approach. The interviewees described the challenges and potential improvements in this admission process, focusing on five themes. First, the characteristics of the patient with his/her health condition and personality and his/her family influence different areas in the admission process. Improvements in the exchange of information between the hospital and the patient could speed up and simplify the admission process. In addition, challenges and potential improvements were found concerning the rehabilitation planning, the organization of the admission process and the interdisciplinary work. This study identified five themes of challenges and potential improvements in the admission process of spinal cord injury patients at a specialized rehabilitation clinic. When planning adaptations of process steps in one of the areas, awareness of effects in other fields is necessary. Improved pre-admission information would be a first important step to optimize the admission process. A common IT-system providing an interdisciplinary overview and possibilities for interdisciplinary exchange would support the management of the admission process. Managers of other hospitals can supplement

Motor Carrier Safety Fitness Determination: An Improved Process

DOT National Transportation Integrated Search

1996-12-01

PREFACE This report was undertaken to define an improved process for motor carrier safety fitness determination. It was produced by the Research and Special Program Administration's (RSPA} John A. Volpe National Transportation Systems Center (the Vol...

20 CFR 1010.300 - What processes are to be implemented to identify covered persons?

Code of Federal Regulations, 2014 CFR

2014-04-01

... 20 Employees' Benefits 4 2014-04-01 2014-04-01 false What processes are to be implemented to identify covered persons? 1010.300 Section 1010.300 Employees' Benefits OFFICE OF THE ASSISTANT SECRETARY... FOR COVERED PERSONS Applying Priority of Service § 1010.300 What processes are to be implemented to...

Process Improvement Tools, Commitment to Change Lead to Serious Turnaround.

PubMed

Birznieks, Derek; Zane, Richard

2017-05-01

The ED at the University of Colorado Hospital (UCH) has undergone a dramatic transformation in recent years, doubling in size while also using process improvement methods to dramatically reduce wait times, eliminate ambulance diversion, and boost patient satisfaction. Throughout this period, volume has continued to increase while the cost per patient and avoidable hospital admissions have experienced steady declines. Guiding the effort has been a series of core principles, with a particular focus on making sure that all processes are patient-centered. . To begin the improvement effort, ED leaders established a leadership team, and hired a process improvement chief with no previous experience in healthcare to provide fresh, outside perspective on processes. . In addition to mandating that all processes be patient-centered, the other guiding principles included a commitment to use and track data, to speak with one voice, to value everyone's perspective, to deliver high-quality care to all patients, and to set a standard for other academic medical centers. . To get points on the board early and win approval from staff, one of the first changes administrators implemented was to hire scribes for every physician so they wouldn't be bogged down with data input. The approach has essentially paid for itself. . Among the biggest changes was the elimination of triage, a process that improvement teams found no longer added value or quality to the patient experience. . Leadership also has moved to equilibrate the size and staff of the various zones in the ED so that they are more generic and less specialized. The move has facilitated patient flow, enabling patients in zones with resuscitation bays to connect with providers quickly.

A Method for Identifying Contours in Processing Digital Images from Computer Tomograph

NASA Astrophysics Data System (ADS)

Roşu, Şerban; Pater, Flavius; Costea, Dan; Munteanu, Mihnea; Roşu, Doina; Fratila, Mihaela

2011-09-01

The first step in digital processing of two-dimensional computed tomography images is to identify the contour of component elements. This paper deals with the collective work of specialists in medicine and applied mathematics in computer science on elaborating new algorithms and methods in medical 2D and 3D imagery.

Improved image processing of road pavement defect by infrared thermography

NASA Astrophysics Data System (ADS)

Sim, Jun-Gi

2018-03-01

This paper intends to achieve improved image processing for the clear identification of defects in damaged road pavement structure using infrared thermography non-destructive testing (NDT). To that goal, 4 types of pavement specimen including internal defects were fabricated to exploit the results obtained by heating the specimens by natural light. The results showed that defects located down to a depth of 3 cm could be detected by infrared thermography NDT using the improved image processing method.

Quality Improvement Process in a Large Intensive Care Unit: Structure and Outcomes.

PubMed

Reddy, Anita J; Guzman, Jorge A

2016-11-01

Quality improvement in the health care setting is a complex process, and even more so in the critical care environment. The development of intensive care unit process measures and quality improvement strategies are associated with improved outcomes, but should be individualized to each medical center as structure and culture can differ from institution to institution. The purpose of this report is to describe the structure of quality improvement processes within a large medical intensive care unit while using examples of the study institution's successes and challenges in the areas of stat antibiotic administration, reduction in blood product waste, central line-associated bloodstream infections, and medication errors. © The Author(s) 2015.

Improved Warm-Working Process For An Iron-Base Alloy

NASA Technical Reports Server (NTRS)

Cone, Fred P.; Cryns, Brendan J.; Miller, John A.; Zanoni, Robert

1992-01-01

Warm-working process produces predominantly unrecrystallized grain structure in forgings of iron-base alloy A286 (PWA 1052 composition). Yield strength and ultimate strength increased, and elongation and reduction of area at break decreased. Improved process used on forgings up to 10 in. thick and weighing up to 900 lb.

Identifying differences in biased affective information processing in major depression.

PubMed

Gollan, Jackie K; Pane, Heather T; McCloskey, Michael S; Coccaro, Emil F

2008-05-30

This study investigates the extent to which participants with major depression differ from healthy comparison participants in the irregularities in affective information processing, characterized by deficits in facial expression recognition, intensity categorization, and reaction time to identifying emotionally salient and neutral information. Data on diagnoses, symptom severity, and affective information processing using a facial recognition task were collected from 66 participants, male and female between ages 18 and 54 years, grouped by major depressive disorder (N=37) or healthy non-psychiatric (N=29) status. Findings from MANCOVAs revealed that major depression was associated with a significantly longer reaction time to sad facial expressions compared with healthy status. Also, depressed participants demonstrated a negative bias towards interpreting neutral facial expressions as sad significantly more often than healthy participants. In turn, healthy participants interpreted neutral faces as happy significantly more often than depressed participants. No group differences were observed for facial expression recognition and intensity categorization. The observed effects suggest that depression has significant effects on the perception of the intensity of negative affective stimuli, delayed speed of processing sad affective information, and biases towards interpreting neutral faces as sad.

Improvement in Patient Transfer Process From the Operating Room to the PICU Using a Lean and Six Sigma-Based Quality Improvement Project.

PubMed

Gleich, Stephen J; Nemergut, Michael E; Stans, Anthony A; Haile, Dawit T; Feigal, Scott A; Heinrich, Angela L; Bosley, Christopher L; Tripathi, Sandeep

2016-08-01

Ineffective and inefficient patient transfer processes can increase the chance of medical errors. Improvements in such processes are high-priority local institutional and national patient safety goals. At our institution, nonintubated postoperative pediatric patients are first admitted to the postanesthesia care unit before transfer to the PICU. This quality improvement project was designed to improve the patient transfer process from the operating room (OR) to the PICU. After direct observation of the baseline process, we introduced a structured, direct OR-PICU transfer process for orthopedic spinal fusion patients. We performed value stream mapping of the process to determine error-prone and inefficient areas. We evaluated primary outcome measures of handoff error reduction and the overall efficiency of patient transfer process time. Staff satisfaction was evaluated as a counterbalance measure. With the introduction of the new direct OR-PICU patient transfer process, the handoff communication error rate improved from 1.9 to 0.3 errors per patient handoff (P = .002). Inefficiency (patient wait time and non-value-creating activity) was reduced from 90 to 32 minutes. Handoff content was improved with fewer information omissions (P < .001). Staff satisfaction significantly improved among nearly all PICU providers. By using quality improvement methodology to design and implement a new direct OR-PICU transfer process with a structured multidisciplinary verbal handoff, we achieved sustained improvements in patient safety and efficiency. Handoff communication was enhanced, with fewer errors and content omissions. The new process improved efficiency, with high staff satisfaction. Copyright © 2016 by the American Academy of Pediatrics.

Awareness of technology-induced errors and processes for identifying and preventing such errors.

PubMed

Bellwood, Paule; Borycki, Elizabeth M; Kushniruk, Andre W

2015-01-01

There is a need to determine if organizations working with health information technology are aware of technology-induced errors and how they are addressing and preventing them. The purpose of this study was to: a) determine the degree of technology-induced error awareness in various Canadian healthcare organizations, and b) identify those processes and procedures that are currently in place to help address, manage, and prevent technology-induced errors. We identified a lack of technology-induced error awareness among participants. Participants identified there was a lack of well-defined procedures in place for reporting technology-induced errors, addressing them when they arise, and preventing them.

The use of data for process and quality improvement in long term care and home care: a systematic review of the literature.

PubMed

Sales, Anne E; Bostrom, Anne-Marie; Bucknall, Tracey; Draper, Kellie; Fraser, Kimberly; Schalm, Corinne; Warren, Sharon

2012-02-01

Standardized resident or client assessments, including the Resident Assessment Instrument (RAI), have been available in long term care and home care settings (continuing care sector) in many jurisdictions for a number of years. Although using these data can make quality improvement activities more efficient and less costly, there has not been a review of the literature reporting quality improvement interventions using standardized data. To address 2 questions: (1) How have RAI and other standardized data been used in process or quality improvement activities in the continuing care sector? and (2) Has the use of RAI and similar data resulted in improvements to resident or other outcomes? Searches using a combination of keyword and controlled vocabulary term searches were conducted in MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMBASE, the Cochrane Library, and PsychINFO. ELIGIBILITY CRITERIA, PARTICIPANTS, AND INTERVENTIONS: English language publications from database inception to October 2008 were included. Eligibility criteria included the following: (1) set in continuing care (long-term care facility or home care), (2) involved some form of intervention designed to improve quality or process of care, and (3) used standardized data in the quality or process improvement intervention. After reviewing the articles, we grouped the studies according to the type of intervention used to initiate process improvement. Four different intervention types were identified. We organized the results and discussion by these 4 intervention types. Key word searches identified 713 articles, of which we excluded 639 on abstract review because they did not meet inclusion criteria. A further 50 articles were excluded on full-text review, leaving a total of 24 articles. Of the 24 studies, 10 used a defined process improvement model, 8 used a combination of interventions (multimodal), 5 implemented new guidelines or protocols, and 1 used an education

Improving Treatment Response for Paediatric Anxiety Disorders: An Information-Processing Perspective.

PubMed

Ege, Sarah; Reinholdt-Dunne, Marie Louise

2016-12-01

Cognitive behavioural therapy (CBT) is considered the treatment of choice for paediatric anxiety disorders, yet there remains substantial room for improvement in treatment outcomes. This paper examines whether theory and research into the role of information-processing in the underlying psychopathology of paediatric anxiety disorders indicate possibilities for improving treatment response. Using a critical review of recent theoretical, empirical and academic literature, the paper examines the role of information-processing biases in paediatric anxiety disorders, the extent to which CBT targets information-processing biases, and possibilities for improving treatment response. The literature reviewed indicates a role for attentional and interpretational biases in anxious psychopathology. While there is theoretical grounding and limited empirical evidence to indicate that CBT ameliorates interpretational biases, evidence regarding the effects of CBT on attentional biases is mixed. Novel treatment methods including attention bias modification training, attention feedback awareness and control training, and mindfulness-based therapy may hold potential in targeting attentional biases, and thereby in improving treatment response. The integration of novel interventions into an existing evidence-based protocol is a complex issue and faces important challenges with regard to determining the optimal treatment package. Novel interventions targeting information-processing biases may hold potential in improving response to CBT for paediatric anxiety disorders. Many important questions remain to be answered.

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

PubMed

Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

2016-01-01

The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Course Development Cycle Time: A Framework for Continuous Process Improvement.

ERIC Educational Resources Information Center

Lake, Erinn

2003-01-01

Details Edinboro University's efforts to reduce the extended cycle time required to develop new courses and programs. Describes a collaborative process improvement framework, illustrated data findings, the team's recommendations for improvement, and the outcomes of those recommendations. (EV)

Quality control process improvement of flexible printed circuit board by FMEA

NASA Astrophysics Data System (ADS)

Krasaephol, Siwaporn; Chutima, Parames

2018-02-01

This research focuses on the quality control process improvement of Flexible Printed Circuit Board (FPCB), centred around model 7-Flex, by using Failure Mode and Effect Analysis (FMEA) method to decrease proportion of defective finished goods that are found at the final inspection process. Due to a number of defective units that were found at the final inspection process, high scraps may be escaped to customers. The problem comes from poor quality control process which is not efficient enough to filter defective products from in-process because there is no In-Process Quality Control (IPQC) or sampling inspection in the process. Therefore, the quality control process has to be improved by setting inspection gates and IPCQs at critical processes in order to filter the defective products. The critical processes are analysed by the FMEA method. IPQC is used for detecting defective products and reducing chances of defective finished goods escaped to the customers. Reducing proportion of defective finished goods also decreases scrap cost because finished goods incur higher scrap cost than work in-process. Moreover, defective products that are found during process can reflect the abnormal processes; therefore, engineers and operators should timely solve the problems. Improved quality control was implemented for 7-Flex production lines from July 2017 to September 2017. The result shows decreasing of the average proportion of defective finished goods and the average of Customer Manufacturers Lot Reject Rate (%LRR of CMs) equal to 4.5% and 4.1% respectively. Furthermore, cost saving of this quality control process equals to 100K Baht.

Improving photometric redshift estimation using GPZ: size information, post processing, and improved photometry

NASA Astrophysics Data System (ADS)

Gomes, Zahra; Jarvis, Matt J.; Almosallam, Ibrahim A.; Roberts, Stephen J.

2018-03-01

The next generation of large-scale imaging surveys (such as those conducted with the Large Synoptic Survey Telescope and Euclid) will require accurate photometric redshifts in order to optimally extract cosmological information. Gaussian Process for photometric redshift estimation (GPZ) is a promising new method that has been proven to provide efficient, accurate photometric redshift estimations with reliable variance predictions. In this paper, we investigate a number of methods for improving the photometric redshift estimations obtained using GPZ (but which are also applicable to others). We use spectroscopy from the Galaxy and Mass Assembly Data Release 2 with a limiting magnitude of r < 19.4 along with corresponding Sloan Digital Sky Survey visible (ugriz) photometry and the UKIRT Infrared Deep Sky Survey Large Area Survey near-IR (YJHK) photometry. We evaluate the effects of adding near-IR magnitudes and angular size as features for the training, validation, and testing of GPZ and find that these improve the accuracy of the results by ˜15-20 per cent. In addition, we explore a post-processing method of shifting the probability distributions of the estimated redshifts based on their Quantile-Quantile plots and find that it improves the bias by ˜40 per cent. Finally, we investigate the effects of using more precise photometry obtained from the Hyper Suprime-Cam Subaru Strategic Program Data Release 1 and find that it produces significant improvements in accuracy, similar to the effect of including additional features.

Improving health care, Part 4: Concepts for improving any clinical process.

PubMed

Batalden, P B; Mohr, J J; Nelson, E C; Plume, S K

1996-10-01

One promising method for streamlining the generation of "good ideas" is to formulate what are sometimes called change concepts-general notions or approaches to change found useful in developing specific ideas for changes that lead to improvement. For example, in current efforts to reduce health care costs by discounting provider charges, the underlying generic concept is "reducing health care costs," and the specific idea is "discounting provider charges." Short-term gains in health care cost reduction can occur by pursuing discounts. After some time, however, limits to such reduction in costs are experienced. Persevering and continuing to travel down the "discounting provider charges" path is less likely to produce further substantial improvement than returning to the basic concept of "reducing health care costs." An interdisciplinary team aiming to reduce costs while improving quality of care for patients in need of hip joint replacement generated ideas for changing "what's done (process) to get better results." After team members wrote down their improvement ideas, they deduced the underlying change concepts and used them to generate even more ideas for improvement. Such change concepts include reordering the sequence of steps (preadmission physical therapy "certification"), eliminating failures at hand-offs between steps (transfer of information from physician's office to hospital), and eliminating a step (epidural pain control). Learning about making change, encouraging change, managing the change within and across organizations, and learning from the changes tested will characterize the sustainable, thriving health systems of the future.

Engaging police to identify challenging school crossings and potential improvements.

PubMed

Bull, Catherine B; Von Hagen, Leigh Ann; Lubin, Andrea; Shivaraman, Gayathri; Chibbaro, Daniel

2018-04-26

This paper discusses the value of police officers as vital sources of information regarding pedestrian safety in their communities by presenting results from a survey of traffic safety police officers. The survey requested information on school crossings that the officers considered most challenging for pedestrians. Officers specified the intersections or mid-block locations with school crossings, and answered questions about elements of the locations, such as what makes the locations challenging, and what might be done to improve conditions at these locations. A key finding from the survey is the police officers' identification of challenging intersections or other crossing locations by criteria other than the occurrence of crashes, including reported pedestrian-vehicle near-miss incidents. A broad literature review of pedestrian safety studies provides context for the use of near-miss data in discussions of improvements to pedestrian crossings. Although not typically considered a primary resource for pedestrian safety information, police officers are most often very familiar with their communities, work in locations where pedestrian and motor vehicle traffic can be experienced and observed, and receive information from their staff and members of the public who use pedestrian crossings. The survey findings demonstrate that police officer insights and near-miss data may serve as important supplementary sources of information in the effort to identify locations in need of interventions before crash occurrence. Copyright © 2018 Elsevier Ltd. All rights reserved.

Persistent Identifiers for Improved Accessibility for Linked Data Querying

NASA Astrophysics Data System (ADS)

Shepherd, A.; Chandler, C. L.; Arko, R. A.; Fils, D.; Jones, M. B.; Krisnadhi, A.; Mecum, B.

2016-12-01

The adoption of linked open data principles within the geosciences has increased the amount of accessible information available on the Web. However, this data is difficult to consume for those who are unfamiliar with Semantic Web technologies such as Web Ontology Language (OWL), Resource Description Framework (RDF) and SPARQL - the RDF query language. Consumers would need to understand the structure of the data and how to efficiently query it. Furthermore, understanding how to query doesn't solve problems of poor precision and recall in search results. For consumers unfamiliar with the data, full-text searches are most accessible, but not ideal as they arrest the advantages of data disambiguation and co-reference resolution efforts. Conversely, URI searches across linked data can deliver improved search results, but knowledge of these exact URIs may remain difficult to obtain. The increased adoption of Persistent Identifiers (PIDs) can lead to improved linked data querying by a wide variety of consumers. Because PIDs resolve to a single entity, they are an excellent data point for disambiguating content. At the same time, PIDs are more accessible and prominent than a single data provider's linked data URI. When present in linked open datasets, PIDs provide balance between the technical and social hurdles of linked data querying as evidenced by the NSF EarthCube GeoLink project. The GeoLink project, funded by NSF's EarthCube initiative, have brought together data repositories include content from field expeditions, laboratory analyses, journal publications, conference presentations, theses/reports, and funding awards that span scientific studies from marine geology to marine ecosystems and biogeochemistry to paleoclimatology.

A multiplex PCR mini-barcode assay to identify processed shark products in the global trade.

PubMed

Cardeñosa, Diego; Fields, Andrew; Abercrombie, Debra; Feldheim, Kevin; Shea, Stanley K H; Chapman, Demian D

2017-01-01

Protecting sharks from overexploitation has become global priority after widespread population declines have occurred. Tracking catches and trade on a species-specific basis has proven challenging, in part due to difficulties in identifying processed shark products such as fins, meat, and liver oil. This has hindered efforts to implement regulations aimed at promoting sustainable use of commercially important species and protection of imperiled species. Genetic approaches to identify shark products exist but are typically based on sequencing or amplifying large DNA regions and may fail to work on heavily processed products in which DNA is degraded. Here, we describe a novel multiplex PCR mini-barcode assay based on two short fragments of the cytochrome oxidase I (COI) gene. This assay can identify to species all sharks currently listed on the Convention of International Trade of Endangered Species (CITES) and most shark species present in the international trade. It achieves species diagnosis based on a single PCR and one to two downstream DNA sequencing reactions. The assay is capable of identifying highly processed shark products including fins, cooked shark fin soup, and skin-care products containing liver oil. This is a straightforward and reliable identification method for data collection and enforcement of regulations implemented for certain species at all governance levels.

A multiplex PCR mini-barcode assay to identify processed shark products in the global trade

PubMed Central

Fields, Andrew; Abercrombie, Debra; Feldheim, Kevin; Shea, Stanley K. H.; Chapman, Demian D.

2017-01-01

Protecting sharks from overexploitation has become global priority after widespread population declines have occurred. Tracking catches and trade on a species-specific basis has proven challenging, in part due to difficulties in identifying processed shark products such as fins, meat, and liver oil. This has hindered efforts to implement regulations aimed at promoting sustainable use of commercially important species and protection of imperiled species. Genetic approaches to identify shark products exist but are typically based on sequencing or amplifying large DNA regions and may fail to work on heavily processed products in which DNA is degraded. Here, we describe a novel multiplex PCR mini-barcode assay based on two short fragments of the cytochrome oxidase I (COI) gene. This assay can identify to species all sharks currently listed on the Convention of International Trade of Endangered Species (CITES) and most shark species present in the international trade. It achieves species diagnosis based on a single PCR and one to two downstream DNA sequencing reactions. The assay is capable of identifying highly processed shark products including fins, cooked shark fin soup, and skin-care products containing liver oil. This is a straightforward and reliable identification method for data collection and enforcement of regulations implemented for certain species at all governance levels. PMID:29020095

Electrical Storm Simulation to Improve the Learning Physics Process

ERIC Educational Resources Information Center

Martínez Muñoz, Miriam; Jiménez Rodríguez, María Lourdes; Gutiérrez de Mesa, José Antonio

2013-01-01

This work is part of a research project whose main objective is to understand the impact that the use of Information and Communication Technology (ICT) has on the teaching and learning process on the subject of Physics. We will show that, with the use of a storm simulator, physics students improve their learning process on one hand they understand…

Decreasing troponin turnaround time in the emergency department using the central laboratory: A process improvement study.

PubMed

Boelstler, Arlene M; Rowland, Ralph; Theoret, Jennifer; Takla, Robert B; Szpunar, Susan; Patel, Shraddha P; Lowry, Andrew M; Pena, Margarita E

2015-03-01

To implement collaborative process improvement measures to reduce emergency department (ED) troponin turnaround time (TAT) to less than 60min using central laboratory. This was an observational, retrospective data study. A multidisciplinary team from the ED and laboratory identified opportunities and developed a new workflow model. Process changes were implemented in ED patient triage, staffing, lab collection and processing. Data collected included TAT of door-to-order, order-to-collect, collect-to-received, received-to-result, door-to-result, ED length of stay, and hemolysis rate before (January-August, 2011) and after (September 2011-June 2013) process improvement. After process improvement and implementation of the new workflow model, decreased median TAT (in min) was seen in door-to-order (54 [IQR43] vs. 11 [IQR20]), order-to-collect (15 [IQR 23] vs. 10 [IQR12]), collect-to-received (6 [IQR8] vs. 5 [IQR5]), received-to-result (30 [IQR12] vs. 24 [IQR11]), and overall door-to-result (117 [IQR60] vs. 60 [IQR40]). A troponin TAT of <60min was realized beginning in May 2012 (59 [IQR39]). Hemolysis rates decreased (14.63±0.74 vs. 3.36±1.99, p<0.0001), as did ED length of stay (5.87±2.73h vs. 5.15±2.34h, p<0.0001). Conclusion Troponin TAT of <60min using a central laboratory was achieved with collaboration between the ED and the laboratory; additional findings include a decreased ED length of stay. Copyright © 2014 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved.

A Prototype for the Support of Integrated Software Process Development and Improvement

NASA Astrophysics Data System (ADS)

Porrawatpreyakorn, Nalinpat; Quirchmayr, Gerald; Chutimaskul, Wichian

An efficient software development process is one of key success factors for quality software. Not only can the appropriate establishment but also the continuous improvement of integrated project management and of the software development process result in efficiency. This paper hence proposes a software process maintenance framework which consists of two core components: an integrated PMBOK-Scrum model describing how to establish a comprehensive set of project management and software engineering processes and a software development maturity model advocating software process improvement. Besides, a prototype tool to support the framework is introduced.

Improving Logistics Processes in Industry Using Web Technologies

NASA Astrophysics Data System (ADS)

Jánošík, Ján; Tanuška, Pavol; Václavová, Andrea

2016-12-01

The aim of this paper is to propose the concept of a system that takes advantage of web technologies and integrates them into the management process and management of internal stocks which may relate to external applications and creates the conditions to transform a Computerized Control of Warehouse Stock (CCWS) in the company. The importance of implementing CCWS is in the elimination of the claims caused by the human factor, as well as to allow the processing of information for analytical purposes and their subsequent use to improve internal processes. Using CCWS in the company would also facilitate better use of the potential tools Business Intelligence and Data Mining.

Development of a strategy for energy efficiency improvement in a Kraft process based on systems interactions analysis

NASA Astrophysics Data System (ADS)

Mateos-Espejel, Enrique

The objective of this thesis is to develop, validate, and apply a unified methodology for the energy efficiency improvement of a Kraft process that addresses globally the interactions of the various process systems that affect its energy performance. An implementation strategy is the final result. An operating Kraft pulping mill situated in Eastern Canada with a production of 700 adt/d of high-grade bleached pulp was the case study. The Pulp and Paper industry is Canada's premier industry. It is characterized by large thermal energy and water consumption. Rising energy costs and more stringent environmental regulations have led the industry to refocus its efforts toward identifying ways to improve energy and water conservation. Energy and water aspects are usually analyzed independently, but in reality they are strongly interconnected. Therefore, there is a need for an integrated methodology, which considers energy and water aspects, as well as the optimal utilization and production of the utilities. The methodology consists of four successive stages. The first stage is the base case definition. The development of a focused, reliable and representative model of an operating process is a prerequisite to the optimization and fine tuning of its energy performance. A four-pronged procedure has been developed: data gathering, master diagram, utilities systems analysis, and simulation. The computer simulation has been focused on the energy and water systems. The second stage corresponds to the benchmarking analysis. The benchmarking of the base case has the objectives of identifying the process inefficiencies and to establish guidelines for the development of effective enhancement measures. The studied process is evaluated by a comparison of its efficiency to the current practice of the industry and by the application of new energy and exergy content indicators. The minimum energy and water requirements of the process are also determined in this step. The third stage is

76 FR 19976 - Proposed Information Collection; Comment Request; Survey of EDA Grant Process Improvement

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-11

...; Comment Request; Survey of EDA Grant Process Improvement AGENCY: Economic Development Administration.... In 2010, EDA made improvements in its grant application process. The proposed short survey of five to... improvements to the grant application process and to make any necessary adjustments. EDA would like to conduct...

Understanding Perspectives of African American Medicaid-Insured Women on the Process of Perinatal Care: An Opportunity for Systems Improvement.

PubMed

Roman, Lee Anne; Raffo, Jennifer E; Dertz, Katherine; Agee, Bonita; Evans, Denise; Penninga, Katherine; Pierce, Tiffany; Cunningham, Belinda; VanderMeulen, Peggy

2017-12-01

Objectives To address disparities in adverse birth outcomes, communities are challenged to improve the quality of health services and foster systems integration. The purpose of this study was to explore the perspectives of Medicaid-insured women about their experiences of perinatal care (PNC) across a continuum of clinical and community-based services. Methods Three focus groups (N = 21) were conducted and thematic analysis methods were used to identify basic and global themes about experiences of care. Women were recruited through a  local Federal Healthy Start (HS) program in Michigan  that targets services to African American women. Results Four basic themes were identified: (1) Pursuit of PNC; (2) Experiences of traditional PNC; (3) Enhanced prenatal and postnatal care; and (4) Women's health: A missed opportunity. Two global themes were also identified: (1) Communication with providers, and (2) Perceived socio-economic and racial bias. Many women experienced difficulties engaging in early care, getting more help, and understanding and communicating with their providers, with some reporting socio-economic and racial bias in care. Delays in PNC limited early access to HS and enhanced prenatal care (EPC) programs with little evidence of supportive transitions to primary care. Notably, women's narratives revealed few connections among clinical and community-based services. Conclusions The process of participating in PNC and community-based programs is challenging for women, especially for those with multiple health problems and living in difficult life circumstances. PNC, HS and other EPC programs could partner to streamline processes, improve the content and process of care, and enhance engagement in services.

Improved silicon carbide for advanced heat engines. I - Process development for injection molding

NASA Technical Reports Server (NTRS)

Whalen, Thomas J.; Trela, Walter

1989-01-01

Alternate processing methods have been investigated as a means of improving the mechanical properties of injection-molded SiC. Various mixing processes (dry, high-sheer, and fluid) were evaluated along with the morphology and particle size of the starting beta-SiC powder. Statistically-designed experiments were used to determine significant effects and interactions of variables in the mixing, injection molding, and binder removal process steps. Improvements in mechanical strength can be correlated with the reduction in flaw size observed in the injection molded green bodies obtained with improved processing methods.

Statistical process management: An essential element of quality improvement

NASA Astrophysics Data System (ADS)

Buckner, M. R.

Successful quality improvement requires a balanced program involving the three elements that control quality: organization, people and technology. The focus of the SPC/SPM User's Group is to advance the technology component of Total Quality by networking within the Group and by providing an outreach within Westinghouse to foster the appropriate use of statistic techniques to achieve Total Quality. SPM encompasses the disciplines by which a process is measured against its intrinsic design capability, in the face of measurement noise and other obscuring variability. SPM tools facilitate decisions about the process that generated the data. SPM deals typically with manufacturing processes, but with some flexibility of definition and technique it accommodates many administrative processes as well. The techniques of SPM are those of Statistical Process Control, Statistical Quality Control, Measurement Control, and Experimental Design. In addition, techniques such as job and task analysis, and concurrent engineering are important elements of systematic planning and analysis that are needed early in the design process to ensure success. The SPC/SPM User's Group is endeavoring to achieve its objectives by sharing successes that have occurred within the member's own Westinghouse department as well as within other US and foreign industry. In addition, failures are reviewed to establish lessons learned in order to improve future applications. In broader terms, the Group is interested in making SPM the accepted way of doing business within Westinghouse.

Relationship between quality improvement processes and clinical performance.

PubMed

Damberg, Cheryl L; Shortell, Stephen M; Raube, Kristiana; Gillies, Robin R; Rittenhouse, Diane; McCurdy, Rodney K; Casalino, Lawrence P; Adams, John

2010-08-01

To examine the association between performance on clinical process measures and intermediate outcomes and the use of chronic care management processes (CMPs), electronic medical record (EMR) capabilities, and participation in external quality improvement (QI) initiatives. Cross-sectional analysis of linked 2006 clinical performance scores from the Integrated Healthcare Association's pay-for-performance program and survey data from the 2nd National Study of Physician Organizations among 108 California physician organizations (POs). Controlling for differences in PO size, organization type (medical group or independent practice association), and Medicaid revenue, we used ordinary least squares regression analysis to examine the association between the use of CMPs, EMR capabilities, and external QI initiatives and performance on the following 3 clinical composite measures: diabetes management, processes of care, and intermediate outcomes (diabetes and cardiovascular). Greater use of CMPs was significantly associated with clinical performance: among POs using more than 5 CMPs, we observed a 3.2-point higher diabetes management score on a performance scale with scores ranging from 0 to 100 (P <.001), while for each 1.0-point increase on the CMP index, we observed a 1.0-point gain in intermediate outcomes (P <.001). Participation in external QI initiatives was positively associated with improved delivery of clinical processes of care: a 1.0-point increase on the QI index translated into a 1.4-point gain in processes-of-care performance (P = .02). No relationship was observed between EMR capabilities and performance. Greater investments in CMPs and QI interventions may help POs raise clinical performance and achieve success under performance-based accountability schemes.

Developing lettuce with improved quality for processed salads.

USDA-ARS?s Scientific Manuscript database

Lettuce is increasingly consumed as minimally processed salads. Cultivars grown for this market may require breeding for improved shelf-life and resistance to physiological defects such as tipburn (TB). Tipburn is a calcium deficiency related defect causing necrosis on the leaf margins, typically on...

The Hepatitis C Cascade of Care: Identifying Priorities to Improve Clinical Outcomes

PubMed Central

Linas, Benjamin P.; Barter, Devra M.; Leff, Jared A.; Assoumou, Sabrina A.; Salomon, Joshua A.; Weinstein, Milton C.; Kim, Arthur Y.; Schackman, Bruce R.

2014-01-01

Background As highly effective hepatitis C virus (HCV) therapies emerge, data are needed to inform the development of interventions to improve HCV treatment rates. We used simulation modeling to estimate the impact of loss to follow-up on HCV treatment outcomes and to identify intervention strategies likely to provide good value for the resources invested in them. Methods We used a Monte Carlo state-transition model to simulate a hypothetical cohort of chronically HCV-infected individuals recently screened positive for serum HCV antibody. We simulated four hypothetical intervention strategies (linkage to care; treatment initiation; integrated case management; peer navigator) to improve HCV treatment rates, varying efficacies and costs, and identified strategies that would most likely result in the best value for the resources required for implementation. Main measures Sustained virologic responses (SVRs), life expectancy, quality-adjusted life expectancy (QALE), costs from health system and program implementation perspectives, and incremental cost-effectiveness ratios (ICERs). Results We estimate that imperfect follow-up reduces the real-world effectiveness of HCV therapies by approximately 75%. In the base case, a modestly effective hypothetical peer navigator program maximized the number of SVRs and QALE, with an ICER compared to the next best intervention of $48,700/quality-adjusted life year. Hypothetical interventions that simultaneously addressed multiple points along the cascade provided better outcomes and more value for money than less costly interventions targeting single steps. The 5-year program cost of the hypothetical peer navigator intervention was $14.5 million per 10,000 newly diagnosed individuals. Conclusions We estimate that imperfect follow-up during the HCV cascade of care greatly reduces the real-world effectiveness of HCV therapy. Our mathematical model shows that modestly effective interventions to improve follow-up would likely be cost

Improving the processes of care and outcomes in obstetrics/gynecology.

PubMed

Simon, N V; Heaps, K P; Chodroff, C H

1997-09-01

The obstetrics/gynecology department of York Hospital (York Health System, York, Pennsylvania) initiated a program to improve the processes of care and control costs for common women's and newborns' health care services. Twelve clinical policies were established between June 1993 and February 1995. CONDUCTING THE QUALITY IMPROVEMENT (QI) PROJECTS: Using the plan-do-check-act (PDCA) improvement cycle method, the QI group established clinical pathways for high-volume conditions or procedures known to have low rates of complications and clinical guidelines for those conditions or procedures not requiring coordinated efforts of a group of health care professionals. EXAMPLE--PYELONEPHRITIS IN PREGNANCY: The literature had indicated that the prevalence of pyelonephritis can be decreased by identifying and treating asymptomatic bacteriuria early in prenatal care. After the validity of the clinical policy was demonstrated in the resident service, the policy was extended to all private obstetric practices. Dissemination of the finding that most of the admissions for pyelonephritis were for referred patients (for whom we had no control over prenatal care) or for patients referred by private physicians who were not yet following the guidelines quickly led to complete compliance by our obstetricians and other health care providers referring patients to the York Health System. The 12 clinical policies resulted in the elimination of 113 admissions and 5,595 inpatient days and in the reduction of the cost of patient care by $1,306,214 for the years 1994-1995 and 1995-1996 combined, without apparent adverse effects on patient health. A voluntary clinical policies program can change the culture of a department and lead to cost-effectiveness and better quality of patient care.

Facilitating process changes in meal delivery and radiological testing to improve inpatient insulin timing using six sigma method.

PubMed

Yamamoto, J Jay; Malatestinic, Bill; Lehman, Angela; Juneja, Rattan

2010-01-01

The objective of this project was to improve the timing of inpatient insulin administration related to meal delivery and the scheduling of radiology tests by Lean Six Sigma method. A multidisciplinary hospital team and a Six Sigma team from a pharmaceutical manufacturer collaborated to evaluate food delivery and radiology scheduling processes related to the timing of insulin administration. Key factors leading to problems within each system were addressed to improve the efficiency of each process while improving the timeliness of glucose testing and insulin administration. Standardizing the food delivery schedule and utilizing scorecards to track on-time meal deliveries to the floor enabled nursing to more accurately administer insulin in coordination with the delivery of meals. Increasing communication and restricting the scheduling of inpatient procedures during mealtimes reduced disruptions to insulin administration. Data at 6 months postimplementation demonstrated that the institution met goals for most primary outcome metrics including increasing on-time meal delivery and the proportion of patients taking insulin scheduled for radiology tests during appropriate times. By implementing the recommendations identified via Lean Six Sigma, this collaborative effort improved the timing of inpatient insulin administration related to meal delivery and radiology testing.

Recent National Transonic Facility Test Process Improvements (Invited)

NASA Technical Reports Server (NTRS)

Kilgore, W. A.; Balakrishna, S.; Bobbitt, C. W., Jr.; Adcock, J. B.

2001-01-01

This paper describes the results of two recent process improvements; drag feed-forward Mach number control and simultaneous force/moment and pressure testing, at the National Transonic Facility. These improvements have reduced the duration and cost of testing. The drag feed-forward Mach number control reduces the Mach number settling time by using measured model drag in the Mach number control algorithm. Simultaneous force/moment and pressure testing allows simultaneous collection of force/moment and pressure data without sacrificing data quality thereby reducing the overall testing time. Both improvements can be implemented at any wind tunnel. Additionally the NTF is working to develop and implement continuous pitch as a testing option as an additional method to reduce costs and maintain data quality.

Recent National Transonic Facility Test Process Improvements (Invited)

NASA Technical Reports Server (NTRS)

Kilgore, W. A.; Balakrishna, S.; Bobbitt, C. W., Jr.; Adcock, J. B.

2001-01-01

This paper describes the results of two recent process improvements; drag feed-forward Mach number control and simultaneous force/moment and pressure testing, at the National Transonic Facility. These improvements have reduced the duration and cost of testing. The drag feedforward Mach number control reduces the Mach number settling time by using measured model drag in the Mach number control algorithm. Simultaneous force/moment and pressure testing allows simultaneous collection of force/moment and pressure data without sacrificing data quality thereby reducing the overall testing time. Both improvements can be implemented at any wind tunnel. Additionally the NTF is working to develop and implement continuous pitch as a testing option as an additional method to reduce costs and maintain data quality.

Improved molding process ensures plastic parts of higher tensile strength

NASA Technical Reports Server (NTRS)

Heier, W. C.

1968-01-01

Single molding process ensures that plastic parts /of a given mechanical design/ produced from a conventional thermosetting molding compound will have a maximum tensile strength. The process can also be used for other thermosetting compounds to produce parts with improved physical properties.

Case Study: Accelerating Process Improvement by Integrating the TSP and CMMI

DTIC Science & Technology

2005-12-01

improve their work? Watts S . Humphrey , a founder of the process improvement initiative at the SEI, de- cided to apply SW-CMM principles to the...authorized PSP instructor. At Schwalb’s urging, Watts Humphrey briefed the SLT on the PSP and TSP, and after the briefing, the team understood...hefley.html. [ Humphrey 96] Humphrey , Watts S . Introduction to the Personal Software Process. Boston, MA: Addison-Wesley Publishing Company, Inc., 1996

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

Abstract There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

IMPROVING TACONITE PROCESSING PLANT EFFICIENCY BY COMPUTER SIMULATION, Final Report

DOE Office of Scientific and Technical Information (OSTI.GOV)

William M. Bond; Salih Ersayin

2007-03-30

This project involved industrial scale testing of a mineral processing simulator to improve the efficiency of a taconite processing plant, namely the Minorca mine. The Concentrator Modeling Center at the Coleraine Minerals Research Laboratory, University of Minnesota Duluth, enhanced the capabilities of available software, Usim Pac, by developing mathematical models needed for accurate simulation of taconite plants. This project provided funding for this technology to prove itself in the industrial environment. As the first step, data representing existing plant conditions were collected by sampling and sample analysis. Data were then balanced and provided a basis for assessing the efficiency ofmore » individual devices and the plant, and also for performing simulations aimed at improving plant efficiency. Performance evaluation served as a guide in developing alternative process strategies for more efficient production. A large number of computer simulations were then performed to quantify the benefits and effects of implementing these alternative schemes. Modification of makeup ball size was selected as the most feasible option for the target performance improvement. This was combined with replacement of existing hydrocyclones with more efficient ones. After plant implementation of these modifications, plant sampling surveys were carried out to validate findings of the simulation-based study. Plant data showed very good agreement with the simulated data, confirming results of simulation. After the implementation of modifications in the plant, several upstream bottlenecks became visible. Despite these bottlenecks limiting full capacity, concentrator energy improvement of 7% was obtained. Further improvements in energy efficiency are expected in the near future. The success of this project demonstrated the feasibility of a simulation-based approach. Currently, the Center provides simulation-based service to all the iron ore mining companies operating in northern

Participatory approach to identify interventions to improve the health, safety, and work productivity of smallholder women vegetable farmers in the Gambia.

PubMed

Vanderwal, Londa; Rautiainen, Risto; Ramirez, Marizen; Kuye, Rex; Peek-Asa, Corinne; Cook, Thomas; Culp, Kennith; Donham, Kelley

2011-03-01

This paper describes the qualitative, community-based participatory approach used to identify culturally-acceptable and sustainable interventions to improve the occupational health, safety, and productivity of smallholder women vegetable farmers in The Gambia (West Africa). This approach was used to conduct: 1) analysis of the tasks and methods traditionally used in vegetable production, and 2) selection of interventions. The most arduous garden tasks that were amenable to interventions were identified, and the interventions were selected through a participatory process for further evaluation. Factors contributing to the successful implementation of the participatory approach used in this study included the following: 1) ensuring that cultural norms were respected and observed; 2) working closely with the existing garden leadership structure; and 3) research team members working with the subjects for an extended period of time to gain first-hand understanding of the selected tasks and to build credibility with the subjects.

Child Support; Need to Improve Efforts to Identify Fathers and Obtain Support Orders.

DTIC Science & Technology

1987-04-01

34 Reduces the stigma of illegitimacy and helps give the child a sense of identity. • Increases the child’s opportunity to develop a close parental...A179 979 CHILD SUPPORT; NEED TO IMPROVE EFFORTS TO IDENTIFY 1/1 FATHERS AND OBTAIN SUPPORT ORDERS(U) GENERAL ACCOUNTING OFFICE WASHINGTON DC HUNAN...April 30, 1987 The Honorable Otis R. Bowen, M.D. The Secretary of Health and Human Services Dear Mr. Secretary: This report discusses child support

Critical differences between elective and emergency surgery: identifying domains for quality improvement in emergency general surgery.

PubMed

Columbus, Alexandra B; Morris, Megan A; Lilley, Elizabeth J; Harlow, Alyssa F; Haider, Adil H; Salim, Ali; Havens, Joaquim M

2018-04-01

The objective of our study was to characterize providers' impressions of factors contributing to disproportionate rates of morbidity and mortality in emergency general surgery to identify targets for care quality improvement. Emergency general surgery is characterized by a high-cost burden and disproportionate morbidity and mortality. Factors contributing to these observed disparities are not comprehensively understood and targets for quality improvement have not been formally developed. Using a grounded theory approach, emergency general surgery providers were recruited through purposive-criterion-based sampling to participate in semi-structured interviews and focus groups. Participants were asked to identify contributors to emergency general surgery outcomes, to define effective care for EGS patients, and to describe operating room team structure. Interviews were performed to thematic saturation. Transcripts were iteratively coded and analyzed within and across cases to identify emergent themes. Member checking was performed to establish credibility of the findings. A total of 40 participants from 5 academic hospitals participated in either individual interviews (n = 25 [9 anesthesia, 12 surgery, 4 nursing]) or focus groups (n = 2 [15 nursing]). Emergency general surgery was characterized by an exceptionally high level of variability, which can be subcategorized as patient-variability (acute physiology and comorbidities) and system-variability (operating room resources and workforce). Multidisciplinary communication is identified as a modifier to variability in emergency general surgery; however, nursing is often left out of early communication exchanges. Critical variability in emergency general surgery may impact outcomes. Patient-variability and system-variability, with focus on multidisciplinary communication, represent potential domains for quality improvement in this field. Copyright © 2017 Elsevier Inc. All rights reserved.

Demystifying process mapping: a key step in neurosurgical quality improvement initiatives.

PubMed

McLaughlin, Nancy; Rodstein, Jennifer; Burke, Michael A; Martin, Neil A

2014-08-01

Reliable delivery of optimal care can be challenging for care providers. Health care leaders have integrated various business tools to assist them and their teams in ensuring consistent delivery of safe and top-quality care. The cornerstone to all quality improvement strategies is the detailed understanding of the current state of a process, captured by process mapping. Process mapping empowers caregivers to audit how they are currently delivering care to subsequently strategically plan improvement initiatives. As a community, neurosurgery has clearly shown dedication to enhancing patient safety and delivering quality care. A care redesign strategy named NERVS (Neurosurgery Enhanced Recovery after surgery, Value, and Safety) is currently being developed and piloted within our department. Through this initiative, a multidisciplinary team led by a clinician neurosurgeon has process mapped the way care is currently being delivered throughout the entire episode of care. Neurosurgeons are becoming leaders in quality programs, and their education on the quality improvement strategies and tools is essential. The authors present a comprehensive review of process mapping, demystifying its planning, its building, and its analysis. The particularities of using process maps, initially a business tool, in the health care arena are discussed, and their specific use in an academic neurosurgical department is presented.

Nominal group technique: a brainstorming tool for identifying areas to improve pain management in hospitalized patients.

PubMed

Peña, Adolfo; Estrada, Carlos A; Soniat, Debbie; Taylor, Benjamin; Burton, Michael

2012-01-01

Pain management in hospitalized patients remains a priority area for improvement; effective strategies for consensus development are needed to prioritize interventions. To identify challenges, barriers, and perspectives of healthcare providers in managing pain among hospitalized patients. Qualitative and quantitative group consensus using a brainstorming technique for quality improvement-the nominal group technique (NGT). One medical, 1 medical-surgical, and 1 surgical hospital unit at a large academic medical center. Nurses, resident physicians, patient care technicians, and unit clerks. Responses and ranking to the NGT question: "What causes uncontrolled pain in your unit?" Twenty-seven health workers generated a total of 94 ideas. The ideas perceived contributing to a suboptimal pain control were grouped as system factors (timeliness, n = 18 ideas; communication, n = 11; pain assessment, n = 8), human factors (knowledge and experience, n = 16; provider bias, n = 8; patient factors, n = 19), and interface of system and human factors (standardization, n = 14). Knowledge, timeliness, provider bias, and patient factors were the top ranked themes. Knowledge and timeliness are considered main priorities to improve pain control. NGT is an efficient tool for identifying general and context-specific priority areas for quality improvement; teams of healthcare providers should consider using NGT to address their own challenges and barriers. Copyright © 2011 Society of Hospital Medicine.

Environmental process improvement feasibility study and demonstration program

NASA Technical Reports Server (NTRS)

Martin, Rodger L.

1994-01-01

This report is the final product of an environmental study conducted by Western Commercial Space Center, Inc. under contract to Tennessee-Calspan Center for Space Transportation and Applied Research. The purpose of this investigation is to accurately document the current environmental and permitting processes associated with commercial space launch activity at Vandenberg AFB, and make recommendations to streamline those processes. The particular areas of interest focus on: identifying applicable Federal, state, and local laws, Department of Defense directives, and Air force regulations; defining the environmental process on Vandenberg AFB and how it relates with other agencies, including Federal and state regulatory agencies; and defining the air quality permit process. Study investigation results are applied to an example Pilot Space Launch Vehicle (PSLV) planning to launch from Vandenberg AFB. The PSLV space hardware is analyzed with respect to environmental and permitting issues associated with vehicle processing, facilities required (existing or new), and launch. The PSLV verified the earlier findings of the study and gave insight into streamlining recommendations.

A quality improvement project using statistical process control methods for type 2 diabetes control in a resource-limited setting.

PubMed

Flood, David; Douglas, Kate; Goldberg, Vera; Martinez, Boris; Garcia, Pablo; Arbour, MaryCatherine; Rohloff, Peter

2017-08-01

Quality improvement (QI) is a key strategy for improving diabetes care in low- and middle-income countries (LMICs). This study reports on a diabetes QI project in rural Guatemala whose primary aim was to improve glycemic control of a panel of adult diabetes patients. Formative research suggested multiple areas for programmatic improvement in ambulatory diabetes care. This project utilized the Model for Improvement and Agile Global Health, our organization's complementary healthcare implementation framework. A bundle of improvement activities were implemented at the home, clinic and institutional level. Control charts of mean hemoglobin A1C (HbA1C) and proportion of patients meeting target HbA1C showed improvement as special cause variation was identified 3 months after the intervention began. Control charts for secondary process measures offered insights into the value of different components of the intervention. Intensity of home-based diabetes education emerged as an important driver of panel glycemic control. Diabetes QI work is feasible in resource-limited settings in LMICs and can improve glycemic control. Statistical process control charts are a promising methodology for use with panels or registries of diabetes patients. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Identifying effective pathways in a successful continuous quality improvement programme: the GEDAPS study.

PubMed

Bodicoat, Danielle H; Mundet, Xavier; Gray, Laura J; Cos, Xavier; Davies, Melanie J; Khunti, Kamlesh; Cano, Juan-Franciso

2014-12-01

Continuous quality improvement programmes often target several aspects of care, some of which may be more effective meaning that resources could be focussed on these. The objective was to identify the effective and ineffective aspects of a successful continuous quality improvement programme for individuals with type 2 diabetes in primary care. Data were from a series of cross-sectional studies (GEDAPS) in primary care, Catalonia, Spain, in 55 centres (2239 participants) in 1993, and 92 centres (5819 participants) in 2002. A structural equation modelling approach was used. The intervention was associated with improved microvascular outcomes through microalbuminuria and funduscopy screening, which had a direct effect on microvascular outcomes, and through attending 2-4 nurse visits and having ≥1 blood pressure measurement, which acted through reducing systolic blood pressure. The intervention was associated with improved macrovascular outcomes through blood pressure measurement and attending 2-4 nurse visits (through systolic blood pressure) and having ≥3 education topics, ≥1 HbA1c measurement and adequate medication (through HbA1c). Cholesterol measurement, weight measurement and foot examination did not contribute towards the effectiveness of the intervention. The pathways through which a continuous quality improvement programme appeared to act to reduce microvascular and macrovascular complications were driven by reductions in systolic blood pressure and HbA1c, which were attained through changes in nurse and education visits, measurement and medication. This suggests that these factors are potential areas on which future quality improvement programmes should focus. © 2014 John Wiley & Sons, Ltd.

A cross-sectional study to identify organisational processes associated with nurse-reported quality and patient safety

PubMed Central

Tvedt, Christine; Sjetne, Ingeborg Strømseng; Helgeland, Jon; Bukholm, Geir

2012-01-01

Objectives The purpose of this study was to identify organisational processes and structures that are associated with nurse-reported patient safety and quality of nursing. Design This is an observational cross-sectional study using survey methods. Setting Respondents from 31 Norwegian hospitals with more than 85 beds were included in the survey. Participants All registered nurses working in direct patient care in a position of 20% or more were invited to answer the survey. In this study, 3618 nurses from surgical and medical wards responded (response rate 58.9). Nurses' practice environment was defined as organisational processes and measured by the Nursing Work Index Revised and items from Hospital Survey on Patient Safety Culture. Outcome measures Nurses' assessments of patient safety, quality of nursing, confidence in how their patients manage after discharge and frequency of adverse events were used as outcome measures. Results Quality system, nurse–physician relation, patient safety management and staff adequacy were process measures associated with nurse-reported work-related and patient-related outcomes, but we found no associations with nurse participation, education and career and ward leadership. Most organisational structures were non-significant in the multilevel model except for nurses’ affiliations to medical department and hospital type. Conclusions Organisational structures may have minor impact on how nurses perceive work-related and patient-related outcomes, but the findings in this study indicate that there is a considerable potential to address organisational design in improvement of patient safety and quality of care. PMID:23263021

Analysis of Alternatives (AoA) Process Improvement Study

DTIC Science & Technology

2016-12-01

stakeholders, and mapped the process activities and durations. We tasked the SAG members with providing the information required on case studies and...are the expected time saves/cost/risk of any changes? (3) Utilization of case studies for both “good” and “challenged” AoAs to identify lessons...16 4 CASE STUDIES

Measurement Comparisons Towards Improving the Understanding of Aerosol-Cloud Processing

NASA Astrophysics Data System (ADS)

Noble, Stephen R.

Cloud processing of aerosol is an aerosol-cloud interaction that is not heavily researched but could have implications on climate. The three types of cloud processing are chemical processing, collision and coalescence processing, and Brownian capture of interstitial particles. All types improve cloud condensation nuclei (CCN) in size or hygroscopicity (kappa). These improved CCN affect subsequent clouds. This dissertation focuses on measurement comparisons to improve our observations and understanding of aerosol-cloud processing. Particle size distributions measured at the continental Southern Great Plains (SGP) site were compared with ground based measurements of cloud fraction (CF) and cloud base altitude (CBA). Particle size distributions were described by a new objective shape parameter to define bimodality rather than an old subjective one. Cloudy conditions at SGP were found to be correlated with lagged shape parameter. Horizontal wind speed and regional CF explained 42%+ of this lag time. Many of these surface particle size distributions were influenced by aerosol-cloud processing. Thus, cloud processing may be more widespread with more implications than previously thought. Particle size distributions measured during two aircraft field campaigns (MArine Stratus/stratocumulus Experiment; MASE; and Ice in Cloud Experiment-Tropical; ICE-T) were compared to CCN distributions. Tuning particle size to critical supersaturation revealed hygroscopicity expressed as ? when the distributions were overlain. Distributions near cumulus clouds (ICE-T) had a higher frequency of the same ?s (48% in ICE-T to 42% in MASE) between the accumulation (processed) and Aitken (unprocessed) modes. This suggested physical processing domination in ICE-T. More MASE (stratus cloud) kappa differences between modes pointed to chemical cloud processing. Chemistry measurements made in MASE showed increases in sulfates and nitrates with distributions that were more processed. This supported

Identifying priorities for quality improvement at an emergency Department in Ghana.

PubMed

DeWulf, Annelies; Otchi, Elom H; Soghoian, Sari

2017-08-30

Healthcare quality improvement (QI) is a global priority, and understanding the perspectives of frontline healthcare workers can help guide sustainable and meaningful change. We report a qualitative investigation of emergency department (ED) staff priorities for QI at a tertiary care hospital in Ghana. The aims of the study were to educate staff about the World Health Organization's (WHO) definition of quality in healthcare, and to identify an initial focus for building a departmental QI program. Semi-structured interviews were conducted with ED staff using open-ended questions to probe their understanding and valuation of the six dimensions of quality defined by the WHO. Participants were then asked to rank the dimensions in order of importance for QI. Qualitative responses were thematically analyzed, and ordinal rank-order was determined for quantitative data regarding QI priorities. Twenty (20) members of staff of different cadres participated, including ED physicians, nurses, orderlies, a security officer, and an accountant. A majority of participants (61%) ranked access to emergency healthcare as high priority for QI. Two recurrent themes - financial accessibility and hospital bed availability - accounted for the majority of discussions, each linked to all the dimensions of healthcare quality. ED staff related all of the WHO quality dimensions to their work, and prioritized access to emergency care as the most important area for improvement. Participants expressed a high degree of motivation to improve healthcare quality, and the study helped with the development of a departmental QI program focused on the broad topic of access to ED services.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

PubMed

Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

2015-12-01

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

Intelligent process mapping through systematic improvement of heuristics

NASA Technical Reports Server (NTRS)

Ieumwananonthachai, Arthur; Aizawa, Akiko N.; Schwartz, Steven R.; Wah, Benjamin W.; Yan, Jerry C.

1992-01-01

The present system for automatic learning/evaluation of novel heuristic methods applicable to the mapping of communication-process sets on a computer network has its basis in the testing of a population of competing heuristic methods within a fixed time-constraint. The TEACHER 4.1 prototype learning system implemented or learning new postgame analysis heuristic methods iteratively generates and refines the mappings of a set of communicating processes on a computer network. A systematic exploration of the space of possible heuristic methods is shown to promise significant improvement.

Control Improvement for Jump-Diffusion Processes with Applications to Finance

DOE Office of Scientific and Technical Information (OSTI.GOV)

Baeuerle, Nicole, E-mail: nicole.baeuerle@kit.edu; Rieder, Ulrich, E-mail: ulrich.rieder@uni-ulm.de

2012-02-15

We consider stochastic control problems with jump-diffusion processes and formulate an algorithm which produces, starting from a given admissible control {pi}, a new control with a better value. If no improvement is possible, then {pi} is optimal. Such an algorithm is well-known for discrete-time Markov Decision Problems under the name Howard's policy improvement algorithm. The idea can be traced back to Bellman. Here we show with the help of martingale techniques that such an algorithm can also be formulated for stochastic control problems with jump-diffusion processes. As an application we derive some interesting results in financial portfolio optimization.

The Data-to-Action Framework: A Rapid Program Improvement Process

ERIC Educational Resources Information Center

Zakocs, Ronda; Hill, Jessica A.; Brown, Pamela; Wheaton, Jocelyn; Freire, Kimberley E.

2015-01-01

Although health education programs may benefit from quality improvement methods, scant resources exist to help practitioners apply these methods for program improvement. The purpose of this article is to describe the Data-to-Action framework, a process that guides practitioners through rapid-feedback cycles in order to generate actionable data to…

Kaizen: a method of process improvement in the emergency department.

PubMed

Jacobson, Gregory H; McCoin, Nicole Streiff; Lescallette, Richard; Russ, Stephan; Slovis, Corey M

2009-12-01

Recent position statements from health care organizations have placed a strong emphasis on continuous quality improvement (CQI). CQI finds many of its roots in kaizen, which emphasizes small, low-cost, low-risk improvements. Based on the successful Kaizen Programs at organizations such as Toyota, the authors thought the emergency department (ED) would be an ideal environment to benefit from such a program. The authors sought to create a CQI program using a suggestion-based model that did not require a large time commitment, was easy to implement, and had the potential to empower all physicians in the department. It would not take the place of other improvement efforts, but instead augment them. The hypothesis was that such a program would foster sustainable engagement of emergency physicians in system improvement efforts and lead to a continuous stream of low-cost implementable system improvement interventions. A CQI program was created for the physician staff of the Department of Emergency Medicine at Vanderbilt University Medical Center, focusing on a suggestion-based model using kaizen philosophy. Lectures teaching kaizen philosophy were presented. Over the past 4 years, a methodology was developed utilizing a Web-based application, the Kaizen Tracker, which aids in the submission and implementation of suggestions that are called kaizen initiatives (KIs). The characteristics of the KIs submitted, details regarding resident and faculty participation, and the effectiveness of the Kaizen Tracker were retrospectively reviewed. There were 169, 105, and 101 KIs placed in the postimplementation calendar years 2006, 2007, and 2008, respectively. Seventy-six percent of KIs submitted thus far have identified a "process problem." Fifty-three percent of KIs submitted have led to operational changes within the ED. Ninety-three percent of the resident physicians entered at least one KI, and 73% of these residents submitted more than one KI. Sixty-nine percent of the

Factors affecting implementation of accreditation programmes and the impact of the accreditation process on quality improvement in hospitals: a SWOT analysis.

PubMed

Ng, G K B; Leung, G K K; Johnston, J M; Cowling, B J

2013-10-01

The objectives of this review were to identify factors that influence implementation of hospital accreditation programmes and to assess the impact of the accreditation process on quality improvement in public hospitals. Two electronic databases, Medline (OvidSP) and PubMed, were systematically searched. "Public hospital", "hospital accreditation", and "quality improvement" were used as the search terms. A total of 348 citations were initially identified. After critical appraisal and study selection, 26 articles were included in the review. The data were extracted and analysed using a SWOT (strengths, weaknesses, opportunities, threats) analysis. Increased staff engagement and communication, multidisciplinary team building, positive changes in organisational culture, and enhanced leadership and staff awareness of continuous quality improvement were identified as strengths. Weaknesses included organisational resistance to change, increased staff workload, lack of awareness about continuous quality improvement, insufficient staff training and support for continuous quality improvement, lack of applicable accreditation standards for local use, and lack of performance outcome measures. Opportunities included identification of improvement areas, enhanced patient safety, additional funding, public recognition, and market advantage. Threats included opportunistic behaviours, funding cuts, lack of incentives for participation, and a regulatory approach to mandatory participation. By relating the findings to the operational issues of accreditation, this review discussed the implications for successful implementation and how accreditation may drive quality improvement. These findings have implications for various stakeholders (government, the public, patients and health care providers), when it comes to embarking on accreditation exercises.

A Study on Improving Information Processing Abilities Based on PBL

ERIC Educational Resources Information Center

Kim, Du Gyu; Lee, JaeMu

2014-01-01

This study examined an instruction method for the improvement of information processing abilities in elementary school students. Current elementary students are required to develop information processing abilities to create new knowledge for this digital age. There is, however, a shortage of instruction strategies for these information processing…

DEVELOPMENT AND OPTIMIZATION OF GAS-ASSISTED GRAVITY DRAINAGE (GAGD) PROCESS FOR IMPROVED LIGHT OIL RECOVERY

DOE Office of Scientific and Technical Information (OSTI.GOV)

Dandina N. Rao; Subhash C. Ayirala; Madhav M. Kulkarni

This report describes the progress of the project ''Development and Optimization of Gas-Assisted Gravity Drainage (GAGD) Process for Improved Light Oil Recovery'' for the duration of the second project year (October 1, 2003--September 30, 2004). There are three main tasks in this research project. Task 1 is scaled physical model study of GAGD process. Task 2 is further development of vanishing interfacial tension (VIT) technique for miscibility determination. Task 3 is determination of multiphase displacement characteristics in reservoir rocks. In Section I, preliminary design of the scaled physical model using the dimensional similarity approach has been presented. Scaled experiments onmore » the current physical model have been designed to investigate the effect of Bond and capillary numbers on GAGD oil recovery. Experimental plan to study the effect of spreading coefficient and reservoir heterogeneity has been presented. Results from the GAGD experiments to study the effect of operating mode, Bond number and capillary number on GAGD oil recovery have been reported. These experiments suggest that the type of the gas does not affect the performance of GAGD in immiscible mode. The cumulative oil recovery has been observed to vary exponentially with Bond and capillary numbers, for the experiments presented in this report. A predictive model using the bundle of capillary tube approach has been developed to predict the performance of free gravity drainage process. In Section II, a mechanistic Parachor model has been proposed for improved prediction of IFT as well as to characterize the mass transfer effects for miscibility development in reservoir crude oil-solvent systems. Sensitivity studies on model results indicate that provision of a single IFT measurement in the proposed model is sufficient for reasonable IFT predictions. An attempt has been made to correlate the exponent (n) in the mechanistic model with normalized solute compositions present in both fluid

Narrative review of provider behavior in primary care behavioral health: How process data can inform quality improvement.

PubMed

Beehler, Gregory P; Lilienthal, Kaitlin R; Possemato, Kyle; Johnson, Emily M; King, Paul R; Shepardson, Robyn L; Vair, Christina L; Reyner, Jacqueline; Funderburk, Jennifer S; Maisto, Stephen A; Wray, Laura O

2017-09-01

Primary care behavioral health (PCBH) is a population-based approach to delivering mental and behavioral health care in the primary care setting. Implementation of the PCBH model varies across practice settings, which can impact how PCBH providers deliver services to patients and in turn may predict a variety of important outcomes. This article aims to characterize PCBH provider engagement in key processes of integrated care as demonstrated in results from empirical studies of real-world clinical practice. For this narrative review of published studies on PCBH provider engagement in processes of care, PubMed and PsycINFO databases were searched from January 1990 through May 2016 to identify relevant articles. Provider adherence to the brief, time-limited treatment model appears suboptimal. Common mental health conditions, such as depression, were often the primary focus of provider attention, with less consistent emphasis on behavioral medicine concerns. Whereas providers regularly conducted qualitative functional assessments with patients, routine use of standardized measures was low. Engagement in interprofessional collaboration with the primary care team was also low, but engagement in behaviors that fostered therapeutic relationships was high. This review identified several strengths and weaknesses of typical PCBH provider practices. Results are discussed in relation to their value as areas for future quality improvement initiatives that can improve PCBH service delivery and, ultimately, patient outcomes. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

Proteomics of Aspergillus fumigatus Conidia-containing Phagolysosomes Identifies Processes Governing Immune Evasion.

PubMed

Schmidt, Hella; Vlaic, Sebastian; Krüger, Thomas; Schmidt, Franziska; Balkenhol, Johannes; Dandekar, Thomas; Guthke, Reinhard; Kniemeyer, Olaf; Heinekamp, Thorsten; Brakhage, Axel A

2018-06-01

Invasive infections by the human pathogenic fungus Aspergillus fumigatus start with the outgrowth of asexual, airborne spores (conidia) into the lung tissue of immunocompromised patients. The resident alveolar macrophages phagocytose conidia, which end up in phagolysosomes. However, A. fumigatus conidia resist phagocytic degradation to a certain degree. This is mainly attributable to the pigment 1,8-dihydroxynaphthalene (DHN) melanin located in the cell wall of conidia, which manipulates the phagolysosomal maturation and prevents their intracellular killing. To get insight in the underlying molecular mechanisms, we comparatively analyzed proteins of mouse macrophage phagolysosomes containing melanized wild-type (wt) or nonmelanized pksP mutant conidia. For this purpose, a protocol to isolate conidia-containing phagolysosomes was established and a reference protein map of phagolysosomes was generated. We identified 637 host and 22 A. fumigatus proteins that were differentially abundant in the phagolysosome. 472 of the host proteins were overrepresented in the pksP mutant and 165 in the wt conidia-containing phagolysosome. Eight of the fungal proteins were produced only in pksP mutant and 14 proteins in wt conidia-containing phagolysosomes. Bioinformatical analysis compiled a regulatory module, which indicates host processes affected by the fungus. These processes include vATPase-driven phagolysosomal acidification, Rab5 and Vamp8-dependent endocytic trafficking, signaling pathways, as well as recruitment of the Lamp1 phagolysosomal maturation marker and the lysosomal cysteine protease cathepsin Z. Western blotting and immunofluorescence analyses confirmed the proteome data and moreover showed differential abundance of the major metabolic regulator mTOR. Taken together, with the help of a protocol optimized to isolate A. fumigatus conidia-containing phagolysosomes and a potent bioinformatics algorithm, we were able to confirm A. fumigatus conidia

How Radiologists Think: Understanding Fast and Slow Thought Processing and How It Can Improve Our Teaching.

PubMed

van der Gijp, Anouk; Webb, Emily M; Naeger, David M

2017-06-01

Scholars have identified two distinct ways of thinking. This "Dual Process Theory" distinguishes a fast, nonanalytical way of thinking, called "System 1," and a slow, analytical way of thinking, referred to as "System 2." In radiology, we use both methods when interpreting and reporting images, and both should ideally be emphasized when educating our trainees. This review provides practical tips for improving radiology education, by enhancing System 1 and System 2 thinking among our trainees. Copyright © 2017 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects.

PubMed

Andersson Hagiwara, Magnus; Andersson Gäre, Boel; Elg, Mattias

2016-01-01

To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

Methodological systematic review identifies major limitations in prioritization processes for updating.

PubMed

Martínez García, Laura; Pardo-Hernandez, Hector; Superchi, Cecilia; Niño de Guzman, Ena; Ballesteros, Monica; Ibargoyen Roteta, Nora; McFarlane, Emma; Posso, Margarita; Roqué I Figuls, Marta; Rotaeche Del Campo, Rafael; Sanabria, Andrea Juliana; Selva, Anna; Solà, Ivan; Vernooij, Robin W M; Alonso-Coello, Pablo

2017-06-01

The aim of the study was to identify and describe strategies to prioritize the updating of systematic reviews (SRs), health technology assessments (HTAs), or clinical guidelines (CGs). We conducted an SR of studies describing one or more methods to prioritize SRs, HTAs, or CGs for updating. We searched MEDLINE (PubMed, from 1966 to August 2016) and The Cochrane Methodology Register (The Cochrane Library, Issue 8 2016). We hand searched abstract books, reviewed reference lists, and contacted experts. Two reviewers independently screened the references and extracted data. We included 14 studies. Six studies were classified as descriptive (6 of 14, 42.9%) and eight as implementation studies (8 of 14, 57.1%). Six studies reported an updating strategy (6 of 14, 42.9%), six a prioritization process (6 of 14, 42.9%), and two a prioritization criterion (2 of 14, 14.2%). Eight studies focused on SRs (8 of 14, 57.1%), six studies focused on CGs (6 of 14, 42.9%), and none were about HTAs. We identified 76 prioritization criteria that can be applied when prioritizing documents for updating. The most frequently cited criteria were as follows: available evidence (19 of 76, 25.0%), clinical relevance (10 of 76; 13.2%), and users' interest (10 of 76; 13.2%). There is wide variability and suboptimal reporting of the methods used to develop and implement processes to prioritize updating of SRs, HTAs, and CGs. Copyright © 2017 Elsevier Inc. All rights reserved.

Improving GPR Surveys Productivity by Array Technology and Fully Automated Processing

NASA Astrophysics Data System (ADS)

Morello, Marco; Ercoli, Emanuele; Mazzucchelli, Paolo; Cottino, Edoardo

2016-04-01

scheme take advantage of 3D data multiplicity by continuous real time data focusing. Pre-stack reflection angle gathers G(x, θ; v) are computed at nv different velocities (by the mean of Kirchhoff depth-migration kernels, that can naturally cope with any acquisition pattern and handle irregular sampling issues). It must be noted that the analysis of pre-stack reflection angle gathers plays a key-role in automated detection: targets are identified and the best local propagation velocities are recovered through a correlation estimate computed for all the nv reflection angle gathers. Indeed, the data redundancy of 3D GPR acquisitions highly improves the proposed automatic detection reliability. The goal of real-time automated processing has been pursued without the need of specific high performance processing hardware (a simple laptop is required). Moreover, the automatization of the entire surveying process allows to obtain high quality and repeatable results without the need of skilled interpreters. The proposed acquisition procedure has been extensively tested: more than 100 Km of acquired data prove the feasibility of the proposed approach.

Women-focused treatment agencies and process improvement: Strategies to increase client engagement

PubMed Central

Wisdom, Jennifer P.; Hoffman, Kim; Rechberger, Elke; Seim, Kay; Owens, Betta

2009-01-01

Behavioral health treatment agencies often struggle to keep clients engaged in treatment. Women clients often have additional factors such as family responsibilities, financial difficulties, or abuse histories that provide extra challenges to remaining in care. As part of a national initiative, four women-focused drug treatment agencies used process improvement to address treatment engagement. Interviews and focus groups with staff assessed the nature and extent of interventions. Women-focused drug treatment agencies selected relational-based interventions to engage clients in treatment and improved four-week treatment retention from 66% to 76%. Process improvement interventions in women-focused treatment may be useful to improve engagement. PMID:20046914

Improving operating room productivity via parallel anesthesia processing.

PubMed

Brown, Michael J; Subramanian, Arun; Curry, Timothy B; Kor, Daryl J; Moran, Steven L; Rohleder, Thomas R

2014-01-01

Parallel processing of regional anesthesia may improve operating room (OR) efficiency in patients undergoes upper extremity surgical procedures. The purpose of this paper is to evaluate whether performing regional anesthesia outside the OR in parallel increases total cases per day, improve efficiency and productivity. Data from all adult patients who underwent regional anesthesia as their primary anesthetic for upper extremity surgery over a one-year period were used to develop a simulation model. The model evaluated pure operating modes of regional anesthesia performed within and outside the OR in a parallel manner. The scenarios were used to evaluate how many surgeries could be completed in a standard work day (555 minutes) and assuming a standard three cases per day, what was the predicted end-of-day time overtime. Modeling results show that parallel processing of regional anesthesia increases the average cases per day for all surgeons included in the study. The average increase was 0.42 surgeries per day. Where it was assumed that three cases per day would be performed by all surgeons, the days going to overtime was reduced by 43 percent with parallel block. The overtime with parallel anesthesia was also projected to be 40 minutes less per day per surgeon. Key limitations include the assumption that all cases used regional anesthesia in the comparisons. Many days may have both regional and general anesthesia. Also, as a case study, single-center research may limit generalizability. Perioperative care providers should consider parallel administration of regional anesthesia where there is a desire to increase daily upper extremity surgical case capacity. Where there are sufficient resources to do parallel anesthesia processing, efficiency and productivity can be significantly improved. Simulation modeling can be an effective tool to show practice change effects at a system-wide level.

The Goddard Cumulus Ensemble Model (GCE): Improvements and Applications for Studying Precipitation Processes

NASA Technical Reports Server (NTRS)

Tao, Wei-Kuo; Lang, Stephen E.; Zeng, Xiping; Li, Xiaowen; Matsui, Toshi; Mohr, Karen; Posselt, Derek; Chern, Jiundar; Peters-Lidard, Christa; Norris, Peter M.;

Statistical process control methods allow the analysis and improvement of anesthesia care.

PubMed

Fasting, Sigurd; Gisvold, Sven E

2003-10-01

Quality aspects of the anesthetic process are reflected in the rate of intraoperative adverse events. The purpose of this report is to illustrate how the quality of the anesthesia process can be analyzed using statistical process control methods, and exemplify how this analysis can be used for quality improvement. We prospectively recorded anesthesia-related data from all anesthetics for five years. The data included intraoperative adverse events, which were graded into four levels, according to severity. We selected four adverse events, representing important quality and safety aspects, for statistical process control analysis. These were: inadequate regional anesthesia, difficult emergence from general anesthesia, intubation difficulties and drug errors. We analyzed the underlying process using 'p-charts' for statistical process control. In 65,170 anesthetics we recorded adverse events in 18.3%; mostly of lesser severity. Control charts were used to define statistically the predictable normal variation in problem rate, and then used as a basis for analysis of the selected problems with the following results: Inadequate plexus anesthesia: stable process, but unacceptably high failure rate; Difficult emergence: unstable process, because of quality improvement efforts; Intubation difficulties: stable process, rate acceptable; Medication errors: methodology not suited because of low rate of errors. By applying statistical process control methods to the analysis of adverse events, we have exemplified how this allows us to determine if a process is stable, whether an intervention is required, and if quality improvement efforts have the desired effect.

Investigation of optical current transformer signal processing method based on an improved Kalman algorithm

NASA Astrophysics Data System (ADS)

Shen, Yan; Ge, Jin-ming; Zhang, Guo-qing; Yu, Wen-bin; Liu, Rui-tong; Fan, Wei; Yang, Ying-xuan

2018-01-01

This paper explores the problem of signal processing in optical current transformers (OCTs). Based on the noise characteristics of OCTs, such as overlapping signals, noise frequency bands, low signal-to-noise ratios, and difficulties in acquiring statistical features of noise power, an improved standard Kalman filtering algorithm was proposed for direct current (DC) signal processing. The state-space model of the OCT DC measurement system is first established, and then mixed noise can be processed by adding mixed noise into measurement and state parameters. According to the minimum mean squared error criterion, state predictions and update equations of the improved Kalman algorithm could be deduced based on the established model. An improved central difference Kalman filter was proposed for alternating current (AC) signal processing, which improved the sampling strategy and noise processing of colored noise. Real-time estimation and correction of noise were achieved by designing AC and DC noise recursive filters. Experimental results show that the improved signal processing algorithms had a good filtering effect on the AC and DC signals with mixed noise of OCT. Furthermore, the proposed algorithm was able to achieve real-time correction of noise during the OCT filtering process.

The operations manual: a mechanism for improving the research process.

PubMed

Bowman, Ann; Wyman, Jean F; Peters, Jennifer

2002-01-01

The development and use of an operations manual has the potential to improve the capacity of nurse scientists to address the complex, multifaceted issues associated with conducting research in today's healthcare environment. An operations manual facilitates communication, standardizes training and evaluation, and enhances the development and standard implementation of clear policies, processes, and protocols. A 10-year review of methodology articles in relevant nursing journals revealed no attention to this topic. This article will discuss how an operations manual can improve the conduct of research methods and outcomes for both small-scale and large-scale research studies. It also describes the purpose and components of a prototype operations manual for use in quantitative research. The operations manual increases reliability and reproducibility of the research while improving the management of study processes. It can prevent costly and untimely delays or errors in the conduct of research.

Accelerating quality improvement within your organization: Applying the Model for Improvement.

PubMed

Crowl, Ashley; Sharma, Anita; Sorge, Lindsay; Sorensen, Todd

2015-01-01

To discuss the fundamentals of the Model for Improvement and how the model can be applied to quality improvement activities associated with medication use, including understanding the three essential questions that guide quality improvement, applying a process for actively testing change within an organization, and measuring the success of these changes on care delivery. PubMed from 1990 through April 2014 using the search terms quality improvement, process improvement, hospitals, and primary care. At the authors' discretion, studies were selected based on their relevance in demonstrating the quality improvement process and tests of change within an organization. Organizations are continuously seeking to enhance quality in patient care services, and much of this work focuses on improving care delivery processes. Yet change in these systems is often slow, which can lead to frustration or apathy among frontline practitioners. Adopting and applying the Model for Improvement as a core strategy for quality improvement efforts can accelerate the process. While the model is frequently well known in hospitals and primary care settings, it is not always familiar to pharmacists. In addition, while some organizations may be familiar with the "plan, do, study, act" (PDSA) cycles-one element of the Model for Improvement-many do not apply it effectively. The goal of the model is to combine a continuous process of small tests of change (PDSA cycles) within an overarching aim with a longitudinal measurement process. This process differs from other forms of improvement work that plan and implement large-scale change over an extended period, followed by months of data collection. In this scenario it may take months or years to determine whether an intervention will have a positive impact. By following the Model for Improvement, frontline practitioners and their organizational leaders quickly identify strategies that make a positive difference and result in a greater degree of

Improved thermodynamic modeling of the no-vent fill process and correlation with experimental data

NASA Technical Reports Server (NTRS)

Taylor, William J.; Chato, David J.

1991-01-01

The United States' plans to establish a permanent manned presence in space and to explore the Solar System created the need to efficiently handle large quantities of subcritical cryogenic fluids, particularly propellants such as liquid hydrogen and liquid oxygen, in low- to zero-gravity environments. One of the key technologies to be developed for fluid handling is the ability to transfer the cryogens between storage and spacecraft tanks. The no-vent fill method was identified as one way to perform this transfer. In order to understand how to apply this method, a model of the no-vent fill process is being developed and correlated with experimental data. The verified models then can be used to design and analyze configurations for tankage and subcritical fluid depots. The development of an improved macroscopic thermodynamic model is discussed of the no-vent fill process and the analytical results from the computer program implementation of the model are correlated with experimental results for two different test tanks.

Economy of Force: Continuous Process Improvement And The Air Service

DTIC Science & Technology

2017-06-01

a household goods move, viewed from the perspective of a customer when interacting with a service organization, assists in demonstrating this...improvement (CPI) as well. The components of a process that deliver a value-added effect to a consumer of the goods or services generated by the process...CPI is largely about the “voice of the customer ” and all organizations, service or production based, have customers and processes. There are value

Improving Process Writing with the Use Authentic Assessment

ERIC Educational Resources Information Center

bin Abdul Aziz, Muhammad Noor; Yusoff, Nurahimah Mohd

2016-01-01

The paper discusses on how process writing is improved with the use of authentic assessment in an English Language classroom. Eleven primary school children from Year 4 in a rural school in Sabah are the participants of the study. Data were collected by observing them during the English Language lessons and at the end of the series of…

Utilizing Lean Six Sigma Methodology to Improve the Authored Works Command Approval Process at Naval Medical Center San Diego.

PubMed

Valdez, Michelle M; Liwanag, Maureen; Mount, Charles; Rodriguez, Rechell; Avalos-Reyes, Elisea; Smith, Andrew; Collette, David; Starsiak, Michael; Green, Richard

2018-03-14

Inefficiencies in the command approval process for publications and/or presentations negatively impact DoD Graduate Medical Education (GME) residency programs' ability to meet ACGME scholarly activity requirements. A preliminary review of the authored works approval process at Naval Medical Center San Diego (NMCSD) disclosed significant inefficiency, variation in process, and a low level of customer satisfaction. In order to facilitate and encourage scholarly activity at NMCSD, and meet ACGME requirements, the Executive Steering Council (ESC) chartered an interprofessional team to lead a Lean Six Sigma (LSS) Rapid Improvement Event (RIE) project. Two major outcome metrics were identified: (1) the number of authored works submissions containing all required signatures and (2) customer satisfaction with the authored works process. Primary metric baseline data were gathered utilizing a Clinical Investigations database tracking publications and presentations. Secondary metric baseline data were collected via a customer satisfaction survey to GME faculty and residents. The project team analyzed pre-survey data and utilized LSS tools and methodology including a "gemba" (environment) walk, cause and effect diagram, critical to quality tree, voice of the customer, "muda" (waste) chart, and a pre- and post-event value stream map. The team selected an electronic submission system as the intervention most likely to positively impact the RIE project outcome measures. The number of authored works compliant with all required signatures improved from 52% to 100%. Customer satisfaction rated as "completely or mostly satisfied" improved from 24% to 97%. For both outcomes, signature compliance and customer satisfaction, statistical significance was achieved with a p < 0.0001. This RIE project utilized LSS methodology and tools to improve signature compliance and increase customer satisfaction with the authored works approval process, leading to 100% signature compliance, a

Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

PubMed

Woo, Russell K; Skarsgard, Erik D

2015-06-01

Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Improved soft-agar colony assay in a fluid processing apparatus.

PubMed

Forsman, A D; Herpich, A R; Chapes, S K

1999-01-01

The standard method for quantitating bone marrow precursor cells has been to count the number of colony-forming units that form in semisolid (0.3%) agar. Recently we adapted this assay for use in hardware, the Fluid Processing Apparatus, that is flown in standard payload lockers of the space shuttle. When mouse or rat macrophage colony-forming units were measured with this hardware in ground-based assays, we found significantly more colony growth than that seen in standard plate assays. The improved growth correlates with increased agar thickness but also appears to be due to properties inherent to the Fluid Processing Apparatus. This paper describes an improved method for determining bone marrow macrophage precursor numbers in semisolid agar.

Usage of information safety requirements in improving tube bending process

NASA Astrophysics Data System (ADS)

Livshitz, I. I.; Kunakov, E.; Lontsikh, P. A.

2018-05-01

This article is devoted to an improvement of the technological process's analysis with the information security requirements implementation. The aim of this research is the competition increase analysis in aircraft industry enterprises due to the information technology implementation by the example of the tube bending technological process. The article analyzes tube bending kinds and current technique. In addition, a potential risks analysis in a tube bending technological process is carried out in terms of information security.

Identifying improvement potentials in cement production with life cycle assessment.

PubMed

Boesch, Michael Elias; Hellweg, Stefanie

2010-12-01

Cement production is an environmentally relevant process responsible for 5% of total anthropogenic carbon dioxide emissions and 7% of industrial fuel use. In this study, life cycle assessment is used to evaluate improvement potentials in the cement production process in Europe and the USA. With a current fuel substitution rate of 18% in Europe and 11% in the USA, both regions have a substantial potential to reduce greenhouse gas emissions and save virgin resources by further increasing the coprocessing of waste fuels. Upgrading production technology would be particularly effective in the USA where many kiln systems with very low energy efficiency are still in operation. Using best available technology and a thermal substitution rate of 50% for fuels, greenhouse gas emissions could be reduced by 9% for Europe and 18% for the USA per tonne of cement. Since clinker production is the dominant pollution producing step in cement production, the substitution of clinker with mineral components such as ground granulated blast furnace slag or fly ash is an efficient measure to reduce the environmental impact. Blended cements exhibit substantially lower environmental footprints than Portland cement, even if the substitutes feature lower grindability and require additional drying and large transport distances. The highest savings in CO(2) emissions and resource consumption are achieved with a combination of measures in clinker production and cement blending.

The road to business process improvement--can you get there from here?

PubMed

Gilberto, P A

1995-11-01

Historically, "improvements" within the organization have been frequently attained through automation by building and installing computer systems. Material requirements planning (MRP), manufacturing resource planning II (MRP II), just-in-time (JIT), computer aided design (CAD), computer aided manufacturing (CAM), electronic data interchange (EDI), and various other TLAs (three-letter acronyms) have been used as the methods to attain business objectives. But most companies have found that installing computer software, cleaning up their data, and providing every employee with training on how to best use the systems have not resulted in the level of business improvements needed. The software systems have simply made management around the problems easier but did little to solve the basic problems. The missing element in the efforts to improve the performance of the organization has been a shift in focus from individual department improvements to cross-organizational business process improvements. This article describes how the Electric Boat Division of General Dynamics Corporation, in conjunction with the Data Systems Division, moved its focus from one of vertical organizational processes to horizontal business processes. In other words, how we got rid of the dinosaurs.

Post-processing for improving hyperspectral anomaly detection accuracy

NASA Astrophysics Data System (ADS)

Wu, Jee-Cheng; Jiang, Chi-Ming; Huang, Chen-Liang

2015-10-01

Anomaly detection is an important topic in the exploitation of hyperspectral data. Based on the Reed-Xiaoli (RX) detector and a morphology operator, this research proposes a novel technique for improving the accuracy of hyperspectral anomaly detection. Firstly, the RX-based detector is used to process a given input scene. Then, a post-processing scheme using morphology operator is employed to detect those pixels around high-scoring anomaly pixels. Tests were conducted using two real hyperspectral images with ground truth information and the results based on receiver operating characteristic curves, illustrated that the proposed method reduced the false alarm rates of the RXbased detector.

Less severe processing improves carbon nanotube photovoltaic performance

NASA Astrophysics Data System (ADS)

Shea, Matthew J.; Wang, Jialiang; Flach, Jessica T.; Zanni, Martin T.; Arnold, Michael S.

2018-05-01

Thin film semiconducting single walled carbon nanotube (s-SWCNT) photovoltaics suffer losses due to trapping and quenching of excitons by defects induced when dispersing s-SWCNTs into solution. We study these aspects by preparing photovoltaic devices from (6,5) carbon nanotubes isolated by different processes: extended ultrasonication, brief ultrasonication, and shear force mixing. Peak quantum efficiency increases from 28% to 38% to 49% as the processing harshness decreases and is attributed to both increasing s-SWCNT length and reducing sidewall defects. Fill-factor and open-circuit voltage also improve with shear force mixing, highlighting the importance of obtaining long, defect-free s-SWCNTs for efficient photoconversion devices.

Evaluating the implementation of a quality improvement process in General Practice using a realist evaluation framework.

PubMed

Moule, Pam; Clompus, Susan; Fieldhouse, Jon; Ellis-Jones, Julie; Barker, Jacqueline

2018-05-25

Underuse of anticoagulants in atrial fibrillation is known to increase the risk of stroke and is an international problem. The National Institute for Health Care and Excellence guidance CG180 seeks to reduce atrial fibrillation related strokes through prescriptions of Non-vitamin K antagonist Oral Anticoagulants. A quality improvement programme was established by the West of England Academic Health Science Network (West of England AHSN) to implement this guidance into General Practice. A realist evaluation identified whether the quality improvement programme worked, determining how and in what circumstances. Six General Practices in 1 region, became the case study sites. Quality improvement team, doctor, and pharmacist meetings within each of the General Practices were recorded at 3 stages: initial planning, review, and final. Additionally, 15 interviews conducted with the practice leads explored experiences of the quality improvement process. Observation and interview data were analysed and compared against the initial programme theory. The quality improvement resources available were used variably, with the training being valued by all. The initial programme theories were refined. In particular, local workload pressures and individual General Practitioner experiences and pre-conceived ideas were acknowledged. Where key motivators were in place, such as prior experience, the programme achieved optimal outcomes and secured a lasting quality improvement legacy. The employment of a quality improvement programme can deliver practice change and improvement legacy outcomes when particular mechanisms are employed and in contexts where there is a commitment to improve service. © 2018 John Wiley & Sons, Ltd.

Using an International Clinical Registry of Regional Anesthesia to Identify Targets for Quality Improvement

PubMed Central

Sites, Brian D.; Barrington, Michael J.; Davis, Matthew

2014-01-01

Background Despite the widespread use of regional anesthesia, limited information on clinical performance exists. Institutions, therefore, have little knowledge of how they are performing in regards to both safety and effectiveness. In this study, we demonstrate how a medical institution (or physician/physician group) may use data from a multi-center clinical registry of regional anesthesia to inform quality improvement strategies. Methods We analyzed data from the International Registry of Regional Anesthesia that includes prospective data on peripheral regional anesthesia procedures from 19 centers located around the world. Using data from the clinical registry, we present summary statistics of the overall safety and effectiveness of regional anesthesia. Furthermore, we demonstrate, using a variety of performance measures, how these data can be used by hospitals to identify areas for quality improvement. To do so, we compare the performance of one member institution (a United States medical center in New Hampshire) to that of the other 18 member institutions of the clinical registry. Results The clinical registry contained information on 23,271 blocks that were performed between June 1, 2011, and May 1, 2014, on 16,725 patients. The overall success rate was 96.7%, immediate complication rate was 2.2%, and the all-cause 60-day rate of neurological sequelae was 8.3 (95% CI, 7.2–9.7) per 10,000. Registry wide major hospital events included 7 wrong site blocks, 3 seizures, 1 complete heart block, 1 retroperitoneal hematoma, and 3 pneumothoraces. For our reference medical center, we identified areas meriting quality improvement. Specifically, after accounting for differences in the age, sex, and health status of patient populations, the reference medical center appeared to rely more heavily on opioids for post procedure management, had higher patient pain scores, and experienced delayed discharge when compared with other member institutions. Conclusions To our

Multivariate data analysis on historical IPV production data for better process understanding and future improvements.

PubMed

Thomassen, Yvonne E; van Sprang, Eric N M; van der Pol, Leo A; Bakker, Wilfried A M

2010-09-01

Historical manufacturing data can potentially harbor a wealth of information for process optimization and enhancement of efficiency and robustness. To extract useful data multivariate data analysis (MVDA) using projection methods is often applied. In this contribution, the results obtained from applying MVDA on data from inactivated polio vaccine (IPV) production runs are described. Data from over 50 batches at two different production scales (700-L and 1,500-L) were available. The explorative analysis performed on single unit operations indicated consistent manufacturing. Known outliers (e.g., rejected batches) were identified using principal component analysis (PCA). The source of operational variation was pinpointed to variation of input such as media. Other relevant process parameters were in control and, using this manufacturing data, could not be correlated to product quality attributes. The gained knowledge of the IPV production process, not only from the MVDA, but also from digitalizing the available historical data, has proven to be useful for troubleshooting, understanding limitations of available data and seeing the opportunity for improvements. 2010 Wiley Periodicals, Inc.

Correcting Inadequate Model Snow Process Descriptions Dramatically Improves Mountain Hydrology Simulations

NASA Astrophysics Data System (ADS)

Pomeroy, J. W.; Fang, X.

2014-12-01

The vast effort in hydrology devoted to parameter calibration as a means to improve model performance assumes that the models concerned are not fundamentally wrong. By focussing on finding optimal parameter sets and ascribing poor model performance to parameter or data uncertainty, these efforts may fail to consider the need to improve models with more intelligent descriptions of hydrological processes. To test this hypothesis, a flexible physically based hydrological model including a full suite of snow hydrology processes as well as warm season, hillslope and groundwater hydrology was applied to Marmot Creek Research Basin, Canadian Rocky Mountains where excellent driving meteorology and basin biophysical descriptions exist. Model parameters were set from values found in the basin or from similar environments; no parameters were calibrated. The model was tested against snow surveys and streamflow observations. The model used algorithms that describe snow redistribution, sublimation and forest canopy effects on snowmelt and evaporative processes that are rarely implemented in hydrological models. To investigate the contribution of these processes to model predictive capability, the model was "falsified" by deleting parameterisations for forest canopy snow mass and energy, blowing snow, intercepted rain evaporation, and sublimation. Model falsification by ignoring forest canopy processes contributed to a large increase in SWE errors for forested portions of the research basin with RMSE increasing from 19 to 55 mm and mean bias (MB) increasing from 0.004 to 0.62. In the alpine tundra portion, removing blowing processes resulted in an increase in model SWE MB from 0.04 to 2.55 on north-facing slopes and -0.006 to -0.48 on south-facing slopes. Eliminating these algorithms degraded streamflow prediction with the Nash Sutcliffe efficiency dropping from 0.58 to 0.22 and MB increasing from 0.01 to 0.09. These results show dramatic model improvements by including snow

Properties of an improved Gabor wavelet transform and its applications to seismic signal processing and interpretation

NASA Astrophysics Data System (ADS)

Ji, Zhan-Huai; Yan, Sheng-Gang

2017-12-01

This paper presents an analytical study of the complete transform of improved Gabor wavelets (IGWs), and discusses its application to the processing and interpretation of seismic signals. The complete Gabor wavelet transform has the following properties. First, unlike the conventional transform, the improved Gabor wavelet transform (IGWT) maps time domain signals to the time-frequency domain instead of the time-scale domain. Second, the IGW's dominant frequency is fixed, so the transform can perform signal frequency division, where the dominant frequency components of the extracted sub-band signal carry essentially the same information as the corresponding components of the original signal, and the subband signal bandwidth can be regulated effectively by the transform's resolution factor. Third, a time-frequency filter consisting of an IGWT and its inverse transform can accurately locate target areas in the time-frequency field and perform filtering in a given time-frequency range. The complete IGW transform's properties are investigated using simulation experiments and test cases, showing positive results for seismic signal processing and interpretation, such as enhancing seismic signal resolution, permitting signal frequency division, and allowing small faults to be identified.

Identifying armed respondents to domestic violence restraining orders and recovering their firearms: process evaluation of an initiative in California.

PubMed

Wintemute, Garen J; Frattaroli, Shannon; Claire, Barbara E; Vittes, Katherine A; Webster, Daniel W

2014-02-01

We evaluated a law enforcement initiative to screen respondents to domestic violence restraining orders for firearm ownership or possession and recover their firearms. The initiative was implemented in San Mateo and Butte counties in California from 2007 through 2010. We used descriptive methods to evaluate the screening process and recovery effort in each county, relying on records for individual cases. Screening relied on an archive of firearm transactions, court records, and petitioner interviews; no single source was adequate. Screening linked 525 respondents (17.7%) in San Mateo County to firearms; 405 firearms were recovered from 119 (22.7%) of them. In Butte County, 88 (31.1%) respondents were linked to firearms; 260 firearms were recovered from 45 (51.1%) of them. Nonrecovery occurred most often when orders were never served or respondents denied having firearms. There were no reports of serious violence or injury. Recovering firearms from persons subject to domestic violence restraining orders is possible. We have identified design and implementation changes that may improve the screening process and the yield from recovery efforts. Larger implementation trials are needed.

Applying industrial process improvement techniques to increase efficiency in a surgical practice.

PubMed

Reznick, David; Niazov, Lora; Holizna, Eric; Siperstein, Allan

2014-10-01

The goal of this study was to examine how industrial process improvement techniques could help streamline the preoperative workup. Lean process improvement was used to streamline patient workup at an endocrine surgery service at a tertiary medical center utilizing multidisciplinary collaboration. The program consisted of several major changes in how patients are processed in the department. The goal was to shorten the wait time between initial call and consult visit and between consult and surgery. We enrolled 1,438 patients enrolled in the program. The wait time from the initial call until consult was reduced from 18.3 ± 0.7 to 15.4 ± 0.9 days. Wait time from consult until operation was reduced from 39.9 ± 1.5 to 33.9 ± 1.3 days for the overall practice and to 15.0 ± 4.8 days for low-risk patients. Patient cancellations were reduced from 27.9 ± 2.4% to 17.3 ± 2.5%. Overall patient flow increased from 30.9 ± 5.1 to 52.4 ± 5.8 consults per month (all P < .01). Utilizing process improvement methodology, surgery patients can benefit from an improved, streamlined process with significant reduction in wait time from call to initial consult and initial consult to surgery, with reduced cancellations. This generalized process has resulted in increased practice throughput and efficiency and is applicable to any surgery practice. Copyright © 2014 Elsevier Inc. All rights reserved.

Application of process improvement principles to increase the frequency of complete airway management documentation.

PubMed

McCarty, L Kelsey; Saddawi-Konefka, Daniel; Gargan, Lauren M; Driscoll, William D; Walsh, John L; Peterfreund, Robert A

2014-12-01

Process improvement in healthcare delivery settings can be difficult, even when there is consensus among clinicians about a clinical practice or desired outcome. Airway management is a medical intervention fundamental to the delivery of anesthesia care. Like other medical interventions, a detailed description of the management methods should be documented. Despite this expectation, airway documentation is often insufficient. The authors hypothesized that formal adoption of process improvement methods could be used to increase the rate of "complete" airway management documentation. The authors defined a set of criteria as a local practice standard of "complete" airway management documentation. The authors then employed selected process improvement methodologies over 13 months in three iterative and escalating phases to increase the percentage of records with complete documentation. The criteria were applied retrospectively to determine the baseline frequency of complete records, and prospectively to measure the impact of process improvements efforts over the three phases of implementation. Immediately before the initial intervention, a retrospective review of 23,011 general anesthesia cases over 6 months showed that 13.2% of patient records included complete documentation. At the conclusion of the 13-month improvement effort, documentation improved to a completion rate of 91.6% (P<0.0001). During the subsequent 21 months, the completion rate was sustained at an average of 90.7% (SD, 0.9%) across 82,571 general anesthetic records. Systematic application of process improvement methodologies can improve airway documentation and may be similarly effective in improving other areas of anesthesia clinical practice.

Performance improvements of binary diffractive structures via optimization of the photolithography and dry etch processes

NASA Astrophysics Data System (ADS)

Welch, Kevin; Leonard, Jerry; Jones, Richard D.

2010-08-01

Increasingly stringent requirements on the performance of diffractive optical elements (DOEs) used in wafer scanner illumination systems are driving continuous improvements in their associated manufacturing processes. Specifically, these processes are designed to improve the output pattern uniformity of off-axis illumination systems to minimize degradation in the ultimate imaging performance of a lithographic tool. In this paper, we discuss performance improvements in both photolithographic patterning and RIE etching of fused silica diffractive optical structures. In summary, optimized photolithographic processes were developed to increase critical dimension uniformity and featuresize linearity across the substrate. The photoresist film thickness was also optimized for integration with an improved etch process. This etch process was itself optimized for pattern transfer fidelity, sidewall profile (wall angle, trench bottom flatness), and across-wafer etch depth uniformity. Improvements observed with these processes on idealized test structures (for ease of analysis) led to their implementation in product flows, with comparable increases in performance and yield on customer designs.

Introducing the CERT (Trademark) Resiliency Engineering Framework: Improving the Security and Sustainability Processes

DTIC Science & Technology

2007-05-01

Organizational Structure 40 6.1.3 Funding Model 40 6.1.4 Role of Information Technology 40 6.2 Considering Process Improvement 41 6.2.1 Dimensions of...to the process definition for resiliency engineering. 6.1.3 Funding Model Just as organizational structures tend to align across security and...responsibility. Adopting an enter- prise view of operational resiliency and a process improvement approach requires that the funding model evolve to one

Recent Improvements in the FDNS CFD Code and its Associated Process

NASA Technical Reports Server (NTRS)

West, Jeff S.; Dorney, Suzanne M.; Turner, Jim (Technical Monitor)

2002-01-01

This viewgraph presentation gives an overview on recent improvements in the Finite Difference Navier Stokes (FDNS) computational fluid dynamics (CFD) code and its associated process. The development of a utility, PreViewer, has essentially eliminated the creeping of simple human error into the FDNS Solution process. Extension of PreViewer to encapsulate the Domain Decompression process has made practical the routine use of parallel processing. The combination of CVS source control and ATS consistency validation significantly increases the efficiency of the CFD process.

Identifying key areas of ecosystem services potential to improve ecological management in Chongqing City, southwest China.

PubMed

Xiao, Yang; Xiao, Qiang

2018-03-29

Because natural ecosystems and ecosystem services (ES) are both critical to the well-being of humankind, it is important to understand their relationships and congruence for conservation planning. Spatial conservation planning is required to set focused preservation priorities and to assess future ecological implications. This study uses the combined measures of ES models and ES potential to estimate and analyze all four groups of ecosystem services to generate opportunities to maximize ecosystem services. Subsequently, we identify the key areas of conservation priorities as future forestation and conservation hotspot zones to improve the ecological management in Chongqing City, located in the upper reaches of the Three Gorges Reservoir Area, China. Results show that ecosystem services potential is extremely obvious. Compared to ecosystem services from 2000, we determined that soil conservation could be increased by 59.11%, carbon sequestration by 129.51%, water flow regulation by 83.42%, and water purification by 84.42%. According to our prioritization results, approximately 48% of area converted to forests exhibited high improvements in all ecosystem services (categorized as hotspot-1, hotspot-2, and hotspot-3). The hotspots identified in this study can be used as an excellent surrogate for evaluation ecological engineering benefits and can be effectively applied in improving ecological management planning.

Multifamily Housing Rehabilitation Process Improvements

DOE Office of Scientific and Technical Information (OSTI.GOV)

Sweet, Marshall L.; Francisco, Abby; Roberts, Sydney G.

Rea Ventures Group, LLC, (Rea Ventures) partnered with Southface Energy Institute (Southface) on the rehabilitation of 418 low-income rental multifamily apartments located at 14 different properties in Georgia (Climate Zones 2-4). These 22-year old, individually-metered units were arranged in rowhouse or townhouse style units. Rehabilitation plans were developed using a process prescribed by the US Department of Agriculture (USDA) Rural Development program, who partially funded the building upgrades. The USDA is responsible for building, upgrading, and subsidizing housing in rural areas nationwide. In 2012, over $100 million was allocated in grants and loans. Due to the unique financing mechanism asmore » well as long-term ownership requirements, property owners are especially motivated to invest in upgrades that will increase durability and tenant retention. These buildings represent a large stock of rural affordable housing that have the potential for significant energy and cost savings for property owners and tenants. Southface analyzed the energy upgrade potential of one stereotypical property in the Rea Ventures portfolio. This study will provide insight into the most cost-effective, implementable energy efficiency and durability upgrades for this age multifamily housing, having an enormous impact not only on the portfolio of Rea Ventures but on the vast USDA and larger Federal portfolio. Additionally, Southface will identify gaps in the current capital needs assessment process, examine available audit and simulation tools and protocols, and evaluate additional auditor training or certification needs.« less

Enhancing performing characteristics of organic semiconducting films by improved solution processing

DOEpatents

Bazan, Guillermo C; Moses, Daniel; Peet, Jeffrey; Heeger, Alan J

2014-05-13

Improved processing methods for enhanced properties of conjugated polymer films are disclosed, as well as the enhanced conjugated polymer films produced thereby. Addition of low molecular weight alkyl-containing molecules to solutions used to form conjugated polymer films leads to improved photoconductivity and improvements in other electronic properties. The enhanced conjugated polymer films can be used in a variety of electronic devices, such as solar cells and photodiodes.

Student Evaluations of the Portfolio Process

PubMed Central

Airey, Tatum C.; Bisso, Andrea M.; Slack, Marion K.

2011-01-01

Objective. To evaluate pharmacy students’ perceived benefits of the portfolio process and to gather suggestions for improving the process. Methods. A questionnaire was designed and administered to 250 first-, second-, and third-year pharmacy students at the University of Arizona College of Pharmacy. Results. Although the objectives of the portfolio process were for students to understand the expected outcomes, understand the impact of extracurricular activities on attaining competencies, identify what should be learned, identify their strengths and weaknesses, and modify their approach to learning, overall students perceived the portfolio process as having less than moderate benefit. First-year students wanted more examples of portfolios while second- and third-year students suggested that more time with their advisor would be beneficial. Conclusions. The portfolio process will continue to be refined and efforts made to improve students’ perceptions of the process as it is intended to develop the self-assessments skills they will need to improve their knowledge and professional skills throughout their pharmacy careers. PMID:21969718

Student evaluations of the portfolio process.

PubMed

Murphy, John E; Airey, Tatum C; Bisso, Andrea M; Slack, Marion K

2011-09-10

To evaluate pharmacy students' perceived benefits of the portfolio process and to gather suggestions for improving the process. A questionnaire was designed and administered to 250 first-, second-, and third-year pharmacy students at the University of Arizona College of Pharmacy. Although the objectives of the portfolio process were for students to understand the expected outcomes, understand the impact of extracurricular activities on attaining competencies, identify what should be learned, identify their strengths and weaknesses, and modify their approach to learning, overall students perceived the portfolio process as having less than moderate benefit. First-year students wanted more examples of portfolios while second- and third-year students suggested that more time with their advisor would be beneficial. The portfolio process will continue to be refined and efforts made to improve students' perceptions of the process as it is intended to develop the self-assessments skills they will need to improve their knowledge and professional skills throughout their pharmacy careers.

Using rule-based natural language processing to improve disease normalization in biomedical text.

PubMed

Kang, Ning; Singh, Bharat; Afzal, Zubair; van Mulligen, Erik M; Kors, Jan A

2013-01-01

In order for computers to extract useful information from unstructured text, a concept normalization system is needed to link relevant concepts in a text to sources that contain further information about the concept. Popular concept normalization tools in the biomedical field are dictionary-based. In this study we investigate the usefulness of natural language processing (NLP) as an adjunct to dictionary-based concept normalization. We compared the performance of two biomedical concept normalization systems, MetaMap and Peregrine, on the Arizona Disease Corpus, with and without the use of a rule-based NLP module. Performance was assessed for exact and inexact boundary matching of the system annotations with those of the gold standard and for concept identifier matching. Without the NLP module, MetaMap and Peregrine attained F-scores of 61.0% and 63.9%, respectively, for exact boundary matching, and 55.1% and 56.9% for concept identifier matching. With the aid of the NLP module, the F-scores of MetaMap and Peregrine improved to 73.3% and 78.0% for boundary matching, and to 66.2% and 69.8% for concept identifier matching. For inexact boundary matching, performances further increased to 85.5% and 85.4%, and to 73.6% and 73.3% for concept identifier matching. We have shown the added value of NLP for the recognition and normalization of diseases with MetaMap and Peregrine. The NLP module is general and can be applied in combination with any concept normalization system. Whether its use for concept types other than disease is equally advantageous remains to be investigated.

Comparison of remote sensing image processing techniques to identify tornado damage areas from Landsat TM data

USGS Publications Warehouse

Myint, S.W.; Yuan, M.; Cerveny, R.S.; Giri, C.P.

2008-01-01

Remote sensing techniques have been shown effective for large-scale damage surveys after a hazardous event in both near real-time or post-event analyses. The paper aims to compare accuracy of common imaging processing techniques to detect tornado damage tracks from Landsat TM data. We employed the direct change detection approach using two sets of images acquired before and after the tornado event to produce a principal component composite images and a set of image difference bands. Techniques in the comparison include supervised classification, unsupervised classification, and objectoriented classification approach with a nearest neighbor classifier. Accuracy assessment is based on Kappa coefficient calculated from error matrices which cross tabulate correctly identified cells on the TM image and commission and omission errors in the result. Overall, the Object-oriented Approach exhibits the highest degree of accuracy in tornado damage detection. PCA and Image Differencing methods show comparable outcomes. While selected PCs can improve detection accuracy 5 to 10%, the Object-oriented Approach performs significantly better with 15-20% higher accuracy than the other two techniques. ?? 2008 by MDPI.

Comparison of Remote Sensing Image Processing Techniques to Identify Tornado Damage Areas from Landsat TM Data

PubMed Central

Myint, Soe W.; Yuan, May; Cerveny, Randall S.; Giri, Chandra P.

2008-01-01

Remote sensing techniques have been shown effective for large-scale damage surveys after a hazardous event in both near real-time or post-event analyses. The paper aims to compare accuracy of common imaging processing techniques to detect tornado damage tracks from Landsat TM data. We employed the direct change detection approach using two sets of images acquired before and after the tornado event to produce a principal component composite images and a set of image difference bands. Techniques in the comparison include supervised classification, unsupervised classification, and object-oriented classification approach with a nearest neighbor classifier. Accuracy assessment is based on Kappa coefficient calculated from error matrices which cross tabulate correctly identified cells on the TM image and commission and omission errors in the result. Overall, the Object-oriented Approach exhibits the highest degree of accuracy in tornado damage detection. PCA and Image Differencing methods show comparable outcomes. While selected PCs can improve detection accuracy 5 to 10%, the Object-oriented Approach performs significantly better with 15-20% higher accuracy than the other two techniques. PMID:27879757

Observations on the Use of SCAN To Identify Children at Risk for Central Auditory Processing Disorder.

ERIC Educational Resources Information Center

Emerson, Maria F.; And Others

1997-01-01

The SCAN: A Screening Test for Auditory Processing Disorders was administered to 14 elementary children with a history of otitis media and 14 typical children, to evaluate the validity of the test in identifying children with central auditory processing disorder. Another experiment found that test results differed based on the testing environment…

Learning to Identify Near-Threshold Luminance-Defined and Contrast-Defined Letters in Observers with Amblyopia

PubMed Central

Chung, Susana T.L.; Li, Roger W.; Levi, Dennis M.

2008-01-01

We assessed whether or not the sensitivity for identifying luminance-defined and contrast-defined letters improved with training in a group of amblyopic observers who have passed the critical period of development. In Experiment 1, we tracked the contrast threshold for identifying luminance-defined letters with training in a group of 11 amblyopic observers. Following training, six observers showed a reduction in thresholds, averaging 20%, for identifying luminance-defined letters. This improvement transferred extremely well to the untrained task of identifying contrast-defined letters (average improvement = 38%) but did not transfer to an acuity measurement. Seven of the 11 observers were subsequently trained on identifying contrast-defined letters in Experiment 2. Following training, five of these seven observers demonstrated a further improvement, averaging 17%, for identifying contrast-defined letters. This improvement did not transfer to the untrained task of identifying luminance-defined letters. Our findings are consistent with predictions based on the locus of learning for first- and second-order stimuli according to the filter-rectifier-filter model for second-order visual processing. PMID:18824189

Improvement Research Priorities: USA Survey and Expert Consensus

PubMed Central

Stevens, Kathleen R.; Ovretveit, John

2013-01-01

The purpose of this study was to identify stakeholder views about national priorities for improvement science and build agreement for action in a national improvement and implementation research network in the USA. This was accomplished using three stages of identification and consensus. (1) Topics were identified through a multipronged environmental scan of the literature and initiatives. (2) Based on this scan, a survey was developed, and stakeholders (n = 2,777) were invited to rate the resulting 33-topic, 9-category list, via an online survey. Data from 560 respondents (20% response) were analyzed. (3) An expert panel used survey results to further refine the research priorities through a Rand Delphi process. Priorities identified were within four categories: care coordination and transitions, high-performing clinical systems and microsystems improvement approaches, implementation of evidence-based improvements and best practices, and culture of quality and safety. The priorities identified were adopted by the improvement science research network as the research agenda to guide strategy. The process and conclusions may be of value to quality improvement research funding agencies, governments, and research units seeking to concentrate their resources on improvement topics where research is capable of yielding timely and actionable answers as well as contributing to the knowledge base for improvement. PMID:24024029

Improvements in the Protein Identifier Cross-Reference service.

PubMed

Wein, Samuel P; Côté, Richard G; Dumousseau, Marine; Reisinger, Florian; Hermjakob, Henning; Vizcaíno, Juan A

2012-07-01

The Protein Identifier Cross-Reference (PICR) service is a tool that allows users to map protein identifiers, protein sequences and gene identifiers across over 100 different source databases. PICR takes input through an interactive website as well as Representational State Transfer (REST) and Simple Object Access Protocol (SOAP) services. It returns the results as HTML pages, XLS and CSV files. It has been in production since 2007 and has been recently enhanced to add new functionality and increase the number of databases it covers. Protein subsequences can be Basic Local Alignment Search Tool (BLAST) against the UniProt Knowledgebase (UniProtKB) to provide an entry point to the standard PICR mapping algorithm. In addition, gene identifiers from UniProtKB and Ensembl can now be submitted as input or mapped to as output from PICR. We have also implemented a 'best-guess' mapping algorithm for UniProt. In this article, we describe the usefulness of PICR, how these changes have been implemented, and the corresponding additions to the web services. Finally, we explain that the number of source databases covered by PICR has increased from the initial 73 to the current 102. New resources include several new species-specific Ensembl databases as well as the Ensembl Genome ones. PICR can be accessed at http://www.ebi.ac.uk/Tools/picr/.

Identifying treatment responders and predictors of improvement after cognitive-behavioral therapy for juvenile fibromyalgia.

PubMed

Sil, Soumitri; Arnold, Lesley M; Lynch-Jordan, Anne; Ting, Tracy V; Peugh, James; Cunningham, Natoshia; Powers, Scott W; Lovell, Daniel J; Hashkes, Philip J; Passo, Murray; Schikler, Kenneth N; Kashikar-Zuck, Susmita

2014-07-01

The primary objective of this study was to estimate a clinically significant and quantifiable change in functional disability to identify treatment responders in a clinical trial of cognitive-behavioral therapy (CBT) for youth with juvenile fibromyalgia (JFM). The second objective was to examine whether baseline functional disability (Functional Disability Inventory), pain intensity, depressive symptoms (Children's Depression Inventory), coping self-efficacy (Pain Coping Questionnaire), and parental pain history predicted treatment response in disability at 6-month follow-up. Participants were 100 adolescents (11-18 years of age) with JFM enrolled in a recently published clinical trial comparing CBT to a fibromyalgia education (FE) intervention. Patients were identified as achieving a clinically significant change in disability (i.e., were considered treatment responders) if they achieved both a reliable magnitude of change (estimated as a > or = 7.8-point reduction on the FDI) using the Reliable Change Index, and a reduction in FDI disability grade based on established clinical reference points. Using this rigorous standard, 40% of patients who received CBT (20 of 50) were identified as treatment responders, compared to 28% who received FE (14 of 50). For CBT, patients with greater initial disability and higher coping efficacy were significantly more likely to achieve a clinically significant improvement in functioning. Pain intensity, depressive symptoms, and parent pain history did not significantly predict treatment response. Estimating clinically significant change for outcome measures in behavioral trials sets a high bar but is a potentially valuable approach to improve the quality of clinical trials, to enhance interpretability of treatment effects, and to challenge researchers to develop more potent and tailored interventions. Copyright © 2014 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

Numerical Processing Efficiency Improved in Experienced Mental Abacus Children

ERIC Educational Resources Information Center

Wang, Yunqi; Geng, Fengji; Hu, Yuzheng; Du, Fenglei; Chen, Feiyan

2013-01-01

Experienced mental abacus (MA) users are able to perform mental arithmetic calculations with unusual speed and accuracy. However, it remains unclear whether their extraordinary gains in mental arithmetic ability are accompanied by an improvement in numerical processing efficiency. To address this question, the present study, using a numerical…

The Role of Evaluation in the School Improvement Process

ERIC Educational Resources Information Center

Lindahl, Ronald A.; Beach, Robert H.

2013-01-01

Although evaluation serves many purposes in education, there is virtually unanimous agreement that evaluation is a critical component of all school improvement processes. Hamilton et al. (2003) asserted that "assessment and evaluation should be built into reform programs from the outset" (p. 26). Kimball, Lander, and Thorn (2010)…

Software quality and process improvement in scientific simulation codes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Ambrosiano, J.; Webster, R.

1997-11-01

This report contains viewgraphs on the quest to develope better simulation code quality through process modeling and improvement. This study is based on the experience of the authors and interviews with ten subjects chosen from simulation code development teams at LANL. This study is descriptive rather than scientific.

Process evaluation improves delivery of a nutrition-sensitive agriculture programme in Burkina Faso.

PubMed

Nielsen, Jennifer N; Olney, Deanna K; Ouedraogo, Marcellin; Pedehombga, Abdoulaye; Rouamba, Hippolyte; Yago-Wienne, Fanny

2017-12-26

Evidence is emerging from rigorous evaluations about the effectiveness of nutrition-sensitive agriculture programmes in improving nutritional outcomes. Additional evidence can elucidate how different programme components and pathways contribute and can be optimized for impact. The International Food Policy Research Institute, with Helen Keller International, designed a comprehensive framework to evaluate the delivery, utilization, and impact of Helen Keller International's enhanced homestead food production programme in Burkina Faso. After 18 months of implementation, a process evaluation was conducted to examine programme impact pathways, using key informant and semistructured interviews with implementing agents and beneficiaries, and with residents of control communities. Data were analyzed by International Food Policy Research Institute and reviewed with project managers and partners through multiple workshops to identify opportunities to strengthen implementation. Findings illuminated gaps between intended and actual delivery schemes, including input constraints, knowledge gaps among community agents in agriculture and young child nutrition practices, and lower than expected activity by community volunteers. In response, staff developed measures to overcome water constraints and expand vegetable and poultry production, retrained volunteers in certain techniques of food production and counselling for nutrition behaviour change, added small incentives to motivate volunteers, and shaped both immediate and long-term changes to the programme model. Working closely with International Food Policy Research Institute on the evaluation activities also expanded the repertoire of research methods and skills of Helen Keller International staff. Process evaluation can strengthen programme delivery, utilization, and design. Collaboration between researchers and implementers can improve programme effectiveness, project staff capacity, and advance delivery science. © 2017

CM Process Improvement and the International Space Station Program (ISSP)

NASA Technical Reports Server (NTRS)

Stephenson, Ginny

2007-01-01

This viewgraph presentation reviews the Configuration Management (CM) process improvements planned and undertaken for the International Space Station Program (ISSP). It reviews the 2004 findings and recommendations and the progress towards their implementation.

Improvement for enhancing effectiveness of universal power system (UPS) continuous testing process

NASA Astrophysics Data System (ADS)

Sriratana, Lerdlekha

2018-01-01

This experiment aims to enhance the effectiveness of the Universal Power System (UPS) continuous testing process of the Electrical and Electronic Institute by applying work scheduling and time study methods. Initially, the standard time of testing process has not been considered that results of unaccurate testing target and also time wasting has been observed. As monitoring and reducing waste time for improving the efficiency of testing process, Yamazumi chart and job scheduling theory (North West Corner Rule) were applied to develop new work process. After the improvements, the overall efficiency of the process possibly increased from 52.8% to 65.6% or 12.7%. Moreover, the waste time could reduce from 828.3 minutes to 653.6 minutes or 21%, while testing units per batch could increase from 3 to 4 units. Therefore, the number of testing units would increase from 12 units up to 20 units per month that also contribute to increase of net income of UPS testing process by 72%.

Computational methods using genome-wide association studies to predict radiotherapy complications and to identify correlative molecular processes

NASA Astrophysics Data System (ADS)

Oh, Jung Hun; Kerns, Sarah; Ostrer, Harry; Powell, Simon N.; Rosenstein, Barry; Deasy, Joseph O.

2017-02-01

The biological cause of clinically observed variability of normal tissue damage following radiotherapy is poorly understood. We hypothesized that machine/statistical learning methods using single nucleotide polymorphism (SNP)-based genome-wide association studies (GWAS) would identify groups of patients of differing complication risk, and furthermore could be used to identify key biological sources of variability. We developed a novel learning algorithm, called pre-conditioned random forest regression (PRFR), to construct polygenic risk models using hundreds of SNPs, thereby capturing genomic features that confer small differential risk. Predictive models were trained and validated on a cohort of 368 prostate cancer patients for two post-radiotherapy clinical endpoints: late rectal bleeding and erectile dysfunction. The proposed method results in better predictive performance compared with existing computational methods. Gene ontology enrichment analysis and protein-protein interaction network analysis are used to identify key biological processes and proteins that were plausible based on other published studies. In conclusion, we confirm that novel machine learning methods can produce large predictive models (hundreds of SNPs), yielding clinically useful risk stratification models, as well as identifying important underlying biological processes in the radiation damage and tissue repair process. The methods are generally applicable to GWAS data and are not specific to radiotherapy endpoints.

Using Medicare Data to Identify Individuals Who Are Electricity Dependent to Improve Disaster Preparedness and Response

PubMed Central

DeSalvo, Karen; Finne, Kristen; Worrall, Chris; Bogdanov, Alina; Dinkler, Ayame; Babcock, Sarah; Kelman, Jeffrey

2014-01-01

During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations. PMID:24832404

Using Medicare data to identify individuals who are electricity dependent to improve disaster preparedness and response.

PubMed

DeSalvo, Karen; Lurie, Nicole; Finne, Kristen; Worrall, Chris; Bogdanov, Alina; Dinkler, Ayame; Babcock, Sarah; Kelman, Jeffrey

2014-07-01

During a disaster or prolonged power outage, individuals who use electricity-dependent medical equipment are often unable to operate it and seek care in acute care settings or local shelters. Public health officials often report that they do not have proactive and systematic ways to rapidly identify and assist these individuals. In June 2013, we piloted a first-in-the-nation emergency preparedness drill in which we used Medicare claims data to identify individuals with electricity-dependent durable medical equipment during a disaster and securely disclosed it to a local health department. We found that Medicare claims data were 93% accurate in identifying individuals using a home oxygen concentrator or ventilator. The drill findings suggest that claims data can be useful in improving preparedness and response for electricity-dependent populations.

A novel mini-DNA barcoding assay to identify processed fins from internationally protected shark species.

PubMed

Fields, Andrew T; Abercrombie, Debra L; Eng, Rowena; Feldheim, Kevin; Chapman, Demian D

2015-01-01

There is a growing need to identify shark products in trade, in part due to the recent listing of five commercially important species on the Appendices of the Convention on International Trade in Endangered Species (CITES; porbeagle, Lamna nasus, oceanic whitetip, Carcharhinus longimanus scalloped hammerhead, Sphyrna lewini, smooth hammerhead, S. zygaena and great hammerhead S. mokarran) in addition to three species listed in the early part of this century (whale, Rhincodon typus, basking, Cetorhinus maximus, and white, Carcharodon carcharias). Shark fins are traded internationally to supply the Asian dried seafood market, in which they are used to make the luxury dish shark fin soup. Shark fins usually enter international trade with their skin still intact and can be identified using morphological characters or standard DNA-barcoding approaches. Once they reach Asia and are traded in this region the skin is removed and they are treated with chemicals that eliminate many key diagnostic characters and degrade their DNA ("processed fins"). Here, we present a validated mini-barcode assay based on partial sequences of the cytochrome oxidase I gene that can reliably identify the processed fins of seven of the eight CITES listed shark species. We also demonstrate that the assay can even frequently identify the species or genus of origin of shark fin soup (31 out of 50 samples).

A Novel Mini-DNA Barcoding Assay to Identify Processed Fins from Internationally Protected Shark Species

PubMed Central

Fields, Andrew T.; Abercrombie, Debra L.; Eng, Rowena; Feldheim, Kevin; Chapman, Demian D.

2015-01-01

There is a growing need to identify shark products in trade, in part due to the recent listing of five commercially important species on the Appendices of the Convention on International Trade in Endangered Species (CITES; porbeagle, Lamna nasus, oceanic whitetip, Carcharhinus longimanus scalloped hammerhead, Sphyrna lewini, smooth hammerhead, S. zygaena and great hammerhead S. mokarran) in addition to three species listed in the early part of this century (whale, Rhincodon typus, basking, Cetorhinus maximus, and white, Carcharodon carcharias). Shark fins are traded internationally to supply the Asian dried seafood market, in which they are used to make the luxury dish shark fin soup. Shark fins usually enter international trade with their skin still intact and can be identified using morphological characters or standard DNA-barcoding approaches. Once they reach Asia and are traded in this region the skin is removed and they are treated with chemicals that eliminate many key diagnostic characters and degrade their DNA (“processed fins”). Here, we present a validated mini-barcode assay based on partial sequences of the cytochrome oxidase I gene that can reliably identify the processed fins of seven of the eight CITES listed shark species. We also demonstrate that the assay can even frequently identify the species or genus of origin of shark fin soup (31 out of 50 samples). PMID:25646789

Identifying the hazard characteristics of powder byproducts generated from semiconductor fabrication processes.

PubMed

Choi, Kwang-Min; An, Hee-Chul; Kim, Kwan-Sick

2015-01-01

Semiconductor manufacturing processes generate powder particles as byproducts which potentially could affect workers' health. The chemical composition, size, shape, and crystal structure of these powder particles were investigated by scanning electron microscopy equipped with an energy dispersive spectrometer, Fourier transform infrared spectrometry, and X-ray diffractometry. The powders generated in diffusion and chemical mechanical polishing processes were amorphous silica. The particles in the chemical vapor deposition (CVD) and etch processes were TiO(2) and Al(2)O(3), and Al(2)O(3) particles, respectively. As for metallization, WO(3), TiO(2), and Al(2)O(3) particles were generated from equipment used for tungsten and barrier metal (TiN) operations. In photolithography, the size and shape of the powder particles showed 1-10 μm and were of spherical shape. In addition, the powders generated from high-current and medium-current processes for ion implantation included arsenic (As), whereas the high-energy process did not include As. For all samples collected using a personal air sampler during preventive maintenance of process equipment, the mass concentrations of total airborne particles were < 1 μg, which is the detection limit of the microbalance. In addition, the mean mass concentrations of airborne PM10 (particles less than 10 μm in diameter) using direct-reading aerosol monitor by area sampling were between 0.00 and 0.02 μg/m(3). Although the exposure concentration of airborne particles during preventive maintenance is extremely low, it is necessary to make continuous improvements to the process and work environment, because the influence of chronic low-level exposure cannot be excluded.

Identifying Eating Occasion-Based Opportunities to Improve the Overall Diets of Australian Adolescents

PubMed Central

Fayet-Moore, Flavia; McConnell, Andrew; Kim, Jean; Mathias, Kevin C.

2017-01-01

Adolescents in Australia have a poor dietary intake, leading to large numbers of them being at risk for inadequate intake of micronutrients, and excessive intake of less healthful dietary components. This study examined dietary intakes at multiple eating occasions to identify opportunities for more targeted recommendations and strategies to improve dietary intakes among adolescents. Data from the first 24-h recall of 14–18 years old in the 2011–2012 National Nutrition and Physical Activity Survey were analysed (n = 772). Participant-defined eating occasions were classified as breakfast, lunch, dinner or other eating occasions combined. The mean percent contribution to the total day intake of top shortfall nutrients (calcium, magnesium, vitamin A, iron), discretionary calories, saturated fat, free sugars and sodium, as well as nutrient density, the foods consumed and the percent of consumers at each eating occasion, were calculated. Breakfast had the lowest prevalence of consumers (81%), contributed the least to total daily energy (14.6%) and almost a quarter of daily calcium and iron. Other eating occasions combined contributed 47.5% of free sugars and were top contributors of daily calcium (34.6%) and magnesium (31.7%). Discretionary foods contributed 32.4% of the energy at lunch, and the sodium content at lunch was 415 mg/1000 kJ. Key opportunities identified for adolescents were to increase breakfast consumption, given the high nutrient densities of breakfasts consumed; improve overall lunch quality, particularly the sodium content; promote the intake of milk, fruit and a variety of vegetables at both lunch and dinner; maintain healthful choices at in-between meal eating occasions while focusing on decreasing the intake of discretionary foods. PMID:28613261

A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

NASA Astrophysics Data System (ADS)

Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

Strategy for 90% autoverification of clinical chemistry and immunoassay test results using six sigma process improvement.