Introducing the Human Side of Total Quality Management into Educational Institutions.

ERIC Educational Resources Information Center

Thor, Linda M.

1994-01-01

Drawing from the experiences of Rio Salado Community College (Arizona) in implementing Total Quality Management, discusses common barriers to change (e.g., time, aversion to change, and pitfalls of change); leadership failure as a cause of failure in TQM implementation; and the importance of constancy of purpose, employee empowerment, and…

Quality Management Framework for Total Diet Study centres in Europe.

PubMed

Pité, Marina; Pinchen, Hannah; Castanheira, Isabel; Oliveira, Luisa; Roe, Mark; Ruprich, Jiri; Rehurkova, Irena; Sirot, Veronique; Papadopoulos, Alexandra; Gunnlaugsdóttir, Helga; Reykdal, Ólafur; Lindtner, Oliver; Ritvanen, Tiina; Finglas, Paul

2018-02-01

A Quality Management Framework to improve quality and harmonization of Total Diet Study practices in Europe was developed within the TDS-Exposure Project. Seventeen processes were identified and hazards, Critical Control Points and associated preventive and corrective measures described. The Total Diet Study process was summarized in a flowchart divided into planning and practical (sample collection, preparation and analysis; risk assessment analysis and publication) phases. Standard Operating Procedures were developed and implemented in pilot studies in five organizations. The flowchart was used to develop a quality framework for Total Diet Studies that could be included in formal quality management systems. Pilot studies operated by four project partners were visited by project assessors who reviewed implementation of the proposed framework and identified areas that could be improved. The quality framework developed can be the starting point for any Total Diet Study centre and can be used within existing formal quality management approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.

Partnerships for Quality: A Statewide Plan for Developing and Implementing a Total Quality Curriculum Delivered through Oregon's Community Colleges.

ERIC Educational Resources Information Center

Oregon State Economic Development Dept., Salem.

The Oregon Advanced Technology Consortium (OATC) created the Partnerships for Quality Project (PQP) to improve Oregon's community colleges by developing a total quality curriculum (TQC) based on the beliefs and practices of total quality management (TQM). This report summarizes the recommendations of the PQP and presents a plan of action for the…

Factors associated with physical therapists' implementation of physical activity interventions in The Netherlands.

PubMed

Huijg, Johanna M; Dusseldorp, Elise; Gebhardt, Winifred A; Verheijden, Marieke W; van der Zouwe, Nicolette; Middelkoop, Barend J C; Duijzer, Geerke; Crone, Mathilde R

2015-04-01

Physical therapists play an important role in the promotion of physical activity (PA) and the effectiveness of PA interventions. However, little is known about the extent to which they implement PA interventions following the intervention protocol and about the factors influencing their implementation behaviors. The study objective was to investigate physical therapists' implementation fidelity regarding PA interventions, including completeness and quality of delivery, and influencing factors with a Theoretical Domains Framework-based questionnaire. The study was based on a cross-sectional design. A total of 268 physical therapists completed the Determinants of Implementation Behavior Questionnaire. Questions about completeness and quality of delivery were based on components and tasks of PA interventions as described by the Royal Dutch Society for Physical Therapy. Multilevel regression analyses were used to identify factors associated with completeness and quality of delivery. High implementation fidelity was found for the physical therapists, with higher scores for completeness of delivery than for quality of delivery. Physical therapists' knowledge, skills, beliefs about capabilities and consequences, positive emotions, behavioral regulation, and the automaticity of PA intervention delivery were the most important predictors of implementation fidelity. Together, the Theoretical Domains Framework accounted for 23% of the variance in both total completeness and total quality scores. The cross-sectional design precluded the determination of causal relationships. Also, the use of a self-report measure to assess implementation fidelity could have led to socially desirable responses, possibly resulting in more favorable ratings for completeness and quality. This study enhances the understanding of how physical therapists implement PA interventions and which factors influence their behaviors. Knowledge about these factors may assist in the development of strategies to improve physical therapists' implementation behaviors. © 2015 American Physical Therapy Association.

Quality in Education: An Implementation Handbook.

ERIC Educational Resources Information Center

Arcaro, Jerome S.

This book describes how the principles of quality can be applied to education. Based on the work of W. Edwards Deming and Joseph M. Juran, the book outlines a systematic and practical approach to implementing quality in educational settings. It also describes how to encourage staff participation in quality initiatives. Total-quality schools are…

Total Quality Management (TQM) Bibliography

DTIC Science & Technology

1990-04-01

GTE FIE COPY DTIC c" ECTE 8JUL 25 1990u TOTAL QUALITY MANAGEMENT (TQM) BIBLIOGRAPHY APRIL-1990 Jointly supported by __’__________-_________ Jointly...Arsenal, AL 35898-5241 1I. TITLE (Include Security Classification) TOTAL QUALITY MANAGEMENT (TQM) BIBL IRAPHY APRIL-1990 12. PERSONAL AUTHOR(S) Knott...implementation of the concept of total quality management (TQM). The selected coverage includes books, periodical articles, conference papers and reports. Coded

Echoes of the Vision: When the Rest of the Organization Talks Total Quality.

ERIC Educational Resources Information Center

Fairhurst, Gail T.

1993-01-01

Describes a case study of an organization that recently began implementing W. E. Deming's Total Quality (TQ). Finds and discusses five framing devices used in routine work conversations between leaders and members to implement the TQ vision: communicated predicaments, possible futures, jargon and vision themes, positive spin, and agenda setting.…

Office of Command Security Total Quality Management Plan

DTIC Science & Technology

1989-07-01

outlines the Office of Command Security instruction for TQM implementation. Keywords: TQM (Total Quality Management ), DLA Office of Command Security, Continuous process improvement, Automatic data processing security.

QUALITY SYSTEMS AND IMPLEMENTATION PLAN FOR A PILOT STUDY OF CHILDREN'S TOTAL EXPOSURE TO PERSISTENT PESTICIDES AND OTHER PERSISTENT ORGANIC PESTICIDES (CTEPP)

EPA Science Inventory

The Quality System Implementation Plan (QSIP) describes the quality assurance and quality control procedures developed for the CTEPP study. It provides the QA/QC procedures used in recruitment of subjects, sample field collection, sample extraction and analysis, data storage, and...

Challenges to Successful Total Quality Management Implementation in Public Secondary Schools: A Case Study of Kohat District, Pakistan

ERIC Educational Resources Information Center

Suleman, Qaiser; Gul, Rizwana

2015-01-01

The current study explores the challenges faced by public secondary schools in successful implementation of total quality management (TQM) in Kohat District. A sample of 25 heads and 75 secondary school teachers selected from 25 public secondary schools through simple random sampling technique was used. Descriptive research designed was used and a…

Supply Operations (DLA-O) Total Quality Management (TQM) Master Plan

DTIC Science & Technology

1989-07-01

This document briefly outlines the DLA Directorate of Supply Operations plan to implement total quality management . It seeks to provide better...service to customers at a lower cost through continuous process improvement and commitment from everyone in the organization. Keywords: TQM (total Quality Management ), Supply operations; Continuous process improvement. (KR)

Total quality management in the hospital setting.

PubMed

Ernst, D F

1994-01-01

With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.

A Guide for Implementing Total Quality Management in the U.S. Coast Guard Reserve

DTIC Science & Technology

1991-12-01

quality field were reviewed. The main ones studied were: Total Quality (Deming 1988); Single-Minute Exchange of Die (SMED) (Shingo 1985); Poka - yoke (mistake...Productivity Press, 1985. Shingo, Shigeo. Zero Quality Control: Source Inspection and the Poka - Yoke System. Cambridge, MA: Productivity Press, 1986. Snead

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed Central

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-01-01

OBJECTIVE: This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. DATA SOURCES AND STUDY SETTING: Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. STUDY DESIGN: The study involved cross-sectional examination of the named relationships. DATA COLLECTION/EXTRACTION METHODS: Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. PRINCIPAL FINDINGS: A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. CONCLUSIONS: What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard. PMID:7782222

Assessing the impact of continuous quality improvement/total quality management: concept versus implementation.

PubMed

Shortell, S M; O'Brien, J L; Carman, J M; Foster, R W; Hughes, E F; Boerstler, H; O'Connor, E J

1995-06-01

This study examines the relationships among organizational culture, quality improvement processes and selected outcomes for a sample of up to 61 U. S. hospitals. Primary data were collected from 61 U. S. hospitals (located primarily in the midwest and the west) on measures related to continuous quality improvement/total quality management (CQI/TQM), organizational culture, implementation approaches, and degree of quality improvement implementation based on the Baldrige Award criteria. These data were combined with independently collected data on perceived impact and objective measures of clinical efficiency (i.e., charges and length of stay) for six clinical conditions. The study involved cross-sectional examination of the named relationships. Reliable and valid scales for the organizational culture and quality improvement implementation measures were developed based on responses from over 7,000 individuals across the 61 hospitals with an overall completion rate of 72 percent. Independent data on perceived impact were collected from a national survey and independent data on clinical efficiency from a companion study of managed care. A participative, flexible, risk-taking organizational culture was significantly related to quality improvement implementation. Quality improvement implementation, in turn, was positively associated with greater perceived patient outcomes and human resource development. Larger-size hospitals experienced lower clinical efficiency with regard to higher charges and higher length of stay, due in part to having more bureaucratic and hierarchical cultures that serve as a barrier to quality improvement implementation. What really matters is whether or not a hospital has a culture that supports quality improvement work and an approach that encourages flexible implementation. Larger-size hospitals face more difficult challenges in this regard.

DCASR (Defense Contract Administration Services Region) Dallas Total Quality Management Implementation Plan

DTIC Science & Technology

1989-07-01

Competitive Success e. What is Total Quality Kaoru Ishikawa Control? The Japanese Way f. Managerial Break Through J. M. Juran g. The Deming Route to...Berger and Thomas H. Hart p. Juran’s Quality Control J. M. Juran Handbook, Fourth Edition q. Guide to Quality Control Kaoru Ishikawa r. Quality Assurance

Total Quality in Higher Education. Total Quality Series.

ERIC Educational Resources Information Center

Lewis, Ralph G.; Smith, Douglas H.

This volume offers a detailed argument for and description of Total Quality Management (TQM) for institutions of higher education. Chapter 1 elaborates on why TQM is good for higher education and includes some warning as to why implementation at colleges and universities may not be easy. Chapter 2 provides an overview of the history of the TQM…

DISC (Defense Industrial Supply Center) TQM (Total Quality Management) Operations Plan

DTIC Science & Technology

1989-07-01

This document represents the continuance of the Defense Industrial Supply Center implementation of Total Quality Management which began in 1986. It...outlines how DISC intends to emphasize process improvement through the integration of all TQM initiates. Quality management at DISC prescribes defining

Integrating Curriculum in a Total Quality School.

ERIC Educational Resources Information Center

Jenkins, Kenneth D.; Jenkins, Doris M.

1998-01-01

Examined the changes implemented by teachers at Brown Barge Middle School, in Pensacola, Florida, to improve curriculum. Notes the teachers' use of total quality education principles and describes six propositions of change: achieving constancy of purpose, building quality, continuous improvement, student-centered approach, using data, and…

Total Quality Management Simplified.

ERIC Educational Resources Information Center

Arias, Pam

1995-01-01

Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…

Total Quality Management Guide. Volume 2. A Guide to Implementation

DTIC Science & Technology

1990-02-15

Kaoru . Guide to Quality Control. Asian Productivity Organization. 1984. Ishikawa , Kaoru . What is Total Quality Control? The Japanese Way. Englewood...of the new Systems Age. The theories of Deming, Juran, Ishikawa , and other management methods that still predominate are pioneers of Systems Age...Feigenbaum, Armand V. Total Quality Control. New York: McGraw-Hill Book Company. 1983. bnai, Masaaki. Kaizen. New York: Random House. 1986. Ishikawa

The Quality Professor: Implementing TQM in the Classroom.

ERIC Educational Resources Information Center

Cornesky, Robert A.

This volume describes Total Quality Management (TQM) in the higher education classroom and guides college faculty in implementing TQM to improve their teaching. Chapter 1 introduces TQM and gives pointers on how to begin implementing it. Chapter 2 describes TQM approaches and principles including the Deming and Crosby approaches, describes the TQM…

Total quality management: Strengths and barriers to implementation and cultural adaptation

NASA Technical Reports Server (NTRS)

Siegfeldt, Denise V.; Glenn, Michael; Hamilton, Louise

1992-01-01

NASA/Langley Research Center (LaRC) is in the process of implementing Total Quality Management (TQM) throughout the organization in order to improve productivity and make the Center an even better place to work. The purpose of this project was to determine strengths and barriers to TQM being implemented and becoming a part of the organizational culture of the Human Resources Management Division (HRMD) at Langley. The target population for this project was both supervisory and nonsupervisory staff of the HMRD. In order to generate data on strengths and barriers to TQM implementation and cultural adaptation, a modified nominal group technique was used.

An Ounce of Application Is Worth a Ton of Abstraction. A Practical Guide to Implementing Total Quality Management.

ERIC Educational Resources Information Center

Crouch, J. Michael

This book explains how to implement a Total Quality Management (TQM) program within an organization focusing in particular on ways to sustain the effort. Part 1 of five offers an overview of the TQM approach and the rationale for adopting it. Topics of discussion include signs of the need for change, what TQM is and what it is not, the basics of…

Quality in Web-Supported Learning.

ERIC Educational Resources Information Center

Fresen, Jill

2002-01-01

Discusses quality assurance for Web-based courses, based on experiences at the University of Pretoria. Topics include evaluation of courseware; the concept of quality, including quality control, quality assurance, and total quality management; implementing a quality management system; measurement techniques; and partnerships. (LRW)

Leadership and Quality Management: An Analysis of Three Key Features of the Greek Education System

ERIC Educational Resources Information Center

Saiti, Anna

2012-01-01

Purpose: This paper aims to investigate whether educational leadership in Greece implements the values of total quality management and contributes to the improvement of the educational process, and to offer proposals for a framework of total quality management that would contribute to an improvement in the overall quality of the education process.…

Total Quality Management in Higher Education: Clearing the Hurdles. A Survey on Strategies for Implementing Quality Management Practices in Higher Education. A GOAL/QPC Application Report.

ERIC Educational Resources Information Center

Seymour, Daniel

Based on a survey of Quality Management (QM) practitioners at 21 colleges, this study presents the 10 most difficult implementation hurdles to QM in higher education and a set of hurdle-clearing strategies. The hurdles are: (1) lack of time to implement QM; (2) perception that QM is something for janitorial and housing staffs but not applicable to…

76 FR 79604 - Effective Date for the Water Quality Standards for the State of Florida's Lakes and Flowing Waters

Federal Register 2010, 2011, 2012, 2013, 2014

2011-12-22

... quality in Florida may be interested in this rulemaking. Entities discharging nitrogen or phosphorus to.../phosphorus pollution in Florida's waters may be affected through implementation of Florida's water quality... inland waters rule established numeric nutrient criteria in the form of total nitrogen, total phosphorus...

An evaluation of the total quality management implementation strategy for the advanced solid rocket motor project at NASA's Marshall Space Flight Center. M.S. Thesis - Tennessee Univ.

NASA Technical Reports Server (NTRS)

Schramm, Harry F.; Sullivan, Kenneth W.

1991-01-01

An evaluation of the NASA's Marshall Space Flight Center (MSFC) strategy to implement Total Quality Management (TQM) in the Advanced Solid Rocket Motor (ASRM) Project is presented. The evaluation of the implementation strategy reflected the Civil Service personnel perspective at the project level. The external and internal environments at MSFC were analyzed for their effects on the ASRM TQM strategy. Organizational forms, cultures, management systems, problem solving techniques, and training were assessed for their influence on the implementation strategy. The influence of ASRM's effort was assessed relative to its impact on mature projects as well as future projects at MSFC.

33 CFR 385.38 - Interim goals.

Code of Federal Regulations, 2010 CFR

2010-07-01

.... (ii) Improvement in water quality; including: (A) Total phosphorus concentrations in the Everglades...) Increases in total spatial extent of restored wetlands; (B) Improvement in habitat quality; and (C... implementation process. In addition, interim goals will facilitate adaptive management and allow the Corps of...

Accountability and Other CAUSES of Total Quality Management.

ERIC Educational Resources Information Center

Aamot, Karen; Piotrowski, Craig

1995-01-01

Describes Total Quality Management (TQM) techniques implemented at Waukesha County Technical College (Wisconsin). The CAUSES program focuses on customers, accountability, understanding, self-improvement, education, and searching. Describes application of TQM to the fixed-asset team project. Four figures are included. (LMI)

Water quality, compliance, and health outcomes among utilities implementing Water Safety Plans in France and Spain.

PubMed

Setty, Karen E; Kayser, Georgia L; Bowling, Michael; Enault, Jerome; Loret, Jean-Francois; Serra, Claudia Puigdomenech; Alonso, Jordi Martin; Mateu, Arnau Pla; Bartram, Jamie

2017-05-01

Water Safety Plans (WSPs), recommended by the World Health Organization since 2004, seek to proactively identify potential risks to drinking water supplies and implement preventive barriers that improve safety. To evaluate the outcomes of WSP application in large drinking water systems in France and Spain, we undertook analysis of water quality and compliance indicators between 2003 and 2015, in conjunction with an observational retrospective cohort study of acute gastroenteritis incidence, before and after WSPs were implemented at five locations. Measured water quality indicators included bacteria (E. coli, fecal streptococci, total coliform, heterotrophic plate count), disinfectants (residual free and total chlorine), disinfection by-products (trihalomethanes, bromate), aluminum, pH, turbidity, and total organic carbon, comprising about 240K manual samples and 1.2M automated sensor readings. We used multiple, Poisson, or Tobit regression models to evaluate water quality before and after the WSP intervention. The compliance assessment analyzed exceedances of regulated, recommended, or operational water quality thresholds using chi-squared or Fisher's exact tests. Poisson regression was used to examine acute gastroenteritis incidence rates in WSP-affected drinking water service areas relative to a comparison area. Implementation of a WSP generally resulted in unchanged or improved water quality, while compliance improved at most locations. Evidence for reduced acute gastroenteritis incidence following WSP implementation was found at only one of the three locations examined. Outcomes of WSPs should be expected to vary across large water utilities in developed nations, as the intervention itself is adapted to the needs of each location. The approach may translate to diverse water quality, compliance, and health outcomes. Copyright © 2017 Elsevier GmbH. All rights reserved.

Total Quality Management in Logistics: A Case Study from the Trucking Industry

DTIC Science & Technology

1992-06-01

Quality Management (TQM) movement on the logistics industry as a whole, and, more specifically, its impact within the trucking industry. Its focus then narrows to study the practical aspects of implementing a W. Edwards Deming-based quality program within a particular trucking company, Mason Transporters, Inc. The effectiveness of the company’s implementation effort is assessed using data collected from a survey questionnaire, formal interviews, and personal observations during an on- site visit. Successes and shortcomings of the implementation process are highlighted

Revitalizing Space Operations through Total Quality Management

NASA Technical Reports Server (NTRS)

Baylis, William T.

1995-01-01

The purpose of this paper is to show the reader what total quality management (TQM) is and how to apply TQM in the space systems and management arena. TQM is easily understood, can be implemented in any type of business organization, and works.

Essentials of total quality management: a meta-analysis.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation. A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010. A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes. The review was limited to articles written in English language during the past 30 years. From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations. Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.

Total Quality Management (TQM): Group Dynamics Workshop

DTIC Science & Technology

1990-05-15

interactions with other OSD decision-making bodies. " Remove barriers /facilitate implementation. " Direct action on unresolved process problems referred...TQM leadership. - Total Quality Management FUNCTIONS: * Translate goals to tangible internal initiatives. " Remove barriers . " Establish and...Quality Management FUNCTIONS: • Identify and remove barriers . " Develop practical process improvements. " Install solutions and measurement systems for

Total Quality Management and Media Services: The Deming Method.

ERIC Educational Resources Information Center

Richie, Mark L.

1992-01-01

W. Edwards Deming built a 40-year record of quality management in Japan known as Total Quality Management (TQM). His 14 points require a change in the belief system of managers and media directors, but their implementation in government agencies and schools will produce increased time for better services, better communications, and new programs.…

Planning and Implementing total Quality Management in an Air Force Service Organization: A Case Study

DTIC Science & Technology

1988-09-01

Quality Management (TQM). Documentation of such implementation methods can provide useful crossfeed to other services organizations attempting similiar efforts. The following research questions were addressed to present the case in a useful context for interpretation: (1) What is TQM and how will it be implemented in AFALC; (2) How can the quality of service organizations be improved and what techniques may be useful for this purpose; (3) How does the environment at AFALC differ from most Air Force organizations implementing TQM and what obstacles must it overcome; (4) How

An Analysis of Oregon State University's Total Quality Management Pilot Program.

ERIC Educational Resources Information Center

Coate, L. Edwin

1993-01-01

Adaptation of the Total Quality Management approach to organizational improvement at Oregon State University involved creation of 10 pilot finance and administration teams and implementation of a 10-step problem-solving process. The approach has improved staff morale as well as client services. (MSE)

Implementation and evaluation of a follow-up programme after intensive care treatment: A practice development project.

PubMed

van Mol, Margo; Ista, Erwin; van Dijk, Monique

2018-05-02

This study aimed to measure the effects of a newly developed follow-up programme on intensive care unit patient quality of care, as perceived by their relatives, and the appropriateness of the programme according to nurses. This before and after implementation study was conducted in a level III intensive care unit for adult patients and related follow-up wards and included 135 intensive care nurses and 105 general ward nurses. The implemented programme included a personalised poster, a revised discharge protocol and follow-up visits on the ward. Eligible relatives of patients who had remained in the intensive care for a minimum of 48 hours were included. Total quality of care and communication were assessed by relatives as high according to the Quality Monitor. Most intensive care nurses evaluated the usefulness of the discharge protocol as positive (71.8% partly/totally agreed) and in accordance with the patients' needs (82.1% partly/totally agreed). Communication and general support as perceived by patients' relatives improved; however, no influence on the total quality of care of the revised discharge protocol was shown. Nurses considered the programme as useful. The intervention might enable nurses to better respond to the instrumental and affective needs of patients and their relatives. Copyright © 2018 Elsevier Ltd. All rights reserved.

Customer focus level following implementation of quality improvement model in Tehran social security hospitals.

PubMed

Mehrabi, F; Nasiripour, A; Delgoshaei, B

2008-01-01

The key factor for the success of total quality management programs in an organization is focusing on the customer. The purpose of this paper is to assess customer focus level following implementation of a quality improvement model in social security hospitals in Tehran Province. This research was descriptive-comparative in nature. The study population consisted of the implementers of quality improvement model in four Tehran social security hospitals. The data were gathered through a checklist addressing customer knowledge and customer satisfaction. The research findings indicated that the average scores on customer knowledge in Shahriar, Alborz, Milad, and Varamin hospitals were 64.1, 61.2, 54.1, and 46.6, respectively. The average scores on customer satisfaction in Shahriar, Alborz, Milad, and Varamin hospitals were 67.7, 65, 59.4, and 50, respectively. The customer focus average scores in Shahriar, Alborz, Milad, and Varamin hospitals were 66.3, 63.3, 57.3, and 48.6, respectively. The total average scores on customer knowledge, satisfaction and customer focus in the investigated hospitals proved to be 56.4, 60.5, and 58.9, respectively. The paper is of value in showing that implementation of the quality improvement model could considerably improve customer focus level.

The Quality Improvement Management Approach as Implemented in a Middle School.

ERIC Educational Resources Information Center

Bayless, David L.; And Others

1992-01-01

The Total Quality Management Theory of W. E. Deming can be adapted within an educational organization to build structures that support educators' beliefs. A case study of the implementation of Deming principles at the LeRoy Martin Middle School in Raleigh (North Carolina) illustrates the effectiveness of this management approach. (SLD)

Summary Report of the Seventh Annual NASA/Contractors Conference on Quality and Productivity: "Total Quality Leadership"

NASA Technical Reports Server (NTRS)

1991-01-01

More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity on October 12-13, 1990, in Grenelefe, Florida. The panel presentations and keynote speeches revolving around the theme of 'Total Quality Leadership" provided a solid base of understanding of the importance, benefits, and principles of total quality management. The implementation of these strategies is critical if we are to effectively pursue our mission of continuous quality improvement and reliability in our products, processes, and services. The annual NASA/contractors conferences serve as catalysts for achieving success in this mission.

Planning and Troubleshooting Guide.

ERIC Educational Resources Information Center

1994

This reference guide serves as an index for an 11-volume series of handbooks that offer guidelines to school administrators on the application and implementation of Total Quality Management (TQM) principles to education--Total Quality Education (TQE). The topics are listed in alphabetical order to show the corresponding volume and page number(s).…

TQM Paradigm for Higher Education in the Philippines

ERIC Educational Resources Information Center

Rodriguez, Janette; Valenzuela, Madonna; Ayuyao, Nunilon

2018-01-01

Purpose: Critical success factors (CSFs) in total quality management (TQM) implementation are vital to the quality improvement of organizations, including higher education institutions (HEIs). The present study aims to attempt to develop a TQM paradigm contextualized to HEIs in the Philippine setting. Design/methodology/approach: A total of 309…

Where Is the Xerox Corporation of the LIS Sector?

ERIC Educational Resources Information Center

Gilchrist, Alan; Brockman, John

1996-01-01

Discusses barriers to the implementation of quality management in the library and information science sector in Europe. Topics include Total Quality Management and other business experiences, an information quality infrastructure, supplier/customer relations, customer satisfaction, and a European Quality Model. (LRW)

Quality management in health care: a 20-year journey.

PubMed

Ruiz, Ulises

2004-01-01

In this article, the total quality programme in the Spanish healthcare system (1986-1992) and the subsequent quality improvement steps that have led to definition and implementation of such an integrated framework, seeking a quality management system and patient safety, are discussed.

Total quality through computer integrated manufacturing in the pharmaceutical industry.

PubMed

Ufret, C M

1995-01-01

The role of Computer Integrated Manufacturing (CIM) in the pursue of total quality in pharmaceutical manufacturing is assessed. CIM key objectives, design criteria, and performance measurements, in addition to its scope and implementation in a hierarchical structure, are explored in detail. Key elements for the success of each phase in a CIM project and a brief status of current CIM implementations in the pharmaceutical industry are presented. The role of World Class Manufacturing performance standards and other key issues to achieve full CIM benefits are also addressed.

Determinants of quality management systems implementation in hospitals.

PubMed

Wardhani, Viera; Utarini, Adi; van Dijk, Jitse Pieter; Post, Doeke; Groothoff, Johan Willem

2009-03-01

To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review. A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper. An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS. Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.

Study Quality in Higher Education Institution: Philosophy and Praxeology of Management

ERIC Educational Resources Information Center

Juodaityte, Audrone

2004-01-01

This article defines total quality philosophy, its transformations and significance for study quality in higher education institution. It reveals the concepts, principles and problems of study quality management and provides overview of implementation of study quality management at today's European universities. The experience of two European…

The Quality Education Challenge.

ERIC Educational Resources Information Center

Downey, Carolyn J.; And Others

Attempts to implement W. Edwards Deming's Total Quality Management (TQM) principles in education and transform school systems into world-class, quality learning environments have proved somewhat disappointing. This book asserts that educators need a way to translate the ideas about corporate quality for adaptation and use in schools. The…

Trends in surface-water quality during implementation of best-management practices in Mill Creek and Muddy Run Basins, Lancaster County, Pennsylvania

USGS Publications Warehouse

Koerkle, Edward H.

2000-01-01

Analyses of water samples collected over a 5-year period (1993-98) in the Mill Creek and Muddy Run Basins during implementation of agricultural best-management practices (BMP’s) indicate statistically significant trends in the concentrations of several nutrient species and in nonfilterable residue (suspended solids). The strongest trends identified were those indicated by a more than 50- percent decrease in the flow-adjusted concentrations of total and dissolved phosphorus and total residue in base flow in the two streams. Analyses of stormflow samples showed a 31-percent decrease in the flow-adjusted concentration of total phosphorus in Mill Creek and a 54-percent decrease in total nonfilterable residue in Muddy Run. A 58-percent increase in the flow-adjusted concentration of total ammonia nitrogen in stormflow was found at Muddy Run.Although the effects of a specific BMP on the indicated trends is uncertain, results of statistical trend tests of the data suggest that stream fencing, possibly in concert with other practices, such as stream crossings for livestock, barnyard runoff control, manure-storage facilities, and rotational grazing, was effective in improving water quality during base flow and probably low to moderate stormflow conditions. Additional improvements in water quality in the Mill Creek and Muddy Run Basins seems likely as the implementation of BMP’s is expected to continue. Thus, the full effect of BMP implementation in the two basins may not be observed for some time.

Using Total Quality Management Principles To Implement School-Based Management.

ERIC Educational Resources Information Center

Terry, Paul M.

Those engaged in school restructuring can find direction in the philosophy of W. Edwards Deming, which has guided the operations of many American corporations. This paper provides an overview of Deming's Fourteen Points of Total Quality Management (TQM) and discusses their applications to education. To develop a successful TQM system, the school…

Total quality management: managing the human dimension in natural resource agencies

Treesearch

Denzil Verardo

1995-01-01

Stewardship in an era of dwindling human resources requires new approaches to the way business is conducted in the public sector, and Total Quality Management (TQM) can be the avenue for this transformation. Resource agencies are no exception to this requirement, although modifications to "traditional" private enterprise versions of TQM implementation...

Application of the Total Quality Management Approach Principles and the ISO 9000 Standards in Engineering Education.

ERIC Educational Resources Information Center

Waks, Shlomo; Frank, Moti

1999-01-01

Discusses the applicability of the definition, principles, and underlying strategies of total quality management (TQM) for engineering education. Describes several tools and methods for the implementation of TQM and its suitability for a variety of school activities. Presents a TQM course outline combining lectures, discussions, suggested…

The Application of a Total Quality Management Approach to Support Student Recruitment in Schools of Music

ERIC Educational Resources Information Center

Weinstein, Larry

2009-01-01

One of the greatest challenges music programme administrators face is that of recruiting students for their programmes. This article suggests that administrators should investigate the benefits of implementing a comprehensive total quality management programme in their institutions. The core values, techniques and tools embodied in the Total…

Total Quality Management: Implications for Higher Education.

ERIC Educational Resources Information Center

Hoffman, Allan M., Ed.; Julius, Daniel J., Ed.

This book contains 19 papers describing the implementation of Total Quality Management in a variety of higher education settings. Following a Foreword by Peter Likins and a Preface by Daniel J. Julius, the chapter titles and authors are: (1) "TQM: Implications for Higher Education--A Look Back to the Future" (Allan M. Hoffman and Randall…

Design and Implementation of Total Quality Management in a Civil Engineering Squadron

DTIC Science & Technology

1989-09-01

instruct employees and seek new ways to integrate quality into all functions, such as planning, marketing , and controlling. The second strategy is for...implement a TQM plan that contributes to the overall DOD TQM process. 7 2. Managers at all levels will provide leadership and integrate TQM principles... integral part of our daily activities. 8 3. Quality improvement is the key to productivity improvement and must be pursued with the necessary resources to

U.S.-MEXICO BORDER PROGRAM ARIZONA BORDER STUDY--QUALITY SYSTEMS AND IMPLEMENTATION PLAN (QSIP) FOR TOTAL HUMAN EXPOSURE IN ARIZONA: A COMPARISON OF THE BORDER COMMUNITIES AND THE STATE

EPA Science Inventory

Prior to initiation of the Arizona Border Survey, a quality systems implementation plan (QSIP) addressing all aspects of the project was developed by the investigating consortium composed of researchers from The University of Arizona (UA), Battelle Memorial Institute (BMI), and t...

Embedding Quality: The Challenges for Higher Education

ERIC Educational Resources Information Center

Lomas, Laurie

2004-01-01

This paper reviews recent research, literature and the views of a small sample of senior managers and academics in English higher education institutions on the challenges associated with embedding quality. When implemented by a university, quality enhancement models such as total quality management and the European Foundation for Quality…

Total quality management in orthodontic practice.

PubMed

Atta, A E

1999-12-01

Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.

Implementation of occupational health service improvements through application of total quality management processes.

PubMed

Thomas, Elizabeth Anne

2011-06-01

The occupational health services department for a manufacturing division of a high-technology firm was redesigned from an outsourced model, in which most services were provided by an outside clinic vendor, to an in-house service model, in which services were provided by an on-site nurse practitioner. The redesign and implementation, accomplished by a cross-functional team using Total Quality Management processes, resulted in a comprehensive occupational health services department that realized significant cost reduction, increased compliance with regulatory and company requirements, and improved employee satisfaction. Implications of this project for occupational health nurses are discussed.

Improvements to the Total Temperature Calibration of the NASA Glenn Icing Research Tunnel

NASA Technical Reports Server (NTRS)

Arrington, E. Allen; Gonsalez, Jose C.

2005-01-01

The ability to accurately set repeatable total temperature conditions is critical for collecting quality icing condition data, particularly near freezing conditions. As part of efforts to continually improve data quality in the NASA Glenn Icing Research Tunnel (IRT), new facility instrumentation and new calibration hardware for total temperature measurement were installed and new operational techniques were developed and implemented. This paper focuses on the improvements made in the calibration of total temperature in the IRT.

Providing Total Quality Fundamentals: 1995 Workshops for the NASA Lewis Research Center's Technical Services Directorate

NASA Technical Reports Server (NTRS)

Antczak, Paul; Jacinto,Gilda; Simek, Jimmy

1997-01-01

The National Aeronautics and Space Administration's (NASA) agency-wide movement to cultivate a quality workplace is the basis for Lewis Research Center to implement Total Quality Fundamentals (TQF) initiatives. The Lewis Technical Services Directorate (TSD) introduced the Total Quality Fundamentals (TQF) workshops to its work force as an opportunity to introduce the concepts and principles of TQF. These workshops also provided the participants with the opportunity to dialogue with fellow TSD employees and managers. This report describes, through the perspective of the Lewis TSD TQF Coaches, how the TQF work- shop process was accomplished in TSD. It describes the structure for addressing the need, implementation process, input the TSD Coaches provided, common themes and concerns raised, conclusions, and recommendations. The Coaches concluded that these types of workshops could be the key to open the communication channels that are necessary to help everyone at Lewis understand where they fit in the organization. TQF workshops can strengthen the participant's connection with the Mission, Vision of the Center, and Vision of the Agency. Reconunendations are given based on these conclusions that can help the TSD Quality Board develop attainable measures towards a quality workplace.

Internal quality control: planning and implementation strategies.

PubMed

Westgard, James O

2003-11-01

The first essential in setting up internal quality control (IQC) of a test procedure in the clinical laboratory is to select the proper IQC procedure to implement, i.e. choosing the statistical criteria or control rules, and the number of control measurements, according to the quality required for the test and the observed performance of the method. Then the right IQC procedure must be properly implemented. This review focuses on strategies for planning and implementing IQC procedures in order to improve the quality of the IQC. A quantitative planning process is described that can be implemented with graphical tools such as power function or critical-error graphs and charts of operating specifications. Finally, a total QC strategy is formulated to minimize cost and maximize quality. A general strategy for IQC implementation is recommended that employs a three-stage design in which the first stage provides high error detection, the second stage low false rejection and the third stage prescribes the length of the analytical run, making use of an algorithm involving the average of normal patients' data.

Optimal implementation of green infrastructure practices to reduce adverse impacts of urban areas on hydrology and water quality

NASA Astrophysics Data System (ADS)

Liu, Y.; Collingsworth, P.; Pijanowski, B. C.; Engel, B.

2016-12-01

Nutrient loading from Maumee River watershed is a significant reason for the harmful algal blooms (HABs) problem in Lake Erie. Although studies have explored strategies to reduce nutrient loading from agricultural areas in the Maumee River watershed, the nutrient loading in urban areas also needs to be reduced. Green infrastructure practices are popular approaches for stormwater management and useful for improving hydrology and water quality. In this study, the Long-Term Hydrologic Impact Assessment-Low Impact Development 2.1 (L-THIA-LID 2.1) model was used to determine how different strategies for implementing green infrastructure practices can be optimized to reduce impacts on hydrology and water quality in an urban watershed in the upper Maumee River system. Community inputs, such as the types of green infrastructure practices of greatest interest and environmental concerns for the community, were also considered during the study. Based on community input, the following environmental concerns were considered: runoff volume, Total Suspended Solids (TSS), Total Phosphorous (TP), Total Kjeldahl Nitrogen (TKN), and Nitrate+Nitrite (NOx); green infrastructure practices of interest included rain barrel, cistern, green roof, permeable patio, porous pavement, grassed swale, bioretention system, grass strip, wetland channel, detention basin, retention pond, and wetland basin. Spatial optimization of green infrastructure practice implementation was conducted to maximize environmental benefits while minimizing the cost of implementation. The green infrastructure practice optimization results can be used by the community to solve hydrology and water quality problems.

Water quality improvement policies: lessons learned from the implementation of Proposition O in Los Angeles, California

Treesearch

Mi-Hyun Park; Michael Stenstrom; Stephanie Pincetl

2009-01-01

This article evaluates the implementation of Proposition O, a stormwater cleanup measure, in Los Angeles, California. The measure was intended to create new funding to help the city comply with the Total Maximum Daily Load requirements under the federal Clean Water Act. Funding water quality objectives through a bond measure was necessary because the city had...

Total quality management practices in Malaysia healthcare industry

NASA Astrophysics Data System (ADS)

Ahmad, Md Fauzi; Nee, Phoi Soo; Nor, Nik Hisyamudin Muhd; Wei, Chan Shiau; Hassan, Mohd Fahrul; Hamid, Nor Aziati Abdul

2017-10-01

The aim of total quality management (TQM) is to achieve customer satisfaction. Healthcare industry is very important in Malaysia for providing good healthcare services to public. However, failure to improve quality and efficiency is a big challenge in a healthcare industry in order to increase quality healthcare services. The objectives of this research are to identify the extent level of TQM implementation; and to determine the impact of TQM implementation on business sustainable in healthcare industry. Quantitative approach has been chosen as the methodology of this study. The survey respondents targeted in this research are staffs in Malaysia private clinic. 70 respondents have participated in this research. Data were analysed by Statistical Package Social Science (SPSS). Analysis result showed that there was a positive significant relationship between TQM practices and business sustainable (r=0.774, P<0.05). All TQM factors have significant relationship with business sustainable factors. The findings of this research will help healthcare industry to understand a better and deeper valuable information on the impact of TQM implementation towards business sustainable in Malaysia healthcare industry.

The quest for quality and productivity in health services.

PubMed

Sahney, V K; Warden, G L

1991-01-01

The leaders of health care organizations across the country are facing significant pressures to improve the quality of their services while reducing the rate of cost increases within the industry. Total Quality Management (TQM) has been credited, by many leaders in the manufacturing industry, as an effective tool to manage their organizations. This article presents key concepts of TQM as discussed by quality experts, namely, Deming, Juran, and Crosby. It discusses 12 key concepts that have formed the foundation of TQM implementation at Henry Ford Health System. The process of implementation is presented in detail, and the role of TQM in clinical applications is discussed. Success factors and visible actions by senior management designed to reinforce the implementation of TQM in any organization are presented.

Implementation and implication of total quality management on client- contractor relationship in residential projects

NASA Astrophysics Data System (ADS)

Murali, Swetha; Ponmalar, V.

2017-07-01

To make innovation and continuous improvement as a norm, some traditional practices must become unlearnt. Change for growth and competitiveness are required for sustainability for any profitable business such as the construction industry. The leading companies are willing to implement Total Quality Management (TQM) principles, to realise potential advantages and improve growth and efficiency. Ironically, researches recollected quality as the most significant provider for competitive advantage in industrial leadership. The two objectives of this paper are 1) Identify TQM effectiveness in residential projects and 2) Identify the client satisfaction/dissatisfaction areas using Analytical Hierarchy Process (AHP) and suggest effective mitigate measures. Using statistical survey techniques like set of questionnaire survey, it is observed that total quality management was applied in some leading successful organization to an extent. The main attributes for quality achievement can be defined as teamwork and better communication with single agreed goal between client and contractor. Onsite safety is a paramount attribute in the identifying quality within the residential projects. It was noticed that the process based quality methods such as onsite safe working condition; safe management system and modern engineering process safety controls etc. as interlinked functions. Training and effective communication with all stakeholders on quality management principles is essential for effective quality work. Late Only through effective TQM principles companies can avoid some contract litigations with an increased client satisfaction Index.

Importance of implementing an analytical quality control system in a core laboratory.

PubMed

Marques-Garcia, F; Garcia-Codesal, M F; Caro-Narros, M R; Contreras-SanFeliciano, T

2015-01-01

The aim of the clinical laboratory is to provide useful information for screening, diagnosis and monitoring of disease. The laboratory should ensure the quality of extra-analytical and analytical process, based on set criteria. To do this, it develops and implements a system of internal quality control, designed to detect errors, and compare its data with other laboratories, through external quality control. In this way it has a tool to detect the fulfillment of the objectives set, and in case of errors, allowing corrective actions to be made, and ensure the reliability of the results. This article sets out to describe the design and implementation of an internal quality control protocol, as well as its periodical assessment intervals (6 months) to determine compliance with pre-determined specifications (Stockholm Consensus(1)). A total of 40 biochemical and 15 immunochemical methods were evaluated using three different control materials. Next, a standard operation procedure was planned to develop a system of internal quality control that included calculating the error of the analytical process, setting quality specifications, and verifying compliance. The quality control data were then statistically depicted as means, standard deviations, and coefficients of variation, as well as systematic, random, and total errors. The quality specifications were then fixed and the operational rules to apply in the analytical process were calculated. Finally, our data were compared with those of other laboratories through an external quality assurance program. The development of an analytical quality control system is a highly structured process. This should be designed to detect errors that compromise the stability of the analytical process. The laboratory should review its quality indicators, systematic, random and total error at regular intervals, in order to ensure that they are meeting pre-determined specifications, and if not, apply the appropriate corrective actions. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Total Quality Management Implementation: Selected Readings

DTIC Science & Technology

1989-04-01

October 1986; Kaoru Ishikawa , Watj is Total Quality Control? The Japanese Way (Englewood Cliffs, NJ.r Prentice Hall, Inc. 1985), pp. 59-71 and chapter 7...and teachings of Dr. Kaoru Ishikawa and Prcfess:- Yoshikazu Tsuda. In their presentations I find ideas which conflict with current belie’s in t- s cou...responsible for S. Kaoru Ishikawa . 147iat is Total Quahn Control’ Th, Japar,,I the safety of all passengers and their belongings. w. (Englewood Hills. NJ

Total quality management and shared governance: synergistic processes.

PubMed

Gardner, D B; Cummings, C

1994-01-01

"Synergism" accurately describes the gains that can be made when total quality management (TQM) and shared governance are employed for reciprocal development. This article explores the relationship between TQM and shared governance from a systems perspective. Systems thinking is the fundamental framework that must be learned by nursing managers. An example of this synergistic process is described from the National Institutes of Health nursing department's experience in implementing TQM and shared governance. The idea that structure is fundamental to problems and solutions when implementing change and focusing upon interdependency issues are the systemic competencies nursing managers need to develop in order to become strong nursing leaders.

A quality implementation of Title I of the Americans With Disabilities Act of 1990.

PubMed

Rybski, D

1992-05-01

The Americans with Disabilities Act (ADA) of 1990 (Public Law 101-336) will have a major effect on private sector employers. Employers with 25 or more employees must provide qualified persons with disabilities equal access to employment with or without reasonable accommodations by July 1992. Employers with 15 to 24 employees must comply with the law by July 1994. Occupational therapy managers must understand the employment provisions of the law and develop strategies for implementation in order to comply with its regulations. This paper suggests the use of a total quality management approach, as espoused by W. E. Deming (1986), as a framework for an implementation plan. This approach focuses on quality improvement in the organization, respect of all workers for their abilities, replacement of fear of persons with disabilities with respect, and the building of partnerships between employers and employees with disabilities. A summary of the provisions of Title I as well as a checklist of measures and a sample job description that adheres to the regulations of Title I is presented to prepare an organization to become compliant. Occupational therapists are seen as uniquely skilled professionals who can contribute greatly in their own organizations as well as act as consultants to other managers in implementing Title I of the ADA using a total quality approach.

Quantification of BMPs Selection and Spatial Placement Impact on Water Quality Controlling Plans in Lower Bear River Watershed, Utah

NASA Astrophysics Data System (ADS)

Salha, A. A.; Stevens, D. K.

2016-12-01

The aim of the watershed-management program in Box Elder County, Utah set by Utah Division of Water Quality (UDEQ) is to evaluate the effectiveness and spatial placement of the implemented best-management practices (BMP) for controlling nonpoint-source contamination at watershed scale. The need to evaluate the performance of BMPs would help future policy and program decisions making as desired end results. The environmental and costs benefits of BMPs in Lower Bear River watershed have seldom been measured beyond field experiments. Yet, implemented practices have rarely been evaluated at the watershed scale where the combined effects of variable soils, climatic conditions, topography and land use/covers and management conditions may significantly change anticipated results and reductions loads. Such evaluation requires distributed watershed models that are necessary for quantifying and reproducing the movement of water, sediments and nutrients. Soil and Water Assessment Tool (SWAT) model is selected as a watershed level tool to identify contaminant nonpoint sources (critical zones) and areas of high pollution risks. Water quality concerns have been documented and are primarily attributed to high phosphorus and total suspended sediment concentrations caused by agricultural and farming practices (required load is 460 kg/day of total phosphorus based on 0.075 mg/l and an average of total suspended solids of 90 mg/l). Input data such as digital elevation model (DEM), land use/Land cover (LULC), soils, and climate data for 10 years (2000-2010) is utilized along with observed water quality at the watershed outlet (USGS) and some discrete monitoring points within the watershed. Statistical and spatial analysis of scenarios of management practices (BMP's) are not implemented (before implementation), during implementation, and after BMP's have been studied to determine whether water quality of the two main water bodies has improved as required by the LBMR watershed's TMDL and if the BMPs are cost-effectively targeting the critical zones.

Cost, staffing and quality impact of bedside electronic medical record (EMR) in nursing homes.

PubMed

Rantz, Marilyn J; Hicks, Lanis; Petroski, Gregory F; Madsen, Richard W; Alexander, Greg; Galambos, Colleen; Conn, Vicki; Scott-Cawiezell, Jill; Zwygart-Stauffacher, Mary; Greenwald, Leslie

2010-09-01

There is growing political pressure for nursing homes to implement the electronic medical record (EMR) but there is little evidence of its impact on resident care. The purpose of this study was to test the unique and combined contributions of EMR at the bedside and on-site clinical consultation by gerontological expert nurses on cost, staffing, and quality of care in nursing homes. Eighteen nursing facilities in 3 states participated in a 4-group 24-month comparison: Group 1 implemented bedside EMR, used nurse consultation; Group 2 implemented bedside EMR only; Group 3 used nurse consultation only; Group 4 neither. Intervention sites (Groups 1 and 2) received substantial, partial financial support from CMS to implement EMR. Costs and staffing were measured from Medicaid cost reports, and staff retention from primary data collection; resident outcomes were measured by MDS-based quality indicators and quality measures. Total costs increased in both intervention groups that implemented technology; staffing and staff retention remained constant. Improvement trends were detected in resident outcomes of ADLs, range of motion, and high-risk pressure sores for both intervention groups but not in comparison groups. Implementation of bedside EMR is not cost neutral. There were increased total costs for all intervention facilities. These costs were not a result of increased direct care staffing or increased staff turnover. Nursing home leaders and policy makers need to be aware of on-going hardware and software costs as well as costs of continual technical support for the EMR and constant staff orientation to use the system. EMR can contribute to the quality of nursing home care and can be enhanced by on-site consultation by nurses with graduate education in nursing and expertise in gerontology. Copyright 2010 American Medical Directors Association. Published by Elsevier Inc. All rights reserved.

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

[Effect analysis on the two total load control methods for poisonous heavy metals].

PubMed

Fu, Guo-Wei

2012-12-01

Firstly it should be made clear that implementation of source total load control for the first type of pollutants is necessary for environmental pollution control legislation and economic structure regulation. This kind of surveillance method has been more practical to be implemented since the Manual of the Industry Discharge Coefficient of First National Pollution Sources Investigation was published. The source total load control and water environment total load control are independent of each other and none of them is redundant, on the other side they can be complementary to each other. In the present, some local planning managers are blurring and confusing the contents and styles of the two surveillance methods. They just use the water total load control to manage all the pollutants, and source total load control is discarded, which results in the loss of control for the first type of pollutants especially for the drinking water source surveillance. There is a big difference between the water quality standards and the water environmental background concentration values for the first type of pollutants in the Environmental quality standard for surface water (GB 3838-88), which means that there are problems such as "relaxing the pollutant discharge permit" and "risk induced by valence state change". Taking an enterprise with 10t electrolytic lead production capacity as an example, there is a big difference between the allowable lead discharged loads by the two total load surveillance methods. In summary, it will bring a lot of harmful effects if the water total load control is implemented for the two types of pollutants, so the source total load control and water environmental total load control should be implemented strictly at the same time.

Can There Ever Be Enough to Impact Water Quality? Evaluating BMPs in Elliot Ditch, Indiana Using the LTHIA-LID Model

NASA Astrophysics Data System (ADS)

Rahman, M. S.; Hoover, F. A.; Bowling, L. C.

2017-12-01

Elliot Ditch is an urban/urbanizing watershed located in the city of Lafayette, IN, USA. The city continues to struggle with stormwater management and combined sewer overflow (CSO) events. Several best-management practices (BMP) such as rain gardens, green roofs, and bioswales have been implemented in the watershed, but the level of adoption needed to achieve meaningful impact is currently unknown. This study's goal is to determine what level of BMP coverage is needed to impact water quality, whether meaningful impact is determined by achieving water quality targets or statistical significance. A power analysis was performed using water quality data for total suspended solids (TSS), E.coli, total phosphorus (TP) and nitrate (NO3-N) from Elliot Ditch from 2011 to 2015. The minimum detectable difference (MDD) was calculated as the percent reduction in load needed to detect a significant change in the watershed. The water quality targets were proposed by stakeholders as part of a watershed management planning process. The water quality targets and the MDD percentages were then compared to simulated load reductions due to BMP implementation using the Long-term Hydrologic Impact Assessment-Low Impact Development (LTHIA-LID) model. Seven baseline model scenarios were simulated by implementing the maximum number of each of six types of BMPs (rain barrels, permeable patios, green roofs, grassed swale/bioswales, bioretention/rain gardens, and porous pavement), as well as all the practices combined in the watershed. These provide the baseline for targeted implementation scenarios designed to determine if statistically and physically meaningful load reductions can be achieved through BMP implementation alone.

Is TQM Right for Schools?

ERIC Educational Resources Information Center

Blankstein, Alan M.; Swain, Heather

1994-01-01

Examines eight reasons why Total Quality Management cannot succeed in education and shows how one Florida elementary school surmounted these obstacles and implemented Deming's quality principles. Principal Nancy Duden overcame resistance to change, leadership misconceptions, reliance on external motivators (promotions and grades), increased…

Strategic Management of Quality: An American and British Perspective.

ERIC Educational Resources Information Center

Weller, L. David; McElwee, Gerard

1997-01-01

Total Quality Management is being implemented in American and British schools to improve educational outcomes. The 14 points of Deming's quality model and Porter's models of competition and drivers of cost provide a systematic, structured template to promote educational excellence and meet the demands of social, political, and economic forces.…

Implementation of Total Employee Involvement as Part of a Continuous Improvement Program at a Fortune 500 Company

ERIC Educational Resources Information Center

Carlson, Kathy Lynn

2012-01-01

Over the last several decades, Continuous Improvement (CI) type initiatives have been implemented in companies across the United States to improve quality, reduce process variation, eliminate waste and ultimately reduce costs. Approximately five years ago, one particular Fortune 500 company implemented CI in its manufacturing facilities. A key…

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement.

PubMed

Whitcomb, Winthrop F; Lagu, Tara; Krushell, Robert J; Lehman, Andrew P; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K

2015-09-01

Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls-patients treated before bundle implementation-45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p=.24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p=.43), and lower median posthospital payments ($704 versus $1,121, p=.002), and were more likely to receive guideline-consistent care (99% versus 95%, p=.05). The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams.

Deming, quality and the small medical group administrator.

PubMed

Noll, D C

1992-01-01

As administrators, writes Douglas Noll, we can coordinate and implement quality measures affecting our practices and which impact the patient's total medical experience. Unfortunately, many smaller groups cannot hire an outside consultant or single employee whose sole purpose would be to monitor quality. Noll offers several simple practices that administrators can use to improve the quality of service in their groups.

Total Quality Management (TQM), an Overview

DTIC Science & Technology

1991-09-01

Quality Management (TQM). It discusses the reasons TQM is a current growth industry, what it is, and how one implements it. It describes the basic analytical tools, statistical process control, some advanced analytical tools, tools used by process improvement teams to enhance their own operations, and action plans for making improvements. The final sections discuss assessing quality efforts and measuring the quality to knowledge

Total quality management in blood transfusion.

PubMed

Smit-Sibinga, C T

2000-01-01

Quality management is an ongoing development resulting in consistency products and services and ever increasing customer satisfaction. The ultimum is Total Quality Management. Quality systems and quality management in transfusion medicine have gained considerable attention since the outbreak of the AIDS epidemic. Where product orientation has long been applied through quality control, Good Manufacturing Practice (GMP) principles were introduced, shifting the developments in the direction of process orientation. Globally, and particularly in the more industrialised world people and system orientation has come along with the introduction of the ISO9001 concept. Harmonisation and a degree of uniformity are needed to implement a universally applicable Quality System and related Quality Management. Where the American Association of Blood Banks (AABB) is the professional organisation with the most extensive experience in quality systems in blood transfusion, the European Union and the Council of Europe now are in the process to design a quality system and management applicable to a larger variety of countries, based on a hybrid of current GMP and ISO9001 principles. The International Federation of Red Cross and Red Crescent Societies has developed a more universally to implement Quality Manual, with a pilot project in Honduras. It is recommendable to harmonise the various designs and bring the approaches under one common denominator.

What is the quality of the maternal near-miss case reviews in WHO European Region? Cross-sectional study in Armenia, Georgia, Latvia, Republic of Moldova and Uzbekistan

PubMed Central

Bacci, Alberta; Hodorogea, Stelian; Khachatryan, Henrik; Babojonova, Shohida; Irsa, Signe; Jansone, Maira; Dondiuc, Iurie; Matarazde, George; Lazdane, Gunta; Lazzerini, Marzia

2018-01-01

Objectives The maternal near-miss case review (NMCR) cycle is a type of clinical audit aiming at improving quality of maternal healthcare by discussing near-miss cases. In several countries this approach has been introduced and supported by WHO and partners since 2004, but information on the quality of its implementation is missing. This study aimed at evaluating the quality of the NMCR implementation in selected countries within WHO European Region. Design Cross-sectional study. Settings Twenty-three maternity units in Armenia, Georgia, Latvia, Moldova and Uzbekistan. Assessment tools A predefined checklist including 50 items, according to WHO methodology. Quality in the NMCR implementation was defined by summary scores ranging from 0 (totally inappropriate) to 3 (appropriate). Results Quality of the NMCR implementation was heterogeneous among different countries, and within the same country. Overall, the first part of the audit cycle (from case identification to case analysis) was fairly well performed (mean score 2.00, 95% CI 1.94 to 2.06), with the exception of the ‘inclusion of users’ views’ (mean score 0.66, 95% CI 0.11 to 1.22), while the second part (developing recommendations, implementing them and ensuring quality) was poorly performed (mean score 0.66, 95% CI 0.11 to 1.22). Each country had at least one champion facility, where quality of the NMCR cycle was acceptable. Quality of the implementation was not associated with its duration. Gaps in implementation were of technical, organisational and attitudinal nature. Conclusions Ensuring quality in the NMCR may be difficult but achievable. The high heterogeneity in results within the same country suggests that quality of the NMCR implementation depends, to a large extent, from hospital factors, including staff’s commitment, managerial support and local coordination. Efforts should be put in preventing and mitigating common barriers that hamper successful NMCR implementation. PMID:29654004

Total Quality Management: A Guide to Implementation

DTIC Science & Technology

1989-08-01

Kaizen. New York: Random House. 1986. Ishikawa , Kaoru . Guide to Quality Control. Asian Productivity Organization. 1984. Ishikawa , Kaoru . What is Total...with the problems and the new management principles are based on the complexities of the new Systems Age. The theories of Deming, Juran, Ishikawa , and...Progress. Jun 1985. Miller, Jeffery G. and Thomas E. Vollmann. "The Hidden Factory." Harvard Business Review. Sep-Oct 1985. Shimoyamada, Kaoru . "The

Total Quality Management in Academic Libraries: Initial Implementation Efforts. Proceedings from the International Conference on TQM and Academic Libraries (1st, Washington, D.C., April 20-22, 1994).

ERIC Educational Resources Information Center

Rounds, Laura, Ed.; Matthews, Michael, Ed.

This document contains conference papers, other speeches, and supplementary material from the first International Conference on Total Quality Management (TQM) and Academic Libraries, held in 1994. The conference was comprised of four sessions, and the introductory remarks of each are included, along with transcriptions of each session's…

Evaluating treatment process redesign by applying the EFQM Excellence Model.

PubMed

Nabitz, Udo; Schramade, Mark; Schippers, Gerard

2006-10-01

To evaluate a treatment process redesign programme implementing evidence-based treatment as part of a total quality management in a Dutch addiction treatment centre. Quality management was monitored over a period of more than 10 years in an addiction treatment centre with 550 professionals. Changes are evaluated, comparing the scores on the nine criteria of the European Foundation for Quality Management (EFQM) Excellence Model before and after a major redesign of treatment processes and ISO certification. In the course of 10 years, most intake, care, and cure processes were reorganized, the support processes were restructured and ISO certified, 29 evidence-based treatment protocols were developed and implemented, and patient follow-up measuring was established to make clinical outcomes transparent. Comparing the situation before and after the changes shows that the client satisfaction scores are stable, that the evaluation by personnel and society is inconsistent, and that clinical, production, and financial outcomes are positive. The overall EFQM assessment by external assessors in 2004 shows much higher scores on the nine criteria than the assessment in 1994. Evidence-based treatment can successfully be implemented in addiction treatment centres through treatment process redesign as part of a total quality management strategy, but not all results are positive.

Interactional Resources for Quality Improvement: Learning From Participants Through a Qualitative Study.

PubMed

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

Implementing quality improvement in hospitals requires a multifaceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: (1) a critical outside perspective on their implementation progress; (2) opportunities to learn from peers, especially around clinical innovations; and (3) external validation to help establish visibility for and commitment to the project. Quality improvement in hospitals is both a clinical endeavor and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs.

Interactional Resources for Quality Improvement: Learning from Participants through a Qualitative Study

PubMed Central

Brooks, Joanna Veazey; Gorbenko, Ksenia; Bosk, Charles

2017-01-01

BACKGROUND Implementing quality improvement in hospitals requires a multi-faceted commitment from leaders, including financial, material, and personnel resources. However, little is known about the interactional resources needed for project implementation. The aim of this analysis was to identify the types of interactional support hospital teams sought in a surgical quality improvement project. METHODS Hospital site visits were conducted using a combination of observations, interviews, and focus groups to explore the implementation of a surgical quality improvement project. Twenty-six site visits were conducted between October 2012 and August 2014 at a total of 16 hospitals that agreed to participate. All interviews were recorded, transcribed, and coded for themes using inductive analysis. RESULTS We interviewed 321 respondents and conducted an additional 28 focus groups. Respondents reported needing the following types of interactional support during implementation of quality improvement interventions: 1) a critical outside perspective on their implementation progress; 2) opportunities to learn from peers, especially around clinical innovations; and 3) external validation to help establish visibility for and commitment to the project. CONCLUSIONS Quality improvement in hospitals is both a clinical and a social endeavor. Our findings show that teams often desire interactional resources as they implement quality improvement initiatives. In-person site visits can provide these resources while also activating emotional energy for teams, which builds momentum and sustainability for quality improvement work. IMPLICATIONS Policymakers and quality improvement leaders will benefit from developing strategies to maximize interactional learning and feedback for quality improvement teams. Further research should investigate the most effective methods for meeting these needs. PMID:28375951

Assessing the impact of general practitioner team service on perceived quality of care among patients with non-communicable diseases in China: a natural experimental study.

PubMed

Yin, Jia; Wei, Xiaolin; Li, Haitao; Jiang, Yanling; Mao, Chunfang

2016-10-01

China issued the national primary care policy of promoting general practitioner (GP) team service in 2011. We conducted this study to assess the impact of the GP team service on quality of primary care as perceived by patients with non-communicable diseases (NCDs). Natural experimental study. This study was conducted in Shanghai, where the policy was effectively implemented, and Kunming, where the policy was not implemented. In both cities, NCD patients were interviewed with primary care assessment tool (PCAT) after their clinical consultations in their community health centers. The implementation of GP team service policy. Multiple linear regressions were employed to compare PCAT scores between the two rounds of the surveys in each city. Difference-in-difference (DID) analysis was used to identify the changes between two cities over time. A total of 663 and 587 patients in Shanghai, and 400 and 441 patients in Kunming were surveyed in 2011 and 2013, respectively. The DID analysis showed that the total primary care quality scores improved in Shanghai compared with Kunming between 2011 and 2013 (β = 1.30, 95% CI: 0.74, 1.87). In Shanghai, care quality in 2013 improved significantly for the total score and the six components when compared with those in 2011. No significant changes were observed in Kunming in the same period. Primary care policies that promote long-term provider-patient relationships, coordinated service with hospitals and capitation payment for the GP team may contribute to the improvement of care quality in Shanghai. © The Author 2016. 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.

Adapting total quality management for general practice: evaluation of a programme.

PubMed Central

Lawrence, M; Packwood, T

1996-01-01

OBJECTIVE: Assessment of the benefits and limitations of a quality improvement programme based on total quality management principles in general practice over a period of one year (October 1993-4). DESIGN: Questionnaires to practice team members before any intervention and after one year. Three progress reports completed by facilitators at four month intervals. Semistructured interviews with a sample of staff from each practice towards the end of the year. SETTING: 18 self selected practices from across the former Oxford Region. Three members of each practice received an initial residential course and three one day seminars during the year. Each practice was supported by a facilitator from their Medical Audit Advisory Group. MEASURES: Extent of understanding and implementation of quality improvement methodology. Number, completeness, and evaluation of quality improvement projects. Practice team members' attitudes to and involvement in team working and quality improvement. RESULTS: 16 of the 18 practices succeeded in implementing the quality improvement methods. 48 initiatives were considered and staff involvement was broad. Practice members showed increased involvement in, and appreciation of, strategic planning and team working, and satisfaction from improved patients services. 11 of the practices intend to continue with the methodology. The commonest barrier expressed was time. CONCLUSION: Quality improvement programmes based on total quality management principles produce beneficial changes in service delivery and team working in most general practices. It is incompatible with traditional doctor centred practice. The methodology needs to be adapted for primary care to avoid quality improvement being seen as separate from routine activity, and to save time. PMID:10161529

COUNCIL FOR REGULATORY ENVIRONMENTAL MODELING (CREM) PILOT WATER QUALITY MODEL SELECTION TOOL

EPA Science Inventory

EPA's Council for Regulatory Environmental Modeling (CREM) is currently supporting the development of a pilot model selection tool that is intended to help the states and the regions implement the total maximum daily load (TMDL) program. This tool will be implemented within the ...

DCCC Takes the TQM Plunge...And Tells How.

ERIC Educational Resources Information Center

Entner, Donald

1993-01-01

Activities at Delaware County Community College (Pennsylvania) in implementing Total Quality Management are examined and compared with criteria used by the United States Chamber of Commerce for making quality awards to businesses. Assessed areas include management leadership, strategic planning, customer focus, employee development, teamwork,…

Quality & Education: Critical Linkages.

ERIC Educational Resources Information Center

McCormick, Betty L., Ed.

This book contains a collection of essays about schools that have successfully implemented Total Quality Management (TQM) through partnerships with the business community, parents, higher education, school board members, and others. Following the preface, foreword, and introduction, the book is divided into five sections: school leaders in Total…

Data collection automation and total quality management: case studies in the health-service industry.

PubMed

Smith, Alan D; Offodile, O Felix

2008-01-01

The limitations, immeasurable, and seemly unquantifiable aspects of the healthcare service industry, make it imperative that quality assurance programs include total quality management (TQM) and automatic identification and data capture (AIDC)-related technologies. Most of standards used in TQM and AIDC require data, to measure improvement and achieve standardization. Major difference between managing a service firm and managing a product-manufacturing firm is the difficulty of achieving consistently high quality. Examination of two different healthcare service providers in the Pittsburgh, Pennsylvania area offers different views as to the implementation and practice of total quality management techniques and AIDC integration. Since the healthcare service industry must take into account its high customization needs, there are positive steps to make the hospital structure itself more patient friendly and quality related; hence improving its heath-marketing strategies to the general public.

[The organization of system of quality management in large multitype hospital].

PubMed

Taĭts, B M; Krichmar, G N; Stvolinskiĭ, I Iu; Grandilevskaia, O L

2013-01-01

The article presents the characteristics and assessment of functioning of model of quality management in large multitype hospital. The results of work of the municipal hospital of Saint Venerable martyr Elizabeth of St Petersburg concerning the implementation of system of quality management in 2001-2011 of the foundation of principles of total quality management of medical service and principles of quality management according international standards ISO and their Russian analogues.

Implementing total quality management in an academic surgery setting: lessons learned.

PubMed

Townes, C; Petit, B; Young, B

1995-01-01

Total Quality Management, a philosophy developed by W. Edwards Deming, has been used successfully in many countries and in many types of organizations to improve the quality of processes. The system is based upon the scientific method and provides the ability to solve long-standing, recalcitrant problems. The application of the TQM philosophy to health care, although recommended by many medical economists, is still in its infancy. At our medical center, three departments (Surgery, Anesthesiology, and Operating Room Services) joined forces to implement TQM. Critical activities early in implementation included establishing a Steering Committee, training key employees, providing systems for communicating TQM activities, and developing the leadership, facilitator, and other resources needed to support teams. Two of our first teams studied very different processes (one in the Operating Room, the other in outpatient Surgery clinics), providing many useful insights regarding keys to successful application of the TQM philosophy. We have learned strategies for increasing acceptance of and participation in TQM efforts on the part of staff members and, in particular, physicians, and for initiating the cultural change needed for TQM. Although the teams have met with resistance to behavioral changes and a lack of full support from some upper-level administrators in the Medical Center and the Hospital, most of them have been quite successful in improving the processes under study. We conclude that, with the proper leadership and facilitation, the TQM philosophy can be successfully implemented in the health care environment. Total Quality Management (TQM) as a system for improving the quality of processes has been successful in many countries throughout the world for organizations offering a wide variety of products and services. This article will describe specific TQM endeavors, both successful and unsuccessful, undertaken in an academic surgery department in the United States. This description will illustrate the lessons we have learned in our attempt to change a complex organization and will enable readers to determine whether an analogy exists between our organization's response to problem solving and theirs.

Experience with Designing and Implementing a Bundled Payment Program for Total Hip Replacement

PubMed Central

Whitcomb, Winthrop F.; Lagu, Tara; Krushell, Robert J.; Lehman, Andrew P.; Greenbaum, Jordan; McGirr, Joan; Pekow, Penelope S.; Calcasola, Stephanie; Benjamin, Evan; Mayforth, Janice; Lindenauer, Peter K.

2015-01-01

Background Bundled payments, also known as episode-based payments, are intended to contain health care costs and promote quality. In 2011 a bundled payment pilot program for total hip replacement was implemented by an integrated health care delivery system in conjunction with a commercial health plan subsidiary. In July 2015 the Centers for Medicare & Medicaid Services (CMS) proposed the Comprehensive Care for Joint Replacement Model to test bundled payment for hip and knee replacement. Methods Stakeholders were identified and a structure for program development and implementation was created. An Oversight Committee provided governance over a Clinical Model Subgroup and a Financial Model Subgroup. Results The pilot program included (1) a clinical model of care encompassing the period from the preoperative evaluation through the third postoperative visit, (2) a pricing model, (3) a program to share savings, and (4) a patient engagement and expectation strategy. Compared to 32 historical controls— patients treated before bundle implementation—45 post-bundle-implementation patients with total hip replacement had a similar length of hospital stay (3.0 versus 3.4 days, p = .24), higher rates of discharge to home or home with services than to a rehabilitation facility (87% versus 63%), similar adjusted median total payments ($22,272 versus $22,567, p = .43), and lower median posthospital payments ($704 versus $1,121, p = .002), and were more likely to receive guideline-consistent care (99% versus 95%, p = .05). Discussion The bundled payment pilot program was associated with similar total costs, decreased posthospital costs, fewer discharges to rehabilitation facilities, and improved quality. Successful implementation of the program hinged on buy-in from stakeholders and close collaboration between stakeholders and the clinical and financial teams. PMID:26289235

Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools.

PubMed

Sá, Juliana P; Branco, Pedro T B S; Alvim-Ferraz, Maria C M; Martins, Fernando G; Sousa, Sofia I V

2017-05-31

Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO₂, CO, NO₂, O₃, CH₂O, total volatile organic compounds (VOC), PM₁, PM 2.5 , PM 10 , Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM 2.5 , PM 10 , CO₂ and CH₂O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO₂. However, mitigation measures were not always sufficient to decrease the pollutants' concentrations till values considered safe to protect human health.

Implementing the patient circle. Call on patients to help improve perceptions of health care quality.

PubMed

Ostasiewski, P; Fugate, D L

1994-01-01

Adapting the quality-circle concept to a health care setting helped one hospital solve a problem and boosted its image among patients. The "patient circle" technique is one step health care providers can take toward delivering "total customer value," a quality perception that can mean the difference between surviving and thriving in the future.

A Study of University Efforts to Provide Students with the Ability to Comprehend and Apply Total Quality Principles in Their Fields of Study

DTIC Science & Technology

1993-09-01

Geber , 1990:30-31). These steps are a formula to implement and measure quality in a service organization. While guidelines such as these apply to...1991. Evans, James R. and William M. Lindsay. The Management and Control of Quality. Minneapolis/St. Paul: West Publishing Company, 1993. Geber

Total Quality Management in Space Shuttle Main Engine manufacturing

NASA Technical Reports Server (NTRS)

Ding, J.

1992-01-01

The Total Quality Management (TQM) philosophy developed in the Marshall Space Flight Center (MSFC) is briefly reviewed and the ongoing TQM implementation effort which is being pursued through the continuous improvement (CI) process is discussed. TQM is based on organizational excellence which integrates the new supportive culture with the technical tools necessary to identify, assess, and correct manufacturing processes. Particular attention is given to the prime contractor's change to the organizational excellence management philosophy in SSME manufacturing facilities.

Phoenix: Quantum Quality at Maricopa: TQM on Campus, Case Study Number Two.

ERIC Educational Resources Information Center

Assar, Kathleen E.

1993-01-01

Implementation of the Total Quality Management approach in the Maricopa County Community College District (Arizona), a large 10-campus system, is described. The program's current early stages are reported noting the serious administrative commitment and thorough training, seen as key factors in potential success. (MSE)

Proceedings of the Acquisition Research Symposium: Imagnination, Innovation, and Implementation, 1991. Volume 1.

DTIC Science & Technology

1991-01-01

Construction Industry Institute, Austin, Texas, April 1990. 6. Ishikawa , Kaoru , What is Total Quality Control? The Japanese Way, Prentice-Hall, N.J., 1985. 7...customer. Ishikawa , a leading Japanese management and line personnel, and where authority on quality management, claims that appropriate, the customer

TQM Reaches the Academy.

ERIC Educational Resources Information Center

Marchese, Ted

1991-01-01

This introduction to the application of Total Quality Management (TQM) on college campuses first reviews the development and application of TQM principles in Japanese industries and recent implementation in industries and the Federal Government in the United States. Twelve principles of TQM are then identified: (1) a focus on quality; (2)…

TQL, A Case Study of Implementation into the Operational Fleet

DTIC Science & Technology

1992-06-18

Methods, Poka - Yoke (mistake proofing of a process), Total Preventive Maintenance, and Group Technology and Quality Circles. All of these methods can be...Thomas, What Every Manager Should Know About Quality, 1991, Marcel Dekker,inc. 9. Poka - Yoke , 1987, Productivity Press. 67 B. STATISTICAL METHODS: 1

The Human Side of Quality: Employee Care and Empowerment.

ERIC Educational Resources Information Center

Thor, Linda M.

Frequently, educational institutions seeking to implement Total Quality Management (TQM) as a means to improve institutional effectiveness, overemphasize training in the application of TQM tools and fail to fully address human needs and concerns, such as the critical issue of employee empowerment. Four principal barriers exist to adequately…

Continuous Quality Improvement: Making the Transition to Education.

ERIC Educational Resources Information Center

Hubbard, Dean L., Ed.

This book is a collection of case studies by 27 educational and industrial leaders describing the implementation of specific Total Quality Management techniques which have demonstrated their value. Essays and their authors are as follows: "Process Improvements Using Team Environments" (Scot M. Faulkner); "Team Effectiveness" (Robert S. Winter);…

[Quality assurance and total quality management in residential home care].

PubMed

Nübling, R; Schrempp, C; Kress, G; Löschmann, C; Neubart, R; Kuhlmey, A

2004-02-01

Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.

Implementation of clinical governance in hospitals: challenges and the keys for success.

PubMed

Mousavi, Seyed Mohammad Hadi; Agharahimi, Zahra; Daryabeigi, Maede; Rezaei, Nima

2014-01-01

There is a number of models and strategies for improving the quality of care such as total quality management, continuous quality improvement and clinical governance. The policy of clinical governance is part of the governments overall strategy for monitoring, assuring and improving in the national health services organization. Clinical governance has been introduced as a bridge between managerial and clinical approaches to quality. For successful implementing of clinical governance, it is necessary to pay attention to firm foundations of the structure, including equipment, staffing arrangement, supporting specialties, and staff training. Therefore, as clinical governance improves safety and quality in health care services, the current situation in hospitals should be evaluated before any intervention while barriers and blocks on structure and process should be determined to select a method for changing them. Considering these points could guarantee success in implementation of clinical governance; otherwise there would be a little chance to achieve the desired results despite consumption of plenty of time and huge paper works.

Strategies for Implementation: The El Camino TQM Story.

ERIC Educational Resources Information Center

Schauerman, Sam; Peachy, Burt

In spring 1989, a group of 33 administrators, supervisors, faculty, and staff from El Camino College (ECC) in Torrance, California, attended 10 days of training in Total Quality Management (TQM) tools and techniques. The subsequent implementation of TQM at ECC included the following six phases: (1) establishing a Campus Commitment to Excellence…

The Navy’s Quality Journey: Operational Implementation of TQL

DTIC Science & Technology

1993-04-01

training. Dr. Kaoru Ishikawa "Guide to Ouality Control" "QC begins with education and ends with education. To implement TQC, we need to carry out...York: McGraw-Hill, 1986. 20. Ishikawa , Kaoru . What is Total Qualit Control? Englewood Cliffs, NJ: Prentice-Hall, Inc., 1985. 21. Ishikawa , Kaoru

TQE, Technology, and Teaching.

ERIC Educational Resources Information Center

Hertzke, Eugene R.; Olson, Warren E.

This book provides a total "how-to" approach for the use of technology, including information on the types of systems, hardware, and software available. It offers guidelines for determining how to match specific systems and needs, as well as strategies for implementing technology and Total Quality Education (TQE) to improve teaching. It…

An Introduction to Quality Management: Selected Readings.

DTIC Science & Technology

total quality management (TQM). Through the kind permission of a number of publishers, we have been able to reproduce here some key articles about...TQM. It is not the intent of this technical note to provide a comprehensive study of quality management , but rather to aid in planning for an...implementation of the Deming approach to TQM. Although the Navy aviation community chose the Deming approach to quality management , as reflected in the selected

Management of unregulated agricultural nonpoint sources through water quality trading market.

PubMed

Mahjoobi, Emad; Sarang, Amin; Ardestani, Mojtaba

2016-11-01

Water quality trading (WQT) could be an innovative policy to incentivize farmers to implement best management practices (BMPs) for their activities. This study focused on assessment of involving unregulated agricultural nonpoint sources (NPS) into the WQT market in Gharesoo watershed in the west of Iran. It also proposes a methodology to determine location-based trading ratios as well as environmental penalty cost to achieve a more well-designed market structure. Trading activities in different scenarios were described by trading volume (TV), participation rate (PR), total exchanged value (TEV), and other market parameters in order to achieve a better comparison of market performance. Results showed that, by applying NPS to the Gharesoo watershed, total phosphorous (TP) trading market could increase TV, PR, and TEV up to 11, 1.7 and 7.5 times, respectively, depending on which level of BMPs are implemented by them. Additionally, it could save 29% of the total cost of implementing a TP total maximum daily load in this watershed compared to the 'command and control' approach. Furthermore, the agricultural sector could profit by $5.49 million (or $75/ha) by choosing solutions such as terrace systems and filter strips to register into the market. This profit can be allocated to the development of new agricultural technologies.

Redefining and expanding quality assurance.

PubMed

Robins, J L

1992-12-01

To meet the current standards of excellence necessary for blood establishments, we have learned from industry that a movement toward organization-wide quality assurance/total quality management must be made. Everyone in the organization must accept responsibility for participating in providing the highest quality products and services. Quality must be built into processes and design systems to support these quality processes. Quality assurance has been redefined to include a quality planning function described as the most effective way of designing quality into processes. A formalized quality planning process must be part of quality assurance. Continuous quality improvement has been identified as the strategy every blood establishment must support while striving for error-free processing as the long-term objective. The auditing process has been realigned to support and facilitate this same objective. Implementing organization-wide quality assurance/total quality management is one proven plan for guaranteeing the quality of the 20 million products that are transfused into 4 million patients each year and for moving toward the new order.

Quality assurance in China: a sleeping tiger awakens

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

Baehr, R.M.

1996-12-31

The People`s Republic of China has undergone major economic reform in the past decade producing a new free-market system that is distinctly Chinese. The Chinese realize that to be successful in world trade, quality management and export trading must be given the highest priority in China`s strategic economic plans. Many manufacturing companies are now implementing Total Quality Management (TQM) and the ISO 9000 i quality management standards. A first hand survey of the quality movement in China today is the objective of this paper.

Highlights of Total Quality Management in the Department of Defense: Lessons Learned, Quality Measurements and Innovative Practices

DTIC Science & Technology

1991-09-26

Quality Management (TQM) through both quantitative and qualitative analyses. Interviews were conducted with top executives from ten exemplar organizations within the Department of Defense (DOD). Survey questionnaires on perceptions of quality practices were administered to a sample of 102 representing members of the executive steering committees at the same organizations. Research identifies lessons learned by top executives during TQM implementation, discusses measures of organization-wide quality management , specifies evaluation mechanisms to

Employee Involvement, Attitudes, and Productivity in High Technology Manufacturing: A Two-Year, Experimental Study.

ERIC Educational Resources Information Center

Stinnett, William D.; And Others

To investigate methods of improving both employees' productivity and the quality of their work life, workers from four businesses were surveyed before and after their organizations implemented a total employees involvement program. Survey questions covered employees' perceptions of (1) the quality of the product produced, (2) the leadership's…

Planning and Implementing Total Quality Management in the Royal Australian Air Force: A Multiple Case Study Analysis

DTIC Science & Technology

1990-09-01

change barriers, and necessary checks and balances built into processes. Furthermore, this assessment should address management system variables which...organisation’s 69 immediate product and their worklife . Focus must be maintained on improving RAAF processes. In addition to a quality committee structure as

Achievements and Lessons Learned from Vietnam's Higher Education Quality Assurance System after a Decade of Establishment

ERIC Educational Resources Information Center

Nguyen, Huu Cuong; Ta, Thi Thu Hien; Nguyen, Thi Thu Huong

2017-01-01

Higher education quality assurance and accreditation were officially implemented in Vietnam over twelve years ago. From a totally centralized model, Vietnam's accreditation system has been becoming more independent, especially with the establishment of accrediting agencies. The first accreditation certificates were also awarded to universities…

Measuring, managing and maximizing refinery performance

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

Bascur, O.A.; Kennedy, J.P.

1996-01-01

Implementing continuous quality improvement is a confluence of total quality management, people empowerment, performance indicators and information engineering. Supporting information technologies allow a refiner to narrow the gap between management objectives and the process control level. Dynamic performance monitoring benefits come from production cost savings, improved communications and enhanced decision making. A refinery workgroup information flow model helps automate continuous improvement of processes, performance and the organization. The paper discusses the rethinking of refinery operations, dynamic performance monitoring, continuous process improvement, the knowledge coordinator and repository manager, an integrated plant operations workflow, and successful implementation.

The TQM Coordinator as Change Agent in Implementing Total Quality Management

DTIC Science & Technology

1989-06-01

Quality Management involves a major change, a paradigm shift, in management philosophy. Implementing TQM requires the use of a change agent to act as a catalyst to change the organization. Interviews with TQM coordinators, and a survey of 143 organizations were done to examine the role of the TQM coordinator. Research identified criteria for selection, and location in the organizational structure. Use of an external consultant in a tem concept is examined. Resistance to change and overcoming that resistance are explored. Ways to measure success are discussed. Keywords:

Implementing QML for radiation hardness assurance

NASA Astrophysics Data System (ADS)

Winokur, P. S.; Sexton, F. W.; Fleetwood, D. M.; Terry, M. D.; Shaneyfelt, M. R.

1990-12-01

The US government has proposed a qualified manufacturers list (QML) methodology to qualify integrated circuits for high reliability and radiation hardness. An approach to implementing QML for single-event upset (SEU) immunity on 16k SRAMs that involves relating values of feedback resistance to system error rates is demonstrated. It is seen that the process capability indices, Cp and Cpk, for the manufacture of 400-k-ohm feedback resistors required to provide SEU tolerance do not conform to 6 sigma quality standards. For total-dose, interface trap charge, Delta Vit, shifts measured on transistors are correlated with circuit response in the space environment. Statistical process control (SPC) is illustrated for Delta Vit, and violations of SPC rules are interpreted in terms of continuous improvement. Design validation for SEU and quality conformance inspections for total-dose are identified as major obstacles to cost-effective QML implementation. Techniques and tools that will help QML provide real cost savings are identified as physical models, 3-D device-plus-circuit codes, and improved design simulators.

An economic analysis of a system wide Lean approach: cost estimations for the implementation of Lean in the Saskatchewan healthcare system for 2012-2014.

PubMed

Sari, Nazmi; Rotter, Thomas; Goodridge, Donna; Harrison, Liz; Kinsman, Leigh

2017-08-03

The costs of investing in health care reform initiatives to improve quality and safety have been underreported and are often underestimated. This paper reports direct and indirect cost estimates for the initial phase of the province-wide implementation of Lean activities in Saskatchewan, Canada. In order to obtain detailed information about each type of Lean event, as well as the total number of corresponding Lean events, we used the Provincial Kaizen Promotion Office (PKPO) Kaizen database. While the indirect cost of Lean implementation has been estimated using the corresponding wage rate for the event participants, the direct cost has been estimated using the fees paid to the consultant and other relevant expenses. The total cost for implementation of Lean over two years (2012-2014), including consultants and new hires, ranged from $44 million CAD to $49.6 million CAD, depending upon the assumptions used. Consultant costs accounted for close to 50% of the total. The estimated cost of Lean events alone ranged from $16 million CAD to $19.5 million CAD, with Rapid Process Improvement Workshops requiring the highest input of resources. Recognizing the substantial financial and human investments required to undertake reforms designed to improve quality and contain cost, policy makers must carefully consider whether and how these efforts result in the desired transformations. Evaluation of the outcomes of these investments must be part of the accountability framework, even prior to implementation.

Workplace Incivility a Hurdle in TQM Practices Implementation in Higher Education Institutes of Balochistan

ERIC Educational Resources Information Center

Ismail, Roqia; Ali, Muhammad

2016-01-01

The basic purpose of the study was to explore the influence of workplace incivility on the total quality management practices implementation in higher education institutes of balochistan. The data was collected through questionnaire and the sample size of the study was 381. The reliability and validity of the questionnaire was checked through…

Evaluation of Low-Cost Mitigation Measures Implemented to Improve Air Quality in Nursery and Primary Schools

PubMed Central

Sá, Juliana P.; Branco, Pedro T. B. S.; Alvim-Ferraz, Maria C. M.; Martins, Fernando G.; Sousa, Sofia I. V.

2017-01-01

Indoor air pollution mitigation measures are highly important due to the associated health impacts, especially on children, a risk group that spends significant time indoors. Thus, the main goal of the work here reported was the evaluation of mitigation measures implemented in nursery and primary schools to improve air quality. Continuous measurements of CO2, CO, NO2, O3, CH2O, total volatile organic compounds (VOC), PM1, PM2.5, PM10, Total Suspended Particles (TSP) and radon, as well as temperature and relative humidity were performed in two campaigns, before and after the implementation of low-cost mitigation measures. Evaluation of those mitigation measures was performed through the comparison of the concentrations measured in both campaigns. Exceedances to the values set by the national legislation and World Health Organization (WHO) were found for PM2.5, PM10, CO2 and CH2O during both indoor air quality campaigns. Temperature and relative humidity values were also above the ranges recommended by American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). In general, pollutant concentrations measured after the implementation of low-cost mitigation measures were significantly lower, mainly for CO2. However, mitigation measures were not always sufficient to decrease the pollutants’ concentrations till values considered safe to protect human health. PMID:28561795

Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery.

PubMed

McLaughlin, Nancy; Upadhyaya, Pooja; Buxey, Farzad; Martin, Neil A

2014-09-01

Care providers have put significant effort into optimizing patient safety and quality of care. Value, defined as meaningful outcomes achieved per dollar spent, is emerging as a promising framework to redesign health care. Scarce data exist regarding cost measurement and containment for episodes of neurosurgical care. The authors assessed how cost measurement and strategic containment could be used to optimize the value of delivered care after the implementation and maturation of quality improvement initiatives. A retrospective study of consecutive patients undergoing microvascular decompression was performed. Group 1 comprised patients treated prior to the implementation of quality improvement interventions, and Group 2 consisted of those treated after the implementation and maturation of quality improvement processes. A third group, Group 3, represented a contemporary group studied after the implementation of cost containment interventions targeting the three most expensive activities: pre-incision time in the operating room (OR) and total OR time, intraoperative neuromonitoring (IOM), and bed assignment (and overall length of stay [LOS]). The value of care was assessed for all three groups. Forty-four patients were included in the study. Average preparation time pre-incision decreased from 73 to 65 to 45 minutes in Groups 1, 2, and 3, respectively. The average total OR time and OR cost were 434 minutes and $8513 in Group 1; 348 minutes and $7592 in Group 2; and 407 minutes and $8333 in Group 3. The average cost for IOM, excluding electrode needles, was $1557, $1585, and $1263, respectively, in Groups 1, 2, and 3. Average total cost for bed assignment was $5747, $5198, and $4535, respectively, in Groups 1, 2, and 3. The average total LOS decreased from 3.16 days in Group 1 to 2.14 days in Group 3. Complete relief of or a significant decrease in preoperative symptomatology was achieved in 42 of the 44 patients, respectively. Overall, the average cost of a surgical care episode (index hospitalization + readmission/reoperation) decreased 25% from Group 1 to 3. Linking cost-containment and cost-reduction strategies to ongoing outcome improvement measures is an important step toward the optimization of value-based delivery of care.

Application of behavior-based ergonomics therapies to improve quality of life and reduce medication usage for Alzheimer's/dementia residents.

PubMed

Mowrey, Corinne; Parikh, Pratik J; Bharwani, Govind; Bharwani, Meena

2013-02-01

Behavior-based ergonomics therapy (BBET) has been proposed in the past as a viable individualized non-pharmacological intervention to manage challenging behaviors and promote engagement among long-term care residents diagnosed with Alzheimer's/dementia. We evaluate the effect of BBET on quality of life and behavioral medication usage in an 18-bed dementia care unit at a not-for-profit continuing care retirement community in West Central Ohio. Comparing a target cohort during the 6-month pre-implementation period with the 6-month post-implementation period, our study indicates that BBET appears to have a positive impact on the resident's quality of life and also appears to correlate with behavioral medical reduction. For instance, the number of days with behavioral episodes decreased by 53%, the total Minimum Data Set (MDS) mood counts decreased by 70%, and the total MDS behavior counts decreased by 65%. From a medication usage standpoint, the number of pro re nata (PRN) Ativan doses decreased by 57%.

Quality registry, a tool for patient advantages - from a preventive caring perspective.

PubMed

Rosengren, Kristina; Höglund, Pär J; Hedberg, Berith

2012-03-01

The aim of this study was to describe nurses' experiences of a recently implemented quality register, Senior Alert, at two hospitals in Sweden. In Sweden, in recent decades, a system of national quality registries has been established in health and medical services for better outcomes for patients, professional development and a better functioning system. Senior Alert (SA) is one quality registry, aimed at preventing malnutrition, pressure ulcers and falls in elderly care. The study comprised a total of eight interviews with nurses working with SA at the ward level. The interviews were analysed using manifest qualitative content analysis. Respect for the individuals was a main concern in the study. All persons who were asked to participate in the study consented to do so. One category 'Patient Advantages' and three subcategories 'Conscious Persevering', 'Supporting Structure' and 'Committed Leadership' were identified to describe staff experiences of implementing SA. Implementation processes need to be sustainable at both staff and managerial levels. A key factor in implementing and using a quality registry in prevention care could be described as keeping the flame burning. However, further research is needed on how patient advantages could be developed using other quality registries in order to improve care from a patient perspective. The results of this study could help other organizations implement quality registries or other change processes, for example new guidelines and treatment. Strategies concerning organizational structure and committed leadership could increase the usefulness of knowledge systems on all levels, which could enable continuous learning and quality improvement in health care. © 2012 Blackwell Publishing Ltd.

77 FR 74449 - Water Quality Standards for the State of Florida's Lakes and Flowing Waters; Proposed Rule; Stay

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-14

... in this rulemaking. Entities discharging nitrogen or phosphorus to lakes and flowing waters of... nitrogen and phosphorus pollution in Florida's waters may be indirectly affected through implementation of... criteria in the form of total nitrogen, total phosphorus, nitrate+nitrite, and chlorophyll a for the...

Solid Waste, Air Pollution and Health

ERIC Educational Resources Information Center

Kupchik, George J.; Franz, Gerald J.

1976-01-01

This article examines the relationships among solid waste disposal, air pollution, and human disease. It is estimated that solid waste disposal contributes 9.7 percent of the total air pollution and 9.9 percent of the total air pollution health effect. Certain disposal-resource recovery systems can be implemented to meet air quality standards. (MR)

Lean Manufacturing and the Infantry: Retaining Quality during Total Mobilization

DTIC Science & Technology

United States last decisive war against a peer threat, World War II, required significant manpower resources. Prioritizing quality manpower ...distribution to technical jobs resulted in the degradation of the infantry, which then required the Army to implement corrective measures to reverse the...deficiency in quality. Should another decisive war occur in the future, the lethality and speed of modern warfare will increase the demand for manpower , which

Anomaly Detection in Power Quality at Data Centers

NASA Technical Reports Server (NTRS)

Grichine, Art; Solano, Wanda M.

2015-01-01

The goal during my internship at the National Center for Critical Information Processing and Storage (NCCIPS) is to implement an anomaly detection method through the StruxureWare SCADA Power Monitoring system. The benefit of the anomaly detection mechanism is to provide the capability to detect and anticipate equipment degradation by monitoring power quality prior to equipment failure. First, a study is conducted that examines the existing techniques of power quality management. Based on these findings, and the capabilities of the existing SCADA resources, recommendations are presented for implementing effective anomaly detection. Since voltage, current, and total harmonic distortion demonstrate Gaussian distributions, effective set-points are computed using this model, while maintaining a low false positive count.

The Autonomous Maintenance Implementation Directory as a Step Toward the Intelligent Quality Management System

NASA Astrophysics Data System (ADS)

Molenda, Michał

2016-12-01

The article describes the effects of the improvement of the production process which one of the industrial enterprises obtained by implementing the method of Autonomous Maintenance (AM), which is one of the pillars of the concept of Total Productive Maintenance (TPM). AM method was presented as an aid to the formation of intelligent, self-improving procesess of the quality management system (QMS). The main part of this article is to present results of studies that have been conducted in one of the large industrial enterprises in Poland, manufacturing for the automotive industry. The aim of the study was to evaluate the effectiveness of the implementation of the AM method as a tool for selfimprovement of industrial processes in the following company. The study was conducted in 2015. The gathering and comparison of data from the period of two years, ie. the year before and the year after the implementation of AM, helped to determine the effectiveness of AM in building intelligent quality management system.

The application of total quality management principles to spacecraft mission operations

NASA Astrophysics Data System (ADS)

Sweetin, Maury

1993-03-01

By now, the philosophies of Total Quality Management have had an impact on every aspect of American industrial life. The trail-blazing work of Deming, Juran, and Crosby, first implemented in Japan, has 're-migrated' across the Pacific and now plays a growing role in America's management culture. While initially considered suited only for a manufacturing environment, TQM has moved rapidly into the 'service' areas of offices, sales forces, and even fast-food restaurants. The next logical step has also been taken - TQM has found its way into virtually all departments of the Federal Government, including NASA. Because of this widespread success, it seems fair to ask whether this new discipline is directly applicable to the profession of spacecraft operations. The results of quality emphasis on OAO Corporation's contract at JPL provide strong support for Total Quality Management as a useful tool in spacecraft operations.

The application of total quality management principles to spacecraft mission operations

NASA Technical Reports Server (NTRS)

Sweetin, Maury

1993-01-01

By now, the philosophies of Total Quality Management have had an impact on every aspect of American industrial life. The trail-blazing work of Deming, Juran, and Crosby, first implemented in Japan, has 're-migrated' across the Pacific and now plays a growing role in America's management culture. While initially considered suited only for a manufacturing environment, TQM has moved rapidly into the 'service' areas of offices, sales forces, and even fast-food restaurants. The next logical step has also been taken - TQM has found its way into virtually all departments of the Federal Government, including NASA. Because of this widespread success, it seems fair to ask whether this new discipline is directly applicable to the profession of spacecraft operations. The results of quality emphasis on OAO Corporation's contract at JPL provide strong support for Total Quality Management as a useful tool in spacecraft operations.

Simulating and evaluating best management practices for integrated landscape management scenarios in biofuel feedstock production

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

Ha, Miae; Wu, May

Sound crop and land management strategies can maintain land productivity and improve the environmental sustainability of agricultural crop and feedstock production. With this study, it evaluates a strategy of incorporating landscape design and management concepts into bioenergy feedstock production. It examines the effect of land conversion and agricultural best management practices (BMPs) on water quality (nutrients and suspended sediments) and hydrology. The strategy was applied to the watershed of the South Fork Iowa River in Iowa, where the focus was on converting low-productivity land to provide cellulosic biomass and implementing riparian buffers. The Soil and Water Assessment Tool (SWAT) wasmore » employed to simulate the impact at watershed and sub-basin scales. The study compared the representation of buffers by using trapping efficiency and area ratio methods in SWAT. Landscape design and management scenarios were developed to quantify water quality under (i) current land use, (ii) partial land conversion to switchgrass, and (iii) riparian buffer implementation. Results show that implementation of vegetative barriers and riparian buffer can trap the loss of total nitrogen, total phosphorus, and sediment significantly. The effect increases with the increase of buffer area coverage. Implementing riparian buffer at 30 m width is able to produce 4 million liters of biofuels. When low-productivity land (15.2% of total watershed land area) is converted to grow switchgrass, suspended sediment, total nitrogen, total phosphorus, and nitrate loadings are reduced by 69.3%, 55.5%, 46.1%, and 13.4%, respectively. The results highlight the significant role of lower-productivity land and buffers in cellulosic biomass and provide insights into the design of an integrated landscape with a conservation buffer for future bioenergy feedstock production.« less

Simulating and evaluating best management practices for integrated landscape management scenarios in biofuel feedstock production

DOE PAGES

Ha, Miae; Wu, May

2015-09-08

Sound crop and land management strategies can maintain land productivity and improve the environmental sustainability of agricultural crop and feedstock production. With this study, it evaluates a strategy of incorporating landscape design and management concepts into bioenergy feedstock production. It examines the effect of land conversion and agricultural best management practices (BMPs) on water quality (nutrients and suspended sediments) and hydrology. The strategy was applied to the watershed of the South Fork Iowa River in Iowa, where the focus was on converting low-productivity land to provide cellulosic biomass and implementing riparian buffers. The Soil and Water Assessment Tool (SWAT) wasmore » employed to simulate the impact at watershed and sub-basin scales. The study compared the representation of buffers by using trapping efficiency and area ratio methods in SWAT. Landscape design and management scenarios were developed to quantify water quality under (i) current land use, (ii) partial land conversion to switchgrass, and (iii) riparian buffer implementation. Results show that implementation of vegetative barriers and riparian buffer can trap the loss of total nitrogen, total phosphorus, and sediment significantly. The effect increases with the increase of buffer area coverage. Implementing riparian buffer at 30 m width is able to produce 4 million liters of biofuels. When low-productivity land (15.2% of total watershed land area) is converted to grow switchgrass, suspended sediment, total nitrogen, total phosphorus, and nitrate loadings are reduced by 69.3%, 55.5%, 46.1%, and 13.4%, respectively. The results highlight the significant role of lower-productivity land and buffers in cellulosic biomass and provide insights into the design of an integrated landscape with a conservation buffer for future bioenergy feedstock production.« less

NCRVE Change Agent. Shaping the Future of Vocational Education. Volume 4, 1994.

ERIC Educational Resources Information Center

NCRVE Change Agent, 1994

1994-01-01

The first of four issues in this volume consists of four review articles. "Tech Prep Quality" reviews a guide to total quality management and tech prep. "Specific, Ocean to Ocean" reviews a publication that identifies 10 preliminary plans for implementing tech prep. "...No Single Option" is about a monograph that evaluates tech prep and other…

Implementation of the Total Quality Leadership Process in U.S. Marine Corps Field Contracting Offices

DTIC Science & Technology

1993-06-01

8 b. Dr. Joseph M. Juran ... .......... 11 c. Dr. Kaoru Ishikawa .... .......... .. 13 2. TQM in the Department of Defense ..... ... 15 3. TQL in the...qualification, etc. [Ref. 8] 12 c. Dr. Kaoru Ishikawa Japan is often lauded as the world’s leader in the quality movement. To understand how the Japanese view the...34The Real Message of the Quality Movement: Building Learning Organizations", Journal for Quality and Participation, March 1992. 10. Ishikawa , Kaoru

A method for developing standardised interactive education for complex clinical guidelines

PubMed Central

2012-01-01

Background Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG) improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care. Methods The workshop was developed using the construct of an educational framework (SCORPIO), the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score. Results Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most challenging theme to resolve. Tutors identified all themes for revision whilst participants identified a number of teaching but no content themes. From version 1 to 5, a significant increasing trend in total quality score was obtained; participants: 55%, p=0.0001; educator: 42%, p=0.0004; tutor peers: 57%, p=0.0001. Conclusions Complex clinical guidelines can be developed into a workshop acceptable to interprofessional participants. Eight quality domains provide a framework to standardise interactive teaching for complex clinical guidelines. Tutor peer review is important for content validity. This methodology may be useful for other guideline implementation. PMID:23131137

A method for developing standardised interactive education for complex clinical guidelines.

PubMed

Vaughan, Janet I; Jeffery, Heather E; Raynes-Greenow, Camille; Gordon, Adrienne; Hirst, Jane; Hill, David A; Arbuckle, Susan

2012-11-06

Although systematic use of the Perinatal Society of Australia and New Zealand internationally endorsed Clinical Practice Guideline for Perinatal Mortality (PSANZ-CPG) improves health outcomes, implementation is inadequate. Its complexity is a feature known to be associated with non-compliance. Interactive education is effective as a guideline implementation strategy, but lacks an agreed definition. SCORPIO is an educational framework containing interactive and didactic teaching, but has not previously been used to implement guidelines. Our aim was to transform the PSANZ-CPG into an education workshop to develop quality standardised interactive education acceptable to participants for learning skills in collaborative interprofessional care. The workshop was developed using the construct of an educational framework (SCORPIO), the PSANZ-CPG, a transformation process and tutor training. After a pilot workshop with key target and stakeholder groups, modifications were made to this and subsequent workshops based on multisource written observations from interprofessional participants, tutors and an independent educator. This participatory action research process was used to monitor acceptability and educational standards. Standardised interactive education was defined as the attainment of content and teaching standards. Quantitative analysis of positive expressed as a percentage of total feedback was used to derive a total quality score. Eight workshops were held with 181 participants and 15 different tutors. Five versions resulted from the action research methodology. Thematic analysis of multisource observations identified eight recurring education themes or quality domains used for standardisation. The two content domains were curriculum and alignment with the guideline and the six teaching domains; overload, timing, didacticism, relevance, reproducibility and participant engagement. Engagement was the most challenging theme to resolve. Tutors identified all themes for revision whilst participants identified a number of teaching but no content themes. From version 1 to 5, a significant increasing trend in total quality score was obtained; participants: 55%, p=0.0001; educator: 42%, p=0.0004; tutor peers: 57%, p=0.0001. Complex clinical guidelines can be developed into a workshop acceptable to interprofessional participants. Eight quality domains provide a framework to standardise interactive teaching for complex clinical guidelines. Tutor peer review is important for content validity. This methodology may be useful for other guideline implementation.

ISO 9001 certification for hospitals in Bulgaria: does it help service?

PubMed

Stoimenova, Assena; Stoilova, Ani; Petrova, Guenka

2014-03-04

The aim of our study is to review the published literature on establishment and implementation of ISO 9001 QMS in European hospitals, to study the availability of International Organization for Standardization (ISO) quality management systems (QMS) in Bulgarian hospitals and to outline the main advantages of ISO implementation in the hospitals in Bulgaria. The information on availability of ISO QMS in the hospitals in Bulgaria was gathered via Bulgarian certification register, the registries of various quality associations, websites of hospitals and certification companies presented in Bulgaria. A total number of 312 hospitals in Bulgaria were screened for the availability of QMS certified against the ISO 9001 requirements. The experience of European hospitals that implemented QMS is positive and the used approaches to improve the processes and the demonstrated effects from ISO implementation are analysed by the researchers. Unlike other European Union member states, the establishment of quality management systems in Bulgaria is not compulsory. However, our study revealed that 14.42% of the hospitals in Bulgaria have implemented and have certified quality systems against the requirements of ISO 9001. Our study confirmed that a quality management system using the ISO 9001 standard is useful for the hospitals as it can help to increase the operational efficiencies, to reduce errors, improve patient safety and produce a more preventive approach instead of a reactive environment.

TQM: A bibliography with abstracts. [total quality management

NASA Technical Reports Server (NTRS)

Gottlich, Gretchen L. (Editor)

1992-01-01

This document is designed to function as a special resource for NASA Langley scientists, engineers, and managers during the introduction and development of total quality management (TQM) practices at the Center. It lists approximately 300 bibliographic citations for articles and reports dealing with various aspects of TQM. Abstracts are also available for the majority of the citations. Citations are organized by broad subject areas, including case studies, customer service, senior management, leadership, communication tools, TQM basics, applications, and implementation. An introduction and indexes provide additional information on arrangement and availability of these materials.

Comparison of Quality Engineering Practices in Malaysian and Indonesian Automotive Related Companies

NASA Astrophysics Data System (ADS)

Putri, Nilda Tri; Sha'ri Mohd, Yusof; Irianto, Dradjad

2016-02-01

The main motivating factor driving this research is to find differences between the automotive related companies in Malaysia and Indonesia with regard to quality engineering (QE) implementation. A comparative study between Malaysia and Indonesia provides the opportunity to gain perspective and thorough understanding of the similarities and differences on the critical factors for successful QE practices in the context of both these countries. Face to face interviews are used to compare the QE practices in two automotive companies in Malaysia and Indonesia, respectively. The findings of study showed that both countries have clear quality objectives to achieving zero defects in processes and products and total customer satisfaction. Top and middle management in both countries were found to be directly involved in quality improvement on the shop floor to provide On-The-Job training and actively encourage team members to perform quality problem solving through the formation of quality control circles (QCC) particularly in Indonesia automotive industry. In Malaysia automotive industry, the implementation was not fully effective, but they have started to cultivate those values in the daily execution. Based on the case study results and analysis, the researcher has provided suggestions for both countries as an improvement plan for successful QE implementation. These recommendations will allow management to implement appropriate strategies for better QE implementation which hopefully can improve company's performance and ultimately the making the automotive industry in both countries to reach world class quality. It is strongly believed that the findings of this study can help Malaysia and Indonesia automotive industries in their efforts to become more effective and competitive.

Quality-improvement initiatives focused on enhancing customer service in the outpatient pharmacy.

PubMed

Poulin, Tenley J; Bain, Kevin T; Balderose, Bonnie K

2015-09-01

The development and implementation of quality-improvement initiatives to enhance customer service in an outpatient pharmacy of a Veterans Affairs (VA) medical center are described. Historically low customer service satisfaction rates with the outpatient pharmacy at the Philadelphia Veterans Affairs Medical Center prompted this quality-improvement project. A three-question survey was designed to be easily and quickly administered to veterans in the outpatient pharmacy waiting area. Using 5-point Likert scale, veterans were asked to rate (1) their overall experience with the outpatient pharmacy service and (2) their satisfaction with the customer service provided by the pharmacy department. They were also asked how they thought the pharmacy department could improve its customer service. After receiving feedback from the survey, several quality-improvement initiatives were developed. The initiatives were categorized as environmental, personnel, communicative, and technological. For each initiative, one or more tasks were developed and the initiatives were subsequently implemented over eight months. After each task was completed, veterans were surveyed to measure the impact of the change. A total of 79 veterans were surveyed before the implementation of the quality-improvement initiatives, and 49% and 68% rated their experience with the outpatient pharmacy and customer service favorably, respectively. Twenty-five veterans were surveyed after the implementation of numerous quality-improvement interventions, with 44% and 72% rating their experience with the outpatient pharmacy and customer service favorably. Customer service satisfaction with an outpatient pharmacy service at a VA medical center was enhanced through the implementation of various quality-improvement initiatives. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

75 FR 62354 - Approval and Promulgation of Implementation Plans; Tennessee: Approval of Section 110(a)(1...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-08

... conventional rounding rules, emission totals listed in Tables 1 and 2 may not reflect the absolute mathematical... absolute mathematical totals. As shown in Table 2 above, the Nashville Area is projected to steadily...-based standard, the air quality design value is simply the standard- related test statistic. Thus, for...

Are quality improvement methods a fashion for hospitals in Taiwan?

PubMed

Chung, Kuo-Piao; Yu, Tsung-Hsien

2012-08-01

This study reviews the rise and fall of the quality improvement (QI) methods implemented by hospitals in Taiwan, and examines the factors related to these methods. Cross-sectional, questionnaire-based survey. One hundred and thirty-nine district teaching hospitals, regional hospitals and medical centers. Directors or the persons in charge of implementing QI methods. s) None. s) Breadth and depth of the 18 QI methods. Seventy-two hospitals responded to the survey, giving a response rate of 52%. In terms of breadth based on the hospitals' self-reporting, the average number of QI methods adopted per hospital was 11.78 (range: 7-17). More than 80% of the surveyed hospitals had implemented eight QI methods, and >50% had implemented five QI methods. The QI methods adopted by over 80% of the surveyed hospitals had been implemented for a period of ∼7 years. On the basis of the authors' classification, seven of the eight QI methods (except for QI team in total quality management) had an implementation depth of almost 70% or higher in the surveyed hospitals. This study provides a snapshot of the QI methods implemented by hospitals in Taiwan. The results show that the average breadth of the QI methods adopted was 11.78; however, only 8.83 were implemented deeply. The hospitals' accreditation level was associated with the breadth and depth of QI method implementation.

Economic evaluation of a mentorship and enhanced supervision program to improve quality of integrated management of childhood illness care in rural Rwanda.

PubMed

Manzi, Anatole; Mugunga, Jean Claude; Iyer, Hari S; Magge, Hema; Nkikabahizi, Fulgence; Hirschhorn, Lisa R

2018-01-01

Integrated management of childhood illness (IMCI) can reduce under-5 morbidity and mortality in low-income settings. A program to strengthen IMCI practices through Mentorship and Enhanced Supervision at Health centers (MESH) was implemented in two rural districts in eastern Rwanda in 2010. We estimated cost per improvement in quality of care as measured by the difference in correct diagnosis and correct treatment at baseline and 12 months of MESH. Costs of developing and implementing MESH were estimated in 2011 United States Dollars (USD) from the provider perspective using both top-down and bottom-up approaches, from programmatic financial records and site-level data. Improvement in quality of care attributed to MESH was measured through case management observations (n = 292 cases at baseline, 413 cases at 12 months), with outcomes from the intervention already published. Sensitivity analyses were conducted to assess uncertainty under different assumptions of quality of care and patient volume. The total annual cost of MESH was US$ 27,955.74 and the average cost added by MESH per IMCI patient was US$1.06. Salary and benefits accounted for the majority of total annual costs (US$22,400 /year). Improvements in quality of care after 12 months of MESH implementation cost US$2.95 per additional child correctly diagnosed and $5.30 per additional child correctly treated. The incremental costs per additional child correctly diagnosed and child correctly treated suggest that MESH could be an affordable method for improving IMCI quality of care elsewhere in Rwanda and similar settings. Integrating MESH into existing supervision systems would further reduce costs, increasing potential for spread.

Linking land cover and water quality in New York City's water supply watersheds.

PubMed

Mehaffey, M H; Nash, M S; Wade, T G; Ebert, D W; Jones, K B; Rager, A

2005-08-01

The Catskill/Delaware reservoirs supply 90% of New York City's drinking water. The City has implemented a series of watershed protection measures, including land acquisition, aimed at preserving water quality in the Catskill/Delaware watersheds. The objective of this study was to examine how relationships between landscape and surface water measurements change between years. Thirty-two drainage areas delineated from surface water sample points (total nitrogen, total phosphorus, and fecal coliform bacteria concentrations) were used in step-wise regression analyses to test landscape and surface-water quality relationships. Two measurements of land use, percent agriculture and percent urban development, were positively related to water quality and consistently present in all regression models. Together these two land uses explained 25 to 75% of the regression model variation. However, the contribution of agriculture to water quality condition showed a decreasing trend with time as overall agricultural land cover decreased. Results from this study demonstrate that relationships between land cover and surface water concentrations of total nitrogen, total phosphorus, and fecal coliform bacteria counts over a large area can be evaluated using a relatively simple geographic information system method. Land managers may find this method useful for targeting resources in relation to a particular water quality concern, focusing best management efforts, and maximizing benefits to water quality with minimal costs.

The Role of "Meeting Pupil Needs and Empowering Staff" in Quality Management System

ERIC Educational Resources Information Center

Cheng, Alison Lai Fong; Yau, Hon Keung

2012-01-01

The study aims to examine the effectiveness of the implementation of "Meeting Pupil Needs and Empowering Staff" in the quality management in Hong Kong primary schools. A case study of nine primary schools was conducted and a qualitative method of interviews was adopted in this study. A total of 9 principals and 9 teachers from 9 primary…

Application of ISO 9000 Standards to Education and Training. Interpretation and Guidelines in a European Perspective. CEDEFOP Document.

ERIC Educational Resources Information Center

Van den Berghe, Wouter

This report brings together European experience on the interpretation and implementation of ISO 9000 in education and training (ET) environments. Chapter 1 discusses the importance of quality concepts in ET and summarizes key concepts of total quality management (TQM) and its relevance for ET. Chapter 2 introduces the ISO 9000 standards. It…

A Total Quality-Control Plan with Right-Sized Statistical Quality-Control.

PubMed

Westgard, James O

2017-03-01

A new Clinical Laboratory Improvement Amendments option for risk-based quality-control (QC) plans became effective in January, 2016. Called an Individualized QC Plan, this option requires the laboratory to perform a risk assessment, develop a QC plan, and implement a QC program to monitor ongoing performance of the QC plan. Difficulties in performing a risk assessment may limit validity of an Individualized QC Plan. A better alternative is to develop a Total QC Plan including a right-sized statistical QC procedure to detect medically important errors. Westgard Sigma Rules provides a simple way to select the right control rules and the right number of control measurements. Copyright © 2016 Elsevier Inc. All rights reserved.

Ninth Annual NASA/Contractors Conference on Quality and Productivity. World Class Excellence: The Journey Continues. Conference presentations

NASA Technical Reports Server (NTRS)

Templeton, Geoffrey B. (Editor); Stewart, Lynne M. (Editor)

1992-01-01

The topics covered include the following: The George M. Low Trophy; total quality assessment and measurement; using award criteria to improve organizational effectiveness; results--keeping an eye on the bottom line; capturing customer satisfaction; moving from management to leadership; leadership versus management; transforming the management team; leadership success stories; success stories in the quest for excellence; small business successes; education success stories; government success stories; tools and techniques for total quality management (TQM) integration; planning and organizing for TQM integration; successful stories for implementing system level TQM/CI tools; assessing TQM results; establishing an environment for continuous improvement at NASA; empowerment; synergism of partnering; and partnerships in education.

7th Annual NASA/Contractors Conference on Quality and Productivity: "Total Quality Leadership"

NASA Technical Reports Server (NTRS)

1991-01-01

More than 750 NASA, government, contractor, and academic representatives attended the Seventh Annual NASA/Contractors Conference on Quality and Productivity on October 12-13, 1990, in Grenelefe, Florida. The panel presentations and keynote speeches revolving around the theme of 'Total Quality Leadership' provided a solid base of understanding of the importance, benefits, and principles of total quality management. The implementation of these strategies is critical if we are to effectively pursue our mission of continuous quality improvement and reliability in our products, processess, and services. The annual NASA/contractors conferences serve as catalysts for achieving success in this mission. The conference was highlighted by the announcement of the first recipients of the George M. Low Trophy: NASA's Quality and Excellence Award. My congratulations go out to all nine finalist organizations and to the two recipients of this prestigious honor: Rockwell Space Systems Division and Marotta Scientific Controls, Inc. (the first small business to achieve this honor). These organizations have demonstrated a commitment to quality that is unsurpassed in the aerospace industry. This report summarizes the presentations and is not intended to be a verbatim proceedings document. You are encouraged to contact the speakers with any requests for further information.

Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients.

PubMed

Benditz, A; Drescher, J; Greimel, F; Zeman, F; Grifka, J; Meißner, W; Völlner, F

2016-12-05

Perioperative pain reduction, particularly during the first two days, is highly important for patients after total knee arthroplasty (TKA). Problems are not only caused by medical issues but by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent benchmarking. All patients included into the study had undergone total knee arthroplasty. Outcome parameters were analyzed by means of a questionnaire on the first postoperative day. A multidisciplinary team implemented a regular procedure of data analyzes and external benchmarking by participating in a nationwide quality improvement project. At the beginning of the study, our hospital ranked 16 th in terms of activity-related pain and 9 th in patient satisfaction among 47 anonymized hospitals participating in the benchmarking project. At the end of the study, we had improved to 1 st activity-related pain and to 2 nd in patient satisfaction. Although benchmarking started and finished with the same standardized pain management concept, results were initially pure. Beside pharmacological treatment, interdisciplinary teamwork and benchmarking with direct feedback mechanisms are also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA.

Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients

PubMed Central

Benditz, A.; Drescher, J.; Greimel, F.; Zeman, F.; Grifka, J.; Meißner, W.; Völlner, F.

2016-01-01

Perioperative pain reduction, particularly during the first two days, is highly important for patients after total knee arthroplasty (TKA). Problems are not only caused by medical issues but by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent benchmarking. All patients included into the study had undergone total knee arthroplasty. Outcome parameters were analyzed by means of a questionnaire on the first postoperative day. A multidisciplinary team implemented a regular procedure of data analyzes and external benchmarking by participating in a nationwide quality improvement project. At the beginning of the study, our hospital ranked 16th in terms of activity-related pain and 9th in patient satisfaction among 47 anonymized hospitals participating in the benchmarking project. At the end of the study, we had improved to 1st activity-related pain and to 2nd in patient satisfaction. Although benchmarking started and finished with the same standardized pain management concept, results were initially pure. Beside pharmacological treatment, interdisciplinary teamwork and benchmarking with direct feedback mechanisms are also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA. PMID:27917911

Implementing the Free Water Protocol does not Result in Aspiration Pneumonia in Carefully Selected Patients with Dysphagia: A Systematic Review.

PubMed

Gillman, Anna; Winkler, Renata; Taylor, Nicholas F

2017-06-01

The Frazier Free Water Protocol was developed with the aim of providing patients with dysphagia an option to consume thin (i.e. unthickened) water in-between mealtimes. A systematic review was conducted of research published in peer-reviewed journals. An electronic search of the EMBASE, CINAHL and MEDLINE databases was completed up to July 2016. A total of 8 studies were identified for inclusion: 5 randomised controlled trials, 2 cohort studies with matched cases and 1 single group pre-post intervention prospective study. A total of 215 rehabilitation inpatients and 30 acute patients with oropharyngeal dysphagia who required thickened fluids or were to remain 'nil by mouth', as determined by bedside swallow assessment and/or videofluoroscopy/fiberoptic endoscopic evaluation of swallowing, were included. Meta-analyses of the data from the rehabilitation studies revealed (1) low-quality evidence that implementing the protocol did not result in increased odds of having lung complications and (2) low-quality evidence that fluid intake may increase. Patients' perceptions of swallow-related quality of life appeared to improve. This review has found that when the protocol is closely adhered to and patients are carefully selected using strict exclusion criteria, including an evaluation of their cognition and mobility, adult rehabilitation inpatients with dysphagia to thin fluids can be offered the choice of implementing the Free Water Protocol. Further research is required to determine if the Free Water Protocol can be implemented in settings other than inpatient rehabilitation.

The use of indicators to improve the quality of intensive care: theoretical aspects and experiences from the Dutch intensive care registry.

PubMed

van der Voort, P H J; van der Veer, S N; de Vos, M L G

2012-10-01

In the concept of total quality management that was originally developed in industry, the use of quality indicators is essential. The implementation of quality indicators in the intensive care unit to improve the quality of care is a complex process. This process can be described in seven subsequent steps of an indicator-based quality improvement (IBQI) cycle. With this IBQI cycle, a continuous quality improvement can be achieved with the use of indicator data in a benchmark setting. After the development of evidence-based indicators, a sense of urgency has to be created, registration should start, raw data must be analysed, feedback must be given, and interpretation and conclusions must be made, followed by a quality improvement plan. The last step is the implementation of changes that needs a sense of urgency, and this completes the IBQI cycle. Barriers and facilitators are found in each step. They should be identified and addressed in a multifaceted quality improvement strategy. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

Effect of the implementation of HACCP on the microbiological quality of meals at a university restaurant.

PubMed

Cenci-Goga, B T; Ortenzi, R; Bartocci, E; Codega de Oliveira, A; Clementi, F; Vizzani, A

2005-01-01

A study was conducted to evaluate the microbiological quality, including total mesophilic counts and markers of bacteriological hygiene, as indicator of food safety of three categories of the most consumed meals in a university restaurant, before and after implementation of the HACCP system and personnel training. Cold gastronomy products, cooked warm-served products, and cooked cold-served products were tested for bacterial contamination. Throughout the experiment, 894 samples were examined for total counts of aerobic bacteria, counts of indicator organisms (coliform organisms and Escherichia coli) and pathogens (Staphylococcus aureus, Bacillus cereus, Salmonella spp., and Listeria monocytogenes). Implementation of the HACCP system, together with training in personnel hygiene, good manufacturing practices, and cleaning and sanitation procedures, resulted in lower aerobic plate counts and a lower incidence of S. aureus, coliform organisms, E. coli, and B. cereus, whereas Salmonella spp. and L. monocytogenes were not found in all samples studied. The microbial results of this study demonstrate that personnel training together with HACCP application contributed to improve the food safety of meals served in the restaurant studied.

A Program Manager’s Guide for Program Improvement in Ongoing Psychological Health and Traumatic Brain Injury Programs. The RAND Toolkit, Volume 4

DTIC Science & Technology

2014-01-01

Hughes EFX, Boerstler H, O’Connor EJ. “Assessing the Impact of Continuous Quality Improvement/ Total Quality Management : Concept versus...facing the public and private sectors. All RAND reports undergo rigorous peer review to ensure high standards for research quality and objectivity. Gery...RAND Program Manager’s Guide helps managers assess program performance, consider options for improvement, implement solutions, then assess whether the

Quality Indicators for the Total Testing Process.

PubMed

Plebani, Mario; Sciacovelli, Laura; Aita, Ada

2017-03-01

ISO 15189:2012 requires the use of quality indicators (QIs) to monitor and evaluate all steps of the total testing process, but several difficulties dissuade laboratories from effective and continuous use of QIs in routine practice. An International Federation of Clinical Chemistry and Laboratory Medicine working group addressed this problem and implemented a project to develop a model of QIs to be used in clinical laboratories worldwide to monitor and evaluate all steps of the total testing process, and decrease error rates and improve patient services in laboratory testing. All laboratories are invited, at no cost, to enroll in the project and contribute to harmonized management at the international level. Copyright © 2016 Elsevier Inc. All rights reserved.

Summary statistics and graphical comparisons of historical hydrologic and water-quality data, Seco Creek Watershed, South-Central Texas

USGS Publications Warehouse

Brown, David W.; Slattery, Richard N.; Gilhousen, Jon R.

1998-01-01

The U.S. Geological Survey collected hydrologic (rainfall, streamflow, and reservoir content) and water-quality data in the Seco Creek watershed, south-central Texas. Most of the data from 15 sites were collected as part of a study in cooperation with the U.S. Department of Agriculture and the Texas State Soil and Water Conservation Board to evaluate the effects of agricultural best-management practices on surface- and ground-water quantity and quality in the 255-square-mile watershed. Nearly 400 best-management practices at 58 sites were implemented by landowners in the watershed during March 1990-September 1995. Most of the data are from the early 1990s, the period during and after implementation of best-management practices. Data from five sites include water quality and are summarized in tables and graphics in the text; and data from all 15 sites are summarized on a diskette. Maximum annual rainfall among the sites for which data are presented in the text (excluding one site) for the during-and-after-implementation period (March 1990-September 1995) was 53.27 inches in water year 1992. Maximum annual total streamflow among the sites for the period was 63,400 acre-feet, also in water year 1992. At the one site with water-quality data (under base-flow conditions) for both the before-implementation period and the during-and-after implementation period of best-management practices, percentiles (5, 25, 50, 75, 95) for specific conductance, nitrate concentration, and fecal coliform density were less for the during-and-after-implementation period than for the before-implementation period.

Can the theoretical domains framework account for the implementation of clinical quality interventions?

PubMed

Lipworth, Wendy; Taylor, Natalie; Braithwaite, Jeffrey

2013-12-21

The health care quality improvement movement is a complex enterprise. Implementing clinical quality initiatives requires attitude and behaviour change on the part of clinicians, but this has proven to be difficult. In an attempt to solve this kind of behavioural challenge, the theoretical domains framework (TDF) has been developed. The TDF consists of 14 domains from psychological and organisational theory said to influence behaviour change. No systematic research has been conducted into the ways in which clinical quality initiatives map on to the domains of the framework. We therefore conducted a qualitative mapping experiment to determine to what extent, and in what ways, the TDF is relevant to the implementation of clinical quality interventions. We conducted a thematic synthesis of the qualitative literature exploring clinicians' perceptions of various clinical quality interventions. We analysed and synthesised 50 studies in total, in five domains of clinical quality interventions: clinical quality interventions in general, structural interventions, audit-type interventions, interventions aimed at making practice more evidence-based, and risk management interventions. Data were analysed thematically, followed by synthesis of these themes into categories and concepts, which were then mapped to the domains of the TDF. Our results suggest that the TDF is highly relevant to the implementation of clinical quality interventions. It can be used to map most, if not all, of the attitudinal and behavioural barriers and facilitators of uptake of clinical quality interventions. Each of these 14 domains appeared to be relevant to many different types of clinical quality interventions. One possible additional domain might relate to perceived trustworthiness of those instituting clinical quality interventions. The TDF can be usefully applied to a wide range of clinical quality interventions. Because all 14 of the domains emerged as relevant, and we did not identify any obvious differences between different kinds of clinical quality interventions, our findings support an initially broad approach to identifying barriers and facilitators, followed by a "drilling down" to what is most contextually salient. In future, it may be possible to establish a model of clinical quality policy implementation using the TDF.

Can the theoretical domains framework account for the implementation of clinical quality interventions?

PubMed Central

2013-01-01

Background The health care quality improvement movement is a complex enterprise. Implementing clinical quality initiatives requires attitude and behaviour change on the part of clinicians, but this has proven to be difficult. In an attempt to solve this kind of behavioural challenge, the theoretical domains framework (TDF) has been developed. The TDF consists of 14 domains from psychological and organisational theory said to influence behaviour change. No systematic research has been conducted into the ways in which clinical quality initiatives map on to the domains of the framework. We therefore conducted a qualitative mapping experiment to determine to what extent, and in what ways, the TDF is relevant to the implementation of clinical quality interventions. Methods We conducted a thematic synthesis of the qualitative literature exploring clinicians’ perceptions of various clinical quality interventions. We analysed and synthesised 50 studies in total, in five domains of clinical quality interventions: clinical quality interventions in general, structural interventions, audit-type interventions, interventions aimed at making practice more evidence-based, and risk management interventions. Data were analysed thematically, followed by synthesis of these themes into categories and concepts, which were then mapped to the domains of the TDF. Results Our results suggest that the TDF is highly relevant to the implementation of clinical quality interventions. It can be used to map most, if not all, of the attitudinal and behavioural barriers and facilitators of uptake of clinical quality interventions. Each of these 14 domains appeared to be relevant to many different types of clinical quality interventions. One possible additional domain might relate to perceived trustworthiness of those instituting clinical quality interventions. Conclusions The TDF can be usefully applied to a wide range of clinical quality interventions. Because all 14 of the domains emerged as relevant, and we did not identify any obvious differences between different kinds of clinical quality interventions, our findings support an initially broad approach to identifying barriers and facilitators, followed by a “drilling down” to what is most contextually salient. In future, it may be possible to establish a model of clinical quality policy implementation using the TDF. PMID:24359085

[IMPLEMENTATION OF A QUALITY MANAGEMENT SYSTEM IN A NUTRITION UNIT ACCORDING TO ISO 9001:2008].

PubMed

Velasco Gimeno, Cristina; Cuerda Compés, Cristina; Alonso Puerta, Alba; Frías Soriano, Laura; Camblor Álvarez, Miguel; Bretón Lesmes, Irene; Plá Mestre, Rosa; Izquierdo Membrilla, Isabel; García-Peris, Pilar

2015-09-01

the implementation of quality management systems (QMS) in the health sector has made great progress in recent years, remains a key tool for the management and improvement of services provides to patients. to describe the process of implementing a quality management system (QMS) according to the standard ISO 9001:2008 in a Nutrition Unit. the implementation began in October 2012. Nutrition Unit was supported by Hospital Preventive Medicine and Quality Management Service (PMQM). Initially training sessions on QMS and ISO standards for staff were held. Quality Committee (QC) was established with representation of the medical and nursing staff. Every week, meeting took place among members of the QC and PMQM to define processes, procedures and quality indicators. We carry on a 2 months follow-up of these documents after their validation. a total of 4 processes were identified and documented (Nutritional status assessment, Nutritional treatment, Monitoring of nutritional treatment and Planning and control of oral feeding) and 13 operating procedures in which all the activity of the Unit were described. The interactions among them were defined in the processes map. Each process has associated specific quality indicators for measuring the state of the QMS, and identifying opportunities for improvement. All the documents associated with requirements of ISO 9001:2008 were developed: quality policy, quality objectives, quality manual, documents and records control, internal audit, nonconformities and corrective and preventive actions. The unit was certified by AENOR in April 2013. the implementation of a QMS causes a reorganization of the activities of the Unit in order to meet customer's expectations. Documenting these activities ensures a better understanding of the organization, defines the responsibilities of all staff and brings a better management of time and resources. QMS also improves the internal communication and is a motivational element. Explore the satisfaction and expectations of patients can include their view in the design of care processes. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

Just-in-time: maximizing its success potential.

PubMed

Johnston, S K

1990-08-01

The effective implementation and use of JIT manufacturing practices depends largely on the education, training, and commitment of all levels of management to a fundamental quality-first policy. Management must transfer and demonstrate that commitment to every level and extension of the manufacturing endeavor. As a company establishes and reaches toward that goal, the move to JIT manufacturing practices becomes rational and justifiable. Failing to establish and commit to a quality directive greatly diminishes the potential benefits of JIT. If all levels of manufacturing participate in the JIT planning, implementing, and maintenance procedure, the realization of positive change and improvement drives the process. Total participation makes the task of JIT implementation not only possible, but practical. Enhanced mutual respect for all concerned is a likely consequence, advancing the productive environment.

A TQM involvement plan.

PubMed

Laws, H F

1993-03-01

We present the plan used to change our 35-bed medical treatment facility to a Deming Total Quality Improvement environment. This was successfully intermeshed with the military hierarchical chain of command and has resulted in a paradigm shift in the least amount of time within the facility. We present this plan, its steps for implementation, and our Quality Council organization so that similar military medical units may learn from our experience.

Level of Adoption of Quality Management Systems Into the Mexican Pork Industry

NASA Astrophysics Data System (ADS)

Maldonado-Siman, Em; Ruíz-Flores, Agustín; Núñez-Domínguez, Rafael; González-Alcorta, Mariano; Hernández-Rodríguez, Bertha Alicia

This research studies the characteristics of the Mexican pork sector; adoption status of quality management systems, and product destinations. Ninety six percent of fifty enterprises have fully answered a questionnaire. Ninety percent are small and medium-sized, the rest are large-sized firms. Nineteen percent of them have totally adopted HACCP, sixty three percent are implementing or planning to do it, the rest have no plans to adopt it. Thirteen percent of the enterprises had ISO 9000. Thirty four percent of their sales go to supermarkets, 57% to other retail chains and 9% to exportation. Product destinations are mainly Central America, United States of America, Asia and Mexico. To improve efficiency and the quality of process it is necessary to implement HACCP. Besides, customers and legal requirements are the external factors, which result in this adoption. In the process of implementing, there are some problems, such as staff motivation and training. The results suggest that HACCP system operating is important for the Mexican pork industry. It also has relevant implications in domestic trade. It is necessary to encourage adoption of quality management systems in the sector.

Experiences of Agency for Healthcare Research and Quality-funded projects that implemented practices for safer patient care.

PubMed

Taylor, Stephanie L; Ridgely, M Susan; Greenberg, Michael D; Sorbero, Melony E S; Teleki, Stephanie S; Damberg, Cheryl L; Farley, Donna O

2009-04-01

To synthesize lessons learned from the experiences of Agency for Healthcare Research and Quality-funded patient safety projects in implementing safe practices. Self-reported data from individual and group interviews with Original, Challenge, and Partnerships in Implementing Patient Safety (PIPS) grantees, from 2003 to 2006. Interviews with three grantee groups (n=60 total) implementing safe practice projects, with comparisons on factors influencing project implementation and sustainability. Semi-structured protocols contained open-ended questions on lessons learned and more structured questions on factors associated with project implementation and sustainability. The grantees shared common experiences, frequently identifying lessons learned regarding structural components needing to be in place before implementation, components of the implementation process, components of interventions' results needed for sustainability, changes in timelines or activities, unanticipated issues, and staff acceptance/adoption. Also, fewer Original grants had many of the factors related project to implementation/sustainability than the PIPS or Challenge grantees had. Although much of what was reported seemed like common sense, surprisingly few projects actually planned for or expected many of the barriers or facilitators they experienced during their project implementation. Others implementing practice improvements likely will share the experiences and issues identified by these implementation projects and can learn from their lessons.

An Overview of the Quality Function Deployment (QFD) Technique

NASA Technical Reports Server (NTRS)

Sherif, Josef S.; Tran, Tuyet-Lan

1995-01-01

QFD is a product planning tool and a process methodology that enables all organizations, departments, and individuals in a business or a project to systematically focus on the critical performance, functions, and/or characteristics of a product that are the most important to the customer. It is part of the Total Quality Management (TQM) concept.. This presentation describes the objectives of QFD, the process for implementing the technique, the benefits derived from proper implementation, the kinds of systems where QFD is best utilized, what the success factors are, how QFD works, some guidelines for selection of a QFD team, and the functional roles of key team members.

An analysis of total quality management in Aeronautical Systems Division

NASA Astrophysics Data System (ADS)

Caudle, Mark D.

1991-09-01

This study investigated the major schools of thought on various aspects of quality management and quality improvement. Areas covered included definitions of waste and quality, views on the cost of quality, tools and techniques used for quality improvement, and management philosophies and frameworks for continuous improvement. In addition, this study analyzed the structure and training content of the current Total Quality Management program at Aeronautical Systems Division (ASD). Pre- and post-test surveys on employee attitudes toward organizational effectiveness were analyzed from the Advanced Cruise Missile System Program Office (SPO), the F-15 SPO, and the ASD Deputy Chief of Staff for Human Resources (ASD/DP). Data was supplemented with semi-structured, personal interviews with ASD personnel involved in TQM. Survey analysis showed that the ACM SPO significantly improved, ASD/DP significantly digressed, and the F-15 SPO remained basically consistent. This led to the conclusion that ASD allows too much flexibility in the implementation of TQM in the three-letter organizations.

Landsat change detection can aid in water quality monitoring

NASA Technical Reports Server (NTRS)

Macdonald, H. C.; Steele, K. F.; Waite, W. P.; Shinn, M. R.

1977-01-01

Comparison between Landsat-1 and -2 imagery of Arkansas provided evidence of significant land use changes during the 1972-75 time period. Analysis of Arkansas historical water quality information has shown conclusively that whereas point source pollution generally can be detected by use of water quality data collected by state and federal agencies, sampling methodologies for nonpoint source contamination attributable to surface runoff are totally inadequate. The expensive undertaking of monitoring all nonpoint sources for numerous watersheds can be lessened by implementing Landsat change detection analyses.

Lessons Learned from the Implementation of Total Quality Management at the Naval Aviation Depot, North Island, California

DTIC Science & Technology

1988-12-01

Kaoru Ishikawa recognized the potential of statistical process control during one of Dr. Deming’s many instructional visits to Japan. He wrote the Guide...to Quality Control which has been utilized for both self-study and classroom training. In the Guide to Quality Control, Dr. Ishikawa describes...job data are essential for making a proper evaluation.( Ishikawa , p. 14) The gathering of data and its subsequent analysis are the foundation of

Implementation of Total Quality Leadership (TQL) at Long Beach Naval Shipyard and Future Perspectives for Implementation by the Hellenic Naval Stations

DTIC Science & Technology

1993-12-01

productivity. "Your work is your self-portrait. Would you sign it? No-not when you give me defective canvas to work with, paint not suited to the job, brushes...seedlings of TQL were carefully planted and nurtured. In the Navy, when a new ship is commissioned, it brings with it the fingerprints of the first

Managed care and total quality management: a necessary integration.

PubMed

Phoon, J; Corder, K; Barter, M

1996-01-01

The process of quality improvement/total quality management (QI/TQM) plays a key role in the delivery of health care in a managed care system. The concepts and ideas surrounding QI/TQM and managed care are interrelated, and the success of health care delivery depends on the integration and coexistence of these two philosophies. In looking more closely at these concepts, it becomes clear that the principles of QI/TQM must underlie strategic decisions involved in the implementation of a managed care system. Nurses play a key role in the success of this integration as nurse case managers, nurse practitioners, and nurse administrators. They have a direct impact on the many variables and goals of both QI/TQM and managed care.

Total chemical management in photographic processing

USGS Publications Warehouse

Luden, Charles; Schultz, Ronald

1985-01-01

The mission of the U. S. Geological Survey's Earth Resources Observation Systems (EROS) Data Center is to produce high-quality photographs of the earth taken from aircraft and Landsat satellite. In order to meet the criteria of producing research-quality photographs, while at the same time meeting strict environmental restrictions, a total photographic chemical management system was installed. This involved a three-part operation consisting of the design of a modern chemical analysis laboratory, the implementation of a chemical regeneration system, and the installation of a waste treatment system, including in-plant pretreatment and outside secondary waste treatment. Over the last ten years the result of this program has yielded high-quality photographs while saving approximately 30,000 per year and meeting all Environmental Protection Agency (EPA) restrictions.

Organizational learning and continuous quality improvement: examining the impact on nursing home performance.

PubMed

Rondeau, Kent V; Wagar, Terry H

2002-01-01

Interest is growing in learning more about the ability of total quality management and continuous quality improvement (TQM/CQI) initiatives to contribute to the performance of healthcare organizations. A major factor in the successful implementation of TQM/CQI is the seminal contribution of an organization's culture. Many implementation efforts have not succeeded because of a corporate culture that failed to stress broader organizational learning. This may help to explain why some TQM/CQI programs have been unsuccessful in improving healthcare organization performance. Organizational performance variables and organizational learning orientation were assessed in a sample of 181 Canadian long-term care organizations that had implemented a formal TQM/CQI program. Categorical regression analysis shows that, in the absence of a strong corporAte culture that stresses organizational learning and employee development, few performance enhancements are reported. The results of the assessment suggest that a TQM/CQI program without the backing of a strong organizational learning culture may be insufficient to achieve augmented organizational performance.

Total Quality Management of Information System for Quality Assessment of Pesantren Using Fuzzy-SERVQUAL

NASA Astrophysics Data System (ADS)

Faizah, Arbiati; Syafei, Wahyul Amien; Isnanto, R. Rizal

2018-02-01

This research proposed a model combining an approach of Total Quality Management (TQM) and Fuzzy method of Service Quality (SERVQUAL) to asses service quality. TQM implementation was as quality management orienting on customer's satisfaction by involving all stakeholders. SERVQUAL model was used to measure quality service based on five dimensions such as tangible, reliability, responsiveness, assurance, and empathy. Fuzzy set theory was to accommodate subjectivity and ambiguity of quality assessment. Input data consisted of indicator data and quality assessment aspect. Input data was, then, processed to be service quality assessment questionnaires of Pesantren by using Fuzzy method to get service quality score. This process consisted of some steps as follows : inputting dimension and questionnaire data to data base system, filling questionnaire through system, then, system calculated fuzzification, defuzzification, gap of quality expected and received by service receivers, and calculating each dimension rating showing quality refinement priority. Rating of each quality dimension was, then, displayed at dashboard system to enable users to see information. From system having been built, it could be known that tangible dimension had the highest gap, -0.399, thus it needs to be prioritized and gets evaluation and refinement action soon.

Sharing Craft Knowledge: The Soul of Principal Peer Assessment.

ERIC Educational Resources Information Center

Abbott, James E.

1996-01-01

Describes the implementation of a peer assessment process for school principals using a New Skills Profile of essential craft skills: teaching methods, budgetary competence, networking, technological literacy, communication, leadership, conflict resolution, diversity, systems thinking, and Total Quality Management principles. Participating…

Sustainability of community-led total sanitation outcomes: Evidence from Ethiopia and Ghana.

PubMed

Crocker, Jonny; Saywell, Darren; Bartram, Jamie

2017-05-01

We conducted a study to evaluate the sustainability of community-led total sanitation (CLTS) outcomes in Ethiopia and Ghana. Plan International, with local actors, implemented four CLTS interventions from 2012 to 2014: health extension worker-facilitated CLTS and teacher-facilitated CLTS in Ethiopia, and NGO-facilitated CLTS with and without training for natural leaders in Ghana. We previously evaluated these interventions using survey data collected immediately after implementation ended, and concluded that in Ethiopia health extension workers were more effective facilitators than teachers, and that in Ghana training natural leaders improved CLTS outcomes. For this study, we resurveyed 3831 households one year after implementation ended, and analyzed latrine use and quality to assess post-intervention changes in sanitation outcomes, to determine if our original conclusions were robust. In one of four interventions evaluated (health extension worker-facilitated CLTS in Ethiopia), there was an 8 percentage point increase in open defecation in the year after implementation ended, challenging our prior conclusion on their effectiveness. For the other three interventions, the initial decreases in open defecation of 8-24 percentage points were sustained, with no significant changes occurring in the year after implementation. On average, latrines in Ethiopia were lower quality than those in Ghana. In the year following implementation, forty-five percent of households in Ethiopia repaired or rebuilt latrines that had become unusable, while only 6% did in Ghana possibly due to higher latrine quality. Across all four interventions and three survey rounds, most latrines remained unimproved. Regardless of the intervention, households in villages higher latrine use were more likely to have sustained latrine use, which together with the high latrine repair rates indicates a potential social norm. There are few studies that revisit villages after an initial evaluation to assess sustainability of sanitation outcomes. This study provides new evidence that CLTS outcomes can be sustained in the presence of training provided to local actors, and strengthens previous recommendations that CLTS is not appropriate in all settings and should be combined with efforts to address barriers households face to building higher quality latrines. Copyright © 2017 The Authors. Published by Elsevier GmbH.. All rights reserved.

Implementation of Evidence-Based Employment Services in Specialty Mental Health

PubMed Central

Hamilton, Alison B; Cohen, Amy N; Glover, Dawn L; Whelan, Fiona; Chemerinski, Eran; McNagny, Kirk P; Mullins, Deborah; Reist, Christopher; Schubert, Max; Young, Alexander S

2013-01-01

Objective. Study a quality improvement approach for implementing evidence-based employment services at specialty mental health clinics. Data Sources/Study Setting. Semistructured interviews with clinicians and administrators before, during, and after implementation. Qualitative field notes, structured baseline and follow-up interviews with patients, semistructured interviews with patients after implementation, and administrative data. Study Design. Site-level controlled trial at four implementation and four control sites. Hybrid implementation–effectiveness study with mixed methods intervention evaluation design. Data Collection/Extraction Methods. Site visits, in-person and telephone interviews, patient surveys, patient self-assessment. A total of 801 patients completed baseline surveys and 53 clinicians and other clinical key stakeholders completed longitudinal qualitative interviews. Principal Findings. At baseline, sites varied in the availability, utilization, and quality of supported employment. Each site needed quality improvement for this service, though for differing reasons, with some needing development of the service itself and others needing increased service capacity. Improvements in knowledge, attitudes, beliefs, and referral behaviors were evident in mid- and postimplementation interviews, though some barriers persisted. Half of patients expressed an interest in working at baseline. Patients at implementation sites were 2.3 times more likely to receive employment services during the study year. Those who had a service visit were more likely to be employed at follow-up than those who did not. Conclusions. Studies of implementation and effectiveness require mixed methods to both enhance implementation in real time and provide context for interpretation of complex results. In this study, a quality improvement approach resulted in superior patient-level outcomes and improved clinician knowledge, attitudes, and behaviors, in the context of substantial variation among sites. PMID:24138608

Quality of surface water before implementation of a flood-control project in Chaska, Minnesota

USGS Publications Warehouse

Tornes, L.H.

1981-01-01

Samples were collected for 1 year from East Creek, Chaska Creek, and Courthouse Lake in Chaska, Minnesota, to determine the water quality before implementation of a flood-control project proposed by the U.S. Army Corps of Engineers. The creeks had similar water-quality characteristics. Data indicate that ground water may be the primary source of dissolved solids, sulfate, chloride, and chromium in the creeks. The pesticides alachlor, atrazine, simazine, and 2,4-D were found in water samples from both creeks but were well below the lethal concentrations for fish. Courthouse Lake, a 57-foot-deep stream-trout lake, had a mean summer trophic-state index of 35. Phytoplankton populations varied seasonally, and blue-green algae were predominant only in late summer. The algal-pollution index was highest in late summer, but did not provide evidence of high organic pollution. The apparently successful recovery of Courthouse Lake from past inundations by Minnesota River floodwaters having total phosphorus concentrations as high as 0.66 milligram per liter suggests that the lake, in time, will also recover from the added runoff expected as a result of implementing the flood-control project. The runoff could temporarily raise the total phosphorus concentration in the lake from 0.03 to 0.12 milligram per liter and raise the spring trophic-state index from 49 to 69.

Nutrient and sediment concentrations and loads in the Steele Bayou Basin, northwestern Mississippi, 2010–14

USGS Publications Warehouse

Hicks, Matthew B.; Murphy, Jennifer C.; Stocks, Shane J.

2017-06-01

The U.S. Geological Survey, in cooperation with the U.S. Army Corps of Engineers-Vicksburg District, monitored streamflow, water quality, and sediment at two stations on the Steele Bayou in northwestern Mississippi from October 2010 through September 2014 to characterize nutrient and sediment concentrations and loads in areas where substantial implementation of conservation efforts have been implemented. The motivation for this effort was to quantify improvements, or lack thereof, in water quality in the Steele Bayou watershed as a result of implementing large- and small-scale best-management practices aimed at reducing nutrient and sediment concentrations and loads. The results of this study document the hydrologic, water-quality, and sedimentation status of these basins following over two decades of ongoing implementation of conservation practices.Results from this study indicate the two Steele Bayou stations have comparable loads and yields of total nitrogen, phosphorus, and suspended sediment when compared to other agricultural basins in the southeastern and central United States. However, nitrate plus nitrite yields from basins in the Mississippi River alluvial plain, including the Steele Bayou Basin, are generally lower than other agricultural basins in the southeastern and central United States.Seasonal variation in nutrient and sediment loads was observed at both stations and for most constituents. About 50 percent of the total annual nutrient and sediment load was observed during the spring (February through May) and between 25 and 50 percent was observed during late fall and winter (October through January). These seasonal patterns probably reflect a combination of seasonal patterns in precipitation, runoff, streamflow, and in the timing of fertilizer application.Median concentrations of total nitrogen, nitrate plus nitrite, total phosphorus, orthophosphate, and suspended sediment were slightly higher at the upstream station, Steele Bayou near Glen Allan, than at the downstream station, Steele Bayou at Grace Road at Hopedale, MS, although the differences typically were not statistically significant. Mean annual loads of nitrate plus nitrite and suspended sediment were also larger at the upstream station, although the annual loads at both stations were generally within the 95-percent confidence intervals of each other.

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

Poncio, S.; Adkison, P.

Coating costs are escalating due to increased awareness of the environment and safety and health issues. Owners can reduce the overall cost of maintenance painting projects through the implementation of a total quality program. This program should encompass project pre-planning, evaluation of safety and quality assurance programs, and analysis of employee absenteeism and turnover. The information presented is a case history of one utility's experience managing a maintenance painting program during a five-year period.

The Total Quality Management Implementation Plan of the DLA Office of Comptroller

DTIC Science & Technology

1989-06-01

throughout the private and public sectors . Since embracing the concept in March 1988, the Office of the Secretary of Defense has directed all Defense...those in the Military Departments and private sector . The establishment of the DLA Finance Center in Columbus, Ohio, will promote standardization of...process and customer. o Worksite amenities and Quality of Worklife elements. o Adoption of incentive programs under which employees share the

An Annotated Reading List for Concurrent Engineering

DTIC Science & Technology

1989-07-01

The seven tools are sometimes referred to as the seven old tools.) -9- Ishikawa , Kaoru , What is Total Quality Control? The Japanese Way, Prentice-Hall...some solutions. * Ishikawa (1982) presents a practical guide (with easy to use tools) for implementing qual- ity control at the working level...study of, :-, ieering for the last two years. Is..ikawa, Kaoru , Guide to Quality Control, Kraus International Publications, White Plains, NY, 1982. The

[European Union Network for Patient Safety and Quality of Care (PASQ). Development and preliminary results in Europe and in the Spanish National Health System].

PubMed

Agra-Varela, Y; Fernández-Maíllo, M; Rivera-Ariza, S; Sáiz-Martínez-Acitorez, I; Casal-Gómez, J; Palanca-Sánchez, I; Bacou, J

2015-01-01

The joint action, European Union Network for Patient Safety and Quality of Care: PaSQ, aims to promote patient safety (PS) in the European Union (EU) and to facilitate the exchange of experiences among Member States (MS) and stakeholders on issues related to quality of care, PS, and patient involvement. The development and preliminary results are presented here, especially as regards the Spanish National Health System (SNHS). PaSQ is developed through 7 work packages, primarily aimed at sharing good practices (GP), which were identified using specific questionnaires and selected by means of explicit criteria, as well as to implement safe clinical practices (SCP) of proven effectiveness and agreed among MS. A total of 482 GP (39% provided by Spanish professionals) were identified. The 34 events organised in the EU, 11 including Spanish participation, facilitate sharing these practices. A total of 194 Health Care centres (49% in Spain) are implementing SCP (hand hygiene, safe surgery, medication reconciliation, and paediatric early warning scores) ACHIEVEMENTS AND FUTURE PERSPECTIVES: PaSQ is making it possible to strengthen collaboration between organizations and professionals at EU and SNHS level regarding PS and quality of care. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.

Effect of a health system's medical error disclosure program on gastroenterology-related claims rates and costs.

PubMed

Adams, Megan A; Elmunzer, B Joseph; Scheiman, James M

2014-04-01

In 2001, the University of Michigan Health System (UMHS) implemented a novel medical error disclosure program. This study analyzes the effect of this program on gastroenterology (GI)-related claims and costs. This was a review of claims in the UMHS Risk Management Database (1990-2010), naming a gastroenterologist. Claims were classified according to pre-determined categories. Claims data, including incident date, date of resolution, and total liability dollars, were reviewed. Mean total liability incurred per claim in the pre- and post-implementation eras was compared. Patient encounter data from the Division of Gastroenterology was also reviewed in order to benchmark claims data with changes in clinical volume. There were 238,911 GI encounters in the pre-implementation era and 411,944 in the post-implementation era. A total of 66 encounters resulted in claims: 38 in the pre-implementation era and 28 in the post-implementation era. Of the total number of claims, 15.2% alleged delay in diagnosis/misdiagnosis, 42.4% related to a procedure, and 42.4% involved improper management, treatment, or monitoring. The reduction in the proportion of encounters resulting in claims was statistically significant (P=0.001), as was the reduction in time to claim resolution (1,000 vs. 460 days) (P<0.0001). There was also a reduction in the mean total liability per claim ($167,309 pre vs. $81,107 post, 95% confidence interval: 33682.5-300936.2 pre vs. 1687.8-160526.7 post). Implementation of a novel medical error disclosure program, promoting transparency and quality improvement, not only decreased the number of GI-related claims per patient encounter, but also dramatically shortened the time to claim resolution.

The National Shipbuilding Research Program. Short Course on Implementing Advanced Technology. Course Notes

DTIC Science & Technology

1996-01-01

12.30PM LUNCH 12.30-1.00 PM EXERCISE - U.S. VERSUS FOREIGN COST BREAKDOWN 1.00-1.30 PM THE CANDY STORE - TOTAL QUALITY MANAGEMENT 1.30-2000 PM SEAMLESS...AVONDALE’S RUSSIAN TANKER, AND BENDER’S REEFER SHIP PROJECTS ALL APPEAR DEAD OTHER U.S. SHIPBUILDERS ARE STILL IN NEGOTIATION WITH POTENTIAL FOREIGN AND...derived: Direct ManhourdCGT Total Employee Manhours/CGT CGT/ Direct worker Year CGT/Total Employee Year 2 3 NATIONAL RESEARCH COUNCIL DESIGN AND

The effect of quality circles on job satisfaction and quality of work-life of staff in emergency medical services.

PubMed

Hosseinabadi, Reza; Karampourian, Arezou; Beiranvand, Shoorangiz; Pournia, Yadollah

2013-10-01

Quality circles, as a participatory management technique, offer one alternative for dealing with frustration and discontent of today's workers. This study was conducted to investigate the effect of implementation of quality circles on nurses' quality of work-life and job satisfaction. In this study, two emergency medical services (EMS) of Hamedan province were selected and randomly assigned as the experimental and control groups. After the experimental group was trained and quality circles were established in this group, the levels of quality of work-life and job satisfaction were measured in the two groups. Then, the statistical analyses were performed using t-test. After the intervention, the results showed significant differences between the scores of motivational factors (p=0.001), the total scores of job satisfaction (p=0.003), and the scores of some quality of work life (QWL) conceptual categories including the use and development of capacities (p=0.008), the total space of life (p=0.003), and the total scores of QWL (p=0.031) in the experimental group compared to those in the control group. This study confirms the effectiveness of quality circles in improving quality of work-life and job satisfaction of nurses working in EMS, and offers their application as a management method that can be used by EMS managers. Copyright © 2012 Elsevier Ltd. All rights reserved.

SIMPLE WAYS TO IMPROVE PH AND ALKALINITY MEASUREMENTS FOR WATER UTILITIES AND LABORATORIES

EPA Science Inventory

Both pH and total alkalinity determinations are critical in characterizing chemical properties of water, being important to implementing good process control, determining corrosivity and other water quality properties, and assessing changes in water characteristics. Poor charac...

The Challenge: Overcoming the Pitfalls.

ERIC Educational Resources Information Center

Lozier, G. Gregory; Teeter, Deborah J.

1993-01-01

Some organizations are having difficulty with the Total Quality Management (TQM) approach. Problems appear to come from reliance on prepackaged TQM programs, large-scale, diffuse implementation, mass training programs, measurement paralysis, overemphasis on tools, process selection, outmoded reward structures, and simplistic views of change and…

August 2015 Proposed Total Maximum Daily Load Document and Appendices for Vermont Segments of Lake Champlain

EPA Pesticide Factsheets

These documents provide allocations of phosphorus loads to Lake Champlain to meet water quality criteria, describe basis for allocation for future growth, & describe how implementation measures were simulated to determine that allocations can be achieved

The Effect of Pay-for-Performance in Nursing Homes: Evidence from State Medicaid Programs

PubMed Central

Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

2013-01-01

Objective Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting—the implementation of P4P for nursing homes by state Medicaid agencies. Data Sources/Study Setting 2001–2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. Study Design Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls. Principal Findings Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change. Conclusions Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered. PMID:23398330

The effect of pay-for-performance in nursing homes: evidence from state Medicaid programs.

PubMed

Werner, Rachel M; Konetzka, R Tamara; Polsky, Daniel

2013-08-01

Pay-for-performance (P4P) is commonly used to improve health care quality in the United States and is expected to be frequently implemented under the Affordable Care Act. However, evidence supporting its use is mixed with few large-scale, rigorous evaluations of P4P. This study tests the effect of P4P on quality of care in a large-scale setting-the implementation of P4P for nursing homes by state Medicaid agencies. 2001-2009 nursing home Minimum Data Set and Online Survey, Certification, and Reporting (OSCAR) datasets. Between 2001 and 2009, eight state Medicaid agencies adopted P4P programs in nursing homes. We use a difference-in-differences approach to test for changes in nursing home quality under P4P, taking advantage of the variation in timing of implementation across these eight states and using nursing homes in the 42 non-P4P states plus Washington, DC as contemporaneous controls. Quality improvement under P4P was inconsistent. While three clinical quality measures (the percent of residents being physically restrained, in moderate to severe pain, and developed pressure sores) improved with the implementation of P4P in states with P4P compared with states without P4P, other targeted quality measures either did not change or worsened. Of the two structural measures of quality that were tied to payment (total number of deficiencies and nurse staffing) deficiency rates worsened slightly under P4P while staffing levels did not change. Medicaid-based P4P in nursing homes did not result in consistent improvements in nursing home quality. Expectations for improvement in nursing home care under P4P should be tempered. © Health Research and Educational Trust.

Is the quality of donated semen deteriorating? Findings from a 15 year longitudinal analysis of weekly sperm samples.

PubMed

Haimov-Kochman, Ronit; Har-Nir, Ruth; Ein-Mor, Eliana; Ben-Shoshan, Vered; Greenfield, Caryn; Eldar, Ido; Bdolah, Yuval; Hurwitz, Arye

2012-06-01

Studies suggest that global semen quality is declining, but the debate remains open owing to geographic variation. To evaluate temporal trends of sperm parameters - namely concentration, motility and total motile sperm count - in sperm donated during the period 1995-2009. In a retrospective longitudinal cohort study we analyzed the sperm count and motility of 2182 semen samples provided on a weekly basis by 58 young, healthy, fertile, university-educated, paid donors. Despite the lowering of criteria for sperm parameters satisfactory for donation that were implemented in 2004, 38% of applicants for sperm donation are now rejected based on semen quality as compared to a third of applicants 10-15 years ago (P < 0.001). If the old strict criteria were in place 88% of candidates would be rejected today (P < 0.0001). Over the study period, the average sperm parameters dropped from a concentration of 106 +/- 25 million spermatozoa/ml with 79% +/- 4.3% motility to 68 +/- 14 million/ ml with 66% +/- 4.5% motile sperm (P < 0.0001, P < 0.0001, respectively). The total motile sperm count per ejaculate also decreased, from 66.4 +/- 18.2 million to 48.7 +/- 12 million (P < 0.005). When the previous criteria were implemented for the analysis of the latest group of sperm donors, only 18% of donors had an acceptable sperm quality, with an average concentration of 87 +/- 12 million spermatozoa/ml, 73% +/- 2.6% motile sperm and total motile sperm count of 53.1 +/- 3.8 million per ejaculate - still significantly lower than 15 years ago (P= 0.01, P= 0.003, P= 0.058 respectively). The rapid deterioration of sperm quality among fertile semen donors is alarming and may lead to cessation of sperm donation programs.

Effects of advanced treatment of municipal wastewater on the White River near Indianapolis, Indiana; trends in water quality, 1978-86

USGS Publications Warehouse

Crawford, Charles G.; Wangsness, David J.

1993-01-01

The City of Indianapolis has constructed state-of-the-art advanced municipal wastewater-treatment systems to enlarge and upgrade the existing secondary-treatment processes at its Belmont and Southport treatment plants. These new advanced-wastewater-treatment plants became operational in 1983. A nonparametric statistical procedure--a modified form of the Wilcoxon-Mann-Whitney rank-sum test--was used to test for trends in time-series water-quality data from four sites on the White River and from the Belmont and Southport wastewater-treatment plants. Time-series data representative of pre-advanced- (1978-1980) and post-advanced- (1983--86) wastewater-treatment conditions were tested for trends, and the results indicate substantial changes in water quality of treated effluent and of the White River downstream from Indianapolis after implementation of advanced wastewater treatment. Water quality from 1981 through 1982 was highly variable due to plant construction. Therefore, this time period was excluded from the analysis. Water quality at sample sites located upstream from the wastewater-treatment plants was relatively constant during the period of study (1978-86). Analysis of data from the two plants and downstream from the plants indicates statistically significant decreasing trends in effluent concentrations of total ammonia, 5-day biochemical-oxygen demand, fecal-coliform bacteria, total phosphate, and total solids at all sites where sufficient data were available for testing. Because of in-plant nitrification, increases in nitrate concentration were statistically significant in the two plants and in the White River. The decrease in ammonia concentrations and 5-day biochemical-oxygen demand in the White River resulted in a statistically significant increasing trend in dissolved-oxygen concentration in the river because of reduced oxygen demand for nitrification and biochemical oxidation processes. Following implementation of advanced wastewater treatment, the number of river-quality samples that failed to meet the water-quality standards for ammonia and dissolved oxygen that apply to the White River decreased substantially.

Rural hospital information technology implementation for safety and quality improvement: lessons learned.

PubMed

Tietze, Mari F; Williams, Josie; Galimbertti, Marisa

2009-01-01

This grant involved a hospital collaborative for excellence using information technology over 3-year period. The project activities focused on the improvement of patient care safety and quality in Southern rural and small community hospitals through the use of technology and education. The technology component of the design involved the implementation of a Web-based business analytic tool that allows hospitals to view data, create reports, and analyze their safety and quality data. Through a preimplementation and postimplementation comparative design, the focus of the implementation team was twofold: to recruit participant hospitals and to implement the technology at each of the 66 hospital sites. Rural hospitals were defined as acute care hospitals located in a county with a population of less than 100 000 or a state-administered Critical Access Hospital, making the total study population target 188 hospitals. Lessons learned during the information technology implementation of these hospitals are reflective of the unique culture, financial characteristics, organizational structure, and technology architecture of rural hospitals. Specific steps such as recruitment, information technology assessment, conference calls for project planning, data file extraction and transfer, technology training, use of e-mail, use of telephones, personnel management, and engaging information technology vendors were found to vary greatly among hospitals.

Total maximum daily loads, sediment budgets, and tracking restoration progress of the north coast watersheds

Treesearch

Matthew S. Buffleben

2012-01-01

One of the predominate water quality problems for northern coastal California watersheds is the impairment of salmonid habitat. Most of the North Coast watersheds are listed as “impaired” under section 303(d) of Clean Water Act. The Clean Water Act requires states to address impaired waters by developing Total Maximum Daily Loads (TMDLs) or implementing...

Taguchi's off line method and Multivariate loss function approach for quality management and optimization of process parameters -A review

NASA Astrophysics Data System (ADS)

Bharti, P. K.; Khan, M. I.; Singh, Harbinder

2010-10-01

Off-line quality control is considered to be an effective approach to improve product quality at a relatively low cost. The Taguchi method is one of the conventional approaches for this purpose. Through this approach, engineers can determine a feasible combination of design parameters such that the variability of a product's response can be reduced and the mean is close to the desired target. The traditional Taguchi method was focused on ensuring good performance at the parameter design stage with one quality characteristic, but most products and processes have multiple quality characteristics. The optimal parameter design minimizes the total quality loss for multiple quality characteristics. Several studies have presented approaches addressing multiple quality characteristics. Most of these papers were concerned with maximizing the parameter combination of signal to noise (SN) ratios. The results reveal the advantages of this approach are that the optimal parameter design is the same as the traditional Taguchi method for the single quality characteristic; the optimal design maximizes the amount of reduction of total quality loss for multiple quality characteristics. This paper presents a literature review on solving multi-response problems in the Taguchi method and its successful implementation in various industries.

Laboratory automation of high-quality and efficient ligand-binding assays for biotherapeutic drug development.

PubMed

Wang, Jin; Patel, Vimal; Burns, Daniel; Laycock, John; Pandya, Kinnari; Tsoi, Jennifer; DeSilva, Binodh; Ma, Mark; Lee, Jean

2013-07-01

Regulated bioanalytical laboratories that run ligand-binding assays in support of biotherapeutics development face ever-increasing demand to support more projects with increased efficiency. Laboratory automation is a tool that has the potential to improve both quality and efficiency in a bioanalytical laboratory. The success of laboratory automation requires thoughtful evaluation of program needs and fit-for-purpose strategies, followed by pragmatic implementation plans and continuous user support. In this article, we present the development of fit-for-purpose automation of total walk-away and flexible modular modes. We shared the sustaining experience of vendor collaboration and team work to educate, promote and track the use of automation. The implementation of laboratory automation improves assay performance, data quality, process efficiency and method transfer to CRO in a regulated bioanalytical laboratory environment.

How to implement Illness Management and Recovery (IMR) in mental health service settings: evaluation of the implementation strategy.

PubMed

Egeland, Karina Myhren; Ruud, Torleif; Ogden, Terje; Färdig, Rickard; Lindstrøm, Jonas Christoffer; Heiervang, Kristin Sverdvik

2017-01-01

The purpose of this study was to evaluate the implementation strategy used in the first-phase of implementation of the Illness Management and Recovery (IMR) programme, an intervention for adults with severe mental illnesses, in nine mental health service settings in Norway. A total of 9 clinical leaders, 31 clinicians, and 44 consumers at 9 service settings participated in the implementation of IMR. Implementation was conducted by an external team of researchers and an experienced trainer. Data were gathered on fidelity to the intervention and implementation strategy, feasibility, and consumer outcomes. Although the majority of clinicians scored within the acceptable range of high intervention fidelity, their participation in the implementation strategy appeared to moderate anticipated future use of IMR. No service settings reached high intervention fidelity scores for organizational quality improvement after 12 months of implementation. IMR implementation seemed feasible, albeit with some challenges. Consumer outcomes indicated significant improvements in illness self-management, severity of problems, functioning, and hope. There were nonsignificant positive changes in symptoms and quality of life. The implementation strategy appeared adequate to build clinician competence over time, enabling clinicians to provide treatment that increased functioning and hope for consumers. Additional efficient strategies should be incorporated to facilitate organizational change and thus secure the sustainability of the implemented practice. Trial registration ClinicalTrials.gov NCT02077829. Registered 25 February 2014.

Implementing a Quality Management System in the Medical Microbiology Laboratory.

PubMed

Carey, Roberta B; Bhattacharyya, Sanjib; Kehl, Sue C; Matukas, Larissa M; Pentella, Michael A; Salfinger, Max; Schuetz, Audrey N

2018-07-01

This document outlines a comprehensive practical approach to a laboratory quality management system (QMS) by describing how to operationalize the management and technical requirements described in the ISO 15189 international standard. It provides a crosswalk of the ISO requirements for quality and competence for medical laboratories to the 12 quality system essentials delineated by the Clinical and Laboratory Standards Institute. The quality principles are organized under three main categories: quality infrastructure, laboratory operations, and quality assurance and continual improvement. The roles and responsibilities to establish and sustain a QMS are outlined for microbiology laboratory staff, laboratory management personnel, and the institution's leadership. Examples and forms are included to assist in the real-world implementation of this system and to allow the adaptation of the system for each laboratory's unique environment. Errors and nonconforming events are acknowledged and embraced as an opportunity to improve the quality of the laboratory, a culture shift from blaming individuals. An effective QMS encourages "systems thinking" by providing a process to think globally of the effects of any type of change. Ultimately, a successful QMS is achieved when its principles are adopted as part of daily practice throughout the total testing process continuum. Copyright © 2018 American Society for Microbiology.

From Continuous Improvement to Organisational Learning: Developmental Theory.

ERIC Educational Resources Information Center

Murray, Peter; Chapman, Ross

2003-01-01

Explores continuous improvement methods, which underlie total quality management, finding barriers to implementation in practice that are related to a one-dimensional approach. Suggests a multiple, unbounded learning cycle, a holistic approach that includes adaptive learning, learning styles, generative learning, and capability development.…

Modeling Mitigation Activities in North Carolina Watersheds

NASA Astrophysics Data System (ADS)

Garcia, A. M.

2017-12-01

Nutrient enrichment and excessive sediment loadings have contributed to the degradation of rivers, lakes and estuaries in North Carolina. The North Carolina Department of Environmental Quality (NCDEQ) has implemented several basin-wide nutrient and sediment management strategies, yet gaps remain in understanding the impact of these strategies given the complexities in quantifying the processes that govern the transport of nutrient and sediment. In particular, improved assessment of the status of nutrient and sediment loadings to lakes and estuaries throughout the state is needed, including characterizing their sources and describing the relative contributions of different areas. The NCDEQ Division of Mitigation Services (DMS) uses watershed planning to identify and prioritize the best locations to implement stream, wetland, and riparian-buffer restoration to improve water quality. To support better decision-making for watershed restoration activities we are developing a SPARROW (SPAtially Referenced Regressions On Watershed attributes) model framework specifically for North Carolina. The SPARROW analysis (developed by the U.S. Geological Survey) relates water-quality monitoring data to better understand the effects of human activities and natural processes on surface-water quality. The core of the model consists of using a nonlinear-regression equation to describe the non-conservative transport of contaminants from point and nonpoint sources on land to rivers, lakes and estuaries through the stream and river network. In this presentation, preliminary total Nitrogen, total Phosphorus, and Total Suspended Solids (TSS) NC-SPARROW models are described that illustrate the SPARROW modeling framework incorporating specific restoration datasets and activity metrics, such as extent of riparian buffer and easements.

Implementing an organization-wide quality improvement initiative: insights from project leads, managers, and frontline nurses.

PubMed

Jeffs, Lianne P; Lo, Joyce; Beswick, Susan; Campbell, Heather

2013-01-01

With the movement to advance quality care and improve health care outcomes, organizations have increasingly implemented quality improvement (QI) initiatives to meet these requirements. Key to implementation success is the multilevel involvement of frontline clinicians and leadership. To explore the perceptions and experiences of frontline nurses, project leads, and managers associated with an organization-wide initiative aimed at engaging nurses in quality improvement work. To address the aims of this study, a qualitative research approach was used. Two focus groups were conducted with a total of 13 nurse participants, and individual interviews were done with 10 managers and 6 project leads. Emergent themes from the interview data included the following: improving care in a networked approach; driving QI and having a sense of pride; and overcoming challenges. Specifically, our findings elucidate the value of communities of practice and ongoing mentorship for nurses as key strategies to acquire and apply QI knowledge to a QI project on their respective units. Key challenges emerged including workload and time constraints, as well as resistance to change from staff. Our study findings suggest that leaders need to provide learning opportunities and protected time for frontline nurses to participate in QI projects.

Building Energy Codes: Policy Overview and Good Practices

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

Cox, Sadie

2016-02-19

Globally, 32% of total final energy consumption is attributed to the building sector. To reduce energy consumption, energy codes set minimum energy efficiency standards for the building sector. With effective implementation, building energy codes can support energy cost savings and complementary benefits associated with electricity reliability, air quality improvement, greenhouse gas emission reduction, increased comfort, and economic and social development. This policy brief seeks to support building code policymakers and implementers in designing effective building code programs.

[Quality management in acute pain therapy: results from a survey of certified hospitals].

PubMed

Böhmer, A B; Poels, M; Simanski, C; Trojan, S; Messer, K; Wirtz, M D; Neugebauer, E A M; Wappler, F; Joppich, R

2012-08-01

Systems for and methods of quality management are increasingly being implemented in public health services. The aim of our study was to analyze the current state of the integrated quality management concept "quality management acute pain therapy" of the TÜV Rheinland® (TÜV) after a 5-year project period. General characteristics of the participating hospitals, number of departments certified by the TÜV and implementation of structures and processes according to the TÜV guidelines were evaluated by a mail questionnaire. Furthermore, positive and negative aspects concerning the effects of certification were evaluated by the hospitals' representatives of certification. A total of 36 questionnaires were returned. Since 2006 the number of certified hospitals (2011: n = 48) and surgical departments (2011: n = 202) has increased continuously. The number of certified medical departments is low (2011: n = 39); however, in the last 3 years, it has increased by about 200-300% annually. Standard operative procedures for pain therapy and measurement of pain intensity at regular intervals were implemented in all certified clinics (100%). Although 41% take part in the benchmarking project QUIPS (Quality Improvement in Postoperative Pain Therapy), 24% do not systematically check the quality of the outcome of pain management. Acceptance of the new pain therapy concepts among nursing staff was rated positively (ratio positive:negative 16:1); however, acceptance among physicians was rated negatively (1:15). Certification by the TÜV leads to sustainable implementation of quality management principles. Future efforts should focus on better integration of physicians in acute pain therapy and the development of an integrated tool to measure patients' outcome.

Implementation of quality management systems and progress towards accreditation of National Tuberculosis Reference Laboratories in Africa

PubMed Central

de Dieu Iragena, Jean; Kao, Kekeletso; Erni, Donatelle; Mekonen, Teferi

2017-01-01

Background Laboratory services are essential at all stages of the tuberculosis care cascade, from diagnosis and drug resistance testing to monitoring response to treatment. Enabling access to quality services is a challenge in low-resource settings. Implementation of a strong quality management system (QMS) and laboratory accreditation are key to improving patient care. Objectives The study objective was to determine the status of QMS implementation and progress towards accreditation of National Tuberculosis Reference Laboratories (NTRLs) in the African Region. Method An online questionnaire was administered to NTRL managers in 47 World Health Organization Regional Office for Africa member states in the region, between February and April 2015, regarding the knowledge of QMS tools and progress toward implementation to inform strategies for tuberculosis diagnostic services strengthening in the region. Results A total of 21 laboratories (43.0%) had received SLMTA/TB-SLMTA training, of which 10 had also used the Global Laboratory Initiative accreditation tool. However, only 36.7% of NTRLs had received a laboratory audit, a first step in quality improvement. Most NTRLs participated in acid-fast bacilli microscopy external quality assurance (95.8%), although external quality assurance for other techniques was lower (60.4% for first-line drug susceptibility testing, 25.0% for second-line drug susceptibility testing, and 22.9% for molecular testing). Barriers to accreditation included lack of training and accreditation programmes. Only 28.6% of NTRLs had developed strategic plans and budgets which included accreditation. Conclusion Good foundations are in place on the continent from which to scale up accreditation efforts. Laboratory audits should be conducted as a first step in developing quality improvement action plans. Political commitment and strong leadership are needed to drive accreditation efforts; advocacy will require clear evidence of patient impact and cost-benefit. PMID:28879161

Implementation and evaluation of a clinical pathway for TRAM breast reconstruction.

PubMed

Hwang, T G; Wilkins, E G; Lowery, J C; Gentile, J

2000-02-01

Among strategies recently proposed to reduce practice variation, promote quality, and control costs in health care delivery, the concept of the clinical pathway has received considerable attention. Because transverse rectus abdominis musculocutaneous (TRAM) breast reconstruction is a common and often costly intervention, this institution sought to evaluate cost and quality outcomes of a clinical pathways program for this procedure. The TRAM reconstruction clinical pathway was implemented in April of 1996 to standardize postoperative care in this patient population. Outcomes of consecutive pathway cases for the first 14 months of the program were assessed in a retrospective cohort design, by using all nonpathway TRAM cases from the 18 months immediately before pathway implementation as controls. Outcomes assessed included length of hospital stay, postoperative complications, total postoperative charges, and total postoperative costs in relative value units. Data on these dependent variables were collected from hospital charts and billing records. The effects of pathway implementation on the outcomes of interest were analyzed by using analysis of covariance to control for potential confounding by other independent variables, including surgical site (unilateral versus bilateral reconstructions), technique (pedicle versus free TRAMs), timing (immediate versus delayed reconstructions), and patient age. Finally, a comparison of variances in the outcomes of interest between the two groups was analyzed by using an Ftest. For all statistical tests, p values of < or = 0.05 were considered significant. Twenty-nine patients were treated in the TRAM pathway group, whereas the control population included 40 nonpathway patients. After implementation of the TRAM pathway, length of stay decreased from 6.0 to 5.2 days; total postoperative charges were reduced from $8587 to $7744; and total postoperative relative value unit utilization declined from 1686 to 1104. Analysis of covariance showed that the decreases in length of hospital stay and relative value units in the TRAM pathway were statistically significant (p = 0.05 and p = 0.007, respectively). By contrast, no significant increase in complications was observed after pathway implementation. Variability in the TRAM pathway group, as measured by SD, decreased significantly for both length of hospital stay (p = 0.039) and relative value units (p = 0.023). Implementation of the TRAM reconstruction clinical pathway resulted in significant declines in length of hospital stay and total costs. These decreases in resource utilization had no significant effect on postoperative complication rates. Although additional research is needed to further assess the impact of clinical pathways, this approach offers considerable promise for improving the cost-effectiveness of health care.

A cost-efficiency and health benefit approach to improve urban air quality.

PubMed

Miranda, A I; Ferreira, J; Silveira, C; Relvas, H; Duque, L; Roebeling, P; Lopes, M; Costa, S; Monteiro, A; Gama, C; Sá, E; Borrego, C; Teixeira, J P

2016-11-01

When ambient air quality standards established in the EU Directive 2008/50/EC are exceeded, Member States are obliged to develop and implement Air Quality Plans (AQP) to improve air quality and health. Notwithstanding the achievements in emission reductions and air quality improvement, additional efforts need to be undertaken to improve air quality in a sustainable way - i.e. through a cost-efficiency approach. This work was developed in the scope of the recently concluded MAPLIA project "Moving from Air Pollution to Local Integrated Assessment", and focuses on the definition and assessment of emission abatement measures and their associated costs, air quality and health impacts and benefits by means of air quality modelling tools, health impact functions and cost-efficiency analysis. The MAPLIA system was applied to the Grande Porto urban area (Portugal), addressing PM10 and NOx as the most important pollutants in the region. Four different measures to reduce PM10 and NOx emissions were defined and characterized in terms of emissions and implementation costs, and combined into 15 emission scenarios, simulated by the TAPM air quality modelling tool. Air pollutant concentration fields were then used to estimate health benefits in terms of avoided costs (external costs), using dose-response health impact functions. Results revealed that, among the 15 scenarios analysed, the scenario including all 4 measures lead to a total net benefit of 0.3M€·y(-1). The largest net benefit is obtained for the scenario considering the conversion of 50% of open fire places into heat recovery wood stoves. Although the implementation costs of this measure are high, the benefits outweigh the costs. Research outcomes confirm that the MAPLIA system is useful for policy decision support on air quality improvement strategies, and could be applied to other urban areas where AQP need to be implemented and monitored. Copyright © 2016. Published by Elsevier B.V.

Total Quality Management Implementation at the Defense Technical Information Center

DTIC Science & Technology

1989-09-01

industry user groups, as well as the contracting process to emphasize the benefits of TQM to the private sector . 5. Demonstrate an Uncompromising... worklife enhancements are important elements in creating the environment in which DTIC personnel will grow, gain new experiences and capabilities, and

Three Hundred Sixty Degree Feedback: program implementation in a local health department.

PubMed

Swain, Geoffrey R; Schubot, David B; Thomas, Virginia; Baker, Bevan K; Foldy, Seth L; Greaves, William W; Monteagudo, Maria

2004-01-01

Three Hundred Sixty Degree Feedback systems, while popular in business, have been less commonly implemented in local public health agencies. At the same time, they are effective methods of improving employee morale, work performance, organizational culture, and attainment of desired organizational outcomes. These systems can be purchased "off-the-shelf," or custom applications can be developed for a better fit with unique organizational needs. We describe the City of Milwaukee Health Department's successful experience customizing and implementing a 360-degree feedback system in the context of its ongoing total quality improvement efforts.

[Comparative analysis of the donor cornea quality and of the interval between death and preservation before and after new sanitary and technique rules in a University Eye Bank].

PubMed

Zantut, Fabio; Holzchuh, Ricardo; Boni, Reginaldo Carlos; Mackus, Eva Cristina; Zantut, Paulo Roberto; Nakano, Claudio; Netto, Adamo Lui; Hida, Richard Yudi

2012-01-01

To compare the interval between death and enucleation (ΔT-O-E), between enucleation and preservation (ΔT-E-P) and the quality of the cornea before and after the implantation of new technique and sanitary rules. A retrospective study that evaluated the records of cornea donors in Sao Paulo's Santa Casa Eye Tissue Bank 2 years before and 2 years after the implementation new sanitary rules. An increase was observed in the absolute number of 205 to 374 donors following the adopted changes. There was no statistically significant difference in Δt-O-E and ΔT-E-P before and after the implemented changes. Of the total of 1,105 donor corneas, 388 donor corneas were observed before the changes and 717 donor corneas after the implemented changes. We observed a statistically significant increase in grading of donor cornea quality from 1.76 ± 0.90 to 1.94 ± 0.88 after the implementation of new standards of resolution. After the changes required by Resolution 347, there was a large increase in the number of donated, taken and preserved corneas. The BTO has not diminished the ΔT O-E and ΔT E-P. Cornea quality presented itself lower after the new rules.

Changes in Water Quality of Grand Lake St. Marys Watershed Following Implementation of a Distressed Watershed Rules Package.

PubMed

Jacquemin, Stephen J; Johnson, Laura T; Dirksen, Theresa A; McGlinch, Greg

2018-01-01

Grand Lake St. Marys watershed has drawn attention over the past decade as water quality issues resulting from nutrient loading have come to the forefront of public opinion, political concern, and scientific study. The objective of this study was to assess long-term changes in water quality (nutrient and sediment concentrations) following the distressed watershed rules package instituted in 2011. Since that time, a variety of rules (e.g., winter manure ban) and best management practices (cover crops, manure storage or transfers, buffers, etc.) have been implemented. We used a general linear model to assess variation in total suspended solids, particulate phosphorus, soluble reactive phosphorus (SRP), nitrate N, and total Kjeldahl nitrogen concentrations from daily Chickasaw Creek (drains ∼25% of watershed) samples spanning 2008 to 2016. Parameters were related to flow (higher values during high flows), timing (lower values during winter months), and the implementation of the distressed watershed rules package (lower values following implementation). Overall, reductions following the distressed designation for all parameters ranged from 5 to 35% during medium and high flow periods (with exception of SRP). Reductions were even more pronounced during winter months covered by the manure ban, where all parameters (including SRP) exhibited decreases at medium and high flows between 20 and 60%. While the reductions seen in this study are significant, concentrations are still highly elevated and continue to be a problem. We are optimistic that this study will serve to inform future management in the region and elsewhere. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

An eight-year report on the implementation of HACCP in a university canteen: impact on the microbiological quality of meals.

PubMed

Osimani, Andrea; Aquilanti, Lucia; Babini, Valentina; Tavoletti, Stefano; Clementi, Francesca

2011-04-01

An investigation aimed at assessing the microbiological quality of meals consumed at a university canteen after implementation of the HACCP system and personnel training was carried out. Cooked and warm-served products (74 samples), cooked and cold-served products (92 samples) and cold gastronomy products (63 samples) sampled from 2000 to 2007 underwent microbiological analyses. All the samples were tested for: Samonella spp., Listeria monocytogenes, total mesophilic aerobes, coliforms, Escherichia coli, Staphylococcus aureus, Bacillus cereus, and sulphite-reducing clostridia. The microbiological contamination of work surfaces (tables, tablewares, cutters, ladles, slicing machines, wash-basins, etc.), hands and white coats of members of the canteen staff was also assessed. The microbiological results clearly demonstrated the success of the HACCP plan implementation, through a general improvement of the hygiene conditions of both meals and work surfaces. © 2011 Taylor & Francis

TQM in a test environment

NASA Technical Reports Server (NTRS)

Chambers, Gary D.; King, Elizabeth A.; Oleson, Keith

1992-01-01

In response to the changing aerospace economic climate, Martin Marietta Astronautics Group (MMAG) has adopted a Total Quality Management (TQM) philosophy to maintain a competitive edge. TQM emphasizes continuous improvement of processes, motivation to improve from within, cross-functional involvement, people empowerment, customer satisfaction, and modern process control techniques. The four major initiatives of TQM are Product Excellence, Manufacturing Resource Planning (MRP II), People Empowerment, and Subcontract Management. The Defense Space and Communications (DS&C) Test Lab's definition and implementation of the MRP II and people empowerment initiatives within TQM are discussed. The application of MRP II to environmental test planning and operations processes required a new and innovative approach. In an 18 month span, the test labs implemented MRP II and people empowerment and achieved a Class 'A' operational status. This resulted in numerous benefits, both tangible and intangible, including significant cost savings and improved quality of life. A detailed description of the implementation process and results are addressed.

TQM in a test environment

NASA Astrophysics Data System (ADS)

Chambers, Gary D.; King, Elizabeth A.; Oleson, Keith

1992-11-01

In response to the changing aerospace economic climate, Martin Marietta Astronautics Group (MMAG) has adopted a Total Quality Management (TQM) philosophy to maintain a competitive edge. TQM emphasizes continuous improvement of processes, motivation to improve from within, cross-functional involvement, people empowerment, customer satisfaction, and modern process control techniques. The four major initiatives of TQM are Product Excellence, Manufacturing Resource Planning (MRP II), People Empowerment, and Subcontract Management. The Defense Space and Communications (DS&C) Test Lab's definition and implementation of the MRP II and people empowerment initiatives within TQM are discussed. The application of MRP II to environmental test planning and operations processes required a new and innovative approach. In an 18 month span, the test labs implemented MRP II and people empowerment and achieved a Class 'A' operational status. This resulted in numerous benefits, both tangible and intangible, including significant cost savings and improved quality of life. A detailed description of the implementation process and results are addressed.

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.

Why TQM does not work in Iranian healthcare organisations.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

Despite the potential benefits of total quality management (TQM), many healthcare organisations encountered difficulties in its implementation. The purpose of this paper is to explore the barriers to successful implementation of TQM in healthcare organisations of Iran. This study involved a mixed research design. In-depth interviews were conducted with TQM practitioners to explore TQM implementation obstacles in Iranian healthcare organisations. In addition, this study involved survey-based research on the obstacles associated with successful TQM transformation. TQM implementation and its impact depend on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in Iranian healthcare organisations can be attributed to the non-holistic approach adopted in its implementation, inadequate knowledge of managers' about TQM implementation, frequent top management turnover, poor planning, vague and short-termed improvement goals, lack of consistent managers' and employees' commitment to and involvement in TQM implementation, lack of a corporate quality culture, lack of team orientation, lack of continuous education and training and lack of customer focus. Human resource problems, cultural and strategic problems were the most important obstacles to TQM successful implementation, respectively. Understanding the factors that are likely to obstruct TQM implementation would enable managers to develop more viable strategies for achieving business excellence. Understanding the factors that are likely to obstruct TQM implementation will help organisations in planning better TQM models.

[Inpatient pain consultation service at a university hospital: a retrospective analysis of patient characteristics and the rate of the implementation of recommendations].

PubMed

Lassen, C L; Sommer, M; Meyer, N; Klier, T W; Graf, B M; Pawlik, M T; Wiese, C H R

2012-08-01

The aim of this study was to conduct an audit of a university inpatient pain consultation service and to examine the quality and the implementation of the recommended therapeutic measures. Factors that influenced the implementation should be identified. All inpatients treated by the consultation service in the years 2009 and 2010 were analyzed retrospectively. Demographic patient characteristics as well as quality parameters of the consultation service and pharmacological and non-pharmacological recommendations and their implementation were analyzed. In total 1,048 requests for the consultation service were processed of which 39.7% of the requests were for patients with acute pain, 33.8% with chronic and 19.9% with tumor-associated pain. Measures recommended most were medication, physiotherapy and psychological treatment. Recommended medications were actually prescribed in more than 80%, physiotherapy recommended in about 75% and psychological treatment recommended in 47% of the cases. Only a few influencing factors for the implementation of the recommended measures could be identified. Many different pain states are seen in an inpatient pain consultation service. The recommendations given are implemented in most cases especially concerning the medication.

Total quality in acute care hospitals: guidelines for hospital managers.

PubMed

Holthof, B

1991-08-01

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

Optimal implementation of best management practices to improve agricultural hydrology and water quality

NASA Astrophysics Data System (ADS)

Liu, Y.; Engel, B.; Collingsworth, P.; Pijanowski, B. C.

2017-12-01

Nutrient loading from the Maumee River watershed is a significant reason for the harmful algal blooms (HABs) problem in Lake Erie. Strategies to reduce nutrient loading from agricultural areas in the Maumee River watershed need to be explored. Best management practices (BMPs) are popular approaches for improving hydrology and water quality. Various scenarios of BMP implementation were simulated in the AXL watershed (an agricultural watershed in Maumee River watershed) using Soil and Water Assessment Tool (SWAT) and a new BMP cost tool to explore the cost-effectiveness of the practices. BMPs of interest included vegetative filter strips, grassed waterways, blind inlets, grade stabilization structures, wetlands, no-till, nutrient management, residue management, and cover crops. The following environmental concerns were considered: streamflow, Total Phosphorous (TP), Dissolved Reactive Phosphorus (DRP), Total Kjeldahl Nitrogen (TKN), and Nitrate+Nitrite (NOx). To obtain maximum hydrological and water quality benefits with minimum cost, an optimization tool was developed to optimally select and place BMPs by connecting SWAT, the BMP cost tool, and optimization algorithms. The optimization tool was then applied in AXL watershed to explore optimization focusing on critical areas (top 25% of areas with highest runoff volume/pollutant loads per area) vs. all areas of the watershed, optimization using weather data for spring (March to July, due to the goal of reducing spring phosphorus in watershed management plan) vs. full year, and optimization results of implementing BMPs to achieve the watershed management plan goal (reducing 2008 TP levels by 40%). The optimization tool and BMP optimization results can be used by watershed groups and communities to solve hydrology and water quality problems.

Quality of diabetes care worldwide and feasibility of implementation of the Alphabet Strategy: GAIA project (Global Alphabet Strategy Implementation Audit).

PubMed

Lee, James D; Saravanan, Ponnusamy; Varadhan, Lakshminarayanan; Morrissey, John R; Patel, Vinod

2014-10-11

The Alphabet Strategy (AS) is a diabetes care checklist ensuring "important, simple things are done right all the time." Current audits of diabetes care in developed countries reveal wide variations in quality with performance of care processes frequently sub-optimal. This study had three components:• an audit to assess diabetes care quality worldwide,• a questionnaire study seeking opinions on the merits of the AS,• a pilot study to assess the practicality of implementation of the AS in a low socioeconomic setting. Audit data was collected from 52 centres across 32 countries. Data from 4537 patients were converted to Quality and Outcome Framework (QOF) scores to enable inter-centre comparison. These were compared to each country's Gross Domestic Product (GDP), and Total Health Expenditure percentage per capita (THE%). The opinions of diabetes patients and healthcare professionals from the diabetes care team at each of these centres were sought through a structured questionnaire. A retrospective audit on 100 randomly selected case notes was conducted prior to AS implementation in a diabetes outpatient clinic in India, followed by a prospective audit after four months to assess its impact on care quality. QOF scores showed wide variation across the centres (mean 49.0, range 10.2-90.1). Although there was a positive relationship between GDP and THE% to QOF scores, there were exceptions. 91% of healthcare professionals felt the AS approach was practical. Patients found the checklist to be a useful education tool. Significant improvements in several aspects of care as well as 36% improvement in QOF score were seen following implementation. International centres observed large variations in care quality, with standards frequently sub-optimal. 71% of health care professionals would consider adopting the AS in their daily practice. Implementation in a low resource country resulted in significant improvements in some aspects of diabetes care. The AS checklist for diabetes care is a freely available in the public domain encompassing patient education, care plans, and educational resources for healthcare professionals including summary guidelines. The AS may provide a unique approach in delivering high quality diabetes care in countries with limited resources.

Refining a taxonomy for guideline implementation: results of an exercise in abstract classification

PubMed Central

2013-01-01

Background To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. Methods A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. Results The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). Conclusions Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support. PMID:23497520

Refining a taxonomy for guideline implementation: results of an exercise in abstract classification.

PubMed

Mazza, Danielle; Bairstow, Phillip; Buchan, Heather; Chakraborty, Samantha Paubrey; Van Hecke, Oliver; Grech, Cathy; Kunnamo, Ilkka

2013-03-15

To better understand the efficacy of various implementation strategies, improved methods for describing and classifying the nature of these strategies are urgently required. The aim of this study was to develop and pilot the feasibility of a taxonomy to classify the nature and content of implementation strategies. A draft implementation taxonomy was developed based on the Cochrane Effective Practice and Organisation of Care (EPOC) data collection checklist. The draft taxonomy had four domains (professional, financial, organisational and regulatory) covering 49 distinct strategies. We piloted the draft taxonomy by using it to classify the implementation strategies described in the conference abstracts of the implementation stream of the 2010 Guideline International Network Conference. Five authors classified the strategies in each abstract individually. Final categorisation was then carried out in a face-to-face consensus meeting involving three authors. The implementation strategies described in 71 conference abstracts were classified. Approximately 15.5% of abstracts utilised strategies that could not be categorised using the draft taxonomy. Of those strategies that could be categorised, the majority were professionally focused (57%). A total of 41% of projects used only one implementation strategy, with 29% using two and 31% three or more. The three most commonly used strategies were changes in quality assurance, quality improvement and/or performance measurement systems, changes in information and communication technology, and distribution of guideline materials (via hard-copy, audio-visual and/or electronic means). Further refinement of the draft taxonomy is required to provide hierarchical dimensions and granularity, particularly in the areas of patient-focused interventions, those concerned with audit and feedback and quality improvement, and electronic forms of implementation, including electronic decision support.

The Role of Individual Differences in Employee Adoption of TQM Orientation.

ERIC Educational Resources Information Center

Coyle-Shapiro, Jacqueline A. -M.; Morrow, Paula C.

2003-01-01

Employee surveys before and 9 and 32 months after total quality management (TQM) implementation (n=186, 166, 118) identified three individual characteristics that collectively explained the variance in and better predicted TQM adoption: organizational commitment, trust in colleagues, and importance of higher-order needs for achievement and…

NHEXAS PHASE I ARIZONA STUDY--QUALITY SYSTEMS AND IMPLEMENTATION PLAN (QSIP).

EPA Science Inventory

The Arizona Consortium scoping studies were designed to be part of the total NHEXAS framework that was developed as a result of a series scientific discussions and workshops conducted by the US EPA from 1992 through 1993. Several scientific issues needed to be addressed to evalua...

Managing Strategic Change through TQM: Learning from Failure.

ERIC Educational Resources Information Center

Redman, Tom; Grieves, Jim

1999-01-01

Case study of a manufacturing firm that implemented total quality management (TQM) found that the initiative may have failed because the company was undergoing rapid, radical structural change. Other problems included short-term focus, communication problems, and employee concerns about job security. TQM may be more compatible with continuous…

TQM--Will It Work in Your Library?

ERIC Educational Resources Information Center

Butcher, Karyle

Scarce resources, changing customer expectation, and the changing role of top management are all factors that have contributed to the implementation of total quality management (TQM) in libraries. Instructional articles, conferences, and videos can alleviate some concerns of cost and time commitment. Many libraries already practice some of the…

Tying Resource Allocation and TQM into Planning and Assessment Efforts.

ERIC Educational Resources Information Center

Mullendore, Richard H.; Wang, Li-Shing

1996-01-01

Describes the evolution of a model, developed by student affairs officials, which outlines a planning process for implementing Total Quality Management. Presents step-by-step instructions for the model's deployment and discusses such issues as transitions, planning forms, goals, and professional and personal growth needs. (RJM)

Composite SAR imaging using sequential joint sparsity

NASA Astrophysics Data System (ADS)

Sanders, Toby; Gelb, Anne; Platte, Rodrigo B.

2017-06-01

This paper investigates accurate and efficient ℓ1 regularization methods for generating synthetic aperture radar (SAR) images. Although ℓ1 regularization algorithms are already employed in SAR imaging, practical and efficient implementation in terms of real time imaging remain a challenge. Here we demonstrate that fast numerical operators can be used to robustly implement ℓ1 regularization methods that are as or more efficient than traditional approaches such as back projection, while providing superior image quality. In particular, we develop a sequential joint sparsity model for composite SAR imaging which naturally combines the joint sparsity methodology with composite SAR. Our technique, which can be implemented using standard, fractional, or higher order total variation regularization, is able to reduce the effects of speckle and other noisy artifacts with little additional computational cost. Finally we show that generalizing total variation regularization to non-integer and higher orders provides improved flexibility and robustness for SAR imaging.

Lean Six Sigma implementation and organizational culture.

PubMed

Knapp, Susan

2015-01-01

The purpose of this paper is to examine the relationship between four organizational cultural types defined by the Competing Values Framework and three Lean Six Sigma implementation components - management involvement, use of Lean Six Sigma methods and Lean Six Sigma infrastructure. The study involved surveying 446 human resource and quality managers from 223 hospitals located in Maine, New Hampshire, Vermont, Massachusetts and Rhode Island using the Organizational Culture Assessment Instrument. Findings - In total, 104 completed responses were received and analyzed using multivariate analysis of variance. Follow-up analysis of variances showed management support was significant, F(3, 100)=4.89, p < 0.01, η2=1.28; infrastructure was not significant, F(3, 100)=1.55, p=0.21, η2=0.05; and using Lean Six Sigma methods was also not significant, F(3, 100)=1.34, p=0.26, η2=0.04. Post hoc analysis identified group and development cultures having significant interactions with management support. The relationship between organizational culture and Lean Six Sigma in hospitals provides information on how specific cultural characteristics impact the Lean Six Sigma initiative key components. This information assists hospital staff who are considering implementing quality initiatives by providing an understanding of what cultural values correspond to effective Lean Six Sigma implementation. Managers understanding the quality initiative cultural underpinnings, are attentive to the culture-shared values and norm's influence can utilize strategies to better implement Lean Six Sigma.

Implementation of a new 'community' laboratory CD4 service in a rural health district in South Africa extends laboratory services and substantially improves local reporting turnaround time.

PubMed

Coetzee, L M; Cassim, N; Glencross, D K

2015-12-16

The CD4 integrated service delivery model (ITSDM) provides for reasonable access to pathology services across South Africa (SA) by offering three new service tiers that extend services into remote, under-serviced areas. ITSDM identified Pixley ka Seme as such an under-serviced district. To address the poor service delivery in this area, a new ITSDM community (tier 3) laboratory was established in De Aar, SA. Laboratory performance and turnaround time (TAT) were monitored post implementation to assess the impact on local service delivery. Using the National Health Laboratory Service Corporate Data Warehouse, CD4 data were extracted for the period April 2012-July 2013 (n=11,964). Total mean TAT (in hours) was calculated and pre-analytical and analytical components assessed. Ongoing testing volumes, as well as external quality assessment performance across ten trials, were used to indicate post-implementation success. Data were analysed using Stata 12. Prior to the implementation of CD4 testing at De Aar, the total mean TAT was 20.5 hours. This fell to 8.2 hours post implementation, predominantly as a result of a lower pre-analytical mean TAT reducing from a mean of 18.9 to 1.8 hours. The analytical testing TAT remained unchanged after implementation and monthly test volumes increased by up to 20%. External quality assessment indicated adequate performance. Although subjective, questionnaires sent to facilities reported improved service delivery. Establishing CD4 testing in a remote community laboratory substantially reduces overall TAT. Additional community CD4 laboratories should be established in under-serviced areas, especially where laboratory infrastructure is already in place.

Total integrated performance excellence system (TIPES): A true north direction for a clinical trial support center.

PubMed

Sather, Mike R; Parsons, Sherry; Boardman, Kathy D; Warren, Stuart R; Davis-Karim, Anne; Griffin, Kevin; Betterton, Jane A; Jones, Mark S; Johnson, Stanley H; Vertrees, Julia E; Hickey, Jan H; Salazar, Thelma P; Huang, Grant D

2018-03-01

This paper presents the quality journey taken by a Federal organization over more than 20 years. These efforts have resulted in the implementation of a Total Integrated Performance Excellence System (TIPES) that combines key principles and practices of established quality systems. The Center has progressively integrated quality system frameworks including the Malcom Baldrige National Quality Award (MBNQA) Framework and Criteria for Performance Excellence, ISO 9001, and the Organizational Project Management Maturity Model (OPM3), as well as supplemental quality systems of ISO 15378 (packaging for medicinal products) and ISO 21500 (guide to project management) to systematically improve all areas of operations. These frameworks were selected for applicability to Center processes and systems, consistency and reinforcement of complimentary approaches, and international acceptance. External validations include the MBNQA, the highest quality award in the US, continued registration and conformance to ISO standards and guidelines, and multiple VA and state awards. With a focus on a holistic approach to quality involving processes, systems and personnel, this paper presents activities and lessons that were critical to building TIPES and establishing the quality environment for conducting clinical research in support of Veterans and national health care.

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals.

PubMed

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-09-20

The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size - the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals.

User involvement in the implementation of clinical guidelines for common mental health disorders: a review and compilation of strategies and resources.

PubMed

Moreno, Eliana M; Moriana, Juan Antonio

2016-08-09

There is now broad consensus regarding the importance of involving users in the process of implementing guidelines. Few studies, however, have addressed this issue, let alone the implementation of guidelines for common mental health disorders. The aim of this study is to compile and describe implementation strategies and resources related to common clinical mental health disorders targeted at service users. The literature was reviewed and resources for the implementation of clinical guidelines were compiled using the PRISMA model. A mixed qualitative and quantitative analysis was performed based on a series of categories developed ad hoc. A total of 263 items were included in the preliminary analysis and 64 implementation resources aimed at users were analysed in depth. A wide variety of types, sources and formats were identified, including guides (40%), websites (29%), videos and leaflets, as well as instruments for the implementation of strategies regarding information and education (64%), self-care, or users' assessment of service quality. The results reveal the need to establish clear criteria for assessing the quality of implementation materials in general and standardising systems to classify user-targeted strategies. The compilation and description of key elements of strategies and resources for users can be of interest in designing materials and specific actions for this target audience, as well as improving the implementation of clinical guidelines.

Obstacles to TQM success in health care systems.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

Many healthcare organisations have found it difficult to implement total quality management (TQM) successfully. The aim of this paper is to explore the barriers to TQM successful implementation in the healthcare sector. This paper reports a literature review exploring the major reasons for the failure of TQM programmes in healthcare organisations. TQM implementation and its impact depend heavily on the ability of managers to adopt and adapt its values and concepts in professional healthcare organisations. Unsuccessful TQM efforts in healthcare organisations can be attributed to the strongly departmentalised, bureaucratic and hierarchical structure, professional autonomy, tensions between managers and professionals and the difficulties involved in evaluating healthcare processes and outcomes. Other obstacles to TQM success include lack of consistent managers' and employees' commitment to and involvement in TQM implementation, poor leadership and management, lack of a quality-oriented culture, insufficient training, and inadequate resources. The review was limited to empirical articles written in the English language during the past 30 years (1980-2010). The findings of this article provide policy makers and managers with a practical understanding of the factors that are likely to obstruct TQM implementation in the healthcare sector. Understanding the factors that obstruct TQM implementation would enable managers to develop more effective strategies for implementing TQM successfully in healthcare organisations.

How healthcare systems evaluate their advance care planning initiatives: Results from a systematic review.

PubMed

Biondo, Patricia D; Lee, Lydia D; Davison, Sara N; Simon, Jessica E

2016-09-01

Advance care planning initiatives are being implemented across healthcare systems around the world, but how best to evaluate their implementation is unknown. To identify gaps and/or redundancies in current evaluative strategies to help healthcare systems develop future evaluative frameworks for ACP. Systematic review. Peer-reviewed and gray literature searches were conducted till February 2015 to answer: "What methods have healthcare systems used to evaluate implementation of advance care planning initiatives?" A PICOS framework was developed to identify articles describing the implementation and evaluation of a health system-level advance care planning initiative. Outcome measures were mapped onto a conceptual quality indicator framework based on the Institute of Medicine and Donabedian models of healthcare quality. A total of 46 studies met inclusion criteria for analysis. Most articles reported on single parts of a healthcare system (e.g. continuing care). The most common outcome measures pertained to document completion, followed by healthcare resource use. Patient-, family-, or healthcare provider-reported outcomes were less commonly measured. Concordance measures (e.g. dying in place of choice) were reported by only 26% of studies. The conceptual quality indicator framework identified gaps and redundancies in measurement and is presented as a potential foundation from which to develop a comprehensive advance care planning evaluation framework. Document completion is frequently used to evaluate advance care planning program implementation; capturing the quality of care appears to be more difficult. This systematic review provides health system administrators with a comprehensive summary of measures used to evaluate advance care planning and may identify gaps in evaluation within their local context. © The Author(s) 2016.

Implementation of a Point-of-Care Radiologist-Technologist Communication Tool in a Quality Assurance Program.

PubMed

Ong, Leonard; Elnajjar, Pierre; Nyman, C Gregory; Mair, Thomas; Juluru, Krishna

2017-07-01

We implemented an Image Quality Reporting and Tracking Solution (IQuaRTS), directly linked from the PACS, to improve communication between radiologists and technologists. IQuaRTS launched in May 2015. We compared MRI issues filed in the period before IQuaRTS implementation (May-September 2014) using a manual system with MRI issues filed in the IQuaRTS period (May-September 2015). The unpaired t test was used for analysis. For assessment of overall results in the IQuaRTS period alone, all issues filed across all modalities were included. Summary statistics and charts were generated using Excel and Tableau. For MRI issues, the number of issues filed during the IQuaRTS period was 498 (2.5% of overall MRI examination volume) compared with 78 issues filed during the period before IQuaRTS implementation (0.4% of total examination volume) (p = 0.0001), representing a 625% relative increase. Tickets that documented excellent work were 8%. Other issues included images not pushed to PACS (20%), film library issues (19%), and documentation or labeling (8%). Of the issues filed, 55% were MRI-related and 25% were CT-related. The issues were stratified across six sites within our institution. Staff requiring additional training could be readily identified, and 80% of the issues were resolved within 72 hours. IQuaRTS is a cost-effective online issue reporting tool that enables robust data collection and analytics to be incorporated into quality improvement programs. One limitation of the system is that it must be implemented in an environment where staff are receptive to quality improvement.

Rainfall, Streamflow, and Water-Quality Data During Stormwater Monitoring, Halawa Stream Drainage Basin, Oahu, Hawaii, July 1, 2000 to June 30, 2001

USGS Publications Warehouse

Presley, Todd K.

2001-01-01

The State of Hawaii Department of Transportation Stormwater Monitoring Program was implemented on January 1, 2001. The program includes the collection of rainfall, streamflow, and water-quality data at selected sites in the Halawa Stream drainage basin. Rainfall and streamflow data were collected from July 1, 2000 to June 30, 2001. Few storms during the year met criteria for antecedent dry conditions or provided enough runoff to sample. The storm of June 5, 2001 was sufficiently large to cause runoff. On June 5, 2001, grab samples were collected at five sites along North Halawa and Halawa Streams. The five samples were later analyzed for nutrients, trace metals, oil and grease, total petroleum hydrocarbons, fecal coliform, biological and chemical oxygen demands, total suspended solids, and total dissolved solids.

School nutrition guidelines: overview of the implementation and evaluation.

PubMed

Gregorič, Matej; Pograjc, Larisa; Pavlovec, Alenka; Simčič, Marjan; Gabrijelčič Blenkuš, Mojca

2015-06-01

To holistically evaluate the extent of implementation of dietary guidelines in schools and present various monitoring systems. The study comprises three methods: (i) a cross-sectional survey (process evaluation); (ii) an indicator-based evaluation (menu quality); and (iii) a 5 d weighed food record of school lunches (output evaluation). Slovenian primary schools. A total 234 food-service managers from 488 schools completed a self-administrated questionnaire for process evaluation; 177 out of 194 randomly selected schools provided menus for menu quality evaluation; and 120 school lunches from twenty-four schools were measured and nutritionally analysed for output evaluation. The survey among food-service managers revealed high levels of implementation at almost all process evaluation areas of the guidelines. An even more successful implementation of these guidelines was found in relation to organization cultural issues as compared with technical issues. Differences found in some process evaluation areas were related to location, size and socio-economic characteristics of schools. Evaluation of school menu quality demonstrated that score values followed a normal distribution. Higher (better) nutrition scores were found in larger-sized schools and corresponding municipalities with higher socio-economic status. School lunches did not meet minimum recommendations for energy, carbohydrates or dietary fibre intake, nor for six vitamins and three (macro, micro and trace) elements. The implementation of the guidelines was achieved differently at distinct levels. The presented multilevel evaluation suggests that different success in implementation might be attributed to different characteristics of individual schools. System changes might also be needed to support and improve implementation of the guidelines.

Implementing guidelines in nursing homes: a systematic review.

PubMed

Diehl, Heinz; Graverholt, Birgitte; Espehaug, Birgitte; Lund, Hans

2016-07-25

Research on guideline implementation strategies has mostly been conducted in settings which differ significantly from a nursing home setting and its transferability to the nursing home setting is therefore limited. The objective of this study was to systematically review the effects of interventions to improve the implementation of guidelines in nursing homes. A systematic literature search was conducted in the Cochrane Library, CINAHL, Embase, MEDLINE, DARE, HTA, CENTRAL, SveMed + and ISI Web of Science from their inception until August 2015. Reference screening and a citation search were performed. Studies were eligible if they evaluated any type of guideline implementation strategy in a nursing home setting. Eligible study designs were systematic reviews, randomised controlled trials, non-randomised controlled trials, controlled before-after studies and interrupted-time-series studies. The EPOC risk of bias tool was used to evaluate the risk of bias in the included studies. The overall quality of the evidence was rated using GRADE. Five cluster-randomised controlled trials met the inclusion criteria, evaluating a total of six different multifaceted implementation strategies. One study reported a small statistically significant effect on professional practice, and two studies demonstrated small to moderate statistically significant effects on patient outcome. The overall quality of the evidence for all comparisons was low or very low using GRADE. Little is known about how to improve the implementation of guidelines in nursing homes, and the evidence to support or discourage particular interventions is inconclusive. More implementation research is needed to ensure high quality of care in nursing homes. PROSPERO 2014: CRD42014007664.

Land use change detection with LANDSAT-2 data for monitoring and predicting regional water quality degradation. [Arkansas

NASA Technical Reports Server (NTRS)

Macdonald, H.; Steele, K. (Principal Investigator); Waite, W.; Rice, R.; Shinn, M.; Dillard, T.; Petersen, C.

1977-01-01

The author has identified the following significant results. Comparison between LANDSAT 1 and 2 imagery of Arkansas provided evidence of significant land use changes during the 1972-75 time period. Analysis of Arkansas historical water quality information has shown conclusively that whereas point source pollution generally can be detected by use of water quality data collected by state and federal agencies, sampling methodologies for nonpoint source contamination attributable to surface runoff are totally inadequate. The expensive undertaking of monitoring all nonpoint sources for numerous watersheds can be lessened by implementing LANDSAT change detection analyses.

Implementation of quality systems by Mexican exporters of processed meat.

PubMed

Maldonado-Siman, E; Bernal-Alcántara, R; Cadena-Meneses, J A; Altamirano-Cárdenas, J R; Martinez-Hernández, P A

2014-12-01

Requirements of hazard analysis and critical control points (HACCP) are becoming essential for international trade in food commodities as a safety assurance component. This research reports the level of the adoption of ISO 9000 and the HACCP system by Federal Inspection Type (TIF) pork-exporting enterprises. Implementation and operating costs are reported as well as the benefits involved in this food industry process. In Mexico, there are 97 companies classified as TIF enterprises, and 22 are registered as exporters of processed pork with the National Services for Safety and Quality and Animal Health of the Secretariat of Agriculture, Livestock, Rural Development, Fisheries and Food. Surveys were administered to 22 companies, with a 95.2% response rate. Enterprise characteristics were evaluated, as well as their operating activities. Fieldwork consisted of administering structured questionnaires to TIF exporters. All the surveyed enterprises had implemented HACCP, whereas the ISO 9000 regulation was applied in only 30%. Of total production, 75% is exported to 13 countries, and 25% goes to the Mexican market niche. Results indicate that the main factors for adopting HACCP are related to accessibility to international markets, improving quality, and reducing product quality audits by customers. The results also indicated that staff training was the most important issue. Microbiological testing was the highest cost of the operation. The main benefits reported were related to better access to international markets and a considerable reduction in microbial counts. This study shows the willingness of Mexican pork processors to implement food safety protocols for producing safe and quality products to compete in the international food trade.

Effects of State Minimum Staffing Standards on Nursing Home Staffing and Quality of Care

PubMed Central

Park, Jeongyoung; Stearns, Sally C

2009-01-01

Objective To investigate the impact of state minimum staffing standards on the level of staffing and quality of nursing home care. Data Sources Online Survey and Certification Reporting System (OSCAR) merged with the Area Resource File from 1998 through 2001. Study Design Between 1998 and 2001, 16 states implemented or expanded staffing standards in excess of federal requirements, creating a natural experiment in comparison with facilities in states without new standards. Difference-in-differences models using facility fixed effects were estimated to determine the effect of state standards. Data Collection/Extraction Methods OSCAR data were linked to the data on market conditions and state policies. A total of 55,248 facility-year observations from 15,217 freestanding facilities were analyzed. Principal Findings Increased standards resulted in small staffing increases for facilities with staffing initially below or close to new standards. Yet the standards were associated with reductions in restraint use and the number of total deficiencies at all types of facilities. Conclusions Mandated staffing standards affect only low-staff facilities facing potential for penalties, and effects are small. Selected facility-level outcomes may show improvement at all facilities due to a general response to increased standards or to other quality initiatives implemented at the same time as staffing standards. PMID:18823448

Measuring, managing and maximizing performance of mineral processing plants

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

Bascur, O.A.; Kennedy, J.P.

1995-12-31

The implementation of continuous quality improvement is the confluence of Total Quality Management, People Empowerment, Performance Indicators and Information Engineering. The supporting information technologies allow a mineral processor to narrow the gap between management business objectives and the process control level. One of the most important contributors is the user friendliness and flexibility of the personal computer in a client/server environment. This synergistic combination when used for real time performance monitoring translates into production cost savings, improved communications and enhanced decision support. Other savings come from reduced time to collect data and perform tedious calculations, act quickly with fresh newmore » data, generate and validate data to be used by others. This paper presents an integrated view of plant management. The selection of the proper tools for continuous quality improvement are described. The process of selecting critical performance monitoring indices for improved plant performance are discussed. The importance of a well balanced technological improvement, personnel empowerment, total quality management and organizational assets are stressed.« less

Image recording requirements for earth observation applications in the next decade

NASA Technical Reports Server (NTRS)

Peavey, B.; Sos, J. Y.

1975-01-01

Future requirements for satellite-borne image recording systems are examined from the standpoints of system performance, system operation, product type, and product quality. Emphasis is on total system design while keeping in mind that the image recorder or scanner is the most crucial element which will affect the end product quality more than any other element within the system. Consideration of total system design and implementation for sustained operational usage must encompass the requirements for flexibility of input data and recording speed, pixel density, aspect ratio, and format size. To produce this type of system requires solution of challenging problems in interfacing the data source with the recorder, maintaining synchronization between the data source and the recorder, and maintaining a consistent level of quality. Film products of better quality than is currently achieved in a routine manner are needed. A 0.1 pixel geometric accuracy and 0.0001 d.u. radiometric accuracy on standard (240 mm) size format should be accepted as a goal to be reached in the near future.

Implementing Total Quality Management in the Department of Defense

DTIC Science & Technology

1991-01-01

America and the DOD. So far, the business schools of American colleges and universities are lagging behind industry in teaching TQM philosophy and...methods. We in DOD have no control over that, but we do have control over our schoolhouses! If the business schools will not teach TQM, then we can. DOD

Process Improvement Teams: A TQM Strategy for Improving Community College Systems.

ERIC Educational Resources Information Center

Needham, Robbie Lee; And Others

The three principle elements of Total Quality Management (TQM) are a focus on customers; an attitude of continuous improvement of a system; and the involvement of everyone within an organization. At Delaware County Community College (DCCC) in Media, Pennsylvania, the first phase of implementing TQM focused on educating top management for the…

78 FR 16785 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Cleveland-Akron-Lorain and...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-19

... mobile source emissions for criteria pollutants and/or their precursors to address pollution from cars, trucks and other on-road vehicles. These mobile source SIP budgets are the portions of the total...(c) of the CAA, transportation plans, Transportation Improvement Programs (TIPs), and transportation...

The TQM "Walk the Talk" Classroom Pilot Program.

ERIC Educational Resources Information Center

Leigh, David

The "Walk the Talk" classroom model was developed at Temple Junior College, in Texas, to help teachers include the principles of total quality management (TQM) in the classroom. This report presents results from a pilot project in which 29 teachers implemented the model. Following a brief summary, key elements of the model and the pilot…

Implementing Total Quality Management at El Camino College.

ERIC Educational Resources Information Center

Gonzales, Frank S.

The California Community Colleges are in the midst of a reform process initiated by Assembly Bill 1725. A major goal of the bill is to fund colleges' staff development efforts. In an effort to transform the campus organizational culture from one of predominant competitiveness to collaboration, El Camino College (ECC) in Torrance, California,…

TQM in Higher Education: What Does the Literature Say?

ERIC Educational Resources Information Center

Hertzler, Elizabeth

The implementation of Total Quality Management (TQM) in an organization implies a fundamental change in the way that organization functions. Therefore an examination of the adoption of the TQM philosophy necessitates a review of the most significant and latest literature on change theory and on the impact of organizational culture on change, as…

The Elyria Schools First: An Initiative To Unleash a Community's Potential Empowering Children To Learn.

ERIC Educational Resources Information Center

Elyria City Board of Education, OH.

Total Quality Management (TQM) is a process and strategy designed to improve an organization's effectiveness and efficiency. The Elyria Schools, named as Ohio's model urban school district in 1991, uses TQM to implement updated strategic goals through a process emphasizing teamwork, best knowledge, prevention, and commitment to continuous…

Attaining Visual Literacy Using Simplified Graphics in Industry.

ERIC Educational Resources Information Center

Burton, Terry

In the current milieu of ISO 9000 certification, just-in-time engineering (JIT), demand flow technology (DFT), and total quality management (TQM), industry is attempting to implement available technology for the creation, control, and delivery of documentation. In most cases, their efforts are in need of outside resources to analyze, develop,…

Making Total Quality Management + Just-in-Time Manufacturing Work.

ERIC Educational Resources Information Center

Waldrop, Phillip S.; Scott, Thomas E.

2000-01-01

In one case study, teamwork was implemented in mainstream production; in a second, teamwork was applied to an ad hoc project. The cases show that process technologies and management strategies such as just-in-time are not enough; selection of the appropriate mix of individuals with complementary traits is crucial. (SK)

76 FR 22817 - Approval and Promulgation of Air Quality Implementation Plans; South Carolina; Update to...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-04-25

... Manufacturing'' 5. ``Section VI--Hot Mix Asphalt Manufacturing'' 6. ``Section VII--Metal Refining;'' [[Page... Industries 1. ``Section III--Kraft Pulp and Paper Manufacturing Plants'' 2. ``Section VI--Hot Mix Asphalt... Manufacturing'' 3. ``Section XI--Total Reduced Sulfur Emissions of Kraft Pulp Mills;'' viii. Regulation 62.5...

Total quality management: It works for aerospace information services

NASA Technical Reports Server (NTRS)

Erwin, James; Eberline, Carl; Colquitt, Wanda

1993-01-01

Today we are in the midst of information and 'total quality' revolutions. At the NASA STI Program's Center for AeroSpace Information (CASI), we are focused on using continuous improvements techniques to enrich today's services and products and to ensure that tomorrow's technology supports the TQM-based improvement of future STI program products and services. The Continuous Improvements Program at CASI is the foundation for Total Quality Management in products and services. The focus is customer-driven; its goal, to identify processes and procedures that can be improved and new technologies that can be integrated with the processes to gain efficiencies, provide effectiveness, and promote customer satisfaction. This Program seeks to establish quality through an iterative defect prevention approach that is based on the incorporation of standards and measurements into the processing cycle. Four projects are described that utilize cross-functional, problem-solving teams for identifying requirements and defining tasks and task standards, management participation, attention to critical processes, and measurable long-term goals. The implementation of these projects provides the customer with measurably improved access to information that is provided through several channels: the NASA STI Database, document requests for microfiche and hardcopy, and the Centralized Help Desk.

An Overview of Total Quality Management (TQM) practice in Construction Sector

NASA Astrophysics Data System (ADS)

Likita, A. J.; Zainun, N. Y.; Rahman, I. Abdul; Awal, A. S. M. Abdul; Alias, A. R.; Rahman, M. Q. Abdul; Ghazali, F. E. Mohamed

2018-04-01

In construction sector TQM can be termed as a philosophy which guides construction professionals on the proper execution of construction projects in terms of quality. The aim of this paper is to discuss on quality management practice in construction sector. This paper evaluated five previous researches and the findings were discussed to find a conclusion of TQM practise in construction sector. The study found that TQM had been successfully practice in construction sector at Saudi Arabia, India, US and South Africa. Application of Artificial Neural Network (ANN) help to improve the implementation of TQM in construction sector. In conclusion, quality management practices will give better control of processes in construction sector.

Forecasting models for flow and total dissolved solids in Karoun river-Iran

NASA Astrophysics Data System (ADS)

Salmani, Mohammad Hassan; Salmani Jajaei, Efat

2016-04-01

Water quality is one of the most important factors contributing to a healthy life. From the water quality management point of view, TDS (total dissolved solids) is the most important factor and many water developing plans have been implemented in recognition of this factor. However, these plans have not been perfect and very successful in overcoming the poor water quality problem, so there are a good volume of related studies in the literature. We study TDS and the water flow of the Karoun river in southwest Iran. We collected the necessary time series data from the Harmaleh station located in the river. We present two Univariate Seasonal Autoregressive Integrated Movement Average (ARIMA) models to forecast TDS and water flow in this river. Then, we build up a Transfer Function (TF) model to formulate the TDS as a function of water flow volume. A performance comparison between the Seasonal ARIMA and the TF models are presented.

Total Quality Management Guide. A Two Volume Guide for Defense Organizations. Volume 1. Key Features of the DoD Implementation

DTIC Science & Technology

1990-02-15

XIALTM DoD 5000.51-G A * FINAL DRAFT 2/15/90 si- N ~LUM I -KY FEATRES OFTHE Do IMLEENAON TOTAL L/ De~rrn QUADefens FOREWORD Government and industry...away with all government inspectors. Rather. government oversight will change from te large scale product inspection and specifying the -how to...in class" - Set the course for the future, and - Provide a baseline for measuring progress. Benchmarking is a continuous process of comparing an

Improvement in Total Joint Replacement Quality Metrics: Year One Versus Year Three of the Bundled Payments for Care Improvement Initiative.

PubMed

Dundon, John M; Bosco, Joseph; Slover, James; Yu, Stephen; Sayeed, Yousuf; Iorio, Richard

2016-12-07

In January 2013, a large, tertiary, urban academic medical center began participation in the Bundled Payments for Care Improvement (BPCI) initiative for total joint arthroplasty, a program implemented by the Centers for Medicare & Medicaid Services (CMS) in 2011. Medicare Severity-Diagnosis Related Groups (MS-DRGs) 469 and 470 were included. We participated in BPCI Model 2, by which an episode of care includes the inpatient and all post-acute care costs through 90 days following discharge. The goal for this initiative is to improve patient care and quality through a patient-centered approach with increased care coordination supported through payment innovation. Length of stay (LOS), readmissions, discharge disposition, and cost per episode of care were analyzed for year 3 compared with year 1 of the initiative. Multiple programs were implemented after the first year to improve performance metrics: a surgeon-directed preoperative risk-factor optimization program, enhanced care coordination and home services, a change in venous thromboembolic disease (VTED) prophylaxis to a risk-stratified protocol, infection-prevention measures, a continued emphasis on discharge to home rather than to an inpatient facility, and a quality-dependent gain-sharing program among surgeons. There were 721 Medicare primary total joint arthroplasty patients in year 1 and 785 in year 3; their data were compared. The average hospital LOS decreased from 3.58 to 2.96 days. The rate of discharge to an inpatient facility decreased from 44% to 28%. The 30-day all-cause readmission rate decreased from 7% to 5%; the 60-day all-cause readmission rate decreased from 11% to 6%; and the 90-day all-cause readmission rate decreased from 13% to 8%. The average 90-day cost per episode decreased by 20%. Mid-term results from the implementation of Medicare BPCI Model 2 for primary total joint arthroplasty demonstrated decreased LOS, decreased discharges to inpatient facilities, decreased readmissions, and decreased cost of the episode of care in year 3 compared with year 1, resulting in increased value to all stakeholders involved in this initiative and suggesting that continued improvement over initial gains is possible.

Safety, reliability, maintainability and quality provisions for the Space Shuttle program

NASA Technical Reports Server (NTRS)

1990-01-01

This publication establishes common safety, reliability, maintainability and quality provisions for the Space Shuttle Program. NASA Centers shall use this publication both as the basis for negotiating safety, reliability, maintainability and quality requirements with Shuttle Program contractors and as the guideline for conduct of program safety, reliability, maintainability and quality activities at the Centers. Centers shall assure that applicable provisions of the publication are imposed in lower tier contracts. Centers shall give due regard to other Space Shuttle Program planning in order to provide an integrated total Space Shuttle Program activity. In the implementation of safety, reliability, maintainability and quality activities, consideration shall be given to hardware complexity, supplier experience, state of hardware development, unit cost, and hardware use. The approach and methods for contractor implementation shall be described in the contractors safety, reliability, maintainability and quality plans. This publication incorporates provisions of NASA documents: NHB 1700.1 'NASA Safety Manual, Vol. 1'; NHB 5300.4(IA), 'Reliability Program Provisions for Aeronautical and Space System Contractors'; and NHB 5300.4(1B), 'Quality Program Provisions for Aeronautical and Space System Contractors'. It has been tailored from the above documents based on experience in other programs. It is intended that this publication be reviewed and revised, as appropriate, to reflect new experience and to assure continuing viability.

Changes in groundwater quality in a conduit-flow-dominated karst aquifer, following BMP implementation

USGS Publications Warehouse

Currens, J.C.

2002-01-01

Water quality in the Pleasant Grove Spring karst groundwater basin, Logan County, Kentucky, was monitored to determine the effectiveness of best management practices (BMPs) in protecting karst aquifers. Ninety-two percent of the 4,069-ha (10,054-acre) watershed is used for agriculture. Water-quality monitoring began in October 1992 and ended in November 1998. By the fall of 1995 approximately 72% of the watershed was enrolled in BMPs sponsored by the US Department of Agriculture Water Quality Incentive Program (WQIP). Pre-BMP nitrate-nitrogen concentration averaged 4.65 mg/1. The median total suspended solids concentration was 127 mg/1. The median triazine concentration measured by immunosorbent assay was 1.44 ??tg/l. Median bacteria counts were 418 colonies per 100 ml (col/100 ml) for fecal coliform and 540 col/100 ml for fecal streptococci. Post-BMP, the average nitrate-nitrogen concentration was 4.74 mg/1. The median total suspended solids concentration was 47.8 mg/1. The median triazine concentration for the post-BMP period was 1.48 ??g/1. The median fecal coliform count increased to 432 col/100 ml after BMP implementation, but the median fecal streptococci count decreased to 441 col/100 ml. The pre- and post-BMP water quality was statistically evaluated by comparing the annual mass flux, annual descriptive statistics, and population of analyses for the two periods. Nitrate-nitrogen concentration was unchanged. Increases in atrazine-equivalent flux and triazine geometric averages were not statistically significant. Total suspended solids concentration decreased slightly, whereas orthophosphate concentration increased slightly. Fecal streptococci counts were reduced. The BMPs were only partially successful because the types available and the rules for participation resulted in less effective BMPs being chosen. Future BMP programs in karst areas should emphasize buffer strips around sinkholes, excluding livestock from streams and karst windows, and withdrawing land from production.

Evaluation of Nonpoint-Source Contamination, Wisconsin: Selected Topics for Water Year 1995

USGS Publications Warehouse

Owens, D.W.; Corsi, Steven R.; Rappold, K.F.

1997-01-01

The objective of the watershed-management evaluation monitoring program in Wisconsin is to evaluate the effectiveness of best-management practices (BMP's) for controlling nonpoint-source contamination in eight rural and four urban watersheds. This report, the fourth in an annual series of reports, presents a summary of the data collected for the program by the U.S. Geological Survey and the results of several detailed analyses of the data. To complement assessments of water quality, a land-use and BMP inventory is ongoing for 12 evaluation monitoring projects to track nonpoint sources of contamination in each watershed and to document implementation of BMP's that were designed to cause changes in the water quality of streams. Each year, updated information is gathered, mapped, and stored in a geographic-information-system data base. Summaries of land-use, BMP implementation, and water-quality data collected during water years 1989-95 are presented. Storm loads, snowmelt-period loads, and annual loads of suspended sediment and total phosphorus are summarized for eight rural sites. Storm-load data for suspended solids, total phosphorus, total recoverable lead, copper, zinc, and cadmium are summarized for four urban sites. Quality-assurance and quality-control (QA/QC) samples were collected at the eight rural sites to evaluate inorganic sample contamination and at one urban site to evaluate sample-collection and filtration techniques for polycyclic aromatic hydrocarbons (PAR's). Some suspended solids and fecal coliform contamination was detected at the rural sites. Corrective actions will be taken to address this contamination. Evaluation of PAR sample-collection techniques did not uncover any deficiencies, but the small amount of data collected was not sufficient to draw any definite conclusions. Evaluation of PAR filtration techniques indicate that water-sample filtration with O.7-um glass-fiber filters in an aluminum filter unit does not result in significant loss of PAR.

Process and implementation of participatory ergonomic interventions: a systematic review.

PubMed

van Eerd, Dwayne; Cole, Donald; Irvin, Emma; Mahood, Quenby; Keown, Kiera; Theberge, Nancy; Village, Judy; St Vincent, Marie; Cullen, Kim

2010-10-01

Participatory ergonomic (PE) interventions may vary in implementation. A systematic review was done to determine the evidence regarding context, barriers and facilitators to the implementation of participatory ergonomic interventions in workplaces. In total, 17 electronic databases were searched. Data on PE process and implementation were extracted from documents meeting content and quality criteria and synthesised. The search yielded 2151 references. Of these, 190 documents were relevant and 52 met content and quality criteria. Different ergonomic teams were described in the documents as were the type, duration and content of ergonomic training. PE interventions tended to focus on physical and work process changes and report positive impacts. Resources, programme support, ergonomic training, organisational training and communication were the most often noted facilitators or barriers. Successful PE interventions require the right people to be involved, appropriate ergonomic training and clear responsibilities. Addressing key facilitators and barriers such as programme support, resources, and communication is paramount. STATEMENT OF RELEVANCE: A recent systematic review has suggested that PE has some effect on reducing symptoms, lost days of work and claims. Systematic reviews of effectiveness provide practitioners with the desire to implement but do not provide clear information about how. This article reviews the literature on process and implementation of PE.

Research on the Relationship between Water Diversion and Water Quality of Xuanwu Lake, China.

PubMed

Song, Weiwei; Xu, Qing; Fu, Xingqian; Zhang, Peng; Pang, Yong; Song, Dahao

2018-06-14

Water diversion is often used to improve water quality to reach the standard of China in the short term. However, this large amount of water diversion can not only improve the water quality, but also lead to a decline in the water quality (total phosphorus, total nitrogen) of Xuanwu Lake. Through theoretical analysis, the relationship between water quality and water diversion is established. We also found that the multiplication of the pollutant degradation coefficient ( K ) and the water residence time ( T ) is a constant ( N ), K⋅T=N. The water quality changed better at first, with the increase of inflow discharge, and then became worse, and the optimal water quality inflow discharge is 180,000 m³/day. By constructing two-dimensional hydrodynamic and water quality models, the optimal diversion water plan is calculated. Through model calculations, it can be seen that reducing the inflow discharge makes the water residence time longer (15.3 days changed to 23.8 days). Thereby, increasing the degradation of pollutants, and thus improving water quality. Compared with other wind directions, the southwest wind makes the water quality of Xuanwu Lake the most uniform. The concentration of water quality first became smaller and then became larger, as the wind speed increased, and eventually became constant. Implementing these results for water quality improvement in small and medium lakes will significantly reduce the cost of water diversion.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients

PubMed Central

Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

2016-01-01

Background The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. Methods All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. Results From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p<0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period. Conclusion Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management. PMID:28031727

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.

PubMed

Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

2016-01-01

The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p <0.05). Among 49 anonymized hospitals, our clinic stayed on first rank in terms of lowest maximum pain and patient satisfaction over the period. Results were already acceptable at the beginning of benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.

Improvement in resource utilization after development of a clinical pathway for patients with pressure ulcers.

PubMed

Dzwierzynski, W W; Spitz, K; Hartz, A; Guse, C; Larson, D L

1998-11-01

Clinical pathways are interdisciplinary patient care plans intended to reduce variance and improve quality of care while lowering health care cost. This study was undertaken to determine whether the development of a clinical pathway for care of patients with pressure ulcers can indeed decrease health care costs while preserving quality of care. A clinical pathway for surgical reconstruction of pressure ulcers was developed by standardizing the current practices of our plastic surgeon group. The pathway provided direction in optimal scheduling of physician interventions along with nursing, physical and occupational therapies, and spinal cord rehabilitation interventions. It covered all potential elements of patient care, including laboratory, radiology, dietary services, intravenous fluids, and use of specialty beds. It defined patient outcomes and outlined discharge planning. Pathways were distributed throughout all services caring for patients with pressure ulcers. Patient charts and billing data were reviewed for the 16-month periods before and after initiation of the pathway. No other significant changes in treatment occurred during this time frame. Ninety-seven patient charts were examined (54 before pathway and 43 after pathway implementation). Parameters evaluated included length of stay and total charges (including bed use, medications, laboratory tests, and radiology). Patient readmission rate was also examined. A significant reduction in patient length of stay and total charges was achieved after implementation of the clinical pathway. Reduction was seen not only for patients treated with flaps by plastic surgery but also for patients with pressure ulcers who were not specifically targeted such as those from other services. The readmission rate decreased slightly, although not significantly, after the pathway inception. Total cost saving was almost $11,000 per patient (23 percent). In conclusion, implementation of a clinical pathway, because it standardizes care and reduces variations and duplication of care, can reduce health care cost without impairing quality of care in the treatment of decubitus ulcer patients.

Meaning and barriers to quality care service provision in Child and Adolescent Mental Health Services: Qualitative study of stakeholder perspectives.

PubMed

Svirydzenka, Nadzeya; Ronzoni, Pablo; Dogra, Nisha

2017-02-20

Defining quality in health presents many challenges. The Institute of Medicine (IOM) defined quality clinical care as care that is equitable, timely, safe, efficient, effective and patient centred. However, it is not clear how different stakeholders within a child and adolescent mental health service (CAMHS) understand and/or apply this framework. This project aims to identify key stakeholders" understanding of the meaning of quality in the context of CAMHS. The study sample comprised of three groups: (i) patients and carers, (ii) CAMHS clinical staff, and (iii) commissioners (Total N = 24). Semi-structured interviews were used to collect data and thematic analysis was applied to explore participant's views on the meaning and measurement of quality and how these might reflect the IOM indicators and their relevance in CAMHS. An initial barrier to implementing quality care in CAMHS was the difficulty and limited agreement in defining the meaning of quality care, its measurement and implementation for all participants. Clinical staff defined quality as personal values, a set of practical rules, or clinical discharge rates; while patients suggested being more involved in the decision-making process. Commissioners, while supportive of adequate safeguarding and patient satisfaction procedures, did not explicitly link their view on quality to commissioning guidelines. Identifying practical barriers to implementing quality care was easier for all interviewees and common themes included: lack of meaningful measures, recourses, accountability, and training. All interviewees considered the IOM six markers as comprehensive and relevant to CAMHS. No respondent individually or within one stakeholder group identified more than a few of the indicators or barriers of a quality CAMHS service. However, the composite responses of the respondents enable us to develop a more complete picture of how to improve quality care in practice and guide future research in the area.

Bottom-up implementation of disease-management programmes: results of a multisite comparison.

PubMed

Lemmens, K M M; Nieboer, A P; Rutten-Van Mölken, M P M H; van Schayck, C P; Spreeuwenberg, C; Asin, J D; Huijsman, R

2011-01-01

To evaluate the implementation of three regional disease-management programmes on chronic obstructive pulmonary disease (COPD) based on bottlenecks experienced in professional practice. The authors performed a multisite comparison of three Dutch regional disease-management programmes combining patient-related, professional-directed and organisational interventions. Process (Assessing Chronic Illness Care survey) and outcome (disease specific quality of life (clinical COPD questionnaire (CCQ); chronic respiratory questionnaire (CRQ)), Medical Research Council dyspnoea and patients' experiences) data were collected for 370 COPD patients and their care providers. Bottlenecks in region A were mostly related to patient involvement, in region B to organisational issues and in region C to both. Selected interventions related to identified bottlenecks were implemented in all programmes, except for patient-related interventions in programme A. Within programmes, significant improvements were found on dyspnoea and patients' experiences with practice nurses. Outcomes on quality of life differed between programmes: programme A did not show any significant improvements; programme B did show any significant improvements on CCQ total (p<0.001), functional (p=0.011) and symptom (p<0.001), CRQ fatigue (p<0.001) and emotional scales (p<0.001); in programme C, CCQ symptom (p<0.001) improved significantly, whereas CCQ mental score (p<0.001) deteriorated significantly. Regression analyses showed that programmes with better implementation of selected interventions resulted in relatively larger improvements in quality of life (CCQ). Bottom-up implementation of COPD disease-management programmes is a feasible approach, which in multiple settings leads to significant improvements in outcomes of care. Programmes with a better fit between implemented interventions and bottlenecks showed more positive changes in outcomes.

Food safety and nutritional quality for the prevention of non communicable diseases: the Nutrient, hazard Analysis and Critical Control Point process (NACCP).

PubMed

Di Renzo, Laura; Colica, Carmen; Carraro, Alberto; Cenci Goga, Beniamino; Marsella, Luigi Tonino; Botta, Roberto; Colombo, Maria Laura; Gratteri, Santo; Chang, Ting Fa Margherita; Droli, Maurizio; Sarlo, Francesca; De Lorenzo, Antonino

2015-04-23

The important role of food and nutrition in public health is being increasingly recognized as crucial for its potential impact on health-related quality of life and the economy, both at the societal and individual levels. The prevalence of non-communicable diseases calls for a reformulation of our view of food. The Hazard Analysis and Critical Control Point (HACCP) system, first implemented in the EU with the Directive 43/93/CEE, later replaced by Regulation CE 178/2002 and Regulation CE 852/2004, is the internationally agreed approach for food safety control. Our aim is to develop a new procedure for the assessment of the Nutrient, hazard Analysis and Critical Control Point (NACCP) process, for total quality management (TMQ), and optimize nutritional levels. NACCP was based on four general principles: i) guarantee of health maintenance; ii) evaluate and assure the nutritional quality of food and TMQ; iii) give correct information to the consumers; iv) ensure an ethical profit. There are three stages for the application of the NACCP process: 1) application of NACCP for quality principles; 2) application of NACCP for health principals; 3) implementation of the NACCP process. The actions are: 1) identification of nutritional markers, which must remain intact throughout the food supply chain; 2) identification of critical control points which must monitored in order to minimize the likelihood of a reduction in quality; 3) establishment of critical limits to maintain adequate levels of nutrient; 4) establishment, and implementation of effective monitoring procedures of critical control points; 5) establishment of corrective actions; 6) identification of metabolic biomarkers; 7) evaluation of the effects of food intake, through the application of specific clinical trials; 8) establishment of procedures for consumer information; 9) implementation of the Health claim Regulation EU 1924/2006; 10) starting a training program. We calculate the risk assessment as follows: Risk (R) = probability (P) × damage (D). The NACCP process considers the entire food supply chain "from farm to consumer"; in each point of the chain it is necessary implement a tight monitoring in order to guarantee optimal nutritional quality.

"I sleep better at night:" How peer review of radiation treatment plans indirectly improves quality of care across radiation treatment programs.

PubMed

Brundage, Michael D; Hart, Margaret; O'Donnell, Jennifer; Reddeman, Lindsay; Gutierrez, Eric; Foxcroft, Sophie; Warde, Padraig

Peer review of radiation oncology treatment plans is increasingly recognized as an important component of quality assurance in radiation treatment planning and delivery. Peer review of treatment plans can directly improve the quality of those plans and can also have indirect effects on radiation treatment programs. We undertook a systematic, qualitative approach to describing the indirect benefits of peer review, factors that were seen to facilitate or act as barriers to the implementation of peer review, and strategies to address these barriers across a provincial jurisdiction of radiation oncology programs (ROPs). Semistructured qualitative interviews were held with radiation oncology department heads and radiation therapy managers (or delegates) in all 14 ROPs in Ontario, Canada. We used a theoretically guided phenomenological qualitative approach to design and analyze the interview content. Themes were recorded by 2 independent reviewers, and any discordance was resolved by consensus. A total of 28 interviews were completed with 32 interviewees. Twenty-two unique themes addressed perceived benefits of peer review, relating to either peer review structure (n = 3), process (n = 9), or outcome (n = 10). Of these 22 themes, 19 related to indirect benefits to ROPs. In addition, 18 themes related to factors that facilitated peer review activities and 30 themes related to key barriers to implementing peer review were identified. Findings were consistent with, and enhanced the understanding of, previous survey-based assessments of the benefits and challenges of implementing peer review programs. Although challenges and concerns regarding the implementation of peer review were evident, the indirect benefits to radiation programs are numerous, far outweigh the implementation challenges, and strongly complement the direct individual-patient benefits that result from peer review quality assurance of radiation treatment plans. Copyright © 2016. Published by Elsevier Inc.

Improving handoff communication from hospital to home: the development, implementation and evaluation of a personalized patient discharge letter.

PubMed

Buurman, Bianca M; Verhaegh, Kim J; Smeulers, Marian; Vermeulen, Hester; Geerlings, Suzanne E; Smorenburg, Susanne; de Rooij, Sophia E

2016-06-01

To develop, implement and evaluate a personalized patient discharge letter (PPDL) to improve the quality of handoff communication from hospital to home. From the end of 2006-09 we conducted a quality improvement project; consisting of a before-after evaluation design, and a process evaluation. Four general internal medicine wards, in a 1024-bed teaching hospital in Amsterdam, the Netherlands. All consecutive patients of 18 years and older, admitted for at least 48 h. A PPDL, a plain language handoff communication tool provided to the patient at hospital discharge. Verbal and written information provision at discharge, feasibility of integrating the PPDL into daily practice, pass rates of PPDLs provided at discharge. A total of 141 patients participated in the before-after evaluation study. The results from the first phase of quality improvement showed that providing patient with a PPDL increased the number of patients receiving verbal and written information at discharge. Patient satisfaction with the PPDL was 7.3. The level of implementation was low (30%). In the second phase, the level of implementation improved because of incorporating the PPDL into the electronic patient record (EPR) and professional education. An average of 57% of the discharged patients received the PPDL upon discharge. The number of discharge conversations also increased. Patients and professionals rated the PPDL positively. Key success factors for implementation were: education of interns, residents and staff, standardization of the content of the PPDL, integrating the PPDL into the electronic medical record and hospital-wide policy. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

[Changes observed in three quality indicators after the implementation of improvement strategies in the respiratory intensive care unit].

PubMed

Álvarez Maldonado, Pablo; Cueto Robledo, Guillermo; Cicero Sabido, Raúl

2015-04-01

To compare the results of quality monitoring after the implementation of improvement strategies in the respiratory intensive care unit (RICU). A prospective, comparative, longitudinal and interventional study was carried out. The RICU of Hospital General de México (Mexico). All patients admitted to the RICU from March 2012 to March 2013. An evidence-based bundle of interventions was implemented in order to reduce the ratios of three quality indicators: non-planned extubation (NPE), reintubation, and ventilator-associated pneumonia (VAP). NPE, reintubation and VAP ratios. A total of 232 patients were admitted, with a mean age of 49.5±17.8years; 119 (50.5%) were woman. The mean Simplified Acute Physiology Score (SAPS-3) was 49.8±17, and the mean Sequential Organ Failure Assessment (SOFA) score was 5.3±4.1. The mortality rate in the RICU was 38.7%. The standardized mortality ratio was 1.50 (95%CI: 1.20-1.84). An improved ratio was observed for reintubation and NPE indicators compared to the ratios of the previous 2011 cohort: 1.6% vs. 7% (P=.02) and 8.1 vs. 17 episodes per 1000 days of mechanical ventilation (P=.04), respectively. A worsened VAP ratio was observed: 18.4 vs. 15.1 episodes per 1000 days of mechanical ventilation (P=.5). Quality improvement is feasible with the identification of areas of opportunity and the implementation of strategies. Nevertheless, the implementation of a bundle of preventive measures in itself does not guarantee improvements. Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

Feasibility study of an Integrated Program for Aerospace-vehicle Design (IPAD) system. Volume 6: Implementation schedule, development costs, operational costs, benefit assessment, impact on company organization, spin-off assessment, phase 1, tasks 3 to 8

NASA Technical Reports Server (NTRS)

Garrocq, C. A.; Hurley, M. J.; Dublin, M.

1973-01-01

A baseline implementation plan, including alternative implementation approaches for critical software elements and variants to the plan, was developed. The basic philosophy was aimed at: (1) a progressive release of capability for three major computing systems, (2) an end product that was a working tool, (3) giving participation to industry, government agencies, and universities, and (4) emphasizing the development of critical elements of the IPAD framework software. The results of these tasks indicate an IPAD first release capability 45 months after go-ahead, a five year total implementation schedule, and a total developmental cost of 2027 man-months and 1074 computer hours. Several areas of operational cost increases were identified mainly due to the impact of additional equipment needed and additional computer overhead. The benefits of an IPAD system were related mainly to potential savings in engineering man-hours, reduction of design-cycle calendar time, and indirect upgrading of product quality and performance.

Effectiveness of Reablement: A Systematic Review.

PubMed

Tessier, Annie; Beaulieu, Marie-Dominique; Mcginn, Carrie Anna; Latulippe, Renée

2016-05-01

The ageing of the population and the increasing need for long-term care services are global issues. Some countries have adapted homecare programs by introducing an intervention called reablement, which is aimed at optimizing independence. The effectiveness of reablement, as well as its different service models, was examined. A systematic literature review was conducted using MEDLINE, CINAHL, PsycINFO and EBM Reviews to search from 2001 to 2014. Core characteristics and facilitators of reablement implementation were identified from international experiences. Ten studies comprising a total of 14,742 participants (including four randomized trials, most of excellent or good quality) showed a positive impact of reablement, especially on health-related quality of life and service utilization. The implementation of reablement was studied in three regions, and all observed a reduction in healthcare service utilization. Considering its effectiveness and positive impact observed in several countries, the implementation of reablement is a promising avenue to be pursued by policy makers. Copyright © 2016 Longwoods Publishing.

The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes.

PubMed

Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P

2014-05-22

This study aimed to (1) evaluate the effectiveness of implementing transition programmes in improving the quality of chronic care delivery and (2) identify the predictive role of (changes in) team climate on the quality of chronic care delivery over time. This longitudinal study was undertaken with professionals working in hospitals and rehabilitation units that participated in the transition programme 'On Your Own Feet Ahead!' in the Netherlands. A total of 145/180 respondents (80.6%) filled in the questionnaire at the beginning of the programme (T1), and 101/173 respondents (58.4%) did so 1 year later at the end of the programme (T2). A total of 90 (52%) respondents filled in the questionnaire at both time points. Two-tailed, paired t tests were used to investigate improvements over time and multilevel analyses to investigate the predictive role of (changes in) team climate on the quality of chronic care delivery. Transition programme. Quality of chronic care delivery measured with the Assessment of Chronic Illness Care Short version (ACIC-S). The overall ACIC-S score at T1 was 5.90, indicating basic or intermediate support for chronic care delivery. The mean ACIC-S score at T2 significantly improved to 6.70, indicating advanced support for chronic care. After adjusting for the quality of chronic care delivery at T1 and significant respondents' characteristics, multilevel regression analyses showed that team climate at T1 (p<0.01) and changes in team climate (p<0.001) predicted the quality of chronic care delivery at T2. The implementation of transition programmes requires a supportive and stimulating team climate to enhance the quality of chronic care delivery to chronically ill adolescents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Spatiotemporal classification of environmental monitoring data in the Yeongsan River basin, Korea, using self-organizing maps.

PubMed

Jin, Y-H; Kawamura, A; Park, S-C; Nakagawa, N; Amaguchi, H; Olsson, J

2011-10-01

Environmental monitoring data for planning, implementing and evaluating the Total Maximum Daily Loads (TMDL) management system have been measured at about 8-day intervals in a number of rivers in Korea since 2004. In the present study, water quality parameters such as Suspended Solids (SS), Biochemical Oxygen Demand (BOD), Dissolved Oxygen (DO), Total Nitrogen (TN), and Total Phosphorus (TP) and the corresponding runoff were collected from six stations in the Yeongsan River basin for six years and transformed into monthly mean values. With the primary objective to understand spatiotemporal characteristics of the data, a methodologically systematic application of a Self-Organizing Map (SOM) was made. The SOM application classified the environmental monitoring data into nine clusters showing exclusively distinguishable patterns. Data frequency at each station on a monthly basis identified the spatiotemporal distribution for the first time in the study area. Consequently, the SOM application provided useful information that the sub-basin containing a metropolitan city is associated with deteriorating water quality and should be monitored and managed carefully during spring and summer for water quality improvement in the river basin.

Implementing evidence-based continuous quality improvement strategies in an urban Aboriginal Community Controlled Health Service in South East Queensland: a best practice implementation pilot.

PubMed

Hogg, Sandra; Roe, Yvette; Mills, Richard

2017-01-01

The Institute for Urban Indigenous Health believes that continuous quality improvement (CQI) contributes to the delivery of high-quality care, thereby improving health outcomes for Aboriginal and Torres Strait Islander people. The opening of a new health service in 2015 provided an opportunity to implement best practice CQI strategies and apply them to a regional influenza vaccination campaign. The aim of this project was to implement an evidence-based CQI process within one Aboriginal Community Controlled Health Service in South East Queensland and use staff engagement as a measure of success. A CQI tool was selected from the Joanna Briggs Institute Practical Application of Clinical Evidence System (PACES) to be implemented in the study site. The study site was a newly established Aboriginal and Torres Strait Islander Community Controlled Health Service located in the northern suburbs of Brisbane. This project used the evidence-based information collected in PACES to develop a set of questions related to known variables resulting in proven CQI uptake. A pre implementation clinical audit, education and self-directed learning, using the Plan Do Study Act framework, included a total of seven staff and was conducted in April 2015. A post implementation audit was conducted in July 2015. There were a total of 11 pre- and post-survey respondents which included representation from most of the clinical team and medical administration. The results of the pre implementation audit identified a number of possible areas to improve engagement with the CQI process including staff training and support, understanding CQI and its impacts on individual work areas, understanding clinical data extraction, clinical indicator benchmarking, strong internal leadership and having an external data extractor. There were improvements to all audit criteria in the post-survey, for example, knowledge regarding the importance of CQI activity, attendance at education and training sessions on CQI, active involvement with CQI activity and a multidisciplinary team approach to problem solving within the CQI process. The study found that the implementation of regular, formally organized CQI strategies does have an immediate impact on clinical practice, in this case, by increasing staff awareness regarding the uptake of influenza vaccination against regional targets. The Plan Do Study Act cycle is an efficient tool to record and monitor the change and to guide discussions. For the CQI process to be effective, continued education and training on data interpretation is pivotal to improve staff confidence to engage in regular data discussions, and this should be incorporated into all future CQI sessions.

Runoff and water-quality characteristics of three Discovery Farms in North Dakota, 2008–16

USGS Publications Warehouse

Galloway, Joel M.; Nustad, Rochelle A.

2017-12-21

Agricultural producers in North Dakota are aware of concerns about degrading water quality, and many of the producers are interested in implementing conservation practices to reduce the export of nutrients from their farms. Producers often implement conservation practices without knowledge of the water quality of the runoff from their farm or if conservation practices they may implement have any effect on water quality. In response to this lack of information, the U.S. Geological Survey, in cooperation with North Dakota State University Extension Service and in coordination with an advisory group consisting of State agencies, agricultural producers, and commodity groups, implemented a monitoring study as part of a Discovery Farms program in North Dakota in 2007. Three data-collection sites were established at each of three farms near Underwood, Embden, and Dazey, North Dakota. The purpose of this report is to describe runoff and water-quality characteristics using data collected at the three Discovery Farms during 2008–16. Runoff and water-quality data were used to help describe the implications of agricultural conservation practices on runoff and water-quality patterns.Runoff characteristics of monitoring sites at the three farms were determined by measuring flow volume and precipitation. Runoff at the Underwood farm monitoring sites generally was controlled by precipitation in the area, antecedent soil moisture conditions, and, after 2012, possibly by the diversion ditch constructed by the producer. Most of the annual runoff was in March and April each year during spring snowmelt. Runoff characteristics at the Embden farm are complex because of the mix of surface runoff and flow through two separate drainage tile systems. Annual flow volumes for the drainage tiles sites (sites E2 and E3) were several orders of magnitude greater than measured at the surface water site E1. Site E1 generally only had runoff briefly in March and April during spring snowmelt and during only a few large rain events throughout 2009–16. Flow was somewhat continuous at sites E2 and E3 throughout the year during years of increased precipitation, such as in 2010 and 2011. At Dazey farm, annual flow volumes at the most downstream site D3 for 2010–15 ranged from 88 acre-feet (2012) to 12,060 acre-feet (2010). The largest monthly runoff volumes at D1 (most upstream site; combination of data from site D1a [original site] and site D1b [relocated site]) and D3 were in March and April during spring snowmelt runoff and rain events.At Underwood farm, total ammonia and total phosphorus had the highest concentrations at the most upstream site (U1) and decreased sequentially at sites U2 and U3 downstream. Total ammonia and total phosphorus concentrations at the sites for Underwood farm also generally were higher than measured at sites for the Dazey and Embden farms. At Embden farm, nitrate plus nitrite concentrations were lowest at site E1 (surface-water site) and highest at sites E2 and E3 (drainage tile sites). Nitrate plus nitrite concentrations at sites E2 and E3 also were the highest among all the sites at all three farms. Median total nitrate plus nitrite concentrations for sites E1, E2, and E3 were 0.22, 13, and 10 milligrams per liter as nitrogen, respectively. Nutrient concentrations generally were greater at site D1 (most upstream site) compared to site D3 (most downstream site) at Dazey farm. Higher concentrations at site D1, which is farther upstream and closer to potential sources of nutrients, compared to lower concentrations at site D3, which is farther downstream and receives more runoff, indicates that dilution may be the reason concentrations decrease downstream.Annual loads for chloride at all three Underwood sites were the greatest in 2011 and the least in 2012, which coincided with years of the greatest and least annual flow volume, respectively. Total ammonia had a similar pattern at the three sites. Nitrate plus nitrite loads displayed a different pattern than chloride and total ammonia, indicating possible different sources. Chloride, total ammonia, total phosphorus, and suspended sediment were transported past site U1 mostly in March and the least from July through October. Monthly nitrate plus nitrite loads had a different pattern than the other constituents, indicating other possible sources such as fertilizer application in the surrounding cropland.Annual loads for Embden farm were considerably greater at sites E2 and E3 compared to site E1. Annual yields for all constituents also were substantially greater at sites E2 and E3 compared to site E1, mainly because of a combination of higher flow volumes and small contributing drainage areas at sites E2 and E3 compared to site E1.The greatest annual loads at Dazey farm site D3 for chloride, nitrate plus nitrite, and suspended sediment were in 2010 and 2011, and zero loads were estimated for 2012 because no flow was measured at the site. Mean monthly loads generally were greatest for most constituents in March and April at sites D1 and D3 except for suspended sediment that had the greatest monthly loads in May.To mitigate runoff and water-quality effects of their operations, the producers implemented various agricultural conservation practices before and during the Discovery Farms monitoring. Even though it was difficult to quantify the effects of the agricultural conservation practices implemented at the farms, the data collected from the Discovery Farms program provided a better understanding of some of the variables that affect runoff and water quality.

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals

PubMed Central

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-01-01

Background The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. Methods A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Results Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. Conclusion QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size – the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals. PMID:16987416

How Schools Can Effectively Plan to Meet the Goal of Improving Student Learning

ERIC Educational Resources Information Center

Grumdahl, Constance Rae

2010-01-01

Purpose. The purpose of the study was to identify the impact on achievement when schools implement a continuous improvement model using Total Quality Management (TQM) principles aligned to strategic planning and the culture of the school. Data collection and analysis. The study combined qualitative and quantitative methods and was conducted in two…

78 FR 54835 - Air Quality Implementation Plan; Alabama; Attainment Plan for the Troy Area 2008 Lead...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-06

... input options commensurate with the Regulatory Modeling Guidance. Perform current and post control.... Table 2--Post-Control Modeling Results \\4\\ Sanders lead facility Max 3-mth Background Total Year maximum...\\ (Facility MET data). The post-control analysis resulted in a predicted impact of 0.15 [mu]g/m\\3\\ (NWS MET...

Development of Game-Like Simulations for Procedural Knowledge in Healthcare Education

ERIC Educational Resources Information Center

Torrente, Javier; Borro-Escribano, Blanca; Freire, Manuel; del Blanco, Ángel; Marchiori, Eugenio J.; Martinez-Ortiz, Iván; Moreno-Ger, Pablo; Fernández-Manjón, Baltasar

2014-01-01

We present EGDA, an educational game development approach focused on the teaching of procedural knowledge using a cost-effective approach. EGDA proposes four tasks: analysis, design, implementation, and quality assurance that are subdivided in a total of 12 subtasks. One of the benefits of EGDA is that anyone can apply it to develop a game since…

The Difficulty in Implementing TQM in Higher Education Instruction: The Duality of Instructor/Student Roles

ERIC Educational Resources Information Center

Meirovich, Gavriel; Romar, Edward J.

2006-01-01

Purpose: The applicability of total quality management (TQM) to higher education instruction is controversial. The purpose of this paper is to help clarify the application of TQM to higher education instruction by identifying and analyzing the dual roles played by both students and instructors. The authors also offer an improvement to the…

77 FR 3681 - Approval and Promulgation of Air Quality Implementation Plans; Minnesota; Regional Haze

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-25

... approach in the BART Guidelines in making a BART determination for a fossil fuel-fired EGU with total... ammonia (NH 3 ), and volatile organic compound (VOCs). Fine particle precursors react in the atmosphere to... standards, low sulfur fuel, and non-road mobile source control programs. The fourth step is to determine...

OC35 - Child Friendly Healthcare Initiative, implementation project in a paediatric department in Greece.

PubMed

Boutopoulou, Barbara; Clarke, Andrew; Christothanopoulou, Ioanna; Douros, Konstantinos; Tsirouda, Maria; Papaevangelou, Vasiliki

2016-05-09

Theme: Accreditation and quality improvement. Child Friendly Healthcare Initiative (CFHI) aims to improve quality of experience and health care given to children and families by improving realisation of children's rights and reducing unnecessary fear, anxiety and suffering during and because of health care. To present results of preliminary CFH assessment. Implementation was initiated in a paediatric department of a University Hospital in Athens, Greece, consisting of a 37-bed ward, Outpatient Clinic and Emergency Department. For the preliminary assessment of the CFHI tool No1, which is for parents-caregiverschildren and health workers, this was translated into Greek. 112 parents-caregivers and six children were interviewed by an independent interviewer. In total, 24 health workers - 5 paediatricians, 11 residents and 8 nurses - responded to the CFHI tool No 1. Issues highlighted were mostly about CFH Standard 3 and Standard 7. Suggestions for improvement in all Standards were suggested. Preliminary assessment revealed the quality of care needs improvement. The next step is the training health workers, planning and making improvements.

Comparison of Measured to Predicted Estimations of Nonpoint Source Contaminants Using Conservation Practices in an Agriculturally-Dominated Watershed in Northeast Arkansas, USA.

PubMed

Frasher, Sarah K; Woodruff, Tracy M; Bouldin, Jennifer L

2016-06-01

In efforts to reduce nonpoint source runoff and improve water quality, Best Management Practices (BMPs) were implemented in the Outlet Larkin Creek Watershed. Farmers need to make scientifically informed decisions concerning BMPs addressing contaminants from agricultural fields. The BMP Tool was developed from previous studies to estimate BMP effectiveness at reducing nonpoint source contaminants. The purpose of this study was to compare the measured percent reduction of dissolved phosphorus (DP) and total suspended solids to the reported percent reductions from the BMP Tool for validation. Similarities were measured between the BMP Tool and the measured water quality parameters. Construction of a sedimentation pond resulted in 74 %-76 % reduction in DP as compared to 80 % as predicted with the BMP Tool. However, further research is needed to validate the tool for additional water quality parameters. The BMP Tool is recommended for future BMP implementation as a useful predictor for farmers.

Medicare program; FY 2014 hospice wage index and payment rate update; hospice quality reporting requirements; and updates on payment reform. final rule.

PubMed

2013-08-07

This final rule updates the hospice payment rates and the wage index for fiscal year (FY) 2014, and continues the phase out of the wage index budget neutrality adjustment factor (BNAF). Including the FY 2014 15 percent BNAF reduction, the total 5 year cumulative BNAF reduction in FY 2014 will be 70 percent. The BNAF phase-out will continue with successive 15 percent reductions in FY 2015 and FY 2016. This final rule also clarifies how hospices are to report diagnoses on hospice claims, and provides updates to the public on hospice payment reform. Additionally, this final rule changes the requirements for the hospice quality reporting program by discontinuing currently reported measures and implementing a Hospice Item Set with seven National Quality Forum (NFQ) endorsed measures beginning July 1, 2014, as proposed. Finally, this final rule will implement the hospice Experience of Care Survey on January 1, 2015, as proposed.

British standard (BS) 5750--quality assurance?

PubMed

Pratt, D J

1995-04-01

BS5750 is the British Standard on "Quality Systems". Its equivalent in European Standards is EN29000 and in the International Standards Organisation ISO9000. This paper points out that these standards lay down formalised procedures and require documentation but do not ipso facto lead to quality assurance. The author points to the Japanese post-war industrial success as being an example of Total Quality Management within the framework provided by the philosophy of Dr. W. Edwards Deming (1988 and 1993). This philosophy on the management of "systems" to provide high quality products and services is briefly outlined. The author argues that improvement in prosthetic and orthotic services will not be reached through implementation of BS5750 but rather through radical rethinking and the adoption and application of the Deming philosophy.

Quality management systems for your in vitro fertilization clinic's laboratory: Why bother?

PubMed

Olofsson, Jan I; Banker, Manish R; Sjoblom, Late Peter

2013-01-01

Several countries have in recent years introduced prescribed requirements for treatment and monitoring of outcomes, as well as a licensing or accreditation requirement for in vitro fertilization (IVF) clinics and their laboratories. It is commonplace for Assisted Reproductive Technology (ART) laboratories to be required to have a quality control system. However, more effective Total Quality Management systems are now being implemented by an increasing number of ART clinics. In India, it is now a requirement to have a quality management system in order to be accredited and to help meet customer demand for improved delivery of ART services. This review contains the proceedings a quality management session at the Indian Fertility Experts Meet (IFEM) 2010 and focuses on the creation of a patient-oriented best-in-class IVF laboratory.

Quality management systems for your in vitro fertilization clinic's laboratory: Why bother?

PubMed Central

Olofsson, Jan I; Banker, Manish R; Sjoblom, Late Peter

2013-01-01

Several countries have in recent years introduced prescribed requirements for treatment and monitoring of outcomes, as well as a licensing or accreditation requirement for in vitro fertilization (IVF) clinics and their laboratories. It is commonplace for Assisted Reproductive Technology (ART) laboratories to be required to have a quality control system. However, more effective Total Quality Management systems are now being implemented by an increasing number of ART clinics. In India, it is now a requirement to have a quality management system in order to be accredited and to help meet customer demand for improved delivery of ART services. This review contains the proceedings a quality management session at the Indian Fertility Experts Meet (IFEM) 2010 and focuses on the creation of a patient-oriented best-in-class IVF laboratory. PMID:23869142

Applying STOPP Guidelines in Primary Care Through Electronic Medical Record Decision Support: Randomized Control Trial Highlighting the Importance of Data Quality.

PubMed

Price, Morgan; Davies, Iryna; Rusk, Raymond; Lesperance, Mary; Weber, Jens

2017-06-15

Potentially Inappropriate Prescriptions (PIPs) are a common cause of morbidity, particularly in the elderly. We sought to understand how the Screening Tool of Older People's Prescriptions (STOPP) prescribing criteria, implemented in a routinely used primary care Electronic Medical Record (EMR), could impact PIP rates in community (non-academic) primary care practices. We conducted a mixed-method, pragmatic, cluster, randomized control trial in research naïve primary care practices. Phase 1: In the randomized controlled trial, 40 fully automated STOPP rules were implemented as EMR alerts during a 16-week intervention period. The control group did not receive the 40 STOPP rules (but received other alerts). Participants were recruited through the OSCAR EMR user group mailing list and in person at user group meetings. Results were assessed by querying EMR data PIPs. EMR data quality probes were included. Phase 2: physicians were invited to participate in 1-hour semi-structured interviews to discuss the results. In the EMR, 40 STOPP rules were successfully implemented. Phase 1: A total of 28 physicians from 8 practices were recruited (16 in intervention and 12 in control groups). The calculated PIP rate was 2.6% (138/5308) (control) and 4.11% (768/18,668) (intervention) at baseline. No change in PIPs was observed through the intervention (P=.80). Data quality probes generally showed low use of problem list and medication list. Phase 2: A total of 5 physicians participated. All the participants felt that they were aware of the alerts but commented on workflow and presentation challenges. The calculated PIP rate was markedly less than the expected rate found in literature (2.6% and 4.0% vs 20% in literature). Data quality probes highlighted issues related to completeness of data in areas of the EMR used for PIP reporting and by the decision support such as problem and medication lists. Users also highlighted areas for better integration of STOPP guidelines with prescribing workflows. Many of the STOPP criteria can be implemented in EMRs using simple logic. However, data quality in EMRs continues to be a challenge and was a limiting step in the effectiveness of the decision support in this study. This is important as decision makers continue to fund implementation and adoption of EMRs with the expectation of the use of advanced tools (such as decision support) without ongoing review of data quality and improvement. Clinicaltrials.gov NCT02130895; https://clinicaltrials.gov/ct2/show/NCT02130895 (Archived by WebCite at http://www.webcitation.org/6qyFigSYT). ©Morgan Price, Iryna Davies, Raymond Rusk, Mary Lesperance, Jens Weber. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 15.06.2017.

Development and Implementation of an Inpatient Otolaryngology Consultation Service at an Academic Medical Center.

PubMed

Huddle, Matthew G; London, Nyall R; Stewart, C Matthew

2018-02-01

To design and implement a formal otolaryngology inpatient consultation service that improves satisfaction of consulting services, increases educational opportunities, improves the quality of patient care, and ensures sustainability after implementation. This was a retrospective cohort study in a large academic medical center encompassing all inpatient otolaryngology service consultations from July 2005 to June 2014. Staged interventions included adding fellow coverage (July 2007 onward), intermittent hospitalist coverage (July 2010 onward), and a physician assistant (October 2011 onward). Billing data were collected for incidences of new patient and subsequent consultation charges. The 2-year preimplementation period (July 2005-June 2007) was compared with the postimplementation periods, divided into 2-year blocks (July 2007-June 2013). Outcome measures of patient encounters and work relative value units were compared between pre- and postimplementation blocks. Total encounters increased from 321 preimplementation to 1211, 1347, and 1073 in postimplementation groups ( P < 0.001). Total work relative value units increased from 515 preimplementation to 2090, 1934, and 1273 in postimplementation groups ( P < 0.001). A formal inpatient consultation service was designed with supervisory oversight by non-Accreditation Council for Graduate Medical Education fellows and then expanded to include intermittent hospitalist management, followed by the addition of a dedicated physician assistant. These additions have led to the formation of a sustainable consultation service that supports the mission of high-quality care and service to consulting teams.

[Implementation of the EndoCert system for certification of arthroplasty centers. Experiences from the pilot phase].

PubMed

Haas, H; Mittelmeier, W

2014-06-01

EndoCert is an initiative of the Deutschen Gesellschaft für Orthopädie und Orthopädische Chirurgie (DGOOC, German Society for Orthopedics and Orthopedic Surgery) which has been available since October 2012 and is the first system worldwide for certification of specialized arthroplasty centers. Before implementation of this certification concept two sequential pilot phases were carried out with representative treatment institutions. The results from these pilot clinics are presented with respect to quality improvement effects. Early effects on the quality of treatment have been achieved by rectification of nonconformities determined in the audit with respect to structural and process quality. A total of 172 nonconformities found in the 23 participating pilot clinics could be rectified. Long-term effects on the quality of results will in future be analyzed in cooperation with the German endoprosthesis register (EPRD) and by accompanying evaluations. A close feedback of the collated experiences and results to the certification committee, which is responsible for the procedure together with the DGOOC, allows continuous further development of the system EndoCert represents a substantial step towards a nationwide safety and improvement of the quality in arthroplasty treatment within the preoperative, perioperative and postoperative framework and can in future represent a decisive tool together with the EPRD in quality management.

Phase quality map based on local multi-unwrapped results for two-dimensional phase unwrapping.

PubMed

Zhong, Heping; Tang, Jinsong; Zhang, Sen

2015-02-01

The efficiency of a phase unwrapping algorithm and the reliability of the corresponding unwrapped result are two key problems in reconstructing the digital elevation model of a scene from its interferometric synthetic aperture radar (InSAR) or interferometric synthetic aperture sonar (InSAS) data. In this paper, a new phase quality map is designed and implemented in a graphic processing unit (GPU) environment, which greatly accelerates the unwrapping process of the quality-guided algorithm and enhances the correctness of the unwrapped result. In a local wrapped phase window, the center point is selected as the reference point, and then two unwrapped results are computed by integrating in two different simple ways. After the two local unwrapped results are computed, the total difference of the two unwrapped results is regarded as the phase quality value of the center point. In order to accelerate the computing process of the new proposed quality map, we have implemented it in a GPU environment. The wrapped phase data are first uploaded to the memory of a device, and then the kernel function is called in the device to compute the phase quality in parallel by blocks of threads. Unwrapping tests performed on the simulated and real InSAS data confirm the accuracy and efficiency of the proposed method.

How Implementation of TQM and the Development of a Process Improvement Model, Within a Forward Support Battalion, Can Improve Preparation of the Material Condition Status Report (DA Form 2406)

DTIC Science & Technology

1990-12-01

studies for the continuing education of managers new to the TQM approach , for informing vendors of their responsibilities under a changed process, and...Department of Defense (DoD) is adopting a management approach known as Total Quality Management (TQM) in an effort to improve quality and productivity...individuals selected be highly knowledgeable about the operations in their shop or unit. The main function of PATs is to collect and summarize process data for

Total Quality Management: Will It Work in the System Program Office?

DTIC Science & Technology

1990-05-01

Quality Management (TQM) is a relatively new philosophy of management which has high-level Department of Defense support and is presently being implemented in the Air Force. In the Air Force Systems Command, weapon system development and acquisition are carried out in System Program Offices (SPOs), staffed with various functionally oriented specialists supplied to the System Program Director by functional ’home offices’ via a matrix management scheme. Can TQM, relying as it does on cross-functional cooperation and on processes which cross functional lines, be

Protecting drinking water: water quality testing and PHAST in South Africa.

PubMed

Breslin, E D

2000-01-01

The paper presents an innovative field-based programme that uses a simple total coliform test and the approach of PHAST (Participatory Hygiene And Sanitation Transformation) to help communities exploring possible water quality problems and actions that can be taken to address them. The Mvula Trust, a South African water and environmental sanitation NGO, has developed the programme. It is currently being tested throughout South Africa. The paper provides two case studies on its implementation in the field, and suggests ways in which the initiative can be improved in the future.

The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service.

PubMed

Laing, G L; Bruce, J L; Aldous, C; Clarke, D L

2014-01-01

The Pietermaritzburg Metropolitan Trauma Service formerly lacked a robust computerised trauma registry. This made surgical audit difficult for the purpose of quality of care improvement and development. We aimed to design, construct and implement a computerised trauma registry within our service. Twelve months following its implementation, we sought to examine and report on the quality of the registry. Formal ethical approval to maintain a computerised trauma registry was obtained prior to undertaking any design and development. Appropriate commercial software was sourced to develop this project. The registry was designed as a flat file. A flat file is a plain text or mixed text and binary file which usually contains one record per line or physical record. Thereafter the registry file was launched onto a secure server. This provided the benefits of access security and automated backups. Registry training was provided to clients by the developer. The exercise of data capture was then integrated into the process of service delivery, taking place at the endpoint of patient care (discharge, transfer or death). Twelve months following its implementation, the compliance rates of data entry were measured. The developer of this project managed to design, construct and implement an electronic trauma registry into the service. Twelve months following its implementation the data were extracted and audited to assess the quality. A total of 2640 patient entries were captured onto the registry. Compliance rates were in the order of eighty percent and client satisfaction rates were high. A number of deficits were identified. These included the omission of weekend discharges and underreporting of deaths. The construction and implementation of the computerised trauma registry was the beginning of an endeavour to continue improvements in the quality of care within our service. The registry provided a reliable audit at twelve months post implementation. Deficits and limitations were identified and new strategies have been planned to overcome these problems and integrate the trauma registry into the process of clinical care. Copyright © 2013 Elsevier Ltd. All rights reserved.

78 FR 30770 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards Revision AGENCY... Illinois state implementation plan (SIP) to reflect current National Ambient Air Quality Standards (NAAQS... Implementation Plan at 35 Illinois Administrative Code part 243, which updates National Ambient Air Quality...

Web-based Comparative Patient-reported Outcome Feedback to Support Quality Improvement and Comparative Effectiveness Research in Total Joint Replacement.

PubMed

Zheng, Hua; Li, Wenjun; Harrold, Leslie; Ayers, David C; Franklin, Patricia D

2014-01-01

Patient-reported outcomes (PROs) are rarely included in quality monitoring systems, surgeon comparative feedback reports, or registries. We present the design and implementation of a secure website in a federally funded research program-Function and Outcomes Research for Comparative Effectiveness in Total Joint Replacement (FORCE-TJR)-to return comparative PRO reports to participating surgeons, in addition to including traditional quality measures, in order to monitor and improve quality and health outcomes. The surgeon-specific comparative PRO reports were designed and structured based on user input for content, data elements, integration, and display. Three questions are addressed regarding the knee and hip joint symptom profiles of patients before TJR, as well as outcomes of surgery. The website is organized with a hierarchical structure to display data at national, practice, and individual surgeon levels, and provides a comprehensive site-level executive summary and surgeon-level data reports that can be downloaded. As of September 2014, over 22,000 patients were enrolled from more than 130 surgeons in 22 states. The reporting website was launched in September 2012 and has been updated quarterly for all surgeons to review their site- and individual-specific outcomes data compared to national benchmarks. In this novel system, quarterly comparative surgeon feedback extends beyond traditional measures of complication rates to include PROs of pain relief and functional gain. We anticipate that this enhanced data will facilitate patient-centered quality improvement (QI) and outcomes research from the registry. As the Centers for Medicare & Medicaid Services (CMS) and other insurers consider future implementation of PROs, surgeons will increasingly need comparative data by which to self-monitor their practice outcomes.

A Comprehensive Approach Towards Quality and Safety in Diagnostic Imaging Services: Our Experience at a Rural Tertiary Health Care Center

PubMed Central

Sindhwani, Geetika; Gupta, Monica; Arora, Sweta; Mishra, Arpita; Bhatt, Jayesh; Arora, Manali; Gehani, Anisha

2017-01-01

Introduction An organization’s transformation from imple-mentation of small, distinct Quality Improvement (QI) efforts to complete incorporation of Quality Improvement Program (QIP) into its culture occurs through a process of churning the foundational elements over time. Aim To develop a quality culture across the employees, identify measurable indicators and various tools to impart effective quality care and develop a learning culture for continuous quality improvement in the field of imaging services. Materials and Methods To establish a QIP, the bare minimum requirement started with forming a quality committee. The committee identified the areas of improvement and ascertaining the core principle of Quality Management System (QMS) by having a Quality Manual, Standard Operating Procedures (SOP’s), work-instructions, identification and monitoring of quality indicators and a training calendar. Appropriate tools like formatted daily registers, periodic check lists, run charts etc., were developed to collect the data followed by multiple PDSA cycles (Plan, Do, Study and Act) which helped identify the process bottlenecks, followed by implementing solutions and reanalysis. Results A total of 17 measurable key performance indicators were identified from the four major quality tasks namely Safety, Process Improvement, Professional Outcome and Satisfaction, to assess the performance measures and targets of QIP. Conclusion Diagnostic services should evaluate how to choose the most appropriate method and develop a comprehensive QIP to meet the needs of the staff and the end users, thus, creating a working environment, where people constitutes the intrinsic value in attaining the ultimate quality and safety. PMID:28969238

Implementation fidelity of a computer-assisted intervention for children with speech sound disorders.

PubMed

McCormack, Jane; Baker, Elise; Masso, Sarah; Crowe, Kathryn; McLeod, Sharynne; Wren, Yvonne; Roulstone, Sue

2017-06-01

Implementation fidelity refers to the degree to which an intervention or programme adheres to its original design. This paper examines implementation fidelity in the Sound Start Study, a clustered randomised controlled trial of computer-assisted support for children with speech sound disorders (SSD). Sixty-three children with SSD in 19 early childhood centres received computer-assisted support (Phoneme Factory Sound Sorter [PFSS] - Australian version). Educators facilitated the delivery of PFSS targeting phonological error patterns identified by a speech-language pathologist. Implementation data were gathered via (1) the computer software, which recorded when and how much intervention was completed over 9 weeks; (2) educators' records of practice sessions; and (3) scoring of fidelity (intervention procedure, competence and quality of delivery) from videos of intervention sessions. Less than one-third of children received the prescribed number of days of intervention, while approximately one-half participated in the prescribed number of intervention plays. Computer data differed from educators' data for total number of days and plays in which children participated; the degree of match was lower as data became more specific. Fidelity to intervention procedures, competency and quality of delivery was high. Implementation fidelity may impact intervention outcomes and so needs to be measured in intervention research; however, the way in which it is measured may impact on data.

Effectiveness of implementation strategies for clinical guidelines to community pharmacy: a systematic review.

PubMed

Watkins, Kim; Wood, Helen; Schneider, Carl R; Clifford, Rhonda

2015-10-29

The clinical role of community pharmacists is expanding, as is the use of clinical guidelines in this setting. However, it is unclear which strategies are successful in implementing clinical guidelines and what outcomes can be achieved. The aim of this systematic review is to synthesise the literature on the implementation of clinical guidelines to community pharmacy. The objectives are to describe the implementation strategies used, describe the resulting outcomes and to assess the effectiveness of the strategies. A systematic search was performed in six electronic databases (Medline, EMBASE, CINAHL, Web of Science, Informit, Cochrane Library) for relevant articles. Studies were included if they reported on clinical guidelines implementation strategies in the community pharmacy setting. Two researchers completed the full-search strategy, data abstraction and quality assessments, independently. A third researcher acted as a moderator. Quality assessments were completed with three validated tools. A narrative synthesis was performed to analyse results. A total of 1937 articles were retrieved and the titles and abstracts were screened. Full-text screening was completed for 36 articles resulting in 19 articles (reporting on 22 studies) included for review. Implementation strategies were categorised according to a modified version of the EPOC taxonomy. Educational interventions were the most commonly utilised strategy (n = 20), and computerised decision support systems demonstrated the greatest effect (n = 4). Most studies were multifaceted and used more than one implementation strategy (n = 18). Overall outcomes were moderately positive (n = 17) but focused on process (n = 22) rather than patient (n = 3) or economic outcomes (n = 3). Most studies (n = 20) were rated as being of low methodological quality and having low or very low quality of evidence for outcomes. Studies in this review did not generally have a well thought-out rationale for the choice of implementation strategy. Most utilised educational strategies, but the greatest effect on outcomes was demonstrated using computerised clinical decision support systems. Poor methodology, in the majority of the research, provided insufficient evidence to be conclusive about the best implementation strategies or the benefit of clinical guidelines in this setting. However, the generally positive outcomes across studies and strategies indicate that implementing clinical guidelines to community pharmacy might be beneficial. Improved methodological rigour in future research is required to strengthen the evidence for this hypothesis. PROSPERO 2012: CRD42012003019 .

Measuring Data Quality Through a Source Data Verification Audit in a Clinical Research Setting.

PubMed

Houston, Lauren; Probst, Yasmine; Humphries, Allison

2015-01-01

Health data has long been scrutinised in relation to data quality and integrity problems. Currently, no internationally accepted or "gold standard" method exists measuring data quality and error rates within datasets. We conducted a source data verification (SDV) audit on a prospective clinical trial dataset. An audit plan was applied to conduct 100% manual verification checks on a 10% random sample of participant files. A quality assurance rule was developed, whereby if >5% of data variables were incorrect a second 10% random sample would be extracted from the trial data set. Error was coded: correct, incorrect (valid or invalid), not recorded or not entered. Audit-1 had a total error of 33% and audit-2 36%. The physiological section was the only audit section to have <5% error. Data not recorded to case report forms had the greatest impact on error calculations. A significant association (p=0.00) was found between audit-1 and audit-2 and whether or not data was deemed correct or incorrect. Our study developed a straightforward method to perform a SDV audit. An audit rule was identified and error coding was implemented. Findings demonstrate that monitoring data quality by a SDV audit can identify data quality and integrity issues within clinical research settings allowing quality improvement to be made. The authors suggest this approach be implemented for future research.

Health Information Technology in Healthcare Quality and Patient Safety: Literature Review.

PubMed

Feldman, Sue S; Buchalter, Scott; Hayes, Leslie W

2018-06-04

The area of healthcare quality and patient safety is starting to use health information technology to prevent reportable events, identify them before they become issues, and act on events that are thought to be unavoidable. As healthcare organizations begin to explore the use of health information technology in this realm, it is often unclear where fiscal and human efforts should be focused. The purpose of this study was to provide a foundation for understanding where to focus health information technology fiscal and human resources as well as expectations for the use of health information technology in healthcare quality and patient safety. A literature review was conducted to identify peer-reviewed publications reporting on the actual use of health information technology in healthcare quality and patient safety. Inductive thematic analysis with open coding was used to categorize a total of 41 studies. Three pre-set categories were used: prevention, identification, and action. Three additional categories were formed through coding: challenges, outcomes, and location. This study identifies five main categories across seven study settings. A majority of the studies used health IT for identification and prevention of healthcare quality and patient safety issues. In this realm, alerts, clinical decision support, and customized health IT solutions were most often implemented. Implementation, interface design, and culture were most often noted as challenges. This study provides valuable information as organizations determine where they stand to get the most "bang for their buck" relative to health IT for quality and patient safety. Knowing what implementations are being effectivity used by other organizations helps with fiscal and human resource planning as well as managing expectations relative to cost, scope, and outcomes. The findings from this scan of the literature suggest that having organizational champion leaders that can shepherd implementation, impact culture, and bridge knowledge with developers would be a valuable resource allocation to consider. ©Sue S Feldman, Scott Buchalter, Leslie W. Hayes. Originally published in JMIR Medical Informatics (http://medinform.jmir.org), 04.06.2018.

The Joint Commission Children’s Asthma Care Quality Measures and Asthma Readmissions

PubMed Central

Fassl, Bernhard A.; Nkoy, Flory L.; Stone, Bryan L.; Srivastava, Rajendu; Simon, Tamara D.; Uchida, Derek A.; Koopmeiners, Karmella; Greene, Tom; Cook, Lawrence J.

2012-01-01

BACKGROUND AND OBJECTIVES: The Joint Commission introduced 3 Children’s Asthma Care (CAC 1–3) measures to improve the quality of pediatric inpatient asthma care. Validity of the commission’s measures has not yet been demonstrated. The objectives of this quality improvement study were to examine changes in provider compliance with CAC 1–3 and associated asthma hospitalization outcomes after full implementation of an asthma care process model (CPM). METHODS: The study included children aged 2 to 17 years who were admitted to a tertiary care children’s hospital for acute asthma between January 1, 2005, and December 31, 2010. The study was divided into 3 periods: preimplementation (January 1, 2005–December 31, 2007), implementation (January 1, 2008–March 31, 2009), and postimplementation (April 1, 2009–December 31, 2010) periods. Changes in provider compliance with CAC 1–3 and associated changes in hospitalization outcomes (length of stay, costs, PICU transfer, deaths, and asthma readmissions within 6 months) were measured. Logistic regression was used to control for age, gender, race, insurance type, and time. RESULTS: A total of 1865 children were included. Compliance with quality measures before and after the CPM implementation was as follows: 99% versus 100%, CAC-1; 100% versus 100%, CAC-2; and 0% versus 87%, CAC-3 (P < .01). Increased compliance with CAC-3 was associated with a sustained decrease in readmissions from an average of 17% to 12% (P = .01) postimplementation. No change in other outcomes was observed. CONCLUSIONS: Implementation of the asthma CPM was associated with improved compliance with CAC-3 and with a delayed, yet significant and sustained decrease in hospital asthma readmission rates, validating CAC-3 as a quality measure. Due to high baseline compliance, CAC-1 and CAC-2 are of questionable value as quality measures. PMID:22908110

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery.

PubMed

Childers, Christopher P; Siletz, Anaar E; Singer, Emily S; Faltermeier, Claire; Hu, Q Lina; Ko, Clifford Y; Golladay, Gregory J; Kates, Stephen L; Wick, Elizabeth C; Maggard-Gibbons, Melinda

2018-01-01

Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery-a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/ Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients.

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: a cohort study: trial protocol.

PubMed

Perkins, Gavin D; Davies, Robin P; Quinton, Sarah; Woolley, Sarah; Gao, Fang; Abella, Ben; Stallard, Nigel; Cooke, Matthew W

2011-10-18

Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. ISRCTN56583860.

TQM: A Flavor-of-the-Month Buzzword or Step One to Designing Processes that Deliver Continuous Value to the Customer?

ERIC Educational Resources Information Center

Secor, John R.

Often when total quality management (TQM) does not live up to expectations, that failure is a sign that implementation of TQM was simply fashionable "management hype" or "window dressing" without strong organizational underpinnings. TQM can have staying power when it is backed up by leadership basics of training people…

NHEXAS PHASE I REGION 5 STUDY--QUALITY SYSTEMS AND IMPLEMENTATION PLAN FOR HUMAN EXPOSURE ASSESSMENT STUDY (RTI/5740/02-02QSIP)

EPA Science Inventory

The RTI/EOHSI Consortium scoping studies were designed to be part of the total NHEXAS framework that was developed as a result of a series scientific discussions and workshops conducted by the US EPA from 1992 through 1993. Several scientific issues needed to be addressed to eval...

Total Quality Management Implementing Plan for Human Resource Management

DTIC Science & Technology

1989-04-01

process improvement that will be refined, adjusted, updated, and revised as we move through the TQM initiative. Please contact Ms. Roberta Peters or myself...pay starting salaries -t3e r s r zec c- pa, sc e: of Zer home bLIvout and reimburse moving e,,oenses : :-_:. tv lcatic. 1-c-ease Em<o-ee benefits and

Quality assurance, an administrative means to a managerial end: Part I. A historical overview.

PubMed

Clark, G B

1990-01-01

Quality has become the hallmark of industrial excellence. Many diverse factors have heightened national concern about managing quality control throughout the health-care industry, including laboratory services. Industry-wide focus on quality control has created a need for an administrative program to evaluate its effectiveness. That program is medical quality assurance. Because of national and industry-wide concern, development of quality assurance theory has gained increasing importance in medical accreditation and management circles. Scrutiny of the application of quality assurance has become particularly prominent during accreditation inspections. Implementing quality assurance programs now demands more of already finite resources. The professional laboratory manager should understand how quality assurance has developed in the United States during the past 150 years. The well-informed manager should recognize why the health-care industry only recently began to develop its own expertise in quality assurance. It is also worthwhile to understand how heavily health care has relied on the lessons learned in the non-health-care sector. This three-part series will present information that will help in applying quality assurance more effectively as a management tool in the medical laboratory. This first part outlines the early industrial, socioeconomic, and medicolegal background of quality assurance. Terminology is defined with some distinction made between the terms management and administration. The second part will address current accreditation requirements. Special emphasis will be placed on the practical application of accreditation guidelines, providing a template for quality assurance methods in the medical laboratory. The third part will provide an overview of quality assurance as a total management tool with some suggestions for developing and implementing a quality assurance program.

78 FR 34964 - Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-11

...] Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation Plan... Ambient Air Quality Standards for Ozone: State Implementation Plan Requirements'' which published in the... the 2008 ozone national ambient air quality standards (NAAQS) (the ``2008 ozone NAAQS'') that were...

Does Person-Centered Care Improve Residents' Satisfaction With Nursing Home Quality?

PubMed

Poey, Judith L; Hermer, Linda; Cornelison, Laci; Kaup, Migette L; Drake, Patrick; Stone, Robyn I; Doll, Gayle

2017-11-01

Person-centered care (PCC) is meant to enhance nursing home residents' quality of life (QOL). Including residents' perspectives is critical to determining whether PCC is meeting residents' needs and desires. This study examines whether PCC practices promote satisfaction with QOL and quality of care and services (QOC and QOS) among nursing home residents. A longitudinal, retrospective cohort study using an in-person survey. Three hundred twenty nursing homes in Kansas enrolled or not enrolled in a pay-for-performance program, Promoting Excellent Alternatives in Kansas (PEAK 2.0), to promote PCC in nursing homes. A total of 6214 nursing home residents in 2013-2014 and 5538 residents in 2014-2015, with a Brief Interview for Mental Status score ≥8, participated in face-to-face interviews. Results were aggregated to the nursing home level. My InnerView developed a Resident Satisfaction Survey for Kansas composed of 32 questions divided into QOL, QOC, QOS, and global satisfaction subdomains. After controlling for facility characteristics, satisfaction with overall QOL and QOC was higher in homes that had fully implemented PCC. Although some individual measures in the QOS domain (eg, food) showed greater satisfaction at earlier levels of implementation, high satisfaction was observed primarily in homes that had fully implemented PCC. These findings provide evidence for the effectiveness of PCC implementation on nursing home resident satisfaction. The PEAK 2.0 program may provide replicable methods for nursing homes and states to implement PCC systematically. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Satellite-aided evaluation of population exposure to air pollution

USGS Publications Warehouse

Todd, William J.; George, Anthony J.; Bryant, Nevin A.

1979-01-01

The Clean Air Act Amendments of 1977 set schedules for states to implement regional, spatial assessments of air quality impacts. Accordingly, the U.S. Environmental Protection Agency recently published guidelines for quantifying population exposure to adverse air quality impact by using air quality and population data by census tracts. Our research complements the EPA guidelines in that it demonstrates the ability to determine population exposure to air pollution through computer processing that utilizes Landsat satellite-derived land use information. Three variables-a 1985 estimate of total suspended particulates for 2-km2 grid cells, Landsat-derived residential land cover data for 0.45-ha cells, and population totals for census tracts-were spatially registered and cross-tabulated to produce tabular and map products illustrating relative air quality exposure for residential population by 2-km2 cells. It would cost $20,000 to replicate our analysis for an area similar in size to the 4000-km2 Portland area. Once completed, the spatially fine, computer-compatible air quality and population data are amenable to the timely and efficient generation of population-at-risk tabular and map information on a continuous or periodic basis.

A review of the current state of digital plate reading of cultures in clinical microbiology.

PubMed

Rhoads, Daniel D; Novak, Susan M; Pantanowitz, Liron

2015-01-01

Digital plate reading (DPR) is increasingly being adopted as a means to facilitate the analysis and improve the quality and efficiency within the clinical microbiology laboratory. This review discusses the role of DPR in the context of total laboratory automation and explores some of the platforms currently available or in development for digital image capturing of microbial growth on media. The review focuses on the advantages and challenges of DPR. Peer-reviewed studies describing the utility and quality of these novel DPR systems are largely lacking, and professional guidelines for DPR implementation and quality management are needed. Further development and more widespread adoption of DPR is anticipated.

A review of the current state of digital plate reading of cultures in clinical microbiology

PubMed Central

Rhoads, Daniel D.; Novak, Susan M.; Pantanowitz, Liron

2015-01-01

Digital plate reading (DPR) is increasingly being adopted as a means to facilitate the analysis and improve the quality and efficiency within the clinical microbiology laboratory. This review discusses the role of DPR in the context of total laboratory automation and explores some of the platforms currently available or in development for digital image capturing of microbial growth on media. The review focuses on the advantages and challenges of DPR. Peer-reviewed studies describing the utility and quality of these novel DPR systems are largely lacking, and professional guidelines for DPR implementation and quality management are needed. Further development and more widespread adoption of DPR is anticipated. PMID:26110091

Trends in Water Quality in the Southeastern United States, 1973-2005

USGS Publications Warehouse

Harned, Douglas A.; Staub, Erik L.; Peak, Kelly L.; Tighe, Kirsten M.; Terziotti, Silvia

2009-01-01

As part of the U.S. Geological Survey National Water-Quality Assessment Program, water-quality data for 334 streams in eight States of the Southeastern United States were assessed for trends from 1973 to 2005. Forty-four U.S. Geological Survey sites were examined for trends in pH, specific conductance, and dissolved oxygen, and in concentrations of dissolved solids, suspended sediment, chloride, sodium, sulfate, silica, potassium, dissolved organic carbon, total nitrogen, total ammonia, total ammonia plus organic nitrogen, dissolved nitrite plus nitrate, and total phosphorus. An additional 290 sites from the U.S. Environmental Protection Agency Storage and Retrieval database were tested for trends in total nitrogen and phosphorus concentrations for the 1975-2004 and 1993-2004 periods. The seasonal Kendall test or Tobit regression was used to detect trends. Concentrations of dissolved constituents have increased in the Southeast during the last 30 years. Specific conductance increased at 62 percent and decreased at 3 percent of the sites, and pH increased at 31 percent and decreased at 11 percent of the sites. Decreasing trends in total nitrogen were detected at 49 percent of the sites, and increasing trends were detected at 10 percent of the sites. Ammonia concentrations decreased at 27 percent of the sites and increased at 6 percent of the sites. Nitrite plus nitrate concentrations increased at 29 percent of the sites and decreased at 10 percent of the sites. These results indicate that the changes in stream nitrogen concentrations generally coincided with improved municipal wastewater-treatment methods. Long-term decreasing trends in total phosphorus were detected at 56 percent of the sites, and increasing trends were detected at 8 percent of the sites. Concentrations of phosphorus have decreased over the last 35 years, which coincided with phosphate-detergent bans and improvements in wastewater treatment that were implemented beginning in 1972. Multiple regression analysis indicated a relation between changes in atmospheric inputs and agricultural practices, and changes in water quality. A long-term water-quality and landscape trends-assessment network for the Southeast is needed to assess changes in water quality over time in response to variations in population, agricultural, wastewater, and landscape variables.

Hospitals’ Readiness for Clinical Governance Implementation in Educational Hospitals of Yazd, Iran

PubMed Central

Bahrami, Mohammad Amin; Sabahi, Ali Akbar; Montazeralfaraj, Razieh; Shamsi, Farimah; Ardekani, Samaneh Entezarian

2014-01-01

Background: Clinical governance is a systematic approach to maintaining and improving the quality of patient care. This study aimed to assess some Iranian educational hospitals’ readiness for clinical governance implementation through the organizational climate. Methods: It was a cross-sectional study that used the Clinical Governance Climate Questionnaire (CGCQ) in three educational hospitals in Yazd, a city in central Iran, in 2012. A total of 186 personnel contributed to the study. Data were analyzed using SPSS version 16. Descriptive statistics and the Kruskal-Wallis test were used for data analyses. Results: The mean scores of the clinical governance climate in Shahid Sadoughi, Shahid Rahnemoon and Afshar hospitals were 2.63±0.29, 2.58±0.32, and 2.68±0.29. The mean scores of quality improvement planning and change, quality improvement integration and motivation, clinical risk management and climate of blame and punishment, organizational learning, and training and development (T&D) opportunities for learning in the studied hospitals were 2.21±0.49, 2.80±0.40, 2.76±0.40, 2.91±0.54 and 3.06±0.72, respectively. Conclusion: The results of this study showed that the educational hospitals’ climate should be more supportive for successful implementation of clinical governance. PMID:25763148

Hospitals' readiness for clinical governance implementation in educational hospitals of yazd, iran.

PubMed

Bahrami, Mohammad Amin; Sabahi, Ali Akbar; Montazeralfaraj, Razieh; Shamsi, Farimah; Ardekani, Samaneh Entezarian

2014-01-01

Clinical governance is a systematic approach to maintaining and improving the quality of patient care. This study aimed to assess some Iranian educational hospitals' readiness for clinical governance implementation through the organizational climate. It was a cross-sectional study that used the Clinical Governance Climate Questionnaire (CGCQ) in three educational hospitals in Yazd, a city in central Iran, in 2012. A total of 186 personnel contributed to the study. Data were analyzed using SPSS version 16. Descriptive statistics and the Kruskal-Wallis test were used for data analyses. The mean scores of the clinical governance climate in Shahid Sadoughi, Shahid Rahnemoon and Afshar hospitals were 2.63±0.29, 2.58±0.32, and 2.68±0.29. The mean scores of quality improvement planning and change, quality improvement integration and motivation, clinical risk management and climate of blame and punishment, organizational learning, and training and development (T&D) opportunities for learning in the studied hospitals were 2.21±0.49, 2.80±0.40, 2.76±0.40, 2.91±0.54 and 3.06±0.72, respectively. The results of this study showed that the educational hospitals' climate should be more supportive for successful implementation of clinical governance.

Potential effects of structural controls and street sweeping on stormwater loads to the lower Charles River, Massachusetts

USGS Publications Warehouse

Zarriello, Phillip J.; Breault, Robert F.; Weiskel, Peter K.

2002-01-01

The water quality of the lower Charles River is periodically impaired by combined sewer overflows (CSOs) and non-CSO stormwater runoff. This study examined the potential non-CSO load reductions of suspended solids, fecal coliform bacteria, total phosphorus, and total lead that could reasonably be achieved by implementation of stormwater best management practices, including both structural controls and systematic street sweeping. Structural controls were grouped by major physical or chemical process; these included infiltration-filtration (physical separation), biofiltration-bioretention (biological mechanisms), or detention-retention (physical settling). For each of these categories, upper and lower quartiles, median, and average removal efficiencies were compiled from three national databases of structural control performance. Removal efficiencies obtained indicated a wide range of performance. Removal was generally greatest for infiltration-filtration controls and suspended solids, and least for biofiltration-bioretention controls and fecal coliform bacteria. Street sweeping has received renewed interest as a water-quality control practice because of reported improvements in sweeper technology and the recognition that opportunities for implementing structural controls are limited in highly urbanized areas. The Stormwater Management Model that was developed by the U.S. Geological Survey for the lower Charles River Watershed was modified to simulate the effects of street sweeping in a single-family land-use basin. Constituent buildup and washoff variable values were calibrated to observed annual and storm-event loads. Once calibrated, the street sweeping model was applied to various permutations of four sweeper efficiencies and six sweeping frequencies that ranged from every day to once every 30 days. Reduction of constituent loads to the lower Charles River by the combined hypothetical practices of structural controls and street sweeping was estimated for a range of removal efficiencies because of their inherent variability and uncertainty. This range of efficiencies, with upper and lower estimates, provides reasonable bounds on the load that could be removed by the practices examined. The upper estimated load reduction from combined street sweeping and structural controls, as a percentage of the total non-CSO load entering the lower Charles River downstream of Watertown Dam, was 44 percent for suspended solids, 34 percent for total lead, 14 percent for total phosphorus, and 17 percent for fecal coliform bacteria. The lower estimated load reduction from combined street sweeping and structural controls from non-CSO sources downstream of Watertown Dam, was 14 percent for suspended solids, 11 percent for total lead, 4.9 percent for total phosphorus, and 7.5 percent for fecal coliform bacteria. Load reductions by these combined management practices can be a small as 1.4 percent for total phosphorus to about 4 percent for the other constituents if the total load above Watertown Dam is added to the load from below the dam. Although the reductions in stormwater loads to the lower Charles River from the control practices examined appear to be minor, these practices would likely provide water-quality benefits to portions of the river during those times that they are most impaired-during and immediately after storms. It should also be recognized that only direct measurements of changes in stormwater loads before and after implementation of control practices can provide definitive evidence of the beneficial effects of these practices on water-quality conditions in the lower Charles River.

Robust Decision Making to Support Water Quality Climate Adaptation: a Case Study in the Chesapeake Bay Watershed

NASA Astrophysics Data System (ADS)

Fischbach, J. R.; Lempert, R. J.; Molina-Perez, E.

2017-12-01

The U.S. Environmental Protection Agency (USEPA), together with state and local partners, develops watershed implementation plans designed to meet water quality standards. Climate uncertainty, along with uncertainty about future land use changes or the performance of water quality best management practices (BMPs), may make it difficult for these implementation plans to meet water quality goals. In this effort, we explored how decision making under deep uncertainty (DMDU) methods such as Robust Decision Making (RDM) could help USEPA and its partners develop implementation plans that are more robust to future uncertainty. The study focuses on one part of the Chesapeake Bay watershed, the Patuxent River, which is 2,479 sq km in area, highly urbanized, and has a rapidly growing population. We simulated the contribution of stormwater contaminants from the Patuxent to the overall Total Maximum Daily Load (TMDL) for the Chesapeake Bay under multiple scenarios reflecting climate and other uncertainties. Contaminants considered included nitrogen, phosphorus, and sediment loads. The assessment included a large set of scenario simulations using the USEPA Chesapeake Bay Program's Phase V watershed model. Uncertainties represented in the analysis included 18 downscaled climate projections (based on 6 general circulation models and 3 emissions pathways), 12 land use scenarios with different population projections and development patterns, and alternative assumptions about BMP performance standards and efficiencies associated with different suites of stormwater BMPs. Finally, we developed cost estimates for each of the performance standards and compared cost to TMDL performance as a key tradeoff for future water quality management decisions. In this talk, we describe how this research can help inform climate-related decision support at USEPA's Chesapeake Bay Program, and more generally how RDM and other DMDU methods can support improved water quality management under climate uncertainty.

The costs of accessible quality assured syphilis diagnostics: informing quality systems for rapid syphilis tests in a Tanzanian setting.

PubMed

Sweeney, Sedona; Mosha, Jacklin F; Terris-Prestholt, Fern; Sollis, Kimberly A; Kelly, Helen; Changalucha, John; Peeling, Rosanna W

2014-08-01

To determine the costs of Rapid Syphilis Test (RSTs) as compared with rapid plasma reagin (RPR) when implemented in a Tanzanian setting, and to determine the relative impact of a quality assurance (QA) system on the cost of RST implementation. The incremental costs for RPR and RST screening programmes in existing antenatal care settings in Geita District, Tanzania were collected for 9 months in subsequent years from nine health facilities that varied in size, remoteness and scope of antenatal services. The costs per woman tested and treated were estimated for each facility. A sensitivity analysis was constructed to determine the impact of parameter and model uncertainty. In surveyed facilities, a total of 6362 women were tested with RSTs compared with 224 tested with RPR. The range of unit costs was $1.76-$3.13 per woman screened and $12.88-$32.67 per woman treated. Unit costs for the QA system came to $0.51 per woman tested, of which 50% were attributed to salaries and transport for project personnel. Our results suggest that rapid syphilis diagnostics are very inexpensive in this setting and can overcome some critical barriers to ensuring universal access to syphilis testing and treatment. The additional costs for implementation of a quality system were found to be relatively small, and could be reduced through alterations to the programme design. Given the potential for a quality system to improve quality of diagnosis and care, we recommend that QA activities be incorporated into RST roll-out. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients’ Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda

PubMed Central

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-01-01

This study aimed at analyzing the effect of 5S practice on staff motivation, patients’ waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement. PMID:28299136

Valuing the non-market benefits of estuarine ecosystem services in a river basin context: Testing sensitivity to scope and scale

NASA Astrophysics Data System (ADS)

Pinto, R.; Brouwer, R.; Patrício, J.; Abreu, P.; Marta-Pedroso, C.; Baeta, A.; Franco, J. N.; Domingos, T.; Marques, J. C.

2016-02-01

A large scale contingent valuation survey is conducted among residents in one of the largest river basins in Portugal to estimate the non-market benefits of the ecosystem services associated with implementation of the European Water Framework Directive (WFD). Statistical tests of public willingness to pay's sensitivity to scope and scale are carried out. Decreasing marginal willingness to pay (WTP) is found when asking respondents to value two water quality improvement scenarios (within sample comparison), from current moderate water quality conditions to good and subsequently excellent ecological status. However, insensitivity to scale is found when asking half of the respondents to value water quality improvements in the estuary only and the other half in the whole basin (between sample comparison). Although respondents living outside the river basin value water quality improvements significantly less than respondents inside the basin, no spatial heterogeneity can be detected within the basin between upstream and downstream residents. This finding has important implications for spatial aggregation procedures across the population of beneficiaries living in the river basin to estimate its total economic value based on public WTP for the implementation of the WFD.

The Effect of 5S-Continuous Quality Improvement-Total Quality Management Approach on Staff Motivation, Patients' Waiting Time and Patient Satisfaction with Services at Hospitals in Uganda.

PubMed

Take, Naoki; Byakika, Sarah; Tasei, Hiroshi; Yoshikawa, Toru

2015-03-31

This study aimed at analyzing the effect of 5S practice on staff motivation, patients' waiting time and patient satisfaction with health services at hospitals in Uganda. Double-difference estimates were measured for 13 Regional Referral Hospitals and eight General Hospitals implementing 5S practice separately. The study for Regional Referral Hospitals revealed 5S practice had the effect on staff motivation in terms of commitment to work in the current hospital and waiting time in the dispensary in 10 hospitals implementing 5S, but significant difference was not identified on patient satisfaction. The study for General Hospitals indicated the effect of 5S practice on patient satisfaction as well as waiting time, but staff motivation in two hospitals did not improve. 5S practice enables the hospitals to improve the quality of services in terms of staff motivation, waiting time and patient satisfaction and it takes as least four years in Uganda. The fourth year since the commencement of 5S can be a threshold to move forward to the next step, Continuous Quality Improvement.

Views on the Effects of the Spanish Dependency Law on Caregivers' Quality of Life Using Concept Mapping.

PubMed

Salvador-Piedrafita, María; Malmusi, Davide; Mehdipanah, Roshanak; Rodríguez-Sanz, Maica; Espelt, Albert; Pérez, Cristina; Solf, Elisabeth; Abajo Del Rincón, María; Borrell, Carme

2017-04-01

In 2006 the Spanish Dependency Law established new rights for people in situation of dependency. The impact of the Law could have also affected the quality of life of their carers. This study aims to understand how the Law may have influenced caregivers' quality of life through their own perceptions and those of Primary Health Care professionals, and to compare both perspectives. The study used Concept Mapping, a mixed methods technique. In total, 16 caregivers and 21 professionals participated. Both groups identified a mix of positive and negative effects. Uncertainties and delays in granting benefits were reported. However, several advantages were identified, such as the possibility of sharing the burden of care, thus reducing its physical, mental and social consequences, while at the same time being able to maintain responsibility. Most of the mechanisms identified were common to both caregivers and professionals; the most notable differences were that the latter attached more importance to economic support and less to the negative effects of implementation of the Law. This study reveals positive effects of the Law on caregivers' quality of life and the potential for improvement of some negative aspects in its implementation related with the context of austerity.

Initial Implementation Indicators From a Statewide Rollout of SafeCare Within a Child Welfare System

PubMed Central

Whitaker, Daniel J.; Ryan, Kerry A.; Wild, Robert C.; Self-Brown, Shannon; Lutzker, John R.; Shanley, Jenelle R.; Edwards, Anna M.; McFry, Erin A.; Moseley, Colby N.; Hodges, Amanda E.

2013-01-01

There is a strong movement toward implementation of evidence-based practices (EBP) in child welfare systems. The SafeCare parenting model is one of few parent-training models that addresses child neglect, the most common form of maltreatment. Here, the authors describe initial findings from a statewide effort to implement the EBP, SafeCare®, into a state child welfare system. A total of 50 agencies participated in training, with 295 individuals entering training to implement SafeCare. Analyses were conducted to describe the trainee sample, describe initial training and implementation indicators, and to examine correlates of initial training performance and implementation indicators. The quality of SafeCare uptake during training and implementation was high with trainees performing very well on training quizzes and role-plays, and demonstrating high fidelity when implementing SafeCare in the field (performing over 90% of expected behaviors). However, the quantity of implementation was generally low, with relatively few providers (only about 25%) implementing the model following workshop training. There were no significant predictors of training or implementation performance, once corrections for multiple comparisons were applied. The Discussion focuses on challenges to large-scale system-wide implementation of EBP. PMID:22146860

The measurement of quality of care in the Veterans Health Administration.

PubMed

Halpern, J

1996-03-01

The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the databases.

Impacts of using rainwater tanks on stormwater harvesting and runoff quality.

PubMed

Khastagir, A; Jayasuriya, L N N

2010-01-01

The popularity of rainwater use in Australia depends completely on the individual householder's preference. The quality of reticulated water supplies in major cities of Australia is far superior to water stored in rainwater tanks. However, due to persistent drought and the implementation of stringent water restrictions, cities such as Melbourne have encouraged the use of rainwater harvesting within the property. The benefits of trapping stormwater within a property and using it effectively also reduce polluted runoff excess reaching receiving water. The study reported herein focuses on the effectiveness of rainwater tanks as a potential water sensitive urban design element used to manage stormwater using the MUSIC model. The study shows that the installation of a 3 kL tank reduces hydraulic loading by 75%, Total Suspended Solids by 97%, Total Phosphorous by 90% and Total Nitrogen by 81% if the rainwater stored in the tank is used to meet the indoor demand (toilet flushing and laundry use) as well as the outdoor demand (garden watering).

An assessment of patient sign-outs conducted by University at Buffalo internal medicine residents.

PubMed

Wheat, Deirdre; Co, Christopher; Manochakian, Rami; Rich, Ellen

2012-01-01

Internal medicine residents were surveyed regarding patient sign-outs at shift change. Data were used to design and implement interventions aimed at improving sign-out quality. This quasi-experimental project incorporated the Plan, Do, Study, Act methodology. Residents completed an anonymous electronic survey regarding experiences during sign-outs. Survey questions assessed structure, process, and outcome of sign-outs. Analysis of qualitative and quantitative data was performed; interventions were implemented based on survey findings. A total of 120 surveys (89% response) and 115 surveys (83% response) were completed by residents of 4 postgraduate years in response to the first (2008) and second (2009) survey requests, respectively. Approximately 79% of the respondents to the second survey indicated that postintervention sign-out systems were superior to preintervention systems. Results indicated improvement in specific areas of structure, process, and outcome. Survey-based modifications to existing sign-out systems effected measurable quality improvement in structure, process, and outcome.

Water quality improvement policies: lessons learned from the implementation of Proposition O in Los Angeles, California.

PubMed

Park, Mi-Hyun; Stenstrom, Michael; Pincetl, Stephanie

2009-03-01

This article evaluates the implementation of Proposition O, a stormwater cleanup measure, in Los Angeles, California. The measure was intended to create new funding to help the city comply with the Total Maximum Daily Load requirements under the federal Clean Water Act. Funding water quality objectives through a bond measure was necessary because the city had insufficient revenues to deploy new projects in its budget. The bond initiative required a supermajority vote (two-thirds of the voters), hence the public had to be convinced that such funding both was necessary and would be effective. The bond act language included project solicitation from the public, as well as multiple benefit objectives. Accordingly, nonprofit organizations mobilized to present projects that included creating new parks, using schoolyards for flood control and groundwater recharge, and replacing parking lots with permeable surfaces, among others. Yet few, if any, of these projects were retained for funding, as the city itself also had a list of priorities and higher technical expertise in justifying them as delivering water quality improvements. Our case study of the implementation of Proposition O points to the potentially different priorities for the renovation of urban infrastructure that are held by nonprofit organizations and city agencies and the importance of structuring public processes clearly so that there are no misimpressions about funding and implementation responsibilities that can lead to disillusionment with government, especially under conditions of fiscal constraints.

Water Quality Improvement Policies: Lessons Learned from the Implementation of Proposition O in Los Angeles, California

NASA Astrophysics Data System (ADS)

Park, Mi-Hyun; Stenstrom, Michael; Pincetl, Stephanie

2009-03-01

This article evaluates the implementation of Proposition O, a stormwater cleanup measure, in Los Angeles, California. The measure was intended to create new funding to help the city comply with the Total Maximum Daily Load requirements under the federal Clean Water Act. Funding water quality objectives through a bond measure was necessary because the city had insufficient revenues to deploy new projects in its budget. The bond initiative required a supermajority vote (two-thirds of the voters), hence the public had to be convinced that such funding both was necessary and would be effective. The bond act language included project solicitation from the public, as well as multiple benefit objectives. Accordingly, nonprofit organizations mobilized to present projects that included creating new parks, using schoolyards for flood control and groundwater recharge, and replacing parking lots with permeable surfaces, among others. Yet few, if any, of these projects were retained for funding, as the city itself also had a list of priorities and higher technical expertise in justifying them as delivering water quality improvements. Our case study of the implementation of Proposition O points to the potentially different priorities for the renovation of urban infrastructure that are held by nonprofit organizations and city agencies and the importance of structuring public processes clearly so that there are no misimpressions about funding and implementation responsibilities that can lead to disillusionment with government, especially under conditions of fiscal constraints.

A resident conference for systems-based practice and practice-based learning.

PubMed

Sultana, Carmen J; Baxter, Jason K

2011-02-01

Improving patient safety and quality of care is part of systems-based practice and practice-based learning for residents. We expanded our obstetrics and gynecology department's regularly scheduled morbidity and mortality conferences to teach quality assurance concepts based on patient care on obstetrics and gynecology fourth-year resident rotations. Obstetrics and gynecology fourth-year residents on one of the two rotations each presented and analyzed a systems-based problem they encountered during patient care. They used an online learning module and proposed solutions, many of which were effectively implemented. Over 5 years, case presentations from 33 conferences were available with problems identified in emergency preparedness, coordination of care, scheduling and supervision, communication, medical practice, documentation, and lack of equipment or facilities. Twenty-two of the suggested solutions were partially or totally implemented. Barriers to implementation were identified. In conclusion, a conference presentation by fourth-year residents can identify patient safety problems, aid in their resolution, and suggest changes to patient care while teaching the principles of systems-based practice and practice-based learning.

Advanced musculoskeletal physiotherapists in post arthroplasty review clinics: a state wide implementation program evaluation.

PubMed

Harding, Paula; Burge, Angela; Walter, Kerrie; Shaw, Bridget; Page, Carolyn; Phan, Uyen; Terrill, Desiree; Liew, Susan

2018-03-01

To evaluate outcomes following a state-wide implementation of post arthroplasty review (PAR) clinics for patients following total hip and knee arthroplasty, led by advanced musculoskeletal physiotherapists in collaboration with orthopaedic specialists. A prospective observational study analysed data collected by 10 implementation sites (five metropolitan and five regional/rural centres) between September 2014 and June 2015. The Victorian Innovation and Reform Impact Assessment Framework was used to assess efficiency, effectiveness (access to care, safety and quality, workforce capacity, utilisation of skill sets, patient and workforce satisfaction) and sustainability (stakeholder engagement, succession planning and availability of ongoing funding). 2362 planned occasions of service (OOS) were provided for 2057 patients. Reduced patient wait times from referral to appointment were recorded and no adverse events occurred. Average cost savings across 10 sites was AUD$38 per OOS (Baseline $63, PAR clinic $35), representing a reduced pathway cost of 44%. Average annual predicted total value of increased orthopaedic specialist capacity was $11,950 per PAR clinic (range $6149 to $23,400). The Australian Orthopaedic Association review guidelines were met (8/10 sites, 80%) and patient-reported outcome measures were introduced as routine clinical care. High workforce and patient satisfaction were expressed. Eighteen physiotherapists were trained creating a sustainable workforce. Eight sites secured ongoing funding. The PAR clinics delivered a safe, cost-efficient model of care that improved patient access and quality of care compared to traditional specialist-led workforce models. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery

PubMed Central

Klemm, Alexandria; Li, Linda C.; Jones, C. Allyson

2016-01-01

Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made. PMID:26089040

Video Monitoring a Simulation-Based Quality Improvement Program in Bihar, India.

PubMed

Dyer, Jessica; Spindler, Hilary; Christmas, Amelia; Shah, Malay Bharat; Morgan, Melissa; Cohen, Susanna R; Sterne, Jason; Mahapatra, Tanmay; Walker, Dilys

2018-04-01

Simulation-based training has become an accepted clinical training andragogy in high-resource settings with its use increasing in low-resource settings. Video recordings of simulated scenarios are commonly used by facilitators. Beyond using the videos during debrief sessions, researchers can also analyze the simulation videos to quantify technical and nontechnical skills during simulated scenarios over time. Little is known about the feasibility and use of large-scale systems to video record and analyze simulation and debriefing data for monitoring and evaluation in low-resource settings. This manuscript describes the process of designing and implementing a large-scale video monitoring system. Mentees and Mentors were consented and all simulations and debriefs conducted at 320 Primary Health Centers (PHCs) were video recorded. The system design, number of video recordings, and inter-rater reliability of the coded videos were assessed. The final dataset included a total of 11,278 videos. Overall, a total of 2,124 simulation videos were coded and 183 (12%) were blindly double-coded. For the double-coded sample, the average inter-rater reliability (IRR) scores were 80% for nontechnical skills, and 94% for clinical technical skills. Among 4,450 long debrief videos received, 216 were selected for coding and all were double-coded. Data quality of simulation videos was found to be very good in terms of recorded instances of "unable to see" and "unable to hear" in Phases 1 and 2. This study demonstrates that video monitoring systems can be effectively implemented at scale in resource limited settings. Further, video monitoring systems can play several vital roles within program implementation, including monitoring and evaluation, provision of actionable feedback to program implementers, and assurance of program fidelity.

[Comprehensive implementation of interprofessional quality circles regarding early prevention of childhood disadvantage in Baden Württemberg (Germany)].

PubMed

Siebolds, Marcus; Münzel, Brigitte; Müller, Roland; Häußermann, Sigrun; Paul, Mechthild; Kahl, Cornelia

2016-10-01

The integration of available early interventions and healthcare for families with children by practicing pediatricians has yet to be systematically established. For this reason, the Association of Statutory Health Insurance Physicians of Baden-Wuerttemberg established overarching, accredited, cross-system quality circles that serve to integrate all representatives of the healthcare system as well as child and youth welfare services. These quality circles are led by specially trained moderator tandems consisting of pediatricians and staff members from youth welfare services. The goal was to evaluate the endpoints of the regional implementation of cross-system quality circles for early interventions in the state of Baden-Wuerttemberg as well as the feasibility of establishing long-term training programs for cross-system moderator tandems. This was a noncontrolled, longitudinal study to prepare a yearly evaluation of the quality-circle assessments as well as to gather statistics on the training of the moderator tandems within the Association of Statutory Health Insurance Physicians of Baden-Wuerttemberg. A total of 59 moderator tandems were trained in nine separate training sessions within the project period from 2011 to 2015. Overall, 33 quality circles were founded. In 2015, 566 persons were participating in the respective circles. Over the course of the study between 26 and 33 of the 44 urban and rural districts in the state of Baden-Wuerttemberg had at least one quality circle dedicated to early interventions. Ten further circles are presently in the process of being founded; 29 moderators have yet to commence their activity or have withdrawn from the program. Between 59 and 81 % of the urban and rural districts implemented cross-system quality circles. The training of the moderator tandems proceeded without complications. Because of the dropout quota of the trained moderator tandems, systematic and continual training of new tandems proves to be necessary.

Assessment of quality guidelines implementation using a continuous quality improvement programme.

PubMed

Richards, Nick; Ayala, Juan Antonio; Cesare, Salvatore; Chazot, Charles; Di Benedetto, Attilio; Gassia, Jean-Paul; Merello, Jose-Ignacio; Rentero, Ramon; Scatizzi, Laura; Marcelli, Daniele

2007-01-01

Data from the Dialysis Outcomes and Practice Patterns Study (DOPPS) study suggest that the level of implementation of the European Best Practice Guidelines (EBPG) is at best partial. The main aim of this study is to describe the level of implementation of the EBPG in the European Fresenius Medical Care (FME) clinic network. Data presented in this investigation were gained through the FME database EuCliD (European Clinical Database). Patient data from 4 countries (Great Britain, France, Italy, Spain) were selected from the EuCliD database. The parameters chosen were haemodialysis adequacy, biocompatibility, anaemia control and serum phosphate control, which are surrogate indicators for quality of care. They were compared, by country, between the first quarter (Q1) 2002 and the fourth quarter (Q4) 2005. During Q1 2002 and Q4 2005, respectively, a total of 7,067 and 9,232 patients were treated in FME clinics located in France, Italy, Spain and the UK. This study confirms variations in haemodialysis practices between countries as already described by the DOPPS study. A large proportion of patients in each country achieved the targets recommended by the EBPG in Q4 2005 and this represented a significant improvement over the results achieved in Q1 2002. Differences in practices between countries still exist. The FME CQI programme allows some of these differences to be overcome leading to an improvement in the quality of the treatment delivered. Copyright 2007 S. Karger AG, Basel.

Collaborative model for training and credentialing point-of-care ultrasound: 6-year experience and quality outcomes.

PubMed

Cormack, Carolynne J; Coombs, Peter R; Guskich, Kate E; Blecher, Gabriel E; Goldie, Neil; Ptasznik, Ronnie

2018-06-01

Point-of-care ultrasound (PoCUS) is a rapidly growing area, providing physicians with a valuable diagnostic tool for patient assessment. This paper describes a collaborative model, utilising radiology department ultrasound expertise, to train and credential physicians in PoCUS. A 6-year experience of the implementation and outcomes of the programme established within the emergency departments of a large, multi-campus hospital network are presented. A collaborative model was initially developed and implemented between radiology and emergency departments. Key elements of the programme included hospital executive support, close collaboration with stakeholders, resource allocation, appointment of a sonographer educator, clear scope of practise and robust quality processes. Participation grew from 36 emergency physicians in 2011 to 96 physicians in 2016. A total 11064 scans were logged with the programme in the 6-year period. Routine quality audit of 61.8% (6836/11064) of all scans included 2836 Focussed Assessment by Sonography in Trauma (FAST) and 1422 Abdominal Aortic Aneurysm (AAA) examinations. False-positive or false-negative diagnoses occurred in 3.6% (102/2836) FAST and 1.3% (19/1422) AAA cases. No adverse clinical outcomes were reported to involve programme-compliant scans. A collaborative model to train and credential physicians in PoCUS has been successfully implemented. The programme grew significantly, produced excellent quality outcomes and resolved many issues of potential conflict related to PoCUS. © 2017 The Royal Australian and New Zealand College of Radiologists.

Automated Fall Detection With Quality Improvement “Rewind” to Reduce Falls in Hospital Rooms

PubMed Central

Rantz, Marilyn J.; Banerjee, Tanvi S.; Cattoor, Erin; Scott, Susan D.; Skubic, Marjorie; Popescu, Mihail

2014-01-01

The purpose of this study was to test the implementation of a fall detection and “rewind” privacy-protecting technique using the Microsoft® Kinect™ to not only detect but prevent falls from occurring in hospitalized patients. Kinect sensors were placed in six hospital rooms in a step-down unit and data were continuously logged. Prior to implementation with patients, three researchers performed a total of 18 falls (walking and then falling down or falling from the bed) and 17 non-fall events (crouching down, stooping down to tie shoe laces, and lying on the floor). All falls and non-falls were correctly identified using automated algorithms to process Kinect sensor data. During the first 8 months of data collection, processing methods were perfected to manage data and provide a “rewind” method to view events that led to falls for post-fall quality improvement process analyses. Preliminary data from this feasibility study show that using the Microsoft Kinect sensors provides detection of falls, fall risks, and facilitates quality improvement after falls in real hospital environments unobtrusively, while taking into account patient privacy. PMID:24296567

[Implementation of a patient data management system. Effects on intensive care documentation].

PubMed

Castellanos, I; Ganslandt, T; Prokosch, H U; Schüttler, J; Bürkle, T

2013-11-01

Patient data management systems (PDMS) enable digital documentation on intensive care units (ICU). A commercial PDMS was implemented in a 25-bed ICU replacing paper-based patient charting. The ICU electronic patient record is completely managed inside the PDMS. It compiles data from vital signs monitors, ventilators and further medical devices and facilitates some drug dose and fluid balance calculations as well as data reuse for administrative purposes. Ventilation time and patient severity scoring as well as coding of diagnoses and procedures is supported. Billing data transferred via interface to the central billing system of the hospital. Such benefits should show in measurable parameters, such as documented ventilator time, number of coded diagnoses and procedures and others. These parameters influence reimbursement in the German DRG system. Therefore, measurable changes in cost and reimbursement data of the ICU were expected. A retrospective analysis of documentation quality parameters, cost data and mortality rate of a 25-bed surgical ICU within a German university hospital 3 years before (2004-2006) and 5 years after (2007-2011) PDMS implementation. Selected parameters were documented electronically, consistently and reproducibly for the complete time span of 8 years including those years where no electronic patient recording was available. The following parameters were included: number of cleared DRG, cleared ventilator time, case mix (CM), case mix index (CMI), length of stay, number of coded diagnoses and procedures, detailed overview of a specific procedure code based on daily Apache II and TISS Core 10 scores, mortality, total ICU costs and revenues and partial profits for specific ICU procedures, such as renal replacement therapy and blood products. Systematic shifts were detected over the study period, such as increasing case numbers and decreasing length of stay as well as annual fluctuations in severity of disease seen in the CM and CMI. After PDMS introduction, the total number of coded diagnoses increased but the proportion of DRG relevant diagnoses dropped significantly. The number of procedures increased (not significantly) and the number of procedures per case did not rise significantly. The procedure 8-980 showed a significant increase after PDMS introduction whereas the DRG-relevant proportion of those procedures dropped insignificantly. The number of ventilator-associated DRG cases as well as the total ventilator time increased but not significantly. Costs and revenues increased slightly but profit varied considerably from year to year in the 5 years after system implementation. A small increase was observed per case, per nursing day and per case mix point. Additional revenues for specific ICU procedures increased in the years before and dropped after PDMS implementation. There was an insignificant increase in ICU mortality rate from 7.4 % in the year 2006 (before) to 8.5 % in 2007 (after PDMS implementation). In the following years mortality dropped below the base level. The implementation of the PDMS showed only small effects on documentation of reimbursement-relevant parameters which were too small to set off against the total investment. The method itself, a long-term follow-up of different parameters proved successful and can be adapted by other organizations. The quality of results depends on the availability of long-term parameters in good quality. No significant influence of PDMS on mortality was found.

77 FR 73320 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-10

... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... Implementation Plan (SIP) revision for the South Coast Air Quality Management District (SCAQMD or District... in a August 15, 2012 letter from the South Coast Air Quality Management District regarding specific...

Optimal Design of Air Quality Monitoring Network and its Application in an Oil Refinery Plant: An Approach to Keep Health Status of Workers.

PubMed

ZoroufchiBenis, Khaled; Fatehifar, Esmaeil; Ahmadi, Javad; Rouhi, Alireza

2015-01-01

Industrial air pollution is a growing challenge to humane health, especially in developing countries, where there is no systematic monitoring of air pollution. Given the importance of the availability of valid information on population exposure to air pollutants, it is important to design an optimal Air Quality Monitoring Network (AQMN) for assessing population exposure to air pollution and predicting the magnitude of the health risks to the population. A multi-pollutant method (implemented as a MATLAB program) was explored for configur-ing an AQMN to detect the highest level of pollution around an oil refinery plant. The method ranks potential monitoring sites (grids) according to their ability to represent the ambient concentration. The term of cluster of contiguous grids that exceed a threshold value was used to calculate the Station Dosage. Selection of the best configuration of AQMN was done based on the ratio of a sta-tion's dosage to the total dosage in the network. Six monitoring stations were needed to detect the pollutants concentrations around the study area for estimating the level and distribution of exposure in the population with total network efficiency of about 99%. An analysis of the design procedure showed that wind regimes have greatest effect on the location of monitoring stations. The optimal AQMN enables authorities to implement an effective program of air quality management for protecting human health.

Selection and placement of best management practices used to reduce water quality degradation in Lincoln Lake watershed

NASA Astrophysics Data System (ADS)

Rodriguez, Hector German; Popp, Jennie; Maringanti, Chetan; Chaubey, Indrajeet

2011-01-01

An increased loss of agricultural nutrients is a growing concern for water quality in Arkansas. Several studies have shown that best management practices (BMPs) are effective in controlling water pollution. However, those affected with water quality issues need water management plans that take into consideration BMPs selection, placement, and affordability. This study used a nondominated sorting genetic algorithm (NSGA-II). This multiobjective algorithm selects and locates BMPs that minimize nutrients pollution cost-effectively by providing trade-off curves (optimal fronts) between pollutant reduction and total net cost increase. The usefulness of this optimization framework was evaluated in the Lincoln Lake watershed. The final NSGA-II optimization model generated a number of near-optimal solutions by selecting from 35 BMPs (combinations of pasture management, buffer zones, and poultry litter application practices). Selection and placement of BMPs were analyzed under various cost solutions. The NSGA-II provides multiple solutions that could fit the water management plan for the watershed. For instance, by implementing all the BMP combinations recommended in the lowest-cost solution, total phosphorous (TP) could be reduced by at least 76% while increasing cost by less than 2% in the entire watershed. This value represents an increase in cost of 5.49 ha-1 when compared to the baseline. Implementing all the BMP combinations proposed with the medium- and the highest-cost solutions could decrease TP drastically but will increase cost by 24,282 (7%) and $82,306 (25%), respectively.

Optimal Design of Air Quality Monitoring Network and its Application in an Oil Refinery Plant: An Approach to Keep Health Status of Workers

PubMed Central

ZoroufchiBenis, Khaled; Fatehifar, Esmaeil; Ahmadi, Javad; Rouhi, Alireza

2015-01-01

Background: Industrial air pollution is a growing challenge to humane health, especially in developing countries, where there is no systematic monitoring of air pollution. Given the importance of the availability of valid information on population exposure to air pollutants, it is important to design an optimal Air Quality Monitoring Network (AQMN) for assessing population exposure to air pollution and predicting the magnitude of the health risks to the population. Methods: A multi-pollutant method (implemented as a MATLAB program) was explored for configur­ing an AQMN to detect the highest level of pollution around an oil refinery plant. The method ranks potential monitoring sites (grids) according to their ability to represent the ambient concentration. The term of cluster of contiguous grids that exceed a threshold value was used to calculate the Station Dosage. Selection of the best configuration of AQMN was done based on the ratio of a sta­tion’s dosage to the total dosage in the network. Results: Six monitoring stations were needed to detect the pollutants concentrations around the study area for estimating the level and distribution of exposure in the population with total network efficiency of about 99%. An analysis of the design procedure showed that wind regimes have greatest effect on the location of monitoring stations. Conclusion: The optimal AQMN enables authorities to implement an effective program of air quality management for protecting human health. PMID:26933646

Introducing systematic dispatcher-assisted cardiopulmonary resuscitation (telephone-CPR) in a non-Advanced Medical Priority Dispatch System (AMPDS): implementation process and costs.

PubMed

Dami, Fabrice; Fuchs, Vincent; Praz, Laurent; Vader, John-Paul

2010-07-01

In order to improve the quality of our Emergency Medical Services (EMS), to raise bystander cardiopulmonary resuscitation rates and thereby meet what is becoming a universal standard in terms of quality of emergency services, we decided to implement systematic dispatcher-assisted or telephone-CPR (T-CPR) in our medical dispatch center, a non-Advanced Medical Priority Dispatch System. The aim of this article is to describe the implementation process, costs and results following the introduction of this new "quality" procedure. This was a prospective study. Over an 8-week period, our EMS dispatchers were given new procedures to provide T-CPR. We then collected data on all non-traumatic cardiac arrests within our state (Vaud, Switzerland) for the following 12 months. For each event, the dispatchers had to record in writing the reason they either ruled out cardiac arrest (CA) or did not propose T-CPR in the event they did suspect CA. All emergency call recordings were reviewed by the medical director of the EMS. The analysis of the recordings and the dispatchers' written explanations were then compared. During the 12-month study period, a total of 497 patients (both adults and children) were identified as having a non-traumatic cardiac arrest. Out of this total, 203 cases were excluded and 294 cases were eligible for T-CPR. Out of these eligible cases, dispatchers proposed T-CPR on 202 occasions (or 69% of eligible cases). They also erroneously proposed T-CPR on 17 occasions when a CA was wrongly identified (false positive). This represents 7.8% of all T-CPR. No costs were incurred to implement our study protocol and procedures. This study demonstrates it is possible, using a brief campaign of sensitization but without any specific training, to implement systematic dispatcher-assisted cardiopulmonary resuscitation in a non-Advanced Medical Priority Dispatch System such as our EMS that had no prior experience with systematic T-CPR. The results in terms of T-CPR delivery rate and false positive are similar to those found in previous studies. We found our results satisfying the given short time frame of this study. Our results demonstrate that it is possible to improve the quality of emergency services at moderate or even no additional costs and this should be of interest to all EMS that do not presently benefit from using T-CPR procedures. EMS that currently do not offer T-CPR should consider implementing this technique as soon as possible, and we expect our experience may provide answers to those planning to incorporate T-CPR in their daily practice.

Modeling the efficacy of future BMP implementation to improve water quality in the highly urbanized watersheds of Dominguez Channel and Machado Lake in Los Angeles California

NASA Astrophysics Data System (ADS)

Gallo, E. M.; Hogue, T. S.; Gold, M.; Mika, K.

2016-12-01

Dominguez Channel and Machado Lake watersheds are located in highly urbanized southern Los Angeles County. The 16 mile long channel that runs through the Dominguez Channel watershed (DCW) captures stormwater from a drainage area of 71 square miles and discharges directly into the Los Angeles Harbor. Machado Lake, located within the Machado Lake watershed (MLW) and directly adjacent to DCW, has a surface area of 40 acres and receives stormwater from 25 square miles. The water quality of receiving streams and waterbodies in DCW and MLW are increasingly polluted from stormwater runoff and highly concentrated areas of industrial activities. The main concern of water impairment within DCW includes copper and zinc while MLW is focused on nutrients, Total Nitrogen and Total Phosphorous. The implementation of Low Impact Developments (LIDs) and stormwater Best Management Practices (BMPs) within the watershed aim to mitigate the effects of urbanization by reducing pollutant loads, runoff volume, and storm peak flow. We utilize the EPA System for Urban Stormwater Treatment and Analysis INtegration (SUSTAIN) model in order to assess the impact of BMPs within the DCW and MLW watersheds by forecasting flow regimes and water quality time series data. Six compliance scenarios are simulated in SUSTAIN to assess pollutant load reduction and cost effectiveness. They each utilize a various suite of the five BMPs selected, which include vegetated swales, bioretention cells, dry ponds, infiltration trenches and porous pavement. Preliminary results show that while the six compliance options reduce pollutant loads by at least 73% in DCW, copper and zinc are only 9% and 50% in compliance, respectively, in terms of the wet weather TMDLs. This study further analyzes these results by comparing DCW to other previously modelled watersheds in Los Angeles, including Ballona Creek watershed and the Los Angeles River watershed. Observed water quality sampling from Machado Lake has shown the mean concentrations of nutrients well above the TMDLs. Machado Lake is currently being restored which includes the implementation BMPs. While the DCW is being modeled to determine the best scenarios for future BMP implementation, MLW is modeled to assess the efficacy of current BMPs to meet TMDL compliance.

Assessing the Relationship between Socioeconomic Conditions and Urban Environmental Quality in Accra, Ghana

PubMed Central

Fobil, Julius; May, Juergen; Kraemer, Alexander

2010-01-01

The influence of socioeconomic status (SES) on health inequalities is widely known, but there is still poor understanding of the precise relationship between area-based socioeconomic conditions and neighborhood environmental quality. This study aimed to investigate the socioeconomic conditions which predict urban neighbourhood environmental quality. The results showed wide variation in levels of association between the socioeconomic variables and environmental conditions, with strong evidence of a real difference in environmental quality across the five socioeconomic classes with respect to total waste generation (p < 0.001), waste collection rate (p < 0.001), sewer disposal rate (p < 0.001), non-sewer disposal (p < 0.003), the proportion of households using public toilets (p = 0.005). Socioeconomic conditions are therefore important drivers of change in environmental quality and urban environmental interventions aimed at infectious disease prevention and control if they should be effective could benefit from simultaneous implementation with other social interventions. PMID:20195437

The Individualized Quality Control Plan - Coming Soon to Clinical Microbiology Laboratories Everywhere!

PubMed

Anderson, Nancy

2015-11-15

As of January 1, 2016, microbiology laboratories can choose to adopt a new quality control option, the Individualized Quality Control Plan (IQCP), under the Clinical Laboratory Improvement Amendments of 1988 (CLIA). This voluntary approach increases flexibility for meeting regulatory requirements and provides laboratories the opportunity to customize QC for their testing in their unique environments and by their testing personnel. IQCP is an all-inclusive approach to quality based on risk management to address potential errors in the total testing process. It includes three main steps, (1) performing a risk assessment, (2) developing a QC plan, and (3) monitoring the plan through quality assessment. Resources are available from the Centers for Medicare & Medicaid Services, Centers for Disease Control and Prevention, American Society for Microbiology, Clinical and Laboratory Standards Institute, and accrediting organizations, such as the College of American Pathologists and Joint Commission, to assist microbiology laboratories implementing IQCP.

Implementing facility-based kangaroo mother care services: lessons from a multi-country study in Africa

PubMed Central

2014-01-01

Background Some countries have undertaken programs that included scaling up kangaroo mother care. The aim of this study was to systematically evaluate the implementation status of facility-based kangaroo mother care services in four African countries: Malawi, Mali, Rwanda and Uganda. Methods A cross-sectional, mixed-method research design was used. Stakeholders provided background information at national meetings and in individual interviews. Facilities were assessed by means of a standardized tool previously applied in other settings, employing semi-structured key-informant interviews and observations in 39 health care facilities in the four countries. Each facility received a score out of a total of 30 according to six stages of implementation progress. Results Across the four countries 95 per cent of health facilities assessed demonstrated some evidence of kangaroo mother care practice. Institutions that fared better had a longer history of kangaroo mother care implementation or had been developed as centres of excellence or had strong leaders championing the implementation process. Variation existed in the quality of implementation between facilities and across countries. Important factors identified in implementation are: training and orientation; supportive supervision; integrating kangaroo mother care into quality improvement; continuity of care; high-level buy in and support for kangaroo mother care implementation; and client-oriented care. Conclusion The integration of kangaroo mother care into routine newborn care services should be part of all maternal and newborn care initiatives and packages. Engaging ministries of health and other implementing partners from the outset may promote buy in and assist with the mobilization of resources for scaling up kangaroo mother care services. Mechanisms for monitoring these services should be integrated into existing health management information systems. PMID:25001366

Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

PubMed

Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D

2016-02-01

In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.

The Impact of an Integrated Electronic Health Record Adoption on Nursing Care Quality.

PubMed

Walker-Czyz, AnneMarie

2016-01-01

The purpose of this study was to measure the impact of an integrated electronic health record (EHR) innovation adoption on the quality of nursing care delivered, including hospital-acquired falls, hospital-acquired pressure ulcers, ventilator-associated pneumonia (VAP), central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), and costs measured in nursing hours. The impact on quality, cost, and nurse satisfaction measured in turnover rates before, during, and after implementation of EHR tools was also investigated. Little is known about the adoption patterns of computerized documentation by nursing and the effects on the practice environment. A quantitative, retrospective analysis using interrupted time series model of a large data set was conducted in a 431-bed urban hospital, with 10 medical surgical units and 2 critical care units. The research was constructed using the Diffusion of Innovations (DOI) theory. Incorporating electronic, evidenced-based practice (EBP) tools into bedside nurse's workflow promotes decision making at the point of care that may improve quality with no negative impact on direct cost. The data revealed that total falls, CAUTI, and CLABSI rates were positively impacted after the implementation of an integrated EHR. Hospital-acquired pressure ulcer and VAP rates were negatively impacted at the implementation period followed by a significant positive rate reduction that surpassed the preimplementation period. Cost indicators, measured in hours per patient day and overtime, were negatively impacted during the implementation period followed by a return to baseline. Nurse turnover had a significant increase from the preimplementation to postimplementation period and failed to return to baseline. This study confirms that nurses have the ability to positively impact the quality of patient care through successful innovation adoption related to the use of EBP computerized documentation tools at the bedside. This study further clarified the practice environment of nurses during DOI.

Evaluation of wetland implementation strategies on phosphorus reduction at a watershed scale

NASA Astrophysics Data System (ADS)

Abouali, Mohammad; Nejadhashemi, A. Pouyan; Daneshvar, Fariborz; Adhikari, Umesh; Herman, Matthew R.; Calappi, Timothy J.; Rohn, Bridget G.

2017-09-01

Excessive nutrient use in agricultural practices is a major cause of water quality degradation around the world, which results in eutrophication of the freshwater systems. Among the nutrients, phosphorus enrichment has recently drawn considerable attention due to major environmental issues such as Lake Erie and Chesapeake Bay eutrophication. One approach for mitigating the impacts of excessive nutrients on water resources is the implementation of wetlands. However, proper site selection for wetland implementation is the key for effective water quality management at the watershed scale, which is the goal of this study. In this regard, three conventional and two pseudo-random targeting methods were considered. A watershed model called the Soil and Water Assessment Tool (SWAT) was coupled with another model called System for Urban Stormwater Treatment and Analysis IntegratioN (SUSTAIN) to simulate the impacts of wetland implementation scenarios in the Saginaw River watershed, located in Michigan. The inter-group similarities of the targeting strategies were investigated and it was shown that the level of similarity increases as the target area increases (0.54-0.86). In general, the conventional targeting method based on phosphorus load generated per unit area at the subwatershed scale had the highest average reduction among all the scenarios (44.46 t/year). However, when considering the total area of implemented wetlands, the conventional method based on long-term impacts of wetland implementation showed the highest amount of phosphorus reduction (36.44 t/year).

The impact of the TelEmergency program on rural emergency care: An implementation study.

PubMed

Sterling, Sarah A; Seals, Samantha R; Jones, Alan E; King, Melissa H; Galli, Robert L; Isom, Kristen C; Summers, Richard L; Henderson, Kristi A

2017-07-01

Introduction Timely, appropriate intervention is key to improving outcomes in many emergent conditions. In rural areas, it is particularly challenging to assure quality, timely emergency care. The TelEmergency (TE) program, which utilizes a dual nurse practitioner and emergency medicine-trained, board-certified physician model, has the potential to improve access to quality emergency care in rural areas. The objective of this study was to examine how the implementation of the TE program impacts rural hospital Emergency Department (ED) operations. Methods Methods included a before and after study of the effect of the TE program on participating rural hospitals between January 2007 and December 2008. Data on ED and hospital operations were collected one year prior to and one year following the implementation of TE. Data from participating hospitals were combined and compared for the two time periods. Results Nine hospitals met criteria for inclusion and participated in the study. Total ED volumes did not significantly change with TE implementation, but ED admissions to the same rural hospital significantly increased following TE implementation (6.7% to 8.1%, p-value = 0.02). Likewise, discharge rates from the ED declined post-initiation (87.1% to 80.0%, p-value = 0.003). ED deaths and transfer rates showed no significant change, while the rate of patient discharge against medical advice significantly increased with TE use. Discussion In this analysis, we found a significant increase in the rate of ED admissions to rural hospitals with TE use. These findings may have important implications for the quality of emergency care in rural areas and the sustainability of rural hospitals' EDs.

Mixed methods evaluation of the Getting it Right First Time programme - improvements to NHS orthopaedic care in England: study protocol.

PubMed

Barratt, Helen; Turner, Simon; Hutchings, Andrew; Pizzo, Elena; Hudson, Emma; Briggs, Tim; Hurd, Rob; Day, Jamie; Yates, Rachel; Gikas, Panagiotis; Morris, Stephen; Fulop, Naomi J; Raine, Rosalind

2017-01-23

Orthopaedic procedures, such as total hip replacement and total knee replacement, are among the commonest surgical procedures in England. The Getting it Right First Time project (GIRFT) aims to deliver improvements in quality and reductions in the cost of NHS orthopaedic care across the country. We will examine whether the planned changes have delivered improvements in the quality of care and patient outcomes. We will also study the processes involved in developing and implementing changes to care, and professional and organisational factors influencing these processes. In doing so, we will identify lessons to guide future improvement work in other services. We will evaluate the implementation of the GIRFT programme, and its impact on outcomes and cost, using a mixed methods design. Qualitative methods will be used to understand the programme theory underlying the approach and study the effect of the intervention on practice, using a case study approach. This will include an analysis of the central GIRFT programme and local provider responses. Data will be collected via semi-structured interviews, non-participant observation, and documentary analysis. Quantitative methods will be used to examine 'what works and at what cost?' We will also conduct focus groups with patients and members of the public to explore their perceptions of the GIRFT programme. The research will draw on theories of adoption, diffusion, and sustainability of innovation; its characteristics; and contextual factors at provider-level that influence implementation. We will identify generalisable lessons to inform the organisation and delivery of future improvement programmes, to optimise their implementation and impact, both within the UK and internationally. Potential challenges involved in conducting the evaluation include the phased implementation of the intervention in different provider organisations; the inclusion of both retrospective and prospective components; and the effects of ongoing organisational turbulence in the English NHS. However, these issues reflect the realities of service change and its evaluation.

77 FR 30900 - Approval and Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

... in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Department in implementing the New Mexico Air Quality Control Act, the joint Air Quality Control Board (AQCB... Promulgation of Implementation Plans; New Mexico; Albuquerque/Bernalillo County; Fees for Permits and...

[Quality assurance: concepts, actions and reflexions].

PubMed

Ruelas Barajas, E

1994-01-01

Importance that the topic of quality of medical care has acquired in recent years, a number of concepts have been utilized to mean many strategies to improve the quality of care. This situation has frequently created confusion between terms such as: quality assessment, quality assurance, total quality management, quality guarantee, etc. The purpose of this paper is to propose a conceptual framework that allows not only to clarify the concepts but also the actions towards the improvement of the quality of care. Therefore, a multidimensional matrix is also proposed in order to classify the multiple actions referred about in the literature and to organize them. The conclusions are: 1) The term "Quality guarantee", at least in spanish, is absolutely pertinent when referred to the quality of medical care; 2) This concept becomes a solid starting point to implement concret actions by integrating different concepts and avoiding confusions; 3) The multidimensional matrix allows to systematize multiple actions; 4) Since there was not a similar conceptual framework it is expected that this paper allows to close the gap between thinking and doing on behalf of every body.

Total Quality Management: Analysis, Evaluation and Implementation Within ACRV Project Teams

NASA Technical Reports Server (NTRS)

Raiman, Laura B.

1991-01-01

Total quality management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The Assured Crew Return Vehicle (ACRV) Project Office was identified as an excellent project in which to demonstrate the applications and benefits of TQM processes. As the ACRV Program moves through its various stages of development, it is vital that effectiveness and efficiency be maintained in order to provide the Space Station Freedom (SSF) crew an affordable, on-time assured return to Earth. A critical factor for the success of the ACRV is attaining the maximum benefit from the resources applied to the program. Through a series of four tutorials on various quality improvement techniques, and numerous one-on-one sessions during the SSF's 10-week term in the project office, results were obtained which are aiding the ACRV Office in implementing a disciplined, ongoing process for generating fundamental decisions and actions that shape and guide the organization. Significant advances were made in improving the processes for two particular groups - the correspondence distribution team and the WATER Test team. Numerous people from across JSC were a part of the various team activities including engineering, man systems, and safety. The work also included significant interaction with the support contractor to the ACRV Project. The results of the improvement activities can be used as models for other organizations desiring to operate under a system of continuous improvement. In particular, they have advanced the ACRV Project Teams further down the path of continuous improvement, in support of a working philosophy of TQM.

Introduction of the identification, situation, background, assessment, recommendations tool to improve the quality of information transfer during medical handover in intensive care.

PubMed

Ramasubbu, Benjamin; Stewart, Emma; Spiritoso, Rosalba

2017-02-01

To audit the quality and safety of the current doctor-to-doctor handover of patient information in our Cardiothoracic Intensive Care Unit. If deficient, to implement a validated handover tool to improve the quality of the handover process. In Cycle 1 we observed the verbal handover and reviewed the written handover information transferred for 50 consecutive patients in St George's Hospital Cardiothoracic Intensive Care Unit. For each patient's handover, we assessed whether each section of the Identification, Situation, Background, Assessment, Recommendations tool was used on a scale of 0-2. Zero if no information in that category was transferred, one if the information was partially transferred and two if all relevant information was transferred. Each patient's handover received a score from 0 to 10 and thus, each cycle a total score of 0-500. Following the implementation of the Identification, Situation, Background, Assessment, Recommendations handover tool in our Intensive Care Unit in Cycle 2, we re-observed the handover process for another 50 consecutive patients hence, completing the audit cycle. There was a significant difference between the total scores from Cycle 1 and 2 (263/500 versus 457/500, p < 0.001). The median handover score for Cycle 1 was 5/10 (interquartile range 4-6). The median handover score for Cycle 2 was 9/10 (interquartile range 9-10). Patient handover scores increased significantly between Cycle 1 and 2, U = 13.5, p < 0.001. The introduction of a standardised handover template (Identification, Situation, Background, Assessment, Recommendations tool) has improved the quality and safety of the doctor-to-doctor handover of patient information in our Intensive Care Unit.

Performance of vegetated swales for improving road runoff quality in a moderate traffic urban area.

PubMed

Leroy, Marie-Charlotte; Portet-Koltalo, Florence; Legras, Marc; Lederf, Franck; Moncond'huy, Vincent; Polaert, Isabelle; Marcotte, Stéphane

2016-10-01

In recent years, due to their economic and ecological advantages, green infrastructures for stormwater management have been widely implemented. The present study focused on vegetated swales and compared two vegetated covers, grassed or planted with macrophytes in order to evaluate their performance in terms of water quality improvement. These swales collected runoff of a moderately busy road (<2500vehday(-1)) in a commercial area. Twelve storm events were analyzed over a two year period with measurement of total suspended solids (TSS), chemical oxygen demand (COD), biochemical oxygen demand (BOD), total hydrocarbons (THC), total phosphorous (TP), total Kjeldahl nitrogen (TKN), trace elements and 16 polycyclic aromatic hydrocarbons (PAHs). The grass cover led to poor results due to lower retention of soil particles on which trace elements and PAHs are bounded. The swales planted with macrophytes, with a deeper root system more capable of retaining soil particles, led to reductions of concentrations from 17 to 45% for trace elements such as lead, zinc and copper and 30% for the 16 PAHs in infiltrated waters. In addition, the macrophyte cover showed lower variability of pollutant concentrations in infiltrated waters compared to incoming waters. This buffering capacity is interesting to mitigate the impact of moderate peak pollution on surface water or ground water quality. Copyright © 2016 Elsevier B.V. All rights reserved.

Identifying knowledge gaps between practice and research for implementation components of sustainable interventions to improve the working environment - A rapid review.

PubMed

Rasmussen, Charlotte Diana Nørregaard; Højberg, Helene; Bengtsen, Elizabeth; Jørgensen, Marie Birk

2018-02-01

In a recent study, we involved all relevant stakeholders to identify practice-based implementation components for successful implementation and sustainability in work environment interventions. To understand possible knowledge gaps between evidence and practice, the aim of this paper is to investigate if effectiveness studies of the 11 practice-based implementation components can be identified in existing scientific literature. PubMed/MEDLINE, PsycINFO, and Web of Science were searched for relevant studies. After screening, 38 articles met the inclusion criteria. Since some of the studies describe more than one practice-based implementation concept a total of 125 quality criteria assessments were made. The overall result is that 10 of the 11 practice-based implementation components can be found in the scientific literature, but the evaluation of them is poor. From this review it is clear that there are knowledge gaps between evidence and practice with respect to the effectiveness of implementation concepts. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Feasibility of the Nationwide Health Information Network.

PubMed

Valle, Jazmine; Gomes, Christian; Godby, Tyler; Coustasse, Alberto

2016-01-01

The Nationwide Health Information Network (NHIN) use in health care facilities was examined for utilization and efficacy; although the advantages are abundant, health care facilities have been reluctant to adopt it because of associated costs. The purpose of this study was to analyze the feasibility of a US NHIN by exploring and determining the benefits of an NHIN and assessing the barriers to its implementation. The research methodology applied in examining the implementation of NHIN in the United States was a qualitative literature review, which followed the basic guidelines of a systematic literature review, partnered with a semistructured interview of a chief information officer of a private, nonprofit, 193-bed hospital located in Westminster, Maryland. A total of 33 sources were referenced. The results of this study suggest that implementation and utilization of NHIN by health care industry stakeholders lead to an increased quality of patient care, increased patient-provider communication, and cost-savings opportunities. Increased quality of care is achieved by reducing adverse drug events and medical errors. Cost-savings opportunities are generated by a reduction in spending and prices that is attributable to electronic health record systems' increased efficiency and effectiveness. Nevertheless, barriers to NHIN implementation and utilization still remain throughout the health care industry, the main one being concerns about interoperability.

Chemistry and quality of Hibiscus (Hibiscus sabdariffa) for developing the natural-product industry in Senegal.

PubMed

Juliani, H R; Welch, C R; Wu, Q; Diouf, B; Malainy, D; Simon, J E

2009-03-01

The objectives of this study were to assess and improve the quality of the hibiscus calyces from Senegal over 2 production seasons (2004 to 2005), to develop and adapt new procedures for the determination of hibiscus anthocyanins and analysis of the 2 major ones, delphinidin-3-sambubioside and cyanidin-3-sambubioside. The foreign matter, total ashes, and acid insoluble ashes showed that the calyces harvested in 2005 were produced following hygienic practices, while the color assessment of the calyces and analysis of hibiscus active principles also showed higher amounts of anthocyanins in 2005. A protocol to measure anthocyanins by pH-differential UV-Vis spectrophotometry was adapted to measure the hibiscus anthocyanins from a water extract. The spectrophotometric method for quantitation of total anthocyanins showed a close correlation (r(2)= 0.82) when compared with the HPLC method, suggesting the use of the colorimetric method in quality control programs as an affordable alternative method to assess anthocyanin content in hibiscus. New and raised standards for the cleanliness and active principle content in hibiscus are also proposed. This study demonstrated that the implementation of a quality control program and the application of agricultural good practices in the production and processing of hibiscus calyces can lead to higher quality natural plant products.

Effects of highway construction on stream water quality and macroinvertebrate condition in a mid-atlantic highlands watershed, USA.

PubMed

Chen, Yushun; Viadero, Roger C; Wei, Xinchao; Fortney, Ronald; Hedrick, Lara B; Welsh, Stuart A; Anderson, James T; Lin, Lian-Shin

2009-01-01

Refining best management practices (BMPs) for future highway construction depends on a comprehensive understanding of environmental impacts from current construction methods. Based on a before-after-control impact (BACI) experimental design, long-term stream monitoring (1997-2006) was conducted at upstream (as control, n = 3) and downstream (as impact, n = 6) sites in the Lost River watershed of the Mid-Atlantic Highlands region, West Virginia. Monitoring data were analyzed to assess impacts of during and after highway construction on 15 water quality parameters and macroinvertebrate condition using the West Virginia stream condition index (WVSCI). Principal components analysis (PCA) identified regional primary water quality variances, and paired t tests and time series analysis detected seven highway construction-impacted water quality parameters which were mainly associated with the second principal component. In particular, impacts on turbidity, total suspended solids, and total iron during construction, impacts on chloride and sulfate during and after construction, and impacts on acidity and nitrate after construction were observed at the downstream sites. The construction had statistically significant impacts on macroinvertebrate index scores (i.e., WVSCI) after construction, but did not change the overall good biological condition. Implementing BMPs that address those construction-impacted water quality parameters can be an effective mitigation strategy for future highway construction in this highlands region.

A tool to measure whether business management capacity in general practice impacts on the quality of chronic illness care.

PubMed

Holton, Christine H; Proudfoot, Judith G; Jayasinghe, Upali W; Grimm, Jane; Bubner, Tanya K; Winstanley, Julie; Harris, Mark F; Beilby, Justin J

2010-11-01

Our aim was to develop a tool to identify specific features of the business and financial management of practices that facilitate better quality care for chronic illness in primary care. Domains of management were identified, resulting in the development of a structured interview tool that was administered in 97 primary care practices in Australia. Interview items were screened and subjected to factor analysis, subscales identified and the overall model fit determined. The instrument's validity was assessed against another measure of quality of care. Analysis provided a four-factor solution containing 21 items, which explained 42.5% of the variance in the total scores. The factors related to administrative processes, human resources, marketing analysis and business development. All scores increased significantly with practice size. The business development subscale and total score were higher for rural practices. There was a significant correlation between the business development subscale and quality of care. The indicators of business and financial management in the final tool appear to be useful predictors of the quality of care. The instrument may help inform policy regarding the structure of general practice and implementation of a systems approach to chronic illness care. It can provide information to practices about areas for further development.

77 FR 52277 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... rule. SUMMARY: EPA is proposing approval of a permitting rule submitted for the South Coast Air Quality Management District (District) portion of the California State Implementation Plan (SIP). The State is...

78 FR 63878 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revised Ambient Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

...] Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revised Ambient Air Quality... State Implementation Plan (SIP). The revisions add ambient air quality standards and associated... Ambient Air Quality Standards (NAAQS) for PM 2.5 . EPA is approving these revisions in accordance with the...

78 FR 30829 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards Revision AGENCY... the Illinois State Implementation Plan (SIP) to reflect current national ambient air quality standards...) 692-2450. 4. Mail: Pamela Blakley, Chief, Control Strategies Section, Air Programs Branch (AR-18J), U...

75 FR 19886 - Approval and Promulgation of Air Quality Implementation Plans; Wyoming; Revisions to the Wyoming...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... Promulgation of Air Quality Implementation Plans; Wyoming; Revisions to the Wyoming Air Quality Standards and.... Wyoming has revised its Air Quality Standards and Regulations, specifically Chapter 1, Section 5... Wyoming's State Implementation Plan (SIP). These revisions amend Wyoming's Air Quality Standards and...

New quality regulations versus established nursing home practice: a qualitative study.

PubMed

Sandvoll, Anne Marie; Kristoffersen, Kjell; Hauge, Solveig

2012-06-07

Western governments have initiated reforms to improve the quality of care for nursing home residents. Most of these reforms encompass the use of regulations and national quality indicators. In the Norwegian context, these regulations comprise two pages of text that are easy to read and understand. They focus particularly on residents' rights to plan their day-to-day life in nursing homes. However, the research literature indicates that the implementation of the new regulations, particularly if they aim to change nursing practice, is extremely challenging. The aim of this study was to further explore and describe nursing practice to gain a deeper understanding of why it is so hard to implement the new regulations. For this qualitative study, an ethnographic design was chosen to explore and describe nursing practice. Fieldwork was conducted in two nursing homes. In total, 45 nurses and nursing aides were included in participant observation, and 10 were interviewed at the end of the field study. Findings indicate that the staff knew little about the new quality regulations, and that the quality of their work was guided by other factors rooted in their nursing practice. Further analyses revealed that the staff appeared to be committed to daily routines and also that they always seemed to know what to do. Having routines and always knowing what to do mutually strengthen and enhance each other, and together they form a powerful force that makes daily nursing care a taken-for-granted activity. New regulations are challenging to implement because nursing practices are so strongly embedded. Improving practice requires systematic and deeply rooted practical change in everyday action and thinking.

Water and nonpoint source pollution estimation in the watershed with limited data availability based on hydrological simulation and regression model.

PubMed

Huiliang, Wang; Zening, Wu; Caihong, Hu; Xinzhong, Du

2015-09-01

Nonpoint source (NPS) pollution is considered as the main reason for water quality deterioration; thus, to quantify the NPS loads reliably is the key to implement watershed management practices. In this study, water quality and NPS loads from a watershed with limited data availability were studied in a mountainous area in China. Instantaneous water discharge was measured through the velocity-area method, and samples were taken for water quality analysis in both flood and nonflood days in 2010. The streamflow simulated by Hydrological Simulation Program-Fortran (HSPF) from 1995 to 2013 and a regression model were used to estimate total annual loads of various water quality parameters. The concentrations of total phosphorus (TP) and total nitrogen (TN) were much higher during the flood seasons, but the concentrations of ammonia nitrogen (NH3-N) and nitrate nitrogen (NO3-N) were lower during the flood seasons. Nevertheless, only TP concentration was positively correlated with the flow rate. The fluctuation of annual load from this watershed was significant. Statistical results indicated the significant contribution of pollutant fluxes during flood seasons to annual fluxes. The loads of TP, TN, NH3-N, and NO3-N in the flood seasons were accounted for 58-85, 60-82, 63-88, 64-81% of the total annual loads, respectively. This study presented a new method for estimation of the water and NPS loads in the watershed with limited data availability, which simplified data collection to watershed model and overcame the scale problem of field experiment method.

Simulation of Triple Oxidation Ditch Wastewater Treatment Process

NASA Astrophysics Data System (ADS)

Yang, Yue; Zhang, Jinsong; Liu, Lixiang; Hu, Yongfeng; Xu, Ziming

2010-11-01

This paper presented the modeling mechanism and method of a sewage treatment system. A triple oxidation ditch process of a WWTP was simulated based on activated sludge model ASM2D with GPS-X software. In order to identify the adequate model structure to be implemented into the GPS-X environment, the oxidation ditch was divided into several completely stirred tank reactors depended on the distribution of aeration devices and dissolved oxygen concentration. The removal efficiency of COD, ammonia nitrogen, total nitrogen, total phosphorus and SS were simulated by GPS-X software with influent quality data of this WWTP from June to August 2009, to investigate the differences between the simulated results and the actual results. The results showed that, the simulated values could well reflect the actual condition of the triple oxidation ditch process. Mathematical modeling method was appropriate in effluent quality predicting and process optimizing.

The effect of mining data k-means clustering toward students profile model drop out potential

NASA Astrophysics Data System (ADS)

Purba, Windania; Tamba, Saut; Saragih, Jepronel

2018-04-01

The high of student success and the low of student failure can reflect the quality of a college. One of the factors of fail students was drop out. To solve the problem, so mining data with K-means Clustering was applied. K-Means Clustering method would be implemented to clustering the drop out students potentially. Firstly the the result data would be clustering to get the information of all students condition. Based on the model taken was found that students who potentially drop out because of the unexciting students in learning, unsupported parents, diffident students and less of students behavior time. The result of process of K-Means Clustering could known that students who more potentially drop out were in Cluster 1 caused Credit Total System, Quality Total, and the lowest Grade Point Average (GPA) compared between cluster 2 and 3.

Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals.

PubMed

Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz

2018-03-01

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.

Spatial and temporal variation of stream chemistry associated with contrasting geology and land-use patterns in the Chesapeake Bay watershed—Summary of results from Smith Creek, Virginia; Upper Chester River, Maryland; Conewago Creek, Pennsylvania; and Difficult Run, Virginia, 2010–2013

USGS Publications Warehouse

Hyer, Kenneth E.; Denver, Judith M.; Langland, Michael J.; Webber, James S.; Böhlke, J.K.; Hively, W. Dean; Clune, John W.

2016-11-17

Despite widespread and ongoing implementation of conservation practices throughout the Chesapeake Bay watershed, water quality continues to be degraded by excess sediment and nutrient inputs. While the Chesapeake Bay Program has developed and maintains a large-scale and long-term monitoring network to detect improvements in water quality throughout the watershed, fewer resources have been allocated for monitoring smaller watersheds, even though water-quality improvements that may result from the implementation of conservation practices are likely to be first detected at smaller watershed scales.In 2010, the U.S. Geological Survey partnered with the U.S. Environmental Protection Agency and the U.S. Department of Agriculture to initiate water-quality monitoring in four selected small watersheds that were targeted for increased implementation of conservation practices. Smith Creek watershed is an agricultural watershed in the Shenandoah Valley of Virginia that is dominated by cattle and poultry production, and the Upper Chester River watershed is an agricultural watershed on the Eastern Shore of Maryland that is dominated by row-cropping activities. The Conewago Creek watershed is an agricultural watershed in southeastern Pennsylvania that is characterized by mixed agricultural activities. The fourth watershed, Difficult Run, is a suburban watershed in northern Virginia that is dominated by medium density residential development. The objective of this study was to investigate spatial and temporal variations in water chemistry and suspended sediment in these four relatively small watersheds that represent a range of land-use patterns and underlying geology to (1) characterize current water-quality conditions in these watersheds, and (2) identify the dominant sources, sinks, and transport processes in each watershed.The general study design involved two components. The first included intensive routine water-quality monitoring at an existing streamgage within each study area (including continuous water-quality monitoring as well as discrete water-quality sampling) to develop a detailed understanding of the temporal and hydrologic variability in stream chemistry and sediment transport in each watershed. The second component involved extensive water-quality monitoring at various sites throughout each watershed to develop a detailed understanding of spatial patterns. Both components were used to improve understanding of sources and transport processes affecting stream chemistry, including nutrients and suspended sediments, and their implications for detecting long-term trends related to best management practices. This report summarizes the results of monitoring that was performed from April 2010 through September 2013.Individual Small Watershed SummariesSummaries for each of the four small watersheds are presented below. Each watershed has a more descriptive and detailed section in the report, but these summaries may be particularly useful for some watershed managers and stakeholders desiring slightly less technical detail.Smith CreekSmith Creek is a 105.39-mi2 watershed within the Shenandoah Valley that drains to the North Fork Shenandoah River. The long-term Smith Creek base-flow index is 72.3 percent, indicating that on average, approximately 72 percent of Smith Creek flow was base flow, which suggests that Smith Creek streamflow is dominated by groundwater discharge rather than stormwater runoff. A series of cluster and principal components analyses demonstrated that the majority of the variability in Smith Creek water quality could be attributed to hydrologic and seasonal variability. Statistically significant positive correlations with flow were observed for turbidity, suspended sediments, total nitrogen, ammonium, orthophosphate, iron, total phosphorus, and the ratio of calcium to magnesium. Statistically significant inverse correlations with flow were observed for specific conductance, magnesium, δ15N of nitrate, pH, bicarbonate, calcium, and δ18O of nitrate. Of particular note, flow and nitrate were not statistically significantly correlated, likely because of the relatively complex concentration-discharge relationship observed in continuous and discrete datasets. Statistically significant seasonal patterns were observed for numerous water-quality constituents: water temperature, turbidity, orthophosphate, total phosphorus, suspended-sediment concentration, and silica were higher during the warm season, but pH, dissolved oxygen, and sulfate were higher during the cool season. Surrogate regression models were developed to compute sediment and nutrient loads in Smith Creek using the continuous water-quality monitors. The mean Smith Creek in-stream sediment load was approximately 6,900 tons per year, with nearly 90 percent of the sediment load over the 3-year study period contributed during the eight largest storm events during that period. The Smith Creek total phosphorus load was approximately 21,000 pounds of phosphorus per year, with the majority of the load contributed during stormflow periods, although a substantial phosphorus load still occurs during base-flow conditions. The Smith Creek total nitrogen load was approximately 400,000 pounds per year, with total nitrogen accumulation less dominated by stormflow contributions (as was the case for sediment and total phosphorus) and strongly affected by base-flow export of nitrogen from the basin.Extensive water-quality monitoring throughout the Smith Creek watershed revealed how the complex geology and hydrology interacted to result in variable water chemistry. During relatively dry and low base-flow periods, much of the discharge in Smith Creek was contributed by a single dominant spring—Lacey Spring. During wetter base-flow periods, the flows in Smith Creek were largely generated by a mixture of headwater springs and forested mountain tributaries with very different geochemical composition. The headwater springs generally issued from limestone bedrock and were characterized as having relatively high nitrate, specific conductance, calcium, and magnesium, as well as relatively low concentrations of phosphorus, ammonium, iron, and manganese. The undeveloped, high-gradient, forested mountain sites were generally characterized by low ionic strength waters with low nutrient concentrations. Nitrate isotope data from the limestone springs generally were consistent with manure-derived nitrogen sources (such as cattle and poultry), although the possibility of other mixed sources cannot be excluded. Nitrate isotope data from the undeveloped, high-gradient forested mountain sites were more consistent with nitrogen from undisturbed soils, atmospheric deposition, or nitrogen fixation. Regardless of the nitrogen source, oxygen isotope data indicate that the nitrate was largely a result of nitrification. Land-use data indicate that manure sources of nitrogen dominated watershed nitrogen inputs. Phosphorus sources were less well studied. The presence of a single point-source discharge near the town of New Market contributed the majority of the phosphorus to Smith Creek under base-flow conditions, but nonpoint sources of phosphorus dominated the loading to Smith Creek during stormflow periods.Implementation of conservation practices increased in the Smith Creek watershed during the study period, and even though a broad range of practice types was implemented, the most common practices included stream fencing (for cattle exclusion), the development of nutrient management plans, conservation crop rotation, and the planting of cover crops. While the implementation of these conservation practices is encouraging, results indicate small increases in nitrate concentrations at the streamgage over the last 29 years, concurrent with small decreases in nitrate fluxes. It will likely be years before the cumulative effect of these practices can be detected in the Smith Creek water quality, and the magnitude of the effect of these conservation practices detected in Smith Creek will depend largely on whether nutrient loading (of manure and commercial fertilizer) is reduced over time.Upper Chester RiverThe Upper Chester River watershed includes the 36-square-mile (mi2) watershed area around several nontidal tributaries that drain into the tidal Chester River. The streamgage is on Chesterville Branch, the largest nontidal tributary (approximately 6.12 mi2) and is the site for continuous water-quality monitoring for this project. The base-flow index at Chesterville Branch is about 72 percent and indicates that, as in most of the Coastal Plain, groundwater is the greatest contributor to streamflow. As such, more than 90 percent of the nitrogen in the stream is in the form of nitrate from groundwater. Continuous and discrete data collected at Chesterville Branch show the effects of streamflow and season on water quality. Significantly positive correlations with flow were observed for ammonium, dissolved and total phosphorus, sediment, and turbidity as runoff carried these constituents from the land surface into Chesterville Branch. Other constituents that increased significantly with flow include potassium, sulfate, iron, and manganese, which are likely contributed from near-stream areas and ponds with high organic-matter content. Total nitrogen, pH, and specific conductance, along with chemical constituents associated with groundwater inputs including nitrate, calcium, ratio of calcium to magnesium, silica, bicarbonate, and sodium, were negatively correlated with flow because concentrations of these constituents were diluted by runoff.Seasonal differences in water chemistry, which are most likely related to increased biologic effects on the uptake and release of chemicals in the stream and near-stream areas, also were observed. Water temperature, orthophosphate, δ15N of nitrate, bicarbonate, sodium, and the ratio of sodium to chloride were higher during the warm season, and dissolved oxygen, total nitrogen, nitrate, magnesium, sulfate, and manganese were higher during the cool season.Surrogate-regression models developed by using continuous water-quality data showed that the annual sediment load for the 2013 water year was about 2,600 tons, with more than 90 percent of this sediment contributed during two storms. The total phosphorus load in 2013 was about 13,000 pounds with more than 90 percent contributed during the same two storms as sediment. The load of total nitrogen, 140,000 pounds, accumulated steadily throughout the 2013 water year as nitrate in groundwater continuously discharged into the stream. The same two large storms that contributed 90 percent of the suspended-sediment and total phosphorus load only contributed about 20 percent of the annual total nitrogen load.Extensive water-quality monitoring of stream base flow throughout the Upper Chester River watershed identified how differences in land use and hydrogeology affected water chemistry. In parts of the watershed with well-drained soil and thick sandy aquifer sediments, concentrations of nitrate and other chemicals associated with fertilizer and lime application increased in streams as agricultural land use increased. More than 90 percent of the nitrogen in streams from these areas was in the form of nitrate, and concentrations ranged from about 5 milligrams per liter (mg/L) to 8 mg/L as nitrogen in the two largest tributaries. Stream nitrate concentrations were about 1 mg/L as nitrogen where soils were more poorly drained, the surficial aquifer sediments were thinner, and forests and wetlands were more widespread than agriculture. Nitrate isotope data were consistent with inorganic fertilizers ± atmospheric deposition and N2 fixation as sources of nitrogen, and with nitrification as the dominant nitrate-forming process. Nitrate reduction was indicated by elevated δ15N and δ18O values in some samples from streams draining watersheds with poorly drained soils. An analysis of land-use data and SPARROW modeling input data attributed almost 90 percent of the nitrogen sources in the Upper Chester River watershed to inorganic fertilizer and fixation of atmospheric nitrogen by legumes, which is in agreement with the isotopic characteristics of nitrate in this watershed. Local sources of manure are limited in this area. Total phosphorus concentrations during base flow ranged from below detection to about 0.2 mg/L. Stream phosphorus concentrations during base flow were generally lower than those measured during storms because most phosphorus transport likely occurs as phosphorus attached to sediment particles during runoff. Because manure is not widely used in this area, the major source of phosphorus is likely fertilizer.The implementation of conservation practices in the Upper Chester River watershed increased substantially during the study period, with a total implementation of 1,194 U.S. Department of Agriculture-compliant practices. The most frequently used practices were oriented towards nutrient and sediment control, including cover crops, nutrient management planning, conservation crop rotation, conservation tillage, and irrigation management. The current Chesapeake Bay model for this area predicts that implementation of best management practices should result in a 13-percent decrease in overall delivery of nitrogen to the Upper Chester River. Because most nitrogen travels through the groundwater system for years to decades before being discharged to streams, the time period of monitoring was not sufficient to see the effects of these practices on water quality. The magnitude of the effect that may eventually be detected will depend on the degree to which nitrate leaching into the groundwater system is reduced over time. Loadings of phosphorus and sediment are primarily transported during large runoff events and are difficult to control and analyze for trends because of their timing and episodic nature.Conewago CreekConewago Creek has two primary monitoring locations—one near the middle of the 47-mi2 watershed and the other near the outlet just upstream of the Susquehanna River. The base-flow index was 47.3 percent for 2012–2013, indicating that on average, approximately 53 percent of the streamflow in Conewago Creek exited the watershed as surface flow, which suggests that the stormwater runoff was somewhat greater than groundwater discharge (base flow). A series of cluster and principal components analyses demonstrated that the majority of the variability in the Conewago Creek water quality could be attributed to hydrologic and seasonal variability. Statistically significant positive correlations with flow were observed at both monitoring sites for ammonium, total phosphorus, orthophosphate, iron, and manganese; additionally, at the upstream monitoring station, total nitrogen demonstrated a statistically significant positive correlation with flow. Statistically significant inverse correlations with flow were observed at both sites for water temperature, specific conductance (at the downstream site only), sulfate, chloride, calcium, and magnesium. Statistically significant seasonal patterns were observed for several water-quality constituents. Water temperature, phosphorus (upstream site only), and orthophosphate were higher during the warm season, and nitrate and total nitrogen (upstream site only) were higher during the cool season.Surrogate regression models were developed to compute sediment and nutrient load in Conewago Creek by using the continuous water-quality monitors and water-quality samples. Conewago Creek sediment load was approximately 9,900 tons in 2012 and approximately 18,900 tons in 2013, with nearly 80 percent of the sediment load in 2013 contributed by the three largest storm events. Annual total nitrogen loads could not be estimated due to poor model performance. The addition of continued monitoring or a continuously recording nitrate sensor could improve estimates of total nitrogen loads. During 2012 and 2013, phosphorus loads in Conewago Creek were approximately 50,000 pounds in each year.Combining data from one high-flow synoptic sampling with the data from routine sampling revealed how the geology and hydrology interact to result in variable water chemistry throughout the Conewago Creek watershed. The areas above the upstream gage in the headwaters are generally underlain by forested non-carbonate bedrock and are characterized by relatively low nitrate, specific conductance, calcium, and magnesium, as well as relatively low concentrations of phosphorus, ammonium, iron, and manganese. The more developed, agricultural areas below the upstream site were generally characterized by higher ionic strength waters with higher nutrient and metal concentrations. An analysis of land-use data and SPAtially Referenced Regressions On Watershed (SPARROW) modeling data indicates that manure sources of nitrogen dominate the input of nitrogen to the watershed.Implementation of conservation practices increased in the Conewago Creek watershed during the study period, and while a broad range of practice types were implemented, the most common practices included residue and tillage management, cover crops, nutrient management, terracing, and stream fencing (for animal exclusion or bank restoration). While the implementation of these conservation practices is encouraging, the cumulative effects of these practices probably will not be detected in Conewago Creek water quality for several years. The magnitude of the effects of these conservation practices on water quality in Conewago Creek will depend largely on the extent to which nutrient loading (septic, manure, and commercial fertilizer) and sediment-producing activities are reduced over time.Difficult RunThe Difficult Run watershed is a 57.82-mi2 watershed that drains to the Potomac River. The long-term Difficult Run base-flow index (from 1936 to 2010) was 57.9, indicating that approximately 58 percent of streamflow exited the watershed as base flow and 42 percent as stormflow; however, with continued development and urbanization of the watershed, the base-flow index has decreased to 50 percent during the last 20 years. This base-flow index was less than those of the other watersheds evaluated in this study, likely because the Difficult Run watershed largely is underlain by crystalline piedmont metamorphic rocks and has a greater proportion of impervious urban land cover. A series of cluster and principal components analyses indicated that most of the variability in Difficult Run water quality could be attributed to hydrologic variability and seasonality. Statistically significant positive correlations with flow were observed for turbidity, dissolved oxygen, suspended sediments, ammonium, orthophosphate, iron, and total phosphorus. Statistically significant inverse correlations with flow were observed for water temperature, pH, specific conductance, bicarbonate, calcium, magnesium, nitrate, δ15N of nitrate, and silica. Statistically significant seasonal patterns were observed for numerous water-quality constituents: water temperature, ammonium, orthophosphate, and δ15N of nitrate were higher during the warm season, and dissolved oxygen, nitrate, and manganese were higher during the cool season. Surrogate regression models were developed to compute sediment and nutrient loading rates. The Difficult Run sediment load was approximately 8,000 tons per year, with greater than 95 percent of the sediment load in the 2013 water year contributed by the seven largest storm events. The total phosphorus load in Difficult Run was approximately 14,000 pounds of phosphorus per year, with the majority of the load contributed during stormflow periods. The total nitrogen load in Difficult Run is estimated to have been approximately 140,000 pounds per year, with total nitrogen accumulation less dominated by stormflow contributions than that of phosphorus and strongly affected by base-flow export of nitrogen from the basin.Extensive water-quality monitoring throughout the Difficult Run watershed revealed relatively uniform generation of flow per unit of watershed area, as well as spatial variation in water quality that is strongly related to land-use activities. Elevated nitrate concentrations were observed in a subset of monitoring sites that are inversely correlated with population density and positively correlated to the septic system density within each subwatershed. The majority of the elevated nitrate concentrations for these sites are hypothesized to be caused by nitrate leaching from septic systems, more so than homeowner fertilizer usage among these subwatersheds that have lower population densities than other parts of the watershed. Nitrate isotope data, temporal patterns in the water-quality data, mass-balance computations, and a separate land-use analysis all generally indicate that leachate from septic systems was the likely source of the elevated nitrate. Another group of water-quality sites have relatively low nitrogen concentrations, are located in areas that are served by city sewer lines, and have experienced stream restoration activities. A final group of sites drained the areas with the highest imperviousness and had strongly elevated specific conductance, chloride, and sodium, which were likely caused by a combination of road salting and other anthropogenic sources draining these urbanized areas in the watershed. A fourth group of sites represents a mixture of water sources and had water quality similar to that at the Difficult Run streamgage. Analysis of the nitrate isotope data generally indicates a broad range of composition indicative of mixed natural and anthropogenic nitrogen sources. Implementation of conservation practices increased in the Difficult Run watershed during the study period, and while a broad range of practice types was implemented, the most common practices included stream restoration. While the implementation of these conservation practices is encouraging, the cumulative effect of these practices probably will not be detected in Difficult Run water quality for several years.

78 FR 44485 - Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

...] Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation Plan... Rule Regarding ``Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State... ground-level ozone formation. B. What should I consider as I prepare my comments for the EPA? 1...

[The comparative evaluation of level of security culture in medical organizations].

PubMed

Roitberg, G E; Kondratova, N V; Galanina, E V

2016-01-01

The study was carried out on the basis of clinic “Medicine” in 2014-2015 concerning security culture. The sampling included 465 filled HSPSC questionnaires. The comparative analysis of received was implemented. The “Zubovskaia district hospital” Having no accreditation according security standards and group of clinics from USA functioning for many years in the system of patient security support were selected as objects for comparison. The evaluation was implemented concerning dynamics of security culture in organization at implementation of strategies of security of patients during 5 years and comparison of obtained results with USA clinics was made. The study results demonstrated that in conditions of absence of implemented standards of security in medical organization total evaluation of security remains extremely low. The study of security culture using HSPSC questionnaire is an effective tool for evaluating implementation of various strategies of security ofpatient. The functioning in the system of international standards of quality, primarily JCI standards, permits during several years to achieve high indices of security culture.

Effective interventions on service quality improvement in a physiotherapy clinic.

PubMed

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

The quality movement in higher education in the United States.

PubMed

Buchanan, H S

1995-09-01

Continuous quality improvement (CQI), often implemented as part of an integrated management system called total quality management (TQM), has been institutionalized within many manufacturing, military and service organizations in the USA as a response to declining market share, low productivity and customer complaints about poor quality. Signs and symptoms suggest that higher education has similar problems which are systematic and relate to the quality ot higher education, financing, facilities, curriculum and graduates. In the 1990S, the quality movement has begun to spread to the field of education as a means of diagnosing and treating the problems widely recognized as residing in US educational institutions, especially in colleges and universities. Many business leaders and authors believe that 'quality is the most important strategic issue facing top management in the 1990s'. This belief arises partly due to the fact that managers are beginning to understand the relationship between healthy, high quality organizations and healthy profits. This article traces the recent US quality movement from its roots in manufacturing and the military, its adoption by service institutions, and its more recent application by higher education institutions.

The effect of real-time CPR feedback and post event debriefing on patient and processes focused outcomes: A cohort study: trial protocol

PubMed Central

2011-01-01

Background Cardiac arrest affects 30-35, 000 hospitalised patients in the UK every year. For these patients to be given the best chance of survival, high quality cardiopulmonary resuscitation (CPR) must be delivered, however the quality of CPR in real-life is often suboptimal. CPR feedback devices have been shown to improve CPR quality in the pre-hospital setting and post-event debriefing can improve adherence to guidelines and CPR quality. However, the evidence for use of these improvement methods in hospital remains unclear. The CPR quality improvement initiative is a prospective cohort study of the Q-CPR real-time feedback device combined with post-event debriefing in hospitalised adult patients who sustain a cardiac arrest. Methods/design The primary objective of this trial is to assess whether a CPR quality improvement initiative will improve rate of return of sustained spontaneous circulation in in-hospital-cardiac-arrest patients. The study is set in one NHS trust operating three hospital sites. Secondary objectives will evaluate: any return of spontaneous circulation; survival to hospital discharge and patient cerebral performance category at discharge; quality of CPR variables and cardiac arrest team factors. Methods: All three sites will have an initial control phase before any improvements are implemented; site 1 will implement audiovisual feedback combined with post event debriefing, site 2 will implement audiovisual feedback only and site 3 will remain as a control site to measure any changes in outcome due to any other trust-wide changes in resuscitation practice. All adult patients sustaining a cardiac arrest and receiving resuscitation from the hospital cardiac arrest team will be included. Patients will be excluded if; they have a Do-not-attempt resuscitation order written and documented in their medical records, the cardiac arrest is not attended by a resuscitation team, the arrest occurs out-of-hospital or the patient has previously participated in this study. The trial will recruit a total of 912 patients from the three hospital sites. Conclusion This trial will evaluate patient and process focussed outcomes following the implementation of a CPR quality improvement initiative using real-time audiovisual feedback and post event debriefing. Trial registration ISRCTN56583860 PMID:22008636

An Ethnographic Study of Health Information Technology Use in Three Intensive Care Units.

PubMed

Leslie, Myles; Paradis, Elise; Gropper, Michael A; Kitto, Simon; Reeves, Scott; Pronovost, Peter

2017-08-01

To identify the impact of a full suite of health information technology (HIT) on the relationships that support safety and quality among intensive care unit (ICU) clinicians. A year-long comparative ethnographic study of three academic ICUs was carried out. A total of 446 hours of observational data was collected in the form of field notes. A subset of these observations-134 hours-was devoted to job-shadowing individual clinicians and conducting a time study of their HIT usage. Significant variation in HIT implementation rates and usage was noted. Average HIT use on the two "high-use" ICUs was 49 percent. On the "low-use" ICU, it was 10 percent. Clinicians on the high-use ICUs experienced "silo" effects with potential safety and quality implications. HIT work was associated with spatial, data, and social silos that separated ICU clinicians from one another and their patients. Situational awareness, communication, and patient satisfaction were negatively affected by this siloing. HIT has the potential to accentuate social and professional divisions as clinical communications shift from being in-person to electronically mediated. Socio-technically informed usability testing is recommended for those hospitals that have yet to implement HIT. For those hospitals already implementing HIT, we suggest rapid, locally driven qualitative assessments focused on developing solutions to identified gaps between HIT usage patterns and organizational quality goals. © Health Research and Educational Trust.

A total quality management approach to healthcare waste management in Namazi Hospital, Iran.

PubMed

Askarian, Mehrdad; Heidarpoor, Peigham; Assadian, Ojan

2010-11-01

Healthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75-90% of these wastes are classified as household waste posing no potential risk, 10-25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran. Namazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period. Before the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste. A structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings. Copyright © 2010 Elsevier Ltd. All rights reserved.

Decreasing Medication Turnaround Time with Digital Scanning Technology in a Canadian Health Region

PubMed Central

Neville, Heather; Nodwell, Lisa; Alsharif, Sahar

2014-01-01

Background: Reducing medication turnaround time can improve efficiency, patient safety, and quality of care in the hospital setting. Digital scanning technology (DST) can be used to electronically transmit scanned prescriber orders to a pharmacy computer queue for verification and processing, which may help to improve medication turnaround time. Objectives: To evaluate medication turnaround time before and after implementation of DST for all medications and for antibiotics only. Methods: Medication turnaround times were evaluated retrospectively for periods before (June 6–10, 2011) and after (September 26–30, 2011) implementation of DST at 2 hospital sites in 1 health region. Medication turnaround time was defined as the time from composition of a medication order by the prescriber to its verification by the pharmacy (phase 1) and the time from prescriber composition to administration to the patient by a nurse (total). Median turnaround times were analyzed with SPSS software using the Mann–Whitney U test. Results: In total, 304 and 244 medication orders were audited before and after DST implementation, respectively. Median phase 1 turnaround time for all medications declined significantly, from 2 h 23 min before DST implementation to 1 h 33 min after DST implementation (p < 0.001). Antibiotics were also processed significantly faster (1 h 51 min versus 1 h 9 min, p = 0.015). However, total turnaround time for all medications did not differ significantly (5 h 15 min versus 5 h 0 min, p = 0.42). Conclusions: Implementation of DST was associated with a 50-min decrease in medication turnaround time for the period from when an order was prescribed to the time it was processed by the pharmacy. Regular evaluation of medication turnaround times is recommended to compare with benchmarks, to ensure that hospital standards are being met, and to measure the effects of policy changes and implementation of new technology on medication-use processes. PMID:25548397

Decreasing medication turnaround time with digital scanning technology in a canadian health region.

PubMed

Neville, Heather; Nodwell, Lisa; Alsharif, Sahar

2014-11-01

Reducing medication turnaround time can improve efficiency, patient safety, and quality of care in the hospital setting. Digital scanning technology (DST) can be used to electronically transmit scanned prescriber orders to a pharmacy computer queue for verification and processing, which may help to improve medication turnaround time. To evaluate medication turnaround time before and after implementation of DST for all medications and for antibiotics only. Medication turnaround times were evaluated retrospectively for periods before (June 6-10, 2011) and after (September 26-30, 2011) implementation of DST at 2 hospital sites in 1 health region. Medication turnaround time was defined as the time from composition of a medication order by the prescriber to its verification by the pharmacy (phase 1) and the time from prescriber composition to administration to the patient by a nurse (total). Median turnaround times were analyzed with SPSS software using the Mann-Whitney U test. In total, 304 and 244 medication orders were audited before and after DST implementation, respectively. Median phase 1 turnaround time for all medications declined significantly, from 2 h 23 min before DST implementation to 1 h 33 min after DST implementation (p < 0.001). Antibiotics were also processed significantly faster (1 h 51 min versus 1 h 9 min, p = 0.015). However, total turnaround time for all medications did not differ significantly (5 h 15 min versus 5 h 0 min, p = 0.42). Implementation of DST was associated with a 50-min decrease in medication turnaround time for the period from when an order was prescribed to the time it was processed by the pharmacy. Regular evaluation of medication turnaround times is recommended to compare with benchmarks, to ensure that hospital standards are being met, and to measure the effects of policy changes and implementation of new technology on medication-use processes.

Quality By Design: Concept To Applications.

PubMed

Swain, Suryakanta; Padhy, Rabinarayan; Jena, Bikash Ranjan; Babu, Sitty Manohar

2018-03-08

Quality by Design is associated to the modern, systematic, scientific and novel approach which is concerned with pre-distinct objectives that not only focus on product, process understanding but also leads to process control. It predominantly signifies the design and product improvement and the manufacturing process in order to fulfill the predefined manufactured goods or final products quality characteristics. It is quite essential to identify desire and required product performance report such as Target Product Profile, typical Quality Target Product Profile (QTPP) and Critical Quality attributes (CQA). This review highlighted about the concepts of QbD design space, for critical material attributes (CMAs) as well as the critical process parameters that can totally affect the CQAs within which the process shall be unaffected and consistently manufacture the required product. Risk assessment tools and design of experiments are its prime components. This paper outlines the basic knowledge of QbD, the key elements; steps as well as various tools for QbD implementation in pharmaceutics field are presented briefly. In addition to this, quite a lot of applications of QbD in numerous pharmaceutical related unit operations are discussed and summarized. This article provides a complete data as well as the road map for universal implementation and application of QbD for pharmaceutical products. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

A fourth-year medical school rotation in quality, patient safety, and population medicine.

PubMed

Dysinger, Wayne S; Pappas, James M

2011-10-01

Quality improvement and population medicine are skills that are increasingly important for physicians to possess. Methods to achieve foundational acquisition of these skills in medical school have not been well described in the past. The primary goal of this project is to provide hands-on, experiential learning in full-cycle population-based care. A description is given of a 4-week, team-based, rapid-cycle quality improvement project embedded in a required fourth-year medical school rotation. Over the course of 4 years a nonspecialty generic Ambulatory Care rotation was converted to a population-based learning rotation. For the last 3 years this rotation has required students to participate in teams of three to four students to assess, plan, implement, and evaluate a quality improvement project. Between 2008 and 2010 a total of 510 students completed the rotation. During this time the project component of the rotation received a 53% average rating of "excellent" or "above average." Qualitative evaluation indicates the project to be an acceptable and worthwhile educational experience for medical students, adding new insights and occasionally career-changing perspectives. Although experiential team-based quality improvement projects are a new format for learning in the medical school environment, it can be implemented in a format that is acceptable and beneficial to future physicians and healthcare systems. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

75 FR 65594 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-26

... Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality Standards AGENCY... the Ohio Administrative Code (OAC) relating to the consolidation of Ohio's Ambient Air Quality Standards (AAQS) into Ohio's State Implementation Plan (SIP) under the Clean Air Act. On April 8, 2009, and...

77 FR 12524 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality Standards AGENCY... Indiana State Implementation Plan (SIP) for lead (Pb) under the Clean Air Act (CAA). This submittal incorporates the National Ambient Air Quality Standards (NAAQS) for Pb promulgated by EPA in 2008. DATES...

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

Control by quality: proposition of a typology.

PubMed

Pujo, P; Pillet, M

The application of Quality tools and methods in industrial management has always had a fundamental impact on the control of production. It influences the behavior of the actors concerned, while introducing the necessary notions and formalizations, especially for production systems with little or no automation, which constitute a large part of the industrial activity. Several quality approaches are applied in the workshop and are implemented at the level of the control. In this paper, the authors present a typology of the various approaches that have successively influenced control, such as statistical process control, quality assurance, and continuous improvement. First the authors present a parallel between production control and quality organizational structure. They note the duality between control, which is aimed at increasing productivity, and quality, which aims to satisfy the needs of the customer. They also note the hierarchical organizational structure of these two systems of management with, at each level, the notion of a feedback loop. This notion is fundamental to any kind of decision making. The paper is organized around the operational, tactical, and strategic levels, by describing for each level the main methods and tools for control by quality. The overview of these tools and methods starts at the operational level, with the Statistical Process Control, the Taguchi technique, and the "six sigma" approach. On the tactical level, we find a quality system approach, with a documented description of the procedures introduced in the firm. The management system can refer here to Quality Assurance, Total Productive Maintenance, or Management by Total Quality. The formalization through procedures of the rules of decision governing the process control enhances the validity of these rules. This leads to the enhancement of their reliability and to their consolidation. All this counterbalances the human, intrinsically fluctuating, behavior of the control operators. Strategic control by quality is then detailed, and the two main approaches, the continuous improvement approach and the proactive improvement approach, are introduced. Finally, the authors observe that at each of the three levels, the continuous process improvement, which is a component of Total Quality, becomes an essential preoccupation for the control. Ultimately, the recursive utilization of the Deming cycle remains the best practice for the control by quality.

Automation Improves Schedule Quality and Increases Scheduling Efficiency for Residents.

PubMed

Perelstein, Elizabeth; Rose, Ariella; Hong, Young-Chae; Cohn, Amy; Long, Micah T

2016-02-01

Medical resident scheduling is difficult due to multiple rules, competing educational goals, and ever-evolving graduate medical education requirements. Despite this, schedules are typically created manually, consuming hours of work, producing schedules of varying quality, and yielding negative consequences for resident morale and learning. To determine whether computerized decision support can improve the construction of residency schedules, saving time and improving schedule quality. The Optimized Residency Scheduling Assistant was designed by a team from the University of Michigan Department of Industrial and Operations Engineering. It was implemented in the C.S. Mott Children's Hospital Pediatric Emergency Department in the 2012-2013 academic year. The 4 metrics of schedule quality that were compared between the 2010-2011 and 2012-2013 academic years were the incidence of challenging shift transitions, the incidence of shifts following continuity clinics, the total shift inequity, and the night shift inequity. All scheduling rules were successfully incorporated. Average schedule creation time fell from 22 to 28 hours to 4 to 6 hours per month, and 3 of 4 metrics of schedule quality significantly improved. For the implementation year, the incidence of challenging shift transitions decreased from 83 to 14 (P < .01); the incidence of postclinic shifts decreased from 72 to 32 (P < .01); and the SD of night shifts dropped by 55.6% (P < .01). This automated shift scheduling system improves the current manual scheduling process, reducing time spent and improving schedule quality. Embracing such automated tools can benefit residency programs with shift-based scheduling needs.

Practical implementation science: developing and piloting the quality implementation tool.

PubMed

Meyers, Duncan C; Katz, Jason; Chien, Victoria; Wandersman, Abraham; Scaccia, Jonathan P; Wright, Annie

2012-12-01

According to the Interactive Systems Framework for Dissemination and Implementation, implementation is a major mechanism and concern in bridging research and practice. The growing number of implementation frameworks need to be synthesized and translated so that the science and practice of quality implementation can be furthered. In this article, we: (1) use the synthesis of frameworks developed by Meyers et al. (Am J Commun Psychol, 2012) and translate the results into a practical implementation science tool to use for improving quality of implementation (i.e., the Quality Implementation Tool; QIT), and (2) present some of the benefits and limitations of the tool by describing how the QIT was implemented in two different pilot projects. We discuss how the QIT can be used to guide collaborative planning, monitoring, and evaluation of how an innovation is implemented.

The Revolving Fund Pharmacy Model: backing up the Ministry of Health supply chain in western Kenya.

PubMed

Manji, Imran; Manyara, Simon M; Jakait, Beatrice; Ogallo, William; Hagedorn, Isabel C; Lukas, Stephanie; Kosgei, Eunice J; Pastakia, Sonak D

2016-10-01

A pressing challenge in low and middle-income countries (LMIC) is inadequate access to essential medicines, especially for chronic diseases. The Revolving Fund Pharmacy (RFP) model is an initiative to provide high-quality medications consistently to patients, using revenues generated from the sale of medications to sustainably resupply medications. This article describes the utilization of RFPs developed by the Academic Model Providing Access to Healthcare (AMPATH) with the aim of stimulating the implementation of similar models elsewhere to ensure sustainable access to quality and affordable medications in similar LMIC settings. The service evaluation of three pilot RFPs started between April 2011 and January 2012 in select government facilities is described. The evaluation assessed cross-sectional availability of essential medicines before and after implementation of the RFPs, number of patient encounters and the impact of community awareness activities. Availability of essential medicines in the three pilot RFPs increased from 40%, 36% and <10% to 90%, 94% and 91% respectively. After the first year of operation, the pilot RFPs had a total of 33 714 patient encounters. As of February 2014, almost 3 years after starting up the first RFP, the RFPs had a total of 115 991 patient encounters. In the Eldoret RFP, community awareness activities led to a 51% increase in sales. With proper oversight and stakeholder involvement, this model is a potential solution to improve availability of essential medicines in LMICs. These pilots exemplify the feasibility of implementing and scaling up this model in other locations. © 2016 Royal Pharmaceutical Society.

Implementation of treatment guidelines for specialist mental health care.

PubMed

Bighelli, Irene; Ostuzzi, Giovanni; Girlanda, Francesca; Cipriani, Andrea; Becker, Thomas; Koesters, Markus; Barbui, Corrado

2016-12-15

A huge gap exists between the production of evidence and its uptake in clinical practice settings. To fill this gap, treatment guidelines, based on explicit assessments of the evidence base, are commonly used in several fields of psychiatry, including schizophrenia and related psychotic disorders. However, it remains unclear whether treatment guidelines have any material impact on provider performance and patient outcomes, and how implementation should be conducted to maximise benefit. The primary objective of this review was to examine the efficacy of guideline implementation strategies in improving process outcomes (performance of healthcare providers) and patient outcomes. We also explored which components of different guideline implementation strategies could influence them. We searched the Cochrane Schizophrenia Group Register (March 2012 and August 2015), as well as references of included studies. Studies that examined schizophrenia-spectrum disorders to compare guideline implementation strategies with usual care or to assess the comparative efficacy of different guideline implementation strategies. Review authors worked independently and in duplicate to critically appraise records from 990 studies; six individual studies met the inclusion criteria. Among the six included studies, significant heterogeneity was found in the focus of the guideline, target of the intervention, implementation strategy, and outcome measures, so meta-analysis was carried out for antipsychotic co-prescribing only. This review now includes six studies, with a total of 1727 participants. Of the six included studies, practitioner impact was assessed in four. Overall, risk of bias was rated as low or unclear, and all evidence in the 'Summary of findings' tables was graded as low or very low quality. Meta-analysis revealed that a combination of several guideline dissemination and implementation strategies targeting healthcare professionals did not reduce antipsychotic co-prescribing in schizophrenia outpatients (2 RCTs, N = 1082, RR 1.10 CI 0.99 to 1.23; corrected for cluster design: N = 310, RR 0.97, CI 0.75 to 1.25, very low-quality evidence). One trial, which studied a nurse-led intervention aimed at promoting cardiovascular disease screening, found a significant effect in the proportion of people receiving screening (Framingham score: N = 110, RR 0.69, 95% CI 0.55 to 0.87), although in the analysis corrected for cluster design, the effect was no longer statistically significant (N = 38, RR 0.71, 95% CI 0.48 to 1.03, very low-quality evidence).One trial reported the patient outcomes of global state, satisfaction with care, treatment adherence, and drug attitude; no effect between treatments was seen. Quality of life was not reported by any of the studies.One trial, which studied the use of re-written guideline text compared to original text, did not find a significant effect on staff receiving training (N = 68, RR 1.03, 95% CI 0.87 to 1.21, low-quality evidence), staff receiving supervision (N = 68, RR 0.86, 95% CI 0.64 to 1.17, low-quality evidence), or staff providing psychological interventions (N = 68, RR 0.86, 95% CI 0.62 to 1.18, low-quality evidence).Regarding participant outcomes, only one trial assessed the efficacy of a shared decision-making implementation strategy and found no impact on psychopathology, satisfaction with care, or drug attitude. Another single trial studied a multifaceted intervention to promote medication adherence and found no effect on adherence rates. Considering the available evidence, it is not possible to arrive at definitive conclusions. The preliminary pattern of evidence suggests that uncertainty remains about clinically meaningful and sustainable effects of treatment guidelines on patient outcomes and how best to implement such guidelines for maximal benefit.

Reducing quality-of-care disparities in childhood asthma: La Red de Asma Infantil intervention in San Juan, Puerto Rico.

PubMed

Lara, Marielena; Ramos-Valencia, Gilberto; González-Gavillán, Jesús A; López-Malpica, Fernando; Morales-Reyes, Beatriz; Marín, Heriberto; Rodríguez-Sánchez, Mario H; Mitchell, Herman

2013-03-01

Although children living in Puerto Rico have the highest asthma prevalence of all US children, little is known regarding the quality-of-care disparities they experience nor the adaptability of existing asthma evidence-based interventions to reduce these disparities. The objective of this study was to describe our experience in reducing quality-of-care disparities among Puerto Rican children with asthma by adapting 2 existing evidence-based asthma interventions. We describe our experience in adapting and implementing 2 previously tested asthma evidence-based interventions: the Yes We Can program and the Inner-City Asthma Study intervention. We assessed the feasibility of combining key components of the 2 interventions to reduce asthma symptoms and estimated the potential cost savings associated with reductions in asthma-related hospitalizations and emergency department visits. A total of 117 children with moderate and severe asthma participated in the 12-month intervention in 2 housing projects in San Juan, Puerto Rico. A community-academic team with the necessary technical and cultural competences adapted and implemented the intervention. Our case study revealed the feasibility of implementing the combined intervention, henceforth referred to as La Red intervention, in the selected Puerto Rican communities experiencing a disproportionately high level of asthma burden. After 1-year follow-up, La Red intervention significantly reduced asthma symptoms and exceeded reductions of the original interventions. Asthma-related hospitalizations and emergency department use, and their associated high costs, were also significantly reduced. Asthma evidence-based interventions can be adapted to improve quality of care for children with asthma in a different cultural community setting.

How Compliance Measures, Behavior Modification, and Continuous Quality Improvement Led to Routine HIV Screening in an Emergency Department in Brooklyn, New York.

PubMed

Isaac, Jermel Kyri; Sanchez, Travis H; Brown, Emily H; Thompson, Gina; Sanchez, Christina; Fils-Aime, Stephany; Maria, Jose

2016-01-01

New York State adopted a new HIV testing law in 2010 requiring medical providers to offer an HIV test to all eligible patients aged 13-64 years during emergency room or ambulatory care visits. Since then, Wyckoff Heights Medical Center (WHMC) in Brooklyn, New York, began implementing routine HIV screening organization-wide using a compliance, behavior-modification, and continuous quality-improvement process. WHMC first implemented HIV screening in the emergency department (ED) and evaluated progress with the following monthly indicators: HIV tests offered, HIV tests accepted, HIV tests ordered (starting in December 2013), HIV tests administered, positive HIV tests, and linkage to HIV care. Compliance with the delivery of HIV testing was determined by the proportion of patients who, after accepting a test, received one. During August 2013 through July 2014, of 57,852 eligible patients seen in the WHMC ED, a total of 31,423 (54.3%) were offered an HIV test. Of those, 8,229 (26.2%) patients accepted a test. Of those, 6,114 (74.3%) underwent a test. A total of 26 of the 6,114 patients tested (0.4%) had a positive test, and 24 of the 26 HIV-positive patients were linked to HIV medical care. By July 2014, the monthly proportion of patients offered a test was 62%; the proportion of those offered a test who had a test ordered was 98%, and the proportion of those with a test ordered who were tested was 81%. Testing compliance increased substantially at the WHMC ED, from 77% in December 2013 to >98% in July 2014. Using compliance-monitoring, behavior-modification, and continuous quality-improvement processes produced substantial increases in offers and HIV test completion. WHMC is replicating this approach across departments, and other hospitals implementing routine HIV screening programs should consider this approach as well.

Improving the quality of cardiopulmonary resuscitation by training dedicated cardiac arrest teams incorporating a mechanical load-distributing device at the emergency department.

PubMed

Ong, Marcus Eng Hock; Quah, Joy Li Juan; Annathurai, Annitha; Noor, Noorkiah Mohamed; Koh, Zhi Xiong; Tan, Kenneth Boon Kiat; Pothiawala, Sohil; Poh, Ah Ho; Loy, Chye Khiaw; Fook-Chong, Stephanie

2013-04-01

Determine if implementing cardiac arrest teams trained with a 'pit-crew' protocol incorporating a load-distributing band mechanical CPR device (Autopulse™ ZOLL) improves the quality of CPR, as determined by no-flow ratio (NFR) in the first 10min of resuscitation. A phased, prospective, non-randomized, before-after cohort evaluation. Data collection was from April 2008 to February 2011. There were 100 before and 148 after cases. Continuous video and chest compression data of all study subjects were analyzed. All non-traumatic, collapsed patients aged 18 years and above presenting to the emergency department were eligible. Primary outcome was NFR. Secondary outcomes were return of spontaneous circulation (ROSC), survival to hospital admission and neurological outcome at discharge. After implementation, mean total NFR for the first 5min decreased from 0.42 to 0.27 (decrease=0.15, 95% CI 0.10-0.19, p<0.005), and from 0.24 to 0.18 (decrease=0.06, 95% CI 0.01-0.11, p=0.02) for the next 5min. The mean time taken to apply Autopulse™ decreased from 208.8s to 141.6s (decrease=67.2, 95% CI, 22.3-112.1, p<0.005). The mean CPR ratio increased from 46.4% to 88.4% (increase=41.9%, 95% CI 36.9-46.9, p<0.005) and the mean total NFR for the first 10min decreased from 0.33 to 0.23 (decrease=0.10, 95% CI 0.07-0.14, p<0.005). Implementation of cardiac arrest teams was associated with a reduction in NFR in the first 10min of resuscitation. Training cardiac arrest teams in a 'pit-crew' protocol may improve the quality of CPR at the ED. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A mobile decision support system for red eye diseases diagnosis: experience with medical students.

PubMed

López, Marta Manovel; López, Miguel Maldonado; de la Torre Díez, Isabel; Jimeno, José Carlos Pastor; López-Coronado, Miguel

2016-06-01

A good primary health care is the base for a better healthcare system. Taking a good decision on time by the primary health care physician could have a huge repercussion. In order to ease the diagnosis task arise the Decision Support Systems (DSS), which offer counselling instead of refresh the medical knowledge, in a profession where it is still learning every day. The implementation of these systems in diseases which are a frequent cause of visit to the doctor like ophthalmologic pathologies are, which affect directly to our quality of life, takes more importance. This paper aims to develop OphthalDSS, a totally new mobile DSS for red eye diseases diagnosis. The main utilities that OphthalDSS offers will be a study guide for medical students and a clinical decision support system for primary care professionals. Other important goal of this paper is to show the user experience results after OphthalDSS being used by medical students of the University of Valladolid. For achieving the main purpose of this research work, a decision algorithm will be developed and implemented by an Android mobile application. Moreover, the Quality of Experience (QoE) has been evaluated by the students through the questions of a short inquiry. The app developed which implements the algorithm OphthalDSS is capable of diagnose more than 30 eye's anterior segment diseases. A total of 67 medical students have evaluated the QoE. The students find the diseases' information presented very valuable, the appearance is adequate, it is always available and they have ever found what they were looking for. Furthermore, the students think that their quality of life has not been improved using the app and they can do the same without using the OphthalDSS app. OphthalDSS is easy to use, which is capable of diagnose more than 30 ocular diseases in addition to be used as a DSS tool as an educational tool at the same time.

75 FR 61369 - Revisions to the California State Implementation Plan; Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

... the California State Implementation Plan; Sacramento Metropolitan Air Quality Management District... approve a revision to the Sacramento Metropolitan Air Quality Management District's portion of the... Metropolitan Air Quality Management District (SMAQMD) adopted the ``Ozone State Implementation Plan Revision...

Improving the Quality of Academic Services through Implementation of Internal Quality Assurance System in State Institute of Islamic Studies STS Jambi

ERIC Educational Resources Information Center

Iskandar

2017-01-01

Implementation of quality assurance systems in IAIN STS Jambi implemented in early 2012, through the build system of internal quality assurance based on ISO 9001: 2008, in the process of implementation required strong reasons behind not growing atmosphere of academic standards of accreditation of study programs and institutions that are reflected…

Quasi-experimental evaluation of a multifaceted intervention to improve quality of end-of-life care and quality of dying for patients with advanced dementia in long-term care institutions.

PubMed

Verreault, René; Arcand, Marcel; Misson, Lucie; Durand, Pierre J; Kroger, Edeltraut; Aubin, Michèle; Savoie, Maryse; Hadjistavropoulos, Thomas; Kaasalainen, Sharon; Bédard, Annick; Grégoire, Annie; Carmichael, Pierre-Hughes

2018-03-01

Improvement in the quality of end-of-life care for advanced dementia is increasingly recognized as a priority in palliative care. To evaluate the impact of a multidimensional intervention to improve quality of care and quality of dying in advanced dementia in long-term care facilities. Quasi-experimental study with the intervention taking place in two long-term care facilities versus usual care in two others over a 1-year period. The intervention had five components: (1) training program to physicians and nursing staff, (2) clinical monitoring of pain using an observational pain scale, (3) implementation of a regular mouth care routine, (4) early and systematic communication with families about end-of-life care issues with provision of an information booklet, and (5) involvement of a nurse facilitator to implement and monitor the intervention. Quality of care was assessed with the Family Perception of Care Scale. The Symptom Management for End-of-Life Care in Dementia and the Comfort Assessment in Dying scales were used to assess the quality of dying. A total of 193 residents with advanced dementia and their close family members were included (97 in the intervention group and 96 in the usual care group). The Family Perception of Care score was significantly higher in the intervention group than in the usual care group (157.3 vs 149.1; p = 0.04). The Comfort Assessment and Symptom Management scores were also significantly higher in the intervention group. Our multidimensional intervention in long-term care facilities for patients with terminal dementia resulted in improved quality of care and quality of dying when compared to usual care.

Model assessment of atmospheric pollution control schemes for critical emission regions

NASA Astrophysics Data System (ADS)

Zhai, Shixian; An, Xingqin; Liu, Zhao; Sun, Zhaobin; Hou, Qing

2016-01-01

In recent years, the atmospheric environment in portions of China has become significantly degraded and the need for emission controls has become urgent. Because more international events are being planned, it is important to implement air quality assurance targeted at significant events held over specific periods of time. This study sets Yanqihu (YQH), Beijing, the location of the 2014 Beijing APEC (Asia-Pacific Economic Cooperation) summit, as the target region. By using the atmospheric inversion model FLEXPART, we determined the sensitive source zones that had the greatest impact on the air quality of the YQH region in November 2012. We then used the air-quality model Models-3/CMAQ and a high-resolution emissions inventory of the Beijing-Tianjian-Hebei region to establish emission reduction tests for the entire source area and for specific sensitive source zones. This was achieved by initiating emission reduction schemes at different ratios and different times. The results showed that initiating a moderate reduction of emissions days prior to a potential event is more beneficial to the air quality of Beijing than initiating a high-strength reduction campaign on the day of the event. The sensitive source zone of Beijing (BJ-Sens) accounts for 54.2% of the total source area of Beijing (BJ), but its reduction effect reaches 89%-100% of the total area, with a reduction efficiency 1.6-1.9 times greater than that of the entire area. The sensitive source zone of Huabei (HuaB-Sens.) only represents 17.6% of the total area of Huabei (HuaB), but its emission reduction effect reaches 59%-97% of the entire area, with a reduction efficiency 4.2-5.5 times greater than that of the total area. The earlier that emission reduction measures are implemented, the greater the effect they have on preventing the transmission of pollutants. In addition, expanding the controlling areas to sensitive provinces and cities around Beijing (HuaB-sens) can significantly accelerate the reduction effects compared to controlling measures only in the Beijing sensitive source zone (BJ-Sens). Therefore, when enacting emission reduction schemes, cooperating with surrounding provinces and cities, as well as narrowing the reduction scope to specific sensitive source zones prior to unfavorable meteorological conditions, can help reduce emissions control costs and improve the efficiency and maneuverability of emission reduction schemes.

Soil Quality Assessment Is a Necessary First Step for Designing Urban Green Infrastructure.

PubMed

Montgomery, James A; Klimas, Christie A; Arcus, Joseph; DeKnock, Christian; Rico, Kathryn; Rodriguez, Yarency; Vollrath, Katherine; Webb, Ellen; Williams, Allison

2016-01-01

This paper describes the results of a preliminary project conducted by a team of DePaul University undergraduate students and staff from the Gary Comer Youth Center located on Chicago's South Side. The team assessed soil quality on 116 samples collected among four abandoned residential lots adjacent to the Comer Center. Soil quality data will be used in a follow-up study to determine the suitability of each lot for green infrastructure implementation. Green infrastructure may be a useful approach for providing ecosystem services and mitigating food deserts in inner-city communities. Soil quality on all lots was poor. All soils had pH >8.0, low biological activity, and low N mineralization potential. The soils were rich in available P and had mean total Pb concentrations above the USEPA threshold (400 mg kg) for children's playlots. Mean bioavailable Pb on the largest of the four lots was 12% of total Pb, indicating that most of the total Pb is not bioavailable. This result is encouraging because high bioavailable Pb concentrations are linked with negative health effects, particularly in children. All lots had NO-N concentrations below those considered to be appropriate for plant growth. On the other hand, no significant differences in mean concentrations of the other analytes were found. The poor soil quality in the four lots presents an opportunity to use green infrastructure to enhance ecosystem services, improve community and environmental health, and provide more equitable access to green space. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.

Aerosol distribution during open suctioning and long-term surveillance of air quality in a respiratory care center within a medical center.

PubMed

Chung, Fen-Fang; Lin, Hui-Ling; Liu, Hsueh-Erh; Lien, Angela Shin-Yu; Hsiao, Hsiu-Feng; Chou, Lan-Ti; Wan, Gwo-Hwa

2015-01-01

The investigation of hospital air quality has been conducted in wards, ICUs, operating theaters, and public areas. Few studies have assessed air quality in respiratory care centers (RCCs), especially in mechanically ventilated patients with open suctioning. The RCC air quality indices (temperature, relative humidity, levels of CO2, total volatile organic compounds, particulate matter [PM], bacteria, and fungi) were monitored over 1 y. The air around the patient's head was sampled during open suctioning to examine the probability of bioaerosol exposure affecting health-care workers. This investigation found that the levels of indoor air pollutants (CO2, PM, bacteria, and fungi) were below the indoor air quality standard set by the Taiwan Environmental Protection Agency. Meanwhile, the levels of total volatile organic compounds sometimes exceeded the indoor air quality standard, particularly in August. The identified bacterial genera included Micrococcus species, Corynebacterium species, and Staphylococcus species, and the predominant fungal genera included yeast, Aspergillus species, Scopulariopsis species, and Trichoderma species. Additionally, airborne PM2.5, PM1, and bacteria were clearly raised during open suctioning in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the bacterial exposure risk of health-care workers. RCC air quality deserves long-term monitoring and evaluation. Health-care workers must implement self-protection strategies during open suctioning to ensure their occupational health and safety in health-care settings. Copyright © 2015 by Daedalus Enterprises.

Bridging existing governance gaps: five evidence-based actions that boards can take to pursue high quality care.

PubMed

Leggat, Sandra G; Balding, Cathy

2017-11-13

Objective To explore the impact of the organisational quality systems on quality of care in Victorian health services. Methods During 2015 a total of 55 focus groups were conducted with more than 350 managers, clinical staff and board members in eight Victorian health services to explore the effectiveness of health service quality systems. A review of the quality and safety goals and strategies outlined in the strategic and operating plans of the participating health services was also undertaken. Results This paper focuses on the data related to the leadership role of health service boards in ensuring safe, high-quality care. The findings suggest that health service boards are not fully meeting their governance accountability to ensure consistently high-quality care. The data uncovered major clinical governance gaps between stated board and executive aspirations for quality and safety and the implementation of these expectations at point of care. These gaps were further compounded by quality system confusion, over-reliance on compliance, and inadequate staff engagement. Conclusion Based on the existing evidence we propose five specific actions boards can take to close the gaps, thereby supporting improved care for all consumers. What is known about this topic? Effective governance is essential for high-quality healthcare delivery. Boards are required to play an active role in their organisation's pursuit of high quality care. What does this paper add? Recent government reports suggest that Australian health service boards are not fully meeting their governance requirements for high quality, safe care delivery, and our research pinpoints key governance gaps. What are the implications for practitioners? Based on our research findings we outline five evidence-based actions for boards to improve their governance of quality care delivery. These actions focus on an organisational strategy for high-quality care, with the chief executive officer held accountable for successful implementation, which is actively guided and monitored by the board.

An evaluation of the relative quality of dike pools for benthic macroinvertebrates in the Lower Missouri River, USA

USGS Publications Warehouse

Poulton, B.C.; Allert, A.L.

2012-01-01

A habitat-based aquatic macroinvertebrate study was initiated in the Lower Missouri River to evaluate relative quality and biological condition of dike pool habitats. Water-quality and sediment-quality parameters and macroinvertebrate assemblage structure were measured from depositional substrates at 18 sites. Sediment porewater was analysed for ammonia, sulphide, pH and oxidation-reduction potential. Whole sediments were analysed for particle-size distribution, organic carbon and contaminants. Field water-quality parameters were measured at subsurface and at the sediment-water interface. Pool area adjacent and downstream from each dike was estimated from aerial photography. Macroinvertebrate biotic condition scores were determined by integrating the following indicator response metrics: % of Ephemeroptera (mayflies), % of Oligochaeta worms, Shannon Diversity Index and total taxa richness. Regression models were developed for predicting macroinvertebrate scores based on individual water-quality and sediment-quality variables and a water/sediment-quality score that integrated all variables. Macroinvertebrate scores generated significant determination coefficients with dike pool area (R2=0.56), oxidation–reduction potential (R2=0.81) and water/sediment-quality score (R2=0.71). Dissolved oxygen saturation, oxidation-reduction potential and total ammonia in sediment porewater were most important in explaining variation in macroinvertebrate scores. The best two-variable regression models included dike pool size + the water/sediment-quality score (R2=0.84) and dike pool size + oxidation-reduction potential (R2=0.93). Results indicate that dike pool size and chemistry of sediments and overlying water can be used to evaluate dike pool quality and identify environmental conditions necessary for optimizing diversity and productivity of important aquatic macroinvertebrates. A combination of these variables could be utilized for measuring the success of habitat enhancement activities currently being implemented in this system.

Surgical Technical Evidence Review for Elective Total Joint Replacement Conducted for the AHRQ Safety Program for Improving Surgical Care and Recovery

PubMed Central

Siletz, Anaar E.; Singer, Emily S.; Faltermeier, Claire; Hu, Q. Lina; Ko, Clifford Y.; Golladay, Gregory J.; Kates, Stephen L.; Wick, Elizabeth C.; Maggard-Gibbons, Melinda

2018-01-01

Background: Use of enhanced recovery pathways (ERPs) can improve patient outcomes, yet national implementation of these pathways remains low. The Agency for Healthcare Research and Quality (AHRQ; funder), the American College of Surgeons, and the Johns Hopkins Medicine Armstrong Institute for Patent Safety and Quality have developed the Safety Program for Improving Surgical Care and Recovery—a national effort to catalyze implementation of practices to improve perioperative care and enhance recovery of surgical patients. This review synthesizes evidence that can be used to develop a protocol for elective total knee arthroplasty (TKA) and total hip arthroplasty (THA). Study Design: This review focuses on potential components of the protocol relevant to surgeons; anesthesia components are reported separately. Components were identified through review of existing pathways and from consultation with technical experts. For each, a structured review of MEDLINE identified systematic reviews, randomized trials, and observational studies that reported on these components in patients undergoing elective TKA/THA. This primary evidence review was combined with existing clinical guidelines in a narrative format. Results: Sixteen components were reviewed. Of the 10 preoperative components, most were focused on risk factor assessment including anemia, diabetes mellitus, tobacco use, obesity, nutrition, immune-modulating therapy, and opiates. Preoperative education, venous thromboembolism (VTE) prophylaxis, and bathing/Staphylococcus aureus decolonization were also included. The routine use of drains was the only intraoperative component evaluated. The 5 postoperative components included early mobilization, continuous passive motion, extended duration VTE prophylaxis, early oral alimentation, and discharge planning. Conclusion: This review synthesizes the evidence supporting potential surgical components of an ERP for elective TKA/THA. The AHRQ Safety Program for Improving Surgical Care and Recovery aims to guide hospitals and surgeons in identifying the best practices to implement in the surgical care of TKA and THA patients. PMID:29468091

Benchmark matrix and guide: Part III.

PubMed

1992-01-01

The final article in the "Benchmark Matrix and Guide" series developed by Headquarters Air Force Logistics Command completes the discussion of the last three categories that are essential ingredients of a successful total quality management (TQM) program. Detailed behavioral objectives are listed in the areas of recognition, process improvement, and customer focus. These vertical categories are meant to be applied to the levels of the matrix that define the progressive stages of the TQM: business as usual, initiation, implementation, expansion, and integration. By charting the horizontal progress level and the vertical TQM category, the quality management professional can evaluate the current state of TQM in any given organization. As each category is completed, new goals can be defined in order to advance to a higher level. The benchmarking process is integral to quality improvement efforts because it focuses on the highest possible standards to evaluate quality programs.

ISO 9001 in a neonatal intensive care unit (NICU).

PubMed

Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

2011-01-01

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

76 FR 55621 - Revisions to the California State Implementation Plan, Yolo-Solano Air Quality Management District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... California State Implementation Plan, Yolo- Solano Air Quality Management District AGENCY: Environmental...-Solano Air Quality Management District portion of the California State Implementation Plan (SIP). This... the following local rule: Yolo-Solano Air Quality Management District Rule 2.41, Expandable...

76 FR 47094 - Revisions to the California State Implementation Plan; South Coast Air Quality Management District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... the California State Implementation Plan; South Coast Air Quality Management District AGENCY... the South Coast Air Quality Management District portion of the California State Implementation Plan... following local rule: South Coast Air Quality Management District Rule 1175, Control of Emissions from the...

76 FR 55581 - Revision to the California State Implementation Plan; Yolo-Solano Air Quality Management District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-09-08

... California State Implementation Plan; Yolo-Solano Air Quality Management District AGENCY: Environmental... revision to the Yolo-Solano Air Quality Management District portion of the California State Implementation...-Solano Air Quality Management District (YSAQMD) Rule 2.41, adopted on September 10, 2008, and submitted...

78 FR 23524 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Particulate Matter...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-19

... Promulgation of Air Quality Implementation Plans; Indiana; Particulate Matter Ambient Air Quality Standards... revise the Indiana State Implementation Plan (SIP) for particulate matter under the Clean Air Act. This submission contains the 24-hour fine particle National Ambient Air Quality Standards (NAAQS) promulgated by...

Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation.

PubMed

Benjamin-Chung, Jade; Sultana, Sonia; Halder, Amal K; Ahsan, Mohammed Ali; Arnold, Benjamin F; Hubbard, Alan E; Unicomb, Leanne; Luby, Stephen P; Colford, John M

2017-05-01

To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. SHEWA-B did not meet UNICEF's ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B's design was suboptimal for improving these outcomes.

What Is the Return on Investment for Implementation of a Crew Resource Management Program at an Academic Medical Center?

PubMed

Moffatt-Bruce, Susan D; Hefner, Jennifer L; Mekhjian, Hagop; McAlearney, John S; Latimer, Tina; Ellison, Chris; McAlearney, Ann Scheck

Crew Resource Management (CRM) training has been used successfully within hospital units to improve quality and safety. This article presents a description of a health system-wide implementation of CRM focusing on the return on investment (ROI). The costs included training, programmatic fixed costs, time away from work, and leadership time. Cost savings were calculated based on the reduction in avoidable adverse events and cost estimates from the literature. Between July 2010 and July 2013, roughly 3000 health system employees across 12 areas were trained, costing $3.6 million. The total number of adverse events avoided was 735-a 25.7% reduction in observed relative to expected events. Savings ranged from a conservative estimate of $12.6 million to as much as $28.0 million. Therefore, the overall ROI for CRM training was in the range of $9.1 to $24.4 million. CRM presents a financially viable way to systematically organize for quality improvement.

Supervising community health workers in low-income countries – a review of impact and implementation issues

PubMed Central

Hill, Zelee; Dumbaugh, Mari; Benton, Lorna; Källander, Karin; Strachan, Daniel; Asbroek, Augustinus ten; Tibenderana, James; Kirkwood, Betty; Meek, Sylvia

2014-01-01

Background Community health workers (CHWs) are an increasingly important component of health systems and programs. Despite the recognized role of supervision in ensuring CHWs are effective, supervision is often weak and under-supported. Little is known about what constitutes adequate supervision and how different supervision strategies influence performance, motivation, and retention. Objective To determine the impact of supervision strategies used in low- and middle-income countries and discuss implementation and feasibility issues with a focus on CHWs. Design A search of peer-reviewed, English language articles evaluating health provider supervision strategies was conducted through November 2013. Included articles evaluated the impact of supervision in low- or middle-income countries using a controlled, pre-/post- or observational design. Implementation and feasibility literature included both peer-reviewed and gray literature. Results A total of 22 impact papers were identified. Papers were from a range of low- and middle-income countries addressing the supervision of a variety of health care providers. We classified interventions as testing supervision frequency, the supportive/facilitative supervision package, supervision mode (peer, group, and community), tools (self-assessment and checklists), focus (quality assurance/problem solving), and training. Outcomes included coverage, performance, and perception of quality but were not uniform across studies. Evidence suggests that improving supervision quality has a greater impact than increasing frequency of supervision alone. Supportive supervision packages, community monitoring, and quality improvement/problem-solving approaches show the most promise; however, evaluation of all strategies was weak. Conclusion Few supervision strategies have been rigorously tested and data on CHW supervision is particularly sparse. This review highlights the diversity of supervision approaches that policy makers have to choose from and, while choices should be context specific, our findings suggest that high-quality supervision that focuses on supportive approaches, community monitoring, and/or quality assurance/problem solving may be most effective. PMID:24815075

[Evaluation on a demonstration project of ecological restoration of ditches at Qianwei Village of Chongming County, Shanghai].

PubMed

Zhou, Xiang-Xiang; Zhang, Li-Quan; Yuan, Lian-Qi

2008-02-01

By using biological slope-protection techniques, oxidation pond system, and zeolite treatment system, a demonstration project of ecological restoration of ditches at the Qianwei Village of Chongming County in Shanghai was implemented, and an evaluation on the project was made via a runoff simulation experiment and the measurements of the parameters soil shear strength, biodiversity, and ditch water quality. The results showed that covering the dich slopes with shrub could significantly increase soil shear strength, compactness and moisture content, and the formed vegetation had significant effects on retarding runoff and removing TSS (P < 0.05). Applying live fascines could significantly increase soil shear strength and TSS removal rate (P < 0.05), but its effects on increasing soil compactness and moisture content and retaining runoff were not significant. After the implement of the demonstration project, the total N and P concentrations in ditch water decreased significantly, habitat quality and aesthetic value of ditch slope improved, and biodiversity enhanced greatly. The integration of the biological techniques with other ecological restoration measures could stabilize ditch slope, improve ditch habitat quality, and restore the ecological environment of the ditches.

Watershed monitoring and modelling and USA regulatory compliance.

PubMed

Turner, B G; Boner, M C

2004-01-01

The aim of the Columbus program was to implement a comprehensive watershed monitoring-network including water chemistry, aquatic biology and alternative sensors to establish water environment health and methods for determining future restoration progress and early warning for protection of drinking water supplies. The program was implemented to comply with USA regulatory requirements including Total Maximum Daily Load (TMDL) rules of the Clean Water Act (CWA) and Source Water Assessment and Protection (SWAP) rules under the Safe Drinking Water Act (SDWA). The USEPA Office of Research and Development and the Water Environment Research Foundation provided quality assurance oversight. The results obtained demonstrated that significant wet weather data is necessary to establish relationships between land use, water chemistry, aquatic biology and sensor data. These measurements and relationships formed the basis for calibrating the US EPA BASINS Model, prioritizing watershed health and determination of compliance with water quality standards. Conclusions specify priorities of cost-effective drainage system controls that attenuate stormwater flows and capture flushed pollutants. A network of permanent long-term real-time monitoring using combination of continuous sensor measurements, water column sampling and aquatic biology surveys and a regional organization is prescribed to protect drinking water supplies and measure progress towards water quality targets.

Approved Air Quality Implementation Plans in Region 10

EPA Pesticide Factsheets

Landing page for information about EPA-approved air quality State Implementation Plans (SIPs), Tribal Implementation Plans (TIPs), and Federal Implementation Plans (FIPs) in Alaska, Idaho, Oregon, Washington.

Reproductive health services in Malawi: an evaluation of a quality improvement intervention.

PubMed

Rawlins, Barbara J; Kim, Young-Mi; Rozario, Aleisha M; Bazant, Eva; Rashidi, Tambudzai; Bandazi, Sheila N; Kachale, Fannie; Sanghvi, Harshad; Noh, Jin Won

2013-01-01

this study was to evaluate the impact of a quality improvement initiative in Malawi on reproductive health service quality and related outcomes. (1) post-only quasi-experimental design comparing observed service quality at intervention and comparison health facilities, and (2) a time-series analysis of service statistics. sixteen of Malawi's 23 district hospitals, half of which had implemented the Performance and Quality Improvement (PQI) intervention for reproductive health at the time of the study. a total of 98 reproductive health-care providers (mostly nurse-midwives) and 139 patients seeking family planning (FP), antenatal care (ANC), labour and delivery (L&D), or postnatal care (PNC) services. health facility teams implemented a performance and quality improvement (PQI) intervention over a 3-year period. Following an external observational assessment of service quality at baseline, facility teams analysed performance gaps, designed and implemented interventions to address weaknesses, and conducted quarterly internal assessments to assess progress. Facilities qualified for national recognition by complying with at least 80% of reproductive health clinical standards during an external verification assessment. key measures include facility readiness to provide quality care, observed health-care provider adherence to clinical performance standards during service delivery, and trends in service utilisation. intervention facilities were more likely than comparison facilities to have the needed infrastructure, equipment, supplies, and systems in place to offer reproductive health services. Observed quality of care was significantly higher at intervention than comparison facilities for PNC and FP. Compared with other providers, those at intervention facilities scored significantly higher on client assessment and diagnosis in three service areas, on clinical management and procedures in two service areas, and on counselling in one service area. Service statistics suggest that the PQI intervention increased the number of Caesarean sections, but showed no impact on other indicators of service utilisation and skilled care. the PQI intervention showed a positive impact on the quality of reproductive health services. The effects of the intervention on service utilisation had likely not yet been fully realized, since none of the facilities had achieved national recognition before the evaluation. Staff turnover needs to be reduced to maximise the effectiveness of the intervention. the PQI intervention evaluated here offers an effective way to improve the quality of health services in low-resource settings and should continue to be scaled up in Malawi. Copyright © 2011 Elsevier Ltd. All rights reserved.

Evaluation of long-term trends in hydrographic and nutrient parameters in a southeast US coastal river.

PubMed

Williams, Asher A; Kimball, Matthew E

2013-12-01

The Nassau River estuary is located in northeast Florida adjacent to the eutrophic St. Johns River. Historically, development has been sparse in the Nassau River's catchment; thus, the system may provide a relatively undisturbed aquatic environment. To monitor the condition of the Nassau River estuary and to discern spatial and temporal trends in water quality, nutrients and hydrographic variables were assessed throughout the estuary from 1997 to 2011. Hydrographic (temperature, salinity, total suspended solids, and turbidity) and nutrient parameters (total phosphorus, ortho-PO₄(3-), total nitrogen, NH₄(+), total Kjeldahl nitrogen, and NO₃(-)) were monitored bimonthly at 12 sites in the mesohaline and polyhaline zones of the river. Nonparametric Kendall's Tau was implemented to analyze long-term water quality patterns. Salinity was found to increase with time, particularly in the mesohaline sampling sites. Dissolved oxygen decreased over time in the estuary and hypoxic conditions became increasingly frequent in the final years of the study. Nutrients increased in the estuary, ranging from 149 to 401%. Rainfall data collected in adjacent conservation areas did not correlate well with nutrients as compared with stream discharge data collected in the basin headwaters, outside of the conservation lands, attributed here to expanding urbanization. During the study period, the Nassau basin underwent rapid human population growth and land development resulting in commensurate impacts to water quality. Nutrient and physical data collected during this study indicate that the Nassau River estuary is becoming more eutrophic with time.

Quality assurance practices in Europe: a survey of molecular genetic testing laboratories

PubMed Central

Berwouts, Sarah; Fanning, Katrina; Morris, Michael A; Barton, David E; Dequeker, Elisabeth

2012-01-01

In the 2000s, a number of initiatives were taken internationally to improve quality in genetic testing services. To contribute to and update the limited literature available related to this topic, we surveyed 910 human molecular genetic testing laboratories, of which 291 (32%) from 29 European countries responded. The majority of laboratories were in the public sector (81%), affiliated with a university hospital (60%). Only a minority of laboratories was accredited (23%), and 26% was certified. A total of 22% of laboratories did not participate in external quality assessment (EQA) and 28% did not use reference materials (RMs). The main motivations given for accreditation were to improve laboratory profile (85%) and national recognition (84%). Nearly all respondents (95%) would prefer working in an accredited laboratory. In accredited laboratories, participation in EQA (P<0.0001), use of RMs (P=0.0014) and availability of continuous education (CE) on medical/scientific subjects (P=0.023), specific tasks (P=0.0018), and quality assurance (P<0.0001) were significantly higher than in non-accredited laboratories. Non-accredited laboratories expect higher restriction of development of new techniques (P=0.023) and improvement of work satisfaction (P=0.0002) than accredited laboratories. By using a quality implementation score (QIS), we showed that accredited laboratories (average score 92) comply better than certified laboratories (average score 69, P<0.001), and certified laboratories better than other laboratories (average score 44, P<0.001), with regard to the implementation of quality indicators. We conclude that quality practices vary widely in European genetic testing laboratories. This leads to a potentially dangerous situation in which the quality of genetic testing is not consistently assured. PMID:22739339

Two-Year Impact of the Alternative Quality Contract on Pediatric Health Care Quality and Spending

PubMed Central

Song, Zirui; Chernew, Michael E.; Landon, Bruce E.; McNeil, Barbara J.; Safran, Dana G.; Schuster, Mark A.

2014-01-01

OBJECTIVE: To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts’ global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. METHODS: Using a difference-in-differences approach, we compared quality and spending trends for 126 975 unique 0- to 21-year-olds receiving care from AQC groups with 415 331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006–2008) and post (2009–2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. RESULTS: During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ∼5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. CONCLUSIONS: During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group. PMID:24366988

Third molar removal and its impact on quality of life: systematic review and meta-analysis.

PubMed

Duarte-Rodrigues, Lucas; Miranda, Ednele Fabyene Primo; Souza, Taiane Oliveira; de Paiva, Haroldo Neves; Falci, Saulo Gabriel Moreira; Galvão, Endi Lanza

2018-05-24

The purpose of this systematic review was to assess the impact of third molar removal on patient's quality of life. To address the study purpose, investigators designed and implemented a systematic review. The primary outcome variable was the quality of life after third molar extraction. An electronic search was conducted through March, 2017, on the PUBMED, Virtual Health Library (VHL), Web of Science, and OVID, to identify relevant literatures. Research studies (randomized or non-randomized clinical trials) were included that evaluated the quality of life in individuals before and after third molar extraction, using validated measures of oral health-related quality of life with quantitative approach, besides procedures performed under local anesthesia. The R software was used to measure the mean difference on the quality of life between the preoperative period and follow-up days. A total of 1141 studies were identified. Of this total, 13 articles were selected in the present systematic review, of which six studies were included in the meta-analysis. All of these 13 articles used the OHIP-14, and 4 of this 13 used OHQoLUK-16 to evaluate the quality of life. Regarding quality assessment, four of the 13 included studies in this review received a maximum score of 9 points, according to the Newcastle-Ottawa (NOS). The OHIP-14 mean score on the first postoperative day was 17.57 (95% CI 11.84-23.30, I 2  = 96%) higher than the preoperative period. On the seventh postoperative day, the quality of life assessed by OHIP-14 got worse again. This systematic review revealed that the highest negative impact on quality of life of individuals submitted to third molar surgery was observed on the first postoperative day, decreasing over the follow-up period.

Two-year impact of the alternative quality contract on pediatric health care quality and spending.

PubMed

Chien, Alyna T; Song, Zirui; Chernew, Michael E; Landon, Bruce E; McNeil, Barbara J; Safran, Dana G; Schuster, Mark A

2014-01-01

To examine the 2-year effect of Blue Cross Blue Shield of Massachusetts' global budget arrangement, the Alternative Quality Contract (AQC), on pediatric quality and spending for children with special health care needs (CSHCN) and non-CSHCN. Using a difference-in-differences approach, we compared quality and spending trends for 126,975 unique 0- to 21-year-olds receiving care from AQC groups with 415,331 propensity-matched patients receiving care from non-AQC groups; 23% of enrollees were CSHCN. We compared quality and spending pre (2006-2008) and post (2009-2010) AQC implementation, adjusting analyses for age, gender, health risk score, and secular trends. Pediatric outcome measures included 4 preventive and 2 acute care measures tied to pay-for-performance (P4P), 3 asthma and 2 attention-deficit/hyperactivity disorder quality measures not tied to P4P, and average total annual medical spending. During the first 2 years of the AQC, pediatric care quality tied to P4P increased by +1.8% for CSHCN (P < .001) and +1.2% for non-CSHCN (P < .001) for AQC versus non-AQC groups; quality measures not tied to P4P showed no significant changes. Average total annual medical spending was ~5 times greater for CSHCN than non-CSHCN; there was no significant impact of the AQC on spending trends for children. During the first 2 years of the contract, the AQC had a small but significant positive effect on pediatric preventive care quality tied to P4P; this effect was greater for CSHCN than non-CSHCN. However, it did not significantly influence (positively or negatively) CSHCN measures not tied to P4P or affect per capita spending for either group.

78 FR 7703 - Revisions to the California State Implementation Plan, South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-04

... the California State Implementation Plan, South Coast Air Quality Management District, Proposed Rule... approve a revision to the South Coast Air Quality Management District (SCAQMD) portion of the California... digesters. Rule 1127 was designed to implement the 2003 Air Quality Management Plan (AQMP) control measure...

76 FR 47074 - Revision to the California State Implementation Plan; South Coast Air Quality Management District

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-04

... California State Implementation Plan; South Coast Air Quality Management District AGENCY: Environmental... revision to the South Coast Air Quality Management District portion of the California State Implementation... Submittal A. What rule did the State submit? We are approving South Coast Air Quality Management District...

Implementation and application of an interactive user-friendly validation software for RADIANCE

NASA Astrophysics Data System (ADS)

Sundaram, Anand; Boonn, William W.; Kim, Woojin; Cook, Tessa S.

2012-02-01

RADIANCE extracts CT dose parameters from dose sheets using optical character recognition and stores the data in a relational database. To facilitate validation of RADIANCE's performance, a simple user interface was initially implemented and about 300 records were evaluated. Here, we extend this interface to achieve a wider variety of functions and perform a larger-scale validation. The validator uses some data from the RADIANCE database to prepopulate quality-testing fields, such as correspondence between calculated and reported total dose-length product. The interface also displays relevant parameters from the DICOM headers. A total of 5,098 dose sheets were used to test the performance accuracy of RADIANCE in dose data extraction. Several search criteria were implemented. All records were searchable by accession number, study date, or dose parameters beyond chosen thresholds. Validated records were searchable according to additional criteria from validation inputs. An error rate of 0.303% was demonstrated in the validation. Dose monitoring is increasingly important and RADIANCE provides an open-source solution with a high level of accuracy. The RADIANCE validator has been updated to enable users to test the integrity of their installation and verify that their dose monitoring is accurate and effective.

Quality assessment of commercially supplied drinking jar water in Chittagong City, Bangladesh

NASA Astrophysics Data System (ADS)

Mina, Sohana Akter; Marzan, Lolo Wal; Sultana, Tasrin; Akter, Yasmin

2018-03-01

Chittagong is the second most populated city in Bangladesh where drinking water is supplied using small jar. Water quality is an important concern for the consumers and, therefore, the present study was done by collecting 38 drinking jar water samples from Chittagong City, Bangladesh to determine the microbial contamination and physiochemical properties. Molecular study was done by the PCR amplification of 16SrDNA, LacZ and uidA gene for the identification of bacteria, coliform and fecal coliform. TVC, MPN and different biochemical test were done for enumeration and identification. TDS, pH, and metals (Fe, As, Pb and Cr) concentration were also measured. No heavy metal (As, Pb and Cr) was found in any of the water samples but Fe was detected in low concentrations (0.02-0.05 mg/l). TDS and pH level were normal in all samples. But microbial contaminations were (60.53 and 50%) recorded in molecular and biochemical test, respectively. The range of total bacterial count was (1.5 × 102-1.6 × 104) cfu/ml. The total coliform count (TCCm) was recorded (14-40) in 100 ml of water samples. The presence of total coliform and fecal coliform was 26.32 and 18.42%, respectively, in PCR analysis but in biochemical test those were 18.42 and 15.78%, respectively. A total of 11 bacterial species: Enterobacter aerogenes, Escherrichia coli, Aeromonas, Bacillus sp., Cardiobacterium, Corynebacterium, Clostridium, Klebsiella sp., Lactobacillus, Micrococcus sp., Pseudomonas sp. were found. This study indicates that some of the drinking jar water samples were of poor quality which may increase the risk of water-borne disease. Hence, the producer of drinking jar water has to implement necessary quality control steps.

Organized DFM

NASA Astrophysics Data System (ADS)

Sato, Takashi; Honma, Michio; Itoh, Hiroyuki; Iriki, Nobuyuki; Kobayashi, Sachiko; Miyazaki, Norihiko; Onodera, Toshio; Suzuki, Hiroyuki; Yoshioka, Nobuyuki; Arima, Sumika; Kadota, Kazuya

2009-04-01

The category and objective of DFM production management are shown. DFM is not limited to an activity within a particular unit process in design and process. A new framework for DFM is required. DFM should be a total solution for the common problems of all processes. Each of them must be linked to one another organically. After passing through the whole of each process on the manufacturing platform, quality of final products is guaranteed and products are shipped to the market. The information platform is layered with DFM, APC, and AEC. Advanced DFM is not DFM for partial optimization of the lithography process and the design, etc. and it should be Organized DFM. They are managed with high-level organizational IQ. The interim quality between each step of the flow should be visualized. DFM will be quality engineering if it is Organized DFM and common metrics of the quality are provided. DFM becomes quality engineering through effective implementation of common industrial metrics and standardized technology. DFM is differential technology, but can leverage standards for efficient development.

Effective secondary fracture prevention: implementation of a global benchmarking of clinical quality using the IOF Capture the Fracture® Best Practice Framework tool.

PubMed

Javaid, M K; Kyer, C; Mitchell, P J; Chana, J; Moss, C; Edwards, M H; McLellan, A R; Stenmark, J; Pierroz, D D; Schneider, M C; Kanis, J A; Akesson, K; Cooper, C

2015-11-01

Fracture Liaison Services are the best model to prevent secondary fractures. The International Osteoporosis Foundation developed a Best Practice Framework to provide a quality benchmark. After a year of implementation, we confirmed that a single framework with set criteria is able to benchmark services across healthcare systems worldwide. Despite evidence for the clinical effectiveness of secondary fracture prevention, translation in the real-world setting remains disappointing. Where implemented, a wide variety of service models are used to deliver effective secondary fracture prevention. To support use of effective models of care across the globe, the International Osteoporosis Foundation's Capture the Fracture® programme developed a Best Practice Framework (BPF) tool of criteria and standards to provide a quality benchmark. We now report findings after the first 12 months of implementation. A questionnaire for the BPF was created and made available to institutions on the Capture the Fracture website. Responses from institutions were used to assign gold, silver, bronze or black (insufficient) level of achievements mapped across five domains. Through an interactive process with the institution, a final score was determined and published on the Capture the Fracture website Fracture Liaison Service (FLS) map. Sixty hospitals across six continents submitted their questionnaires. The hospitals served populations from 20,000 to 15 million and were a mix of private and publicly funded. Each FLS managed 146 to 6200 fragility fracture patients per year with a total of 55,160 patients across all sites. Overall, 27 hospitals scored gold, 23 silver and 10 bronze. The pathway for the hip fracture patients had the highest proportion of gold grading while vertebral fracture the lowest. In the first 12 months, we have successfully tested the BPF tool in a range of health settings across the globe. Initial findings confirm a significant heterogeneity in service provision and highlight the importance of a global approach to ensure high quality secondary fracture prevention services.

Effects of highway construction on stream water quality and macroinvertebrate condition in a mid-Atlantic highlands watershed, USA

USGS Publications Warehouse

Welsh, Stuart A.; Chen, Yushun; Viadero, Stuart C.; Wei, Xinchao; Hedrick, Lara B.; Anderson, James T.; Lin, Lian-Shin

2009-01-01

Refining best management practices (BMPs) for future highway construction depends on a comprehensive understanding of environmental impacts from current construction methods. Based on a before-after-control impact (BACI) experimental design, long-term stream monitoring (1997–2006) was conducted at upstream (as control, n = 3) and downstream (as impact, n = 6) sites in the Lost River watershed of the Mid-Atlantic Highlands region, West Virginia. Monitoring data were analyzed to assess impacts of during and after highway construction on 15 water quality parameters and macroinvertebrate condition using the West Virginia stream condition index (WVSCI). Principal components analysis (PCA) identified regional primary water quality variances, and paired t tests and time series analysis detected seven highway construction-impacted water quality parameters which were mainly associated with the second principal component. In particular, impacts on turbidity, total suspended solids, and total iron during construction, impacts on chloride and sulfate during and after construction, and impacts on acidity and nitrate after construction were observed at the downstream sites. The construction had statistically significant impacts on macroinvertebrate index scores (i.e., WVSCI) after construction, but did not change the overall good biological condition. Implementing BMPs that address those construction-impacted water quality parameters can be an effective mitigation strategy for future highway construction in this highlands region.

Learn, how to learn

NASA Astrophysics Data System (ADS)

Narayanan, M.

2002-12-01

Ernest L. Boyer, in his 1990 book, "Scholarship Reconsidered: Priorities of the Professorate" cites some ground breaking studies and offers a new paradigm that identifies the need to recognize the growing conversation about teaching, scholarship and research in the Universities. The use of `ACORN' model suggested by Hawkins and Winter to conquer and mastering change, may offer some helpful hints for the novice professor, whose primary objective might be to teach students to `learn how to learn'. Action : It is possible to effectively change things only when a teaching professor actually tries out a new idea. Communication : Changes are successful only when the new ideas effectively communicated and implemented. Ownership : Support for change is extremely important and is critical. Only strong commitment for accepting changes demonstrates genuine leadership. Reflection : Feedback helps towards thoughtful evaluation of the changes implemented. Only reflection can provide a tool for continuous improvement. Nurture : Implemented changes deliver results only when nurtured and promoted with necessary support systems, documentation and infrastructures. Inspired by the ACORN model, the author experimented on implementing certain principles of `Total Quality Management' in the classroom. The author believes that observing the following twenty principles would indeed help the student learners how to learn, on their own towards achieving the goal of `Lifelong Learning'. The author uses an acronym : QUOTES : Quality Underscored On Teaching Excellence Strategy, to describe his methods for improving classroom teacher-learner participation. 1. Break down all barriers. 2. Create consistency of purpose with a plan. 3. Adopt the new philosophy of quality. 4. Establish high Standards. 5. Establish Targets / Goals. 6. Reduce dependence on Lectures. 7. Employ Modern Methods. 8. Control the Process. 9. Organize to reach goals. 10. Prevention vs. Correction. 11. Periodic Improvements. 12. Maintain Momentum. 13. Feedback : Communication. 14. Fact - Based Decisions. 15. Exploit Opportunities. 16. Mobilization of Expertise. 17. Drive out Fear. 18. Recognition / Keep Score. 19. Identify Accomplishments. 20. Customer Focus / Results. In conclusion, the author believes that the ACORN model and the QUOTES model may offer some guidelines that would help and enable the instructor to motivate learners to learn on their own. References Boyer, Ernest L. (1990). Scholarship reconsidered: Priorities of the Professorate. Princeton, NJ: Carnegie Foundation for the Advancement of Teaching. Hawkins, P., and Winter, J. (1997). Mastering change: Learning the lessons of the enterprise in higher education initiative. London: Department for Education and Employment. Narayanan, Mysore (2002). Total Quality Management (TQM) and the Teaching Professor. Oxford, Ohio. : Mimi University : 22nd Annual Lilly Conference on College Teaching.

Successful Geriatric Rehabilitation: Effects on Patients' Outcome of a National Program to Improve Quality of Care, the SINGER Study.

PubMed

Holstege, Marije S; Caljouw, Monique A A; Zekveld, Ineke G; van Balen, Romke; de Groot, Aafke J; van Haastregt, Jolanda C M; Schols, Jos M G A; Hertogh, Cees M P M; Gussekloo, Jacobijn; Achterberg, Wilco P

2017-05-01

To determine whether the implementation of a national program to improve quality of care in geriatric rehabilitation (GR) in the Netherlands improves successful GR in terms of independence in activities of daily living (ADL), discharge destination, and length of stay. Prospective longitudinal study, comparing 2 consecutive cohorts: at the start of implementation (n = 386) and at 1 year after implementation (n = 357) of this program. Included were 16 skilled nursing facilities, 743 patients (median age 80 years, interquartile range 72-85; 64.5% females) indicated for GR and their health care professionals (elderly care physicians, physiotherapists, and nursing staff). National program to stimulate self-organizing capacity to develop integrated care to improve GR service delivery in 4 domains: alignment with patients' (care) needs, care coordination, team cooperation, and quality of care. Data on patients' characteristics, functional outcomes at admission and discharge, length of stay, and discharge destination were collected via an online questionnaire sent to health care professionals. The primary outcome measure was successful rehabilitation defined as independence in ADL (Barthel Index ≥15), discharge home, and a short length of stay (lowest 25% per diagnostic group). Generalized estimating equation analysis was used to adjust for age, gender, and clustering effects in the total population and for the 2 largest diagnostic subgroups, traumatic injuries and stroke. In the total population, at 1 year postimplementation there was 12% more ADL independence [odds ratio (OR) 1.59, 95% confidence interval (CI) 1.00-2.54]. Although successful rehabilitation (independence in ADL, discharge home, short length of stay) was similar in the 2 cohorts, patients with traumatic injuries were more successful 1 year postimplementation (OR 1.61, 95% CI 1.01-2.54). In stroke patients, successful rehabilitation was similar between the cohorts, but with more independence in ADL in the follow-up cohort (OR 1.99, 95% CI 1.09-3.63). This study shows that 1-year after the implementation of the Dutch national program to improve quality of care there was more independence in ADL at discharge, but the combined outcome of successful GR (independence in ADL, discharge home, short length of stay) was only significantly improved in patients with traumatic injuries. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

The Instrument for Measuring the Implementation Situation of Traditional Chinese Medicine Guideline: Evaluation and Application

PubMed Central

Wang, Yangyang; Chen, Yaolong; Wang, Xiaoyun; Deng, Jingwen

2017-01-01

Clinical practice guidelines play an important role in reducing the variations in clinical practices and improving the quality of care. To assess the real effect, measuring its implementation situation is needed. The implementation situation can be reflected by testing the consistency between the actual clinical practice and the guideline. We constructed an instrument to measure the implementation situation of Traditional Chinese Medicine (TCM) guideline through consistency testing. The main objectives of our study were to validate the instrument and evaluate the implementation situation of menopause syndrome guideline of TCM, using the data from the consistency test of comparing the medical records with the guideline. A total of 621 cases were included for data analysis. Cronbach's Alpha coefficient is 0.73. The model fit of 7 items in four dimensions was good (SRMR = 0.04; GFI = 0.97; NFI = 0.97; TLI = 0.96; CFI = 0.98; AGFI = 0.90). This instrument is of good reliability and validity. It can help the guideline developers to measure the implementation situation, find the reasons affecting the implementation, and revise the guideline. The method of using consistency test to measure the implementation situation may provide a sample for evaluating the guideline implementation in other fields. PMID:29234379

The Liverpool Care Pathway for cancer patients dying in hospital medical wards: a before-after cluster phase II trial of outcomes reported by family members.

PubMed

Costantini, Massimo; Pellegrini, Fabio; Di Leo, Silvia; Beccaro, Monica; Rossi, Carla; Flego, Guia; Romoli, Vittoria; Giannotti, Michela; Morone, Paola; Ivaldi, Giovanni P; Cavallo, Laura; Fusco, Flavio; Higginson, Irene J

2014-01-01

Hospital is the most common place of cancer death but concerns regarding the quality of end-of-life care remain. Preliminary assessment of the effectiveness of the Liverpool Care Pathway on the quality of end-of-life care provided to adult cancer patients during their last week of life in hospital. Uncontrolled before-after intervention cluster trial. The trial was performed within four hospital wards participating in the pilot implementation of the Italian version of the Liverpool Care Pathway programme. All cancer patients who died in the hospital wards 2-4 months before and after the implementation of the Italian version of Liverpool Care Pathway were identified. A total of 2 months after the patient's death, bereaved family members were interviewed using the Toolkit After-Death Family Interview (seven 0-100 scales assessing the quality of end-of-life care) and the Italian version of the Views of Informal Carers - Evaluation of Services (VOICES) (three items assessing pain, breathlessness and nausea-vomiting). An interview was obtained for 79 family members, 46 (73.0%) before and 33 (68.8%) after implementation of the Italian version of Liverpool Care Pathway. Following Italian version of Liverpool Care Pathway implementation, there was a significant improvement in the mean scores of four Toolkit scales: respect, kindness and dignity (+16.8; 95% confidence interval = 3.6-30.0; p = 0.015); family emotional support (+20.9; 95% confidence interval = 9.6-32.3; p < 0.001); family self-efficacy (+14.3; 95% confidence interval = 0.3-28.2; p = 0.049) and coordination of care (+14.3; 95% confidence interval = 4.2-24.3; p = 0.007). No significant improvement in symptom' control was observed. These results provide the first robust data collected from family members of a preliminary clinically significant improvement, in some aspects, of quality of care after the implementation of the Italian version of Liverpool Care Pathway programme. The poor effect for symptom control suggests areas for further innovation and development.

Integrating Point-of-Care Testing into a Community Emergency Department: A Mixed-Methods Evaluation.

PubMed

Pines, Jesse M; Zocchi, Mark S; Carter, Caitlin; Marriott, Charles Z; Bernard, Matthew; Warner, Leah H

2018-05-13

Point-of-care testing (POCT) is a commonly used technology that hastens the time to laboratory results in emergency departments (ED). We evaluated an ED-based POCT program on ED length of stay and time to care, coupled with qualitative interviews of local ED stakeholders. We conducted a mixed-methods study (2012-16) to examine the impact of point-of-care testing in a single, community ED. The quantiative analysis involved an observational before-after study comparing time to laboratory test result (POC troponin or POC chemistry) and ED length of stay after implementation of POCT, using a propensity-weighted interrupted time series analysis (ITSA). A complementary qualitative analysis involved five semi-structured interviews with staff using grounded theory on the benefits and challenges to ED POCT. A total of 47,399 ED visits were included in the study (24,705 in pre-intervention period and 22,694 in post-intervention). After POCT implementation, overall laboratory testing increased marginally from 61 to 62%. Central laboratory troponin and chemistry declined by >50% and was replaced by POCT. Prior to POCT implementation, time to troponin and chemistry had declined steadily due to other improvements in laboratory efficiency. After POCT implementation, there was an immediate 20 minute further decline (p<0.001) in both time to troponin and time to chemistry results using the propensity-weighted comparisons. However, the declining trend observed prior to POCT implementation did not continue at the same rate post implementation. Similarly, prior to POCT implementation, ED length of stay (LOS) declined due to other quality improvements. After POCT implementation, LOS continued declined at a similar rate. Because of this prior trend, the ITSA did not show a significant decline in LOS attributable to POCT. Common benefits of POCT perceived by staff in qualitative interviews included improved quality of care (64%), and reductions in time to test results (44%). Common challenges included concerns over POCT accuracy (32%), and technical barriers (29%). In the study ED, implementation of POCT was associated with a reduction in time to test result for both troponin and chemistry. Local staff felt that faster time to test result improved quality of care; however, concerns were raised with POCT accuracy. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Masks for prevention of respiratory viruses on the BMT unit: results of a quality initiative.

PubMed

Sokol, Kelsey A; De la Vega-Diaz, Imelda; Edmondson-Martin, Kathleen; Kim, Sara; Tindle, Sharon; Wallach, Fran; Steinberg, Amir

2016-12-01

Respiratory viral infections (RVI) cause significant morbidity and mortality in hospitalized oncology patients. These viruses are easily spread from asymptomatic and/or symptomatic healthcare workers and visitors to immunocompromised patients, and literature review of facemasks for prevention of infection revealed mixed results. The Bone Marrow Transplant (BMT) Quality Assurance (QA) Committee at Mount Sinai began a surgical mask initiative on the BMT unit. The purpose of our initiative was to assess the impact of surgical mask implementation for healthcare workers and visitors on nosocomial RVI in all patients hospitalized on the BMT unit. We hypothesized that implementing surgical masks would reduce the number of hospital-acquired RVI. We performed a retrospective study involving all patients with malignancy hospitalized on the BMT unit for 4 years. During the latter 2 years, all healthcare workers and visitors were required to wear a surgical mask in every patient room on the BMT unit. Primary endpoint was incidence of RVI after implementation of surgical masks. The 2-year incidence of RVI in the pre-mask period was 14 out of a total of 15 001 patient days on the unit vs 2 out of 15 608 patient days after mask implementation. The difference in incidence of RVI within the two time intervals was noted to be statistically significant (P<.05, 2-proportion z-test). Our quality initiative demonstrated that surgical masks are an infection control modality that may provide benefit to oncology/BMT units by decreasing the risk for hospital-acquired RVI. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

Involving self-help groups in health-care institutions: the patients' contribution to and their view of 'self-help friendliness' as an approach to implement quality criteria of sustainable co-operation.

PubMed

Nickel, Stefan; Trojan, Alf; Kofahl, Christopher

2017-04-01

The importance of patient participation and involvement is now widely acknowledged; in the past, few systematic health-care institution policies existed to establish sustainable co-operation. In 2004, in Germany, the initiative 'Self-Help Friendliness (SHF) and Patient-Centeredness in Health Care' was launched to establish and implement quality criteria related to collaboration with patient groups. The objective of this study was to describe (i) how patients were involved in the development of SHF by summarizing a number of studies and (ii) a new survey on the importance and feasibility of SHF. In a series of participative studies, SHF was shaped, tested and implemented in 40 health-care institutions in Germany. Representatives from 157 self-help groups (SHGs), 50 self-help organizations and 17 self-help clearing houses were actively involved. The second objective was reached through a survey of 74 of the 115 member associations of the biggest self-help umbrella organization at federal level (response rate: 64 %). Patient involvement included the following: identification of the needs and wishes of SHGs regarding co-operation, their involvement in the definition of quality criteria of co-operation, having a crucial role during the implementation of SHF and accrediting health-care institutions as self-help friendly. The ten criteria in total were positively valued and perceived as moderately practicable. Through the intensive involvement of self-help representatives, it was feasible to develop SHF as a systematic approach to closer collaboration of professionals and SHGs. Some challenges have to be taken into account involving patients and the limitations of our empirical study. © 2016 The Authors. Health Expectations published by John Wiley & Sons Ltd.

Nucleic acid testing: Is it the only answer for safe Blood in India?

PubMed Central

Naidu, N. K.; Bharucha, Z. S.; Sonawane, Vandana; Ahmed, Imran

2016-01-01

Background: With the implementation of NAT in countries around the world, there is a growing pressure on the transfusion services in India to adopt NAT testing. India has about 2545 licensed Blood Centres. The Transfusion Services in India are fragmented, poorly regulated and the quality standards are poorly implemented. Blood Centres are still dependent on replacement/family donors and in most places laboratory testing for Transfusion transmitted infections is not quality assured, laboratory equipment are not calibrated and maintained, and validation of results is not carried out. Against the current scenario introducing NAT for screening of blood donors in India would pose a challenge. Aim: To study the prudence of universal NAT testing in India. Materials and Methods: A retrospective study of 5 years from 2008-2012 was undertaken to study the true reactivity of donors using WHO strategy II and III and therefore the true seroprevalence of TTI infections in the donor populations. Results: The true reactivity of the donors was much less as compared to the initially reactive donors due to the use of a well designed testing algorithm. In addition having a total voluntary blood collection along with good pre-donation counseling program also reduces the transmission of infections. Conclusions: What India essentially needs to do is religiously implement the strategies outlined in the WHO Aide-memoire. The blood should be collected only from voluntary non remunerative and repeat donors, there should be stringent donor selection with pre-donation counseling instituted. Strict implementation of quality management system, development of well defined testing startegies and strong haemovigilance system could take us a step in the right direction. PMID:27011677

Scaling Up a Water, Sanitation, and Hygiene Program in Rural Bangladesh: The Role of Program Implementation

PubMed Central

Sultana, Sonia; Halder, Amal K.; Ahsan, Mohammed Ali; Arnold, Benjamin F.; Hubbard, Alan E.; Unicomb, Leanne; Luby, Stephen P.; Colford, John M.

2017-01-01

Objectives. To evaluate whether the quality of implementation of a water, sanitation, and hygiene program called SHEWA-B and delivered by UNICEF to 20 million people in rural Bangladesh was associated with health behaviors and sanitation infrastructure access. Methods. We surveyed 33 027 households targeted by SHEWA-B and 1110 SHEWA-B hygiene promoters in 2011 and 2012. We developed an implementation quality index and compared the probability of health behaviors and sanitation infrastructure access in counterfactual scenarios over the range of implementation quality. Results. Forty-seven percent of households (n = 14 622) had met a SHEWA-B hygiene promoter, and 47% of hygiene promoters (n = 527) could recall all key program messages. The frequency of hygiene promoter visits was not associated with improved outcomes. Higher implementation quality was not associated with better health behaviors or infrastructure access. Outcomes differed by only 1% to 3% in scenarios in which all clusters received low versus high implementation quality. Conclusions. SHEWA-B did not meet UNICEF’s ideal implementation quality in any area. Improved implementation quality would have resulted in marginal changes in health behaviors or infrastructure access. This suggests that SHEWA-B’s design was suboptimal for improving these outcomes. PMID:28323462

Regionalisation of parameters of a large-scale water quality model in Lithuania using PAIC-SWAT

NASA Astrophysics Data System (ADS)

Zarrineh, Nina; van Griensven, Ann; Sennikovs, Juris; Bekere, Liga; Plunge, Svajunas

2015-04-01

To comply with the EU Water Framework Directive, all water bodies need to achieve good ecological status. To reach these goals, the Environmental Protection Agency (AAA) has to elaborate river basin districts management plans and programmes of measures for all catchments in Lithuania. For this purpose, a Soil and Water Assessment Tool (SWAT) model was set up for all Lithuanian catchments using the most recent version of SWAT2012 rev627 implemented and imbedded in a Python workflow by the Center of Processes Analysis and Research (PAIC). The model was calibrated and evaluated using all monitoring data of river discharge, nitrogen and phosphorous concentrations and load. A regionalisation strategy has been set up by identifying 13 hydrological regions according to the runoff formation and hydrological conditions. In each region, a representative catchment was selected and calibrated using a combination of manual and automated calibration techniques. After final parameterization and fulfilling of calibrating and validating evaluation criteria, the same parameters sets have been extrapolated to other catchments within the same hydrological region. Multi variable cal/val strategy was implemented for the following variables: river flow and in-stream NO3, Total Nitrogen, PO4 and Total Phosphorous concentrations. The criteria used for calibration, validation and extrapolation are: Nash-Sutcliffe Efficiency (NSE) for flow and R-squared for water quality variables and PBIAS (percentage bias) for all variables. For the hydrological calibration, NSE values greater than 0.5 should be achieved, while for validation and extrapolation the threshold is respectively 0.4 and 0.3. PBIAS errors have to be less than 20% for calibration and for validation and extrapolation less than 25% and 30%, respectively. In water quality calibration, R-squared should be achieved to 0.5 for calibration and for validation and extrapolation to 0.4 and 0.3 respectively for nitrogen variables. Besides PBIAS error should be less than 40% for calibration, and less than 70% for validation and extrapolation for all mentioned water quality variables. For the flow calibration, daily discharge data for 62 stations were provided for the period 1997-2012. For more than 500 stations, water quality data was provided and 135 data-rich stations was pre-processed in a database containing all observations from 1997-2012. Finally by implementing this regionalisation strategy, the model could satisfactorily predict the selected variables so that in the hydrological part more than 90% of stations fulfilled the criteria and in the water quality part more than 95% of stations fulfilled the criteria. Keywords: Water Quality Modelling, Regionalisation, Parameterization, Nitrogen and Phosphorus Prediction, Calibration, PAIC-SWAT.

Quality assurance planning for lunar Mars exploration

NASA Technical Reports Server (NTRS)

Myers, Kay

1991-01-01

A review is presented of the tools and techniques required to meet the challenge of total quality in the goal of traveling to Mars and returning to the moon. One program used by NASA to ensure the integrity of baselined requirements documents is configuration management (CM). CM is defined as an integrated management process that documents and identifies the functional and physical characteristics of a facility's systems, structures, computer software, and components. It also ensures that changes to these characteristics are properly assessed, developed, approved, implemented, verified, recorded, and incorporated into the facility's documentation. Three principal areas are discussed that will realize significant efficiencies and enhanced effectiveness, change assessment, change avoidance, and requirements management.

Measuring management's perspective of data quality in Pakistan's Tuberculosis control programme: a test-based approach to identify data quality dimensions.

PubMed

Ali, Syed Mustafa; Anjum, Naveed; Kamel Boulos, Maged N; Ishaq, Muhammad; Aamir, Javariya; Haider, Ghulam Rasool

2018-01-16

Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective. Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice. Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.

[External quality assessment in clinical biochemistry laboratories: pilot study in 11 laboratories of Lomé (Togo)].

PubMed

Kouassi, Kafui; Fétéké, Lochina; Assignon, Selom; Dorkenoo, Ameyo; Napo-Koura, Gado

2015-01-01

This study aims to evaluate the performance of a few biochemistry analysis and make recommendations to the place of the stakeholders. It is a cross-sectional study conducted between the October 1(st), 2012 and the July 31, 2013 bearing on the results of 5 common examinations of clinical biochemistry, provided by 11 laboratories volunteers opening in the public and private sectors. These laboratories have analysed during the 3 cycles, 2 levels (medium and high) of serum concentration of urea, glucose, creatinine and serum aminotransferases. The performance of laboratories have been determined from the acceptable limits corresponding to the limits of total errors, defined by the French Society of Clinical Biology (SFBC). A system of internal quality control is implemented by all laboratories and 45% of them participated in international programs of external quality assessment (EQA). The rate of acceptable results for the entire study was of 69%. There was a significant difference (p<0.002) between the performance of the group of laboratories engaged in a quality approach and the group with default implementation of the quality approach. Also a significant difference was observed between the laboratories of the central level and those of the peripheral level of our health system (p<0.047). The performance of the results provided by the laboratories remains relatively unsatisfactory. It is important that the Ministry of Health put in place a national program of EQA with mandatory participation.

Ambient air quality trends and driving factor analysis in Beijing, 1983-2007.

PubMed

Zhang, Ju; Ouyang, Zhiyun; Miao, Hong; Wang, Xiaoke

2011-01-01

The rapid development in Beijing, the capital of China, has resulted in serious air pollution problems. Meanwhile great efforts have been made to improve the air quality, especially since 1998. The variation in air quality under the interaction of pollution and control in this mega city has attracted much attention. We analyzed the changes in ambient air quality in Beijing since the 1980's using the Daniel trend test based on data from long-term monitoring stations. The results showed that different pollutants displayed three trends: a decreasing trend, an increasing trend and a flat trend. SO2, dustfall, B[a]P, NO2 and PM10 fit decreasing trend pattern, while NOx showed an increasing trend, and CO, ozone pollution, total suspended particulate (TSP), as well as Pb fit the flat trend. The cause of the general air pollution in Beijing has changed from being predominantly related to coal burning to mixed traffic exhaust and coal burning related pollution. Seasonally, the pollution level is typically higher during the heating season from November to the following March. The interaction between pollution sources change and implementation of air pollution control measures was the main driving factor that caused the variation in air quality. Changes of industrial structure and improved energy efficiency, the use of clean energy and preferred use of clean coal, reduction in pollution sources, and implementation of advanced environmental standards have all contributed to the reduction in air pollution, particularly since 1998.

Providing activity for people with dementia in care homes: a cluster randomised controlled trial.

PubMed

Wenborn, Jennifer; Challis, David; Head, Jenny; Miranda-Castillo, Claudia; Popham, Carolyn; Thakur, Ruchi; Illes, Jacqueline; Orrell, Martin

2013-12-01

Activity levels remain low in care homes, but activity engagement can enhance residents' quality of life. This study aimed to assess an occupational therapy programme designed to enable care home staff to increase activity provision. A cluster randomised controlled trial with blinded assessment of outcome was conducted. A total of 210 residents with dementia in 16 care homes were recruited. Intervention homes received the programme, and control homes were provided usual care. Primary outcome is quality of life; secondary measures are dependency, challenging behaviour, depression, anxiety, severity of dementia and number and type of medication. Quality of life decreased overall with statistically significant change in staff ratings (p < 0.001). At follow-up, staff-rated quality of life was slightly lower in the intervention group (mean difference in staff ratings = -1.91, 95% CI -3.39 to -0.43, p = 0.01). There were no significant differences between the two groups for self-rated quality of life or secondary outcomes. The results may be related to the following: wide variability in how the intervention was implemented, such as low staff attendance at the education and coaching sessions, and patchy provision of additional activities to residents; or the residents' severity of dementia or the choice of outcome measures. Future studies need to pay more attention to process measures such as implementation and fidelity strategies, and outcome measures that better capture the focus of the intervention such as level of engagement and activity. Copyright © 2013 John Wiley & Sons, Ltd.

Approved Air Quality Implementation Plans in The Virgin Islands

EPA Pesticide Factsheets

This site contains information about air quality regulations called State Implementation Plans (SIPs), Federal Implementation Plans (FIPs), and Tribal Implementation Plans (TIPs) approved by EPA within the U.S. Virgin Islands.

Occurrence of phosphorus, nitrate, and suspended solids in streams of the Cheney Reservoir Watershed, south-central Kansas, 1997-2000

USGS Publications Warehouse

Milligan, Chad R.; Pope, Larry M.

2001-01-01

Improving water quality of Cheney Reservoir in south-central Kansas is an important objective of State and local water managers. The reservoir serves as a water supply for about 350,00 people in the Wichita area and an important recreational resource for the area. In 1992, a task force was formed to study and prepare a plan to identify and mitigate potential sources of stream contamination in the Cheney Reservoir watershed. This task force was established to develop stream-water-quality goals to aid in the development and implementation of best-management practices in the watershed. In 1996, the U.S. Geological Survey entered into a cooperative study with the city of Wichita to assess the water quality in the Cheney Reservoir watershed. Water-quality constituents of particular concern in the Cheney Reservoir watershed are phosphorus, nitrate, and total suspended solids. Water-quality samples were collected at five streamflow-gaging sites upstream from the reservoir and at the outflow of the reservoir. The purpose of this report is to present the results of a 4-year (1997-2000) data-collection effort to quantify the occurrence of phosphorus, nitrate, and suspended solids during base-flow, runoff, and long-term streamflow conditions (all available data for 1997-2000) and to compare these results to stream-water-quality goals established by the Cheney Reservoir Task Force. Mean concentrations of each of the constituents examined during this study exceeded the Cheney Reservoir Task Force stream-water-quality goal for at least one of the streamflow conditions evaluated. Most notably, mean base-flow and mean long-term concentrations of total phosphorus and mean base-flow concentrations of dissolved nitrate exceeded the goals of 0.05, 0.10, and 0.25 milligram per liter, respectively, at all five sampling sites upstream from the reservoir. Additionally, the long-term stream-water-quality goal for dissolved nitrate was exceeded by the mean concentration at one upstream sampling site, and the base-flow total suspended solids goal (20 milligrams per liter) and long-term total suspended solids goal (100 milligrams per liter) were each exceeded by mean concentrations at three upstream sampling sites. Generally, it seems unlikely that water-quality goals for streams in the Cheney Reservoir watershed will be attainable for mean base-flow and mean long-term total phosphorus and total suspended solids concentrations and for mean base-flow dissolved nitrate concentrations as long as current (2001) watershed conditions and practices persist. However, future changes in these conditions and practices that mitigate the transport of these consitutents may modify this conclusion.

Implementation Science: New Approaches to Integrating Quality and Safety Education for Nurses Competencies in Nursing Education.

PubMed

Dolansky, Mary A; Schexnayder, Julie; Patrician, Patricia A; Sales, Anne

Although quality and safety competencies were developed and disseminated nearly a decade ago by the Quality and Safety Education for Nurses (QSEN) project, the uptake in schools of nursing has been slow. The use of implementation science methods may be useful to accelerate quality and safety competency integration in nursing education. The article includes a definition and description of implementation science methods and practical implementation strategies for nurse educators to consider when integrating the QSEN competencies into nursing curriculum.

76 FR 44535 - Revisions to the California State Implementation Plan, Northern Sierra Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-26

... the California State Implementation Plan, Northern Sierra Air Quality Management District, Sacramento Metropolitan Air Quality Management District, and South Coast Air Quality Management District AGENCY... the Northern Sierra Air Quality Management District (NSAQMD), Sacramento Metropolitan Air Quality...

78 FR 53270 - Revision of Air Quality Implementation Plan; California; Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-08-29

... Quality Implementation Plan; California; Sacramento Metropolitan Air Quality Management District... to the Sacramento Metropolitan Air Quality Management District (SMAQMD or District) portion of the..., Sacramento Metropolitan Air Quality Management District, Rule 214 (Federal New Source Review), Rule 203...

77 FR 38246 - Revisions to the Arizona State Implementation Plan, Arizona Department of Environmental Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-27

... the Arizona State Implementation Plan, Arizona Department of Environmental Quality, Maricopa County Air Quality Department, and Pima County Department of Environmental Quality AGENCY: Environmental... Department of Environmental Quality (ADEQ), Maricopa County Air Quality Department (MCAQD), and Pima County...

A strategy for the implementation of a quality indicator system in German primary care.

PubMed

van den Heuvel, Henricus

2011-01-01

The Quality and Outcomes Framework (QOF) has had a major impact on the quality of care in British general practice. It is seen as a major innovation amongst quality indicator systems and as a result various countries are looking at whether such initiatives could be used in their primary care. In Germany also the development of similar schemes has started. To propose a strategy indicating key issues for the implementation of a quality indicator scheme in German primary care. Literature review with a focus on the QOF and German quality indicator literature. There are major differences between the German and British healthcare and primary care systems. The development of quality indicator systems for German general practice is in progress and there is a net force for the implementation of such systems. The following ten key factors are suggested for the successful implementation of such a system in German primary care: involvement of general practitioners (GPs) at all levels of the development, a clear implementation process, investment in practice information technology (IT) systems, an accepted quality indicator set, a quality indicator setting institution and data collection organisation, clear financial and non-financial incentives, a 'practice registration' structure, an exception reporting mechanism, delegation of routine clinical data collection tasks to practice assistants, a stepped implementation approach and adequate evaluation processes. For the successful implementation of a quality indicator system in German primary care a number of key issues, as presented in this article, need to be taken into account.

Microbiological performance of dairy processing plants is influenced by scale of production and the implemented food safety management system: a case study.

PubMed

Opiyo, Beatrice Atieno; Wangoh, John; Njage, Patrick Murigu Kamau

2013-06-01

The effects of existing food safety management systems and size of the production facility on microbiological quality in the dairy industry in Kenya were studied. A microbial assessment scheme was used to evaluate 14 dairies in Nairobi and its environs, and their performance was compared based on their size and on whether they were implementing hazard analysis critical control point (HACCP) systems and International Organization for Standardization (ISO) 22000 recommendations. Environmental samples from critical sampling locations, i.e., workers' hands and food contact surfaces, and from end products were analyzed for microbial quality, including hygiene indicators and pathogens. Microbial safety level profiles (MSLPs) were constructed from the microbiological data to obtain an overview of contamination. The maximum MSLP score for environmental samples was 18 (six microbiological parameters, each with a maximum MSLP score of 3) and that for end products was 15 (five microbiological parameters). Three dairies (two large scale and one medium scale; 21% of total) achieved the maximum MSLP scores of 18 for environmental samples and 15 for the end product. Escherichia coli was detected on food contact surfaces in three dairies, all of which were small scale dairies, and the microorganism was also present in end product samples from two of these dairies, an indication of cross-contamination. Microbial quality was poorest in small scale dairies. Most operations in these dairies were manual, with minimal system documentation. Noncompliance with hygienic practices such as hand washing and cleaning and disinfection procedures, which is common in small dairies, directly affects the microbial quality of the end products. Dairies implementing HACCP systems or ISO 22000 recommendations achieved maximum MSLP scores and hence produced safer products.

The social burden and quality of life of patients with haemophilia in Italy

PubMed Central

Kodra, Yllka; Cavazza, Marianna; Schieppati, Arrigo; De Santis, Marta; Armeni, Patrizio; Arcieri, Romano; Calizzani, Gabriele; Fattore, Giovanni; Manzoli, Lamberto; Mantovani, Lorenzo; Taruscio, Domenica

2014-01-01

Background In Italy, the project on the social burden and quality of life (QoL) of patients with haemophilia investigates costs from a society perspective and provides an overview of their quality of life. Moreover, as life expectancy increased in recent years along with new treatment strategies implemented in the last decades, it analyses trends of costs other than drugs simulating impacts during patient whole life. Material and methods We ran a web-based cross-sectional survey supported by the Italian Federation of Haemophilia Societies in recruiting patients with haemophilia and their caregivers. We developed a questionnaire to collect information on demographic characteristics, healthcare and social services consumption, formal and informal care utilisation, productivity loss and quality of life. In particular, quality of life was assessed through the EuroQoL tool. Last, we applied the illness cost method from a society perspective. Results On average, quality of life is worse in adult patients compared to child and caregivers: more than 75% of adult patients declare physical problems, 43% of adult patients and 54% of their parents have anxiety problems. Assuming a society perspective, the estimated mean annual total cost per patient in 2012 is 117,732 €. Drugs represent 92% of total costs. Focusing on costs other than drugs, each additional point of EuroQoL tool implies a costs’ reduction of 279 €. The impact of age varies across age groups: each added year implies a total decrease of costs up to 46.6 years old. Afterwards, every additional year increases costs. Discussion Quality of life of patients with haemophilia and their caregivers improved and it influences positively on consumed resources and on their contribution to the social-economic system. Costs other than drugs for patients with haemophilia follow the same trends of general population. PMID:24922297

Development and status of data quality assurance program at NASA Langley research center: Toward national standards

NASA Technical Reports Server (NTRS)

Hemsch, Michael J.

1996-01-01

As part of a continuing effort to re-engineer the wind tunnel testing process, a comprehensive data quality assurance program is being established at NASA Langley Research Center (LaRC). The ultimate goal of the program is routing provision of tunnel-to-tunnel reproducibility with total uncertainty levels acceptable for test and evaluation of civilian transports. The operational elements for reaching such levels of reproducibility are: (1) statistical control, which provides long term measurement uncertainty predictability and a base for continuous improvement, (2) measurement uncertainty prediction, which provides test designs that can meet data quality expectations with the system's predictable variation, and (3) national standards, which provide a means for resolving tunnel-to-tunnel differences. The paper presents the LaRC design for the program and discusses the process of implementation.

A genetic algorithm application in backcross breeding problem

NASA Astrophysics Data System (ADS)

Carnia, E.; Napitupulu, H.; Supriatna, A. K.

2018-03-01

In this paper we discuss a mathematical model of goat breeding strategy, i.e. the backcrossing breeding. The model is aimed to obtain a strategy in producing better variant of species. In this strategy, a female (doe) of a lesser quality goat, in terms of goat quality is bred with a male (buck) of an exotic goat which has a better goat quality. In this paper we will explore a problem on how to harvest the population optimally. A genetic algorithm (GA) approach will been devised to obtain the solution of the problem. We do several trials of the GA implementation which gives different set of solutions, but relatively close to each other in terms of the resulting total revenue, except a few. Further study need to be done to obtain GA solution that closer to the exact solution.

Assessment of water quality index of bore well water samples from some selected locations of South Gujarat, India.

PubMed

Tripathi, S; Patel, H M; Srivastava, P K; Bafna, A M

2013-10-01

The present study calculates the water quality index (WQI) of some selected sites from South Gujarat (India) and assesses the impact of industries, agriculture and human activities. Chemical parameters were monitored for the calculation of WQI of some selected bore well samples. The results revealed that the WQI of the some bore well samples exceeded acceptable levels due to the dumping of wastes from municipal, industrial and domestic sources and agricultural runoff as well. Inverse Distance Weighting (IDW) was implemented for interpolation of each water quality parameter (pH, EC, alkalinity, total hardness, chloride, nitrate and sulphate) for the entire sampled area. The bore water is unsuitable for drinking and if the present state of affairs continues for long, it may soon become an ecologically dead bore.

Describing teacher-student interactions: a qualitative assessment of teacher implementation of the 7th grade keepin' it REAL substance use intervention.

PubMed

Pettigrew, Jonathan; Miller-Day, Michelle; Shin, Youngju; Hecht, Michael L; Krieger, Janice L; Graham, John W

2013-03-01

Variations in the delivery of school-based substance use prevention curricula affect students' acquisition of the lesson content and program outcomes. Although adaptation is sometimes viewed as a lack of fidelity, it is unclear what types of variations actually occur in the classroom. This observational study investigated teacher and student behaviors during implementation of a middle school-based drug prevention curriculum in 25 schools across two Midwestern states. Trained observers coded videos of 276 lessons, reflecting a total of 31 predominantly Caucasian teachers (10 males and 21 females) in 73 different classes. Employing qualitative coding procedures, the study provides a working typology of implementation patterns based on varying levels of teacher control and student participation. These patterns are fairly consistent across lessons and across classes of students, suggesting a teacher-driven delivery model where teachers create a set of constraints within which students vary their engagement. Findings provide a descriptive basis grounded in observation of classroom implementation that can be used to test models of implementation fidelity and quality as well as impact training and other dissemination research.

Population-Level Cost-Effectiveness of Implementing Evidence-Based Practices into Routine Care

PubMed Central

Fortney, John C; Pyne, Jeffrey M; Burgess, James F

2014-01-01

Objective The objective of this research was to apply a new methodology (population-level cost-effectiveness analysis) to determine the value of implementing an evidence-based practice in routine care. Data Sources/Study Setting Data are from sequentially conducted studies: a randomized controlled trial and an implementation trial of collaborative care for depression. Both trials were conducted in the same practice setting and population (primary care patients prescribed antidepressants). Study Design The study combined results from a randomized controlled trial and a pre-post-quasi-experimental implementation trial. Data Collection/Extraction Methods The randomized controlled trial collected quality-adjusted life years (QALYs) from survey and medication possession ratios (MPRs) from administrative data. The implementation trial collected MPRs and intervention costs from administrative data and implementation costs from survey. Principal Findings In the randomized controlled trial, MPRs were significantly correlated with QALYs (p = .03). In the implementation trial, patients at implementation sites had significantly higher MPRs (p = .01) than patients at control sites, and by extrapolation higher QALYs (0.00188). Total costs (implementation, intervention) were nonsignificantly higher ($63.76) at implementation sites. The incremental population-level cost-effectiveness ratio was $33,905.92/QALY (bootstrap interquartile range −$45,343.10/QALY to $99,260.90/QALY). Conclusions The methodology was feasible to operationalize and gave reasonable estimates of implementation value. PMID:25328029

How to implement quality indicators successfully in palliative care services: perceptions of team members about facilitators of and barriers to implementation.

PubMed

Leemans, Kathleen; Van den Block, Lieve; Vander Stichele, Robert; Francke, Anneke L; Deliens, Luc; Cohen, Joachim

2015-12-01

There is an increasing demand for the use of quality indicators in palliative care. With previous research about implementation in this field lacking, we aimed to evaluate the barriers to and facilitators of implementation. Three focus group interviews were organized with 21 caregivers from 18 different specialized palliative care services in Belgium. Four had already worked with the indicators during a pilot study. The focus group discussions were transcribed verbatim and analyzed using the thematic framework approach. The caregivers anticipated that a positive attitude by the team towards quality improvement, the presence of a good leader, and the possible link between quality indicators and reimbursement might facilitate the implementation of quality indicators in specialized palliative care services. Other facilitators concerned the presence of a need to demonstrate quality of care, to perform improvement actions, and to learn from other caregivers and services in the field. A negative attitude by caregivers towards quality measurement and a lack of skills, time, and staff were mentioned as barriers to successful implementation. Palliative caregivers anticipate a number of opportunities and problems when implementing quality indicators. These relate to the attitudes of the team regarding quality measurement; the attitudes, knowledge, and skills of the individual caregivers within the team; and the organizational context and the economic and political context. Training in the advantages of quality indicators and how to use them is indispensable, as are structural changes in the policy concerning palliative care, in order to progress towards systematic quality monitoring.

Evolution of transanal total mesorectal excision for rectal cancer: From top to bottom

PubMed Central

Emile, Sameh Hany; de Lacy, F Borja; Keller, Deborah Susan; Martin-Perez, Beatriz; Alrawi, Sadir; Lacy, Antonio M; Chand, Manish

2018-01-01

The gold standard for curative treatment of locally advanced rectal cancer involves radical resection with a total mesorectal excision (TME). TME is the most effective treatment strategy to reduce local recurrence and improve survival outcomes regardless of the surgical platform used. However, there are associated morbidities, functional consequences, and quality of life (QoL) issues associated with TME; these risks must be considered during the modern-day multidisciplinary treatment for rectal cancer. This has led to the development of new surgical techniques to improve patient, oncologic, and QoL outcomes. In this work, we review the evolution of TME to the transanal total mesorectal excision (TaTME) through more traditional minimally invasive platforms. The review the development, safety and feasibility, proposed benefits and risks of the procedure, implementation and education models, and future direction for research and implementation of the TaTME in colorectal surgery. While satisfactory short-term results have been reported, the procedure is in its infancy, and long term outcomes and definitive results from controlled trials are pending. As evidence for safety and feasibility accumulates, structured training programs to standardize teaching, training, and safe expansion will aid the safe spread of the TaTME. PMID:29588809

Performance of the full-scale biological nutrient removal plant at Noosa in Queensland, Australia: nutrient removal and disinfection.

PubMed

Urbain, V; Wright, P; Thomas, M

2001-01-01

Stringent effluent quality guidelines are progressively implemented in coastal and sensitive areas in Australia. Biological Nutrient Removal (BNR) plants are becoming a standard often including a tertiary treatment for disinfection. The BNR plant in Noosa - Queensland is designed to produce a treated effluent with less than 5 mg/l of BOD5, 5 mg/l of total nitrogen, 1 mg/l of total phosphorus, 5 mg/l of suspended solids and total coliforms of less than 10/100 ml. A flexible multi-stage biological process with a prefermentation stage, followed by sand filtration and UV disinfection was implemented to achieve this level of treatment. Acetic acid is added for phosphorus removal because: i) the volatile fatty acids (VFA) concentration in raw wastewater varies a lot, and ii) the prefermenter had to be turned off due to odor problems on the primary sedimentation tanks. An endogenous anoxic zone was added to the process to further reduce the nitrate concentration. This resulted in some secondary P-release events, a situation that happens when low nitrate and low phosphorus objectives are targeted. Long-term performance data and specific results on nitrogen removal and disinfection are presented in this paper.

Does the integration of TB medical services in the general hospital improve the quality of TB care? Evidence from a case study in China.

PubMed

Sun, Qiang; Yin, Jia; Yin, Xiao; Zou, Guanyang; Liang, Mingli; Zhong, Jieming; Walley, John; Wei, Xiaolin

2013-06-01

Moving the clinical services from tuberculosis (TB) dispensary to the integrated county hospital (called integrated approach) has been practiced in China; however, it is unknown the quality of TB care in the integrated approach and in the dispensary approach. A total of 202 new TB patients were investigated using structured questionnaires in three counties implementing the integrated approach and one county implementing the dispensary approach. The quality of TB care is measured based on success rate of treatment, medical expenditure, health system delay and second-line drug use. The integrated approach showed a high success treatment rate. The medical expenditure in the integrated approach was USD 432, significantly lower than that in the dispensary approach (Z = -5.771, P < 0.001). The integrated approach had a shorter health system delay (5 days) than the dispensary approach (32 days). Twenty-six percent of patients in integrated hospitals were prescribed with second-line TB drugs, significantly lower than that in the TB dispensary (47%, χ(2) = 7.452, P = 0.006). However, the medical expenditure, use of second-line anti-TB drug and liver-protection drugs indeed varied greatly across the three integrated hospitals. The integrated approach showed better quality of TB care, but the performance of the integrated hospitals varied greatly. A method to standardize TB treatment and management of this approach is urgent.

[Possibilities and perspectives of quality management in radiation oncology].

PubMed

Seegenschmiedt, M H; Zehe, M; Fehlauer, F; Barzen, G

2012-11-01

The medical discipline radiation oncology and radiation therapy (treatment with ionizing radiation) has developed rapidly in the last decade due to new technologies (imaging, computer technology, software, organization) and is one of the most important pillars of tumor therapy. Structure and process quality play a decisive role in the quality of outcome results (therapy success, tumor response, avoidance of side effects) in this field. Since 2007 all institutions in the health and social system are committed to introduce and continuously develop a quality management (QM) system. The complex terms of reference, the complicated technical instruments, the highly specialized personnel and the time-consuming processes for planning, implementation and assessment of radiation therapy made it logical to introduce a QM system in radiation oncology, independent of the legal requirements. The Radiation Center Hamburg (SZHH) has functioned as a medical care center under medical leadership and management since 2009. The total QM and organization system implemented for the Radiation Center Hamburg was prepared in 2008 and 2009 and certified in June 2010 by the accreditation body (TÜV-Süd) for DIN EN ISO 9001:2008. The main function of the QM system of the SZHH is to make the basic principles understandable for insiders and outsiders, to have clear structures, to integrate management principles into the routine and therefore to organize the learning processes more effectively both for interior and exterior aspects.

[Potential for the survey of quality indicators based on a national emergency department registry : A systematic literature search].

PubMed

Hörster, A C; Kulla, M; Brammen, D; Lefering, R

2018-06-01

Emergency department processes are often key for successful treatment. Therefore, collection of quality indicators is demanded. A basis for the collection is systematic, electronic documentation. The development of paper-based documentation into an electronic and interoperable national emergency registry is-besides the establishment of quality management for emergency departments-a target of the AKTIN project. The objective of this research is identification of internationally applied quality indicators. For the investigation of the current status of quality management in emergency departments based on quality indicators, a systematic literature search of the database PubMed, the Cochrane Library and the internet was performed. Of the 170 internationally applied quality indicators, 25 with at least two references are identified. A total of 10 quality indicators are ascertainable by the data set. An enlargement of the data set will enable the collection of seven further quality indicators. The implementation of data of care behind the emergency processes will provide eight additional quality indicators. This work was able to show that the potential of a national emergency registry for the establishment of quality indicators corresponds with the international systems taken into consideration and could provide a comparable collection of quality indicators.

Management Practices Used in Agricultural Drainage Ditches to Reduce Gulf of Mexico Hypoxia.

PubMed

Faust, Derek R; Kröger, Robert; Moore, Matthew T; Rush, Scott A

2018-01-01

Agricultural non-point sources of nutrients and sediments have caused eutrophication and other water quality issues in aquatic and marine ecosystems, such as the annual occurrence of hypoxia in the Gulf of Mexico. Management practices have been implemented adjacent to and in agricultural drainage ditches to promote their wetland characteristics and functions, including reduction of nitrogen, phosphorus, and sediment losses downstream. This review: (1) summarized studies examining changes in nutrient and total suspended solid concentrations and loads associated with management practices in drainage ditches (i.e., riser and slotted pipes, two-stage ditches, vegetated ditches, low-grade weirs, and organic carbon amendments) with emphasis on the Lower Mississippi Alluvial Valley, (2) quantified management system effects on nutrient and total suspended solid concentrations and loads and, (3) identified information gaps regarding water quality associated with these management practices and research needs in this area. In general, management practices used in drainage ditches at times reduced losses of total suspended solids, N, and P. However, management practices were often ineffective during storm events that were uncommon and intense in duration and volume, although these types of events could increase in frequency and intensity with climate change. Studies on combined effects of management practices on drainage ditch water quality, along with research towards improved nutrient and sediment reduction efficiency during intense storm events are urgently needed.

Evolution of an Implementation-Ready Interprofessional Pain Assessment Reference Model

PubMed Central

Collins, Sarah A; Bavuso, Karen; Swenson, Mary; Suchecki, Christine; Mar, Perry; Rocha, Roberto A.

2017-01-01

Standards to increase consistency of comprehensive pain assessments are important for safety, quality, and analytics activities, including meeting Joint Commission requirements and learning the best management strategies and interventions for the current prescription Opioid epidemic. In this study we describe the development and validation of a Pain Assessment Reference Model ready for implementation on EHR forms and flowsheets. Our process resulted in 5 successive revisions of the reference model, which more than doubled the number of data elements to 47. The organization of the model evolved during validation sessions with panels totaling 48 subject matter experts (SMEs) to include 9 sets of data elements, with one set recommended as a minimal data set. The reference model also evolved when implemented into EHR forms and flowsheets, indicating specifications such as cascading logic that are important to inform secondary use of data. PMID:29854125