Evaluating the effectiveness of implementing quality management practices in the medical industry.

PubMed

Yeh, T-M; Lai, H-P

2015-01-01

To discuss the effectiveness of 30 quality management practices (QMP) including Strategic Management, Balanced ScoreCard, Knowledge Management, and Total Quality Management in the medical industry. A V-shaped performance evaluation matrix is applied to identify the top ten practices that are important but not easy to use or implement. Quality Function Deployment (QFD) is then utilized to find key factors to improve the implementation of the top ten tools. The questionnaires were sent to the nursing staff and administrators in a hospital through e-mail and posts. A total of 250 copies were distributed and 217 copies were valid. The importance, easiness, and achievement (i.e., implementation level) of 30 quality management practices were used. Key factors for QMP implementation were sequenced in order of importance as top management involvement, inter-department communication and coordination, teamwork, hospital-wide participation, education and training, consultant professionalism, continuous internal auditing, computerized process, and incentive compensation. Top management can implement the V-shaped performance matrix to determine whether quality management practices need improvement and if so, utilize QFD to find the key factors for improvement.

Nurses' Perceptions and Practices Related to Alarm Management: A Quality Improvement Initiative.

PubMed

Cameron, Hannah L; Little, Barbara

2018-05-01

The purpose of this quality improvement project was to develop, implement, and assess the effects of an alarm management policy and educational program on nurses' perceptions and practices of alarm management in an acute care hospital. Nurses from an acute care hospital in the southeastern United States attended a mandatory alarm management education program. The hospital implemented the evidence-based alarm management education to achieve the NPSG.06.01.01: Alarm Management. Pre- and posttests were administered to evaluate the education and the changes in nurses' perceptions and practices of clinical alarms. A total of 417 nurses received the educational intervention. All participants completed the pretest, and 215 (51%) completed the voluntary posttest. Significant improvements were made in alarm perceptions and practices. Nurses suggested unit-specific alarm education, improved staffing, and updated equipment. Findings support the benefits of continued education in alarm management for nurses. Bedside nurses are a critical member of a multidisciplinary alarm management team because they are at the forefront of patient safety and most at risk for experiencing alarm fatigue. J Contin Educ Nurs. 2018;49(5):207-215. Copyright 2018, SLACK Incorporated.

Can formal collaborative methodologies improve quality in primary health care in New Zealand? Insights from the EQUIPPED Auckland Collaborative.

PubMed

Palmer, Celia; Bycroft, Janine; Healey, Kate; Field, Adrian; Ghafel, Mazin

2012-12-01

Auckland District Health Board was one of four District Health Boards to trial the Breakthrough Series (BTS) methodology to improve the management of long-term conditions in New Zealand, with support from the Ministry of Health. To improve clinical outcomes, facilitate planned care and promote quality improvement within participating practices in Auckland. Implementation of the Collaborative followed the improvement model / Institute for Healthcare Improvement methodology. Three topic areas were selected: system redesign, cardio-vascular disease/diabetes, and self-management support. An expert advisory group and the Improvement Foundation Australia helped guide project development and implementation. Primary Health Organisation facilitators were trained in the methodology and 15 practice teams participated in the three learning workshops and action periods over 12 months. An independent evaluation study using both quantitative and qualitative methods was conducted. Improvements were recorded in cardiovascular disease risk assessment, practice-level systems of care, self-management systems and follow-up and coordination for patients. Qualitative research found improvements in coordination and teamwork, knowledge of practice populations and understanding of managing long-term conditions. The Collaborative process delivered some real improvements in the systems of care for people with long-term conditions and a change in culture among participating practices. The findings suggest that by strengthening facilitation processes, improving access to comprehensive population audit tools and lengthening the time frame, the process has the potential to make significant improvements in practice. Other organisations should consider this approach when investigating quality improvement programmes.

The Impact of Management Decision-Making on Student Success in Community Colleges: A Case Study

ERIC Educational Resources Information Center

Alt, Albert G.

2012-01-01

This case study examined a multi-college community college district in northern California in a primarily rural area, to understand how their practices compared to management best practices designed to improve student success, barriers that may exist in implementing best practices, and how the institution may improve its own practices. The problem…

Nutrition training improves health workers' nutrition knowledge and competence to manage child undernutrition: a systematic review.

PubMed

Sunguya, Bruno F; Poudel, Krishna C; Mlunde, Linda B; Urassa, David P; Yasuoka, Junko; Jimba, Masamine

2013-09-24

Medical and nursing education lack adequate practical nutrition training to fit the clinical reality that health workers face in their practices. Such a deficit creates health workers with poor nutrition knowledge and child undernutrition management practices. In-service nutrition training can help to fill this gap. However, no systematic review has examined its collective effectiveness. We thus conducted this study to examine the effectiveness of in-service nutrition training on health workers' nutrition knowledge, counseling skills, and child undernutrition management practices. We conducted a literature search on nutrition interventions from PubMed/MEDLINE, CINAHL, EMBASE, ISI Web of Knowledge, and World Health Organization regional databases. The outcome variables were nutrition knowledge, nutrition-counseling skills, and undernutrition management practices of health workers. Due to heterogeneity, we conducted only descriptive analyses. Out of 3910 retrieved articles, 25 were selected as eligible for the final analysis. A total of 18 studies evaluated health workers' nutrition knowledge and showed improvement after training. A total of 12 studies with nutrition counseling as the outcome variable also showed improvement among the trained health workers. Sixteen studies evaluated health workers' child undernutrition management practices. In all such studies, child undernutrition management practices and competence of health workers improved after the nutrition training intervention. In-service nutrition training improves quality of health workers by rendering them more knowledge and competence to manage nutrition-related conditions, especially child undernutrition. In-service nutrition training interventions can help to fill the gap created by the lack of adequate nutrition training in the existing medical and nursing education system. In this way, steps can be taken toward improving the overall nutritional status of the child population.

Quality assurance and the need to evaluate interventions and audit programme outcomes.

PubMed

Zhao, Min; Vaartjes, Ilonca; Klipstein-Grobusch, Kerstin; Kotseva, Kornelia; Jennings, Catriona; Grobbee, Diederick E; Graham, Ian

2017-06-01

Evidence-based clinical guidelines provide standards for the provision of healthcare. However, these guidelines have been poorly implemented in daily practice. Clinical audit is a quality improvement tool to promote quality of care in daily practice and to improve outcomes through the systematic review of care delivery and implementation of changes. A major priority in the management of subjects with cardiovascular disease (CVD) management is secondary prevention by controlling cardiovascular risk factors and providing appropriate medical treatment. Clinical audits can be applied to monitor modifiable risk factors and evaluate quality improvements of CVD management in daily practice. Existing clinical audits have provided an overview of the burden of risk factors in subjects with CVD and reflect real-world risk factor recording and management. However, consistent and representative data from clinic audits are still insufficient to fully monitor quality improvement of CVD management. Data are lacking in particular from low- and middle-income countries, limiting the evaluation of CVD management quality by clinical audit projects in many settings. To support the development of clinical standards, monitor daily practice performance, and improve quality of care in CVD management at national and international levels, more widespread clinical audits are warranted.

Management Design Theories

NASA Astrophysics Data System (ADS)

Pries-Heje, Jan; Baskerville, Richard L.

This paper elaborates a design science approach for management planning anchored to the concept of a management design theory. Unlike the notions of design theories arising from information systems, management design theories can appear as a system of technological rules, much as a system of hypotheses or propositions can embody scientific theories. The paper illus trates this form of management design theories with three grounded cases. These grounded cases include a software process improvement study, a user involvement study, and an organizational change study. Collectively these studies demonstrate how design theories founded on technological rules can not only improve the design of information systems, but that these concepts have great practical value for improving the framing of strategic organi zational design decisions about such systems. Each case is either grounded in an empirical sense, that is to say, actual practice, or it is grounded to practices described extensively in the practical literature. Such design theories will help managers more easily approach complex, strategic decisions.

The relationship between quality management practices and organisational performance: A structural equation modelling approach

NASA Astrophysics Data System (ADS)

Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.

2015-02-01

The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to managers so that they can allocate resources to improve these practices to get better performance.

A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan

PubMed Central

Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko

2017-01-01

Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148

76 FR 16818 - Central Valley Project Improvement Act, Standard Criteria for Ag and Urban Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-25

... Valley Project water conservation best management practices (BMPs) that shall develop Criteria for... project contractors using best available cost- effective technology and best management practices.'' The... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Standard...

Independent practice associations and physician-hospital organizations can improve care management for smaller practices.

PubMed

Casalino, Lawrence P; Wu, Frances M; Ryan, Andrew M; Copeland, Kennon; Rittenhouse, Diane R; Ramsay, Patricia P; Shortell, Stephen M

2013-08-01

Pay-for-performance, public reporting, and accountable care organization programs place pressures on physicians to use health information technology and organized care management processes to improve the care they provide. But physician practices that are not large may lack the resources and size to implement such processes. We used data from a unique national survey of 1,164 practices with fewer than twenty physicians to provide the first information available on the extent to which independent practice associations (IPAs) and physician-hospital organizations (PHOs) might make it possible for these smaller practices to share resources to improve care. Nearly a quarter of the practices participated in an IPA or a PHO that accounted for a significant proportion of their patients. On average, practices participating in these organizations provided nearly three times as many care management processes for patients with chronic conditions as nonparticipating practices did (10.4 versus 3.8). Half of these processes were provided only by IPAs or PHOs. These organizations may provide a way for small and medium-size practices to systematically improve care and participate in accountable care organizations.

A collaborative project to improve identification and management of patients with chronic kidney disease in a primary care setting in Greater Manchester.

PubMed

Humphreys, John; Harvey, Gill; Coleiro, Michelle; Butler, Brook; Barclay, Anna; Gwozdziewicz, Maciek; O'Donoghue, Donal; Hegarty, Janet

2012-08-01

Research has demonstrated a knowledge and practice gap in the identification and management of chronic kidney disease (CKD). In 2009, published data showed that general practices in Greater Manchester had a low detection rate for CKD. A 12-month improvement collaborative, supported by an evidence-informed implementation framework and financial incentives. 19 general practices from four primary care trusts within Greater Manchester. Number of recorded patients with CKD on practice registers; percentage of patients on registers achieving nationally agreed blood pressure targets. The collaborative commenced in September 2009 and involved three joint learning sessions, interspersed with practice level rapid improvement cycles, and supported by an implementation team from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care for Greater Manchester. At baseline, the 19 collaborative practices had 4185 patients on their CKD registers. At final data collection in September 2010, this figure had increased by 1324 to 5509. Blood pressure improved from 34% to 74% of patients on practice registers having a recorded blood pressure within recommended guidelines. Evidence-based improvement can be implemented in practice for chronic disease management. A collaborative approach has been successful in enabling teams to test and apply changes to identify patients and improve care. The model has proved to be more successful for some practices, suggesting a need to develop more context-sensitive approaches to implementation and actively manage the factors that influence the success of the collaborative.

Using Social Network Analysis to Examine the Effect of Care Management Structure on Chronic Disease Management Communication Within Primary Care.

PubMed

Holtrop, Jodi Summers; Ruland, Sandra; Diaz, Stephanie; Morrato, Elaine H; Jones, Eric

2018-05-01

Care management and care managers are becoming increasingly prevalent in primary care medical practice as a means of improving population health and reducing unnecessary care. Care managers are often involved in chronic disease management and associated transitional care. In this study, we examined the communication regarding chronic disease care within 24 primary care practices in Michigan and Colorado. We sought to answer the following questions: Do care managers play a key role in chronic disease management in the practice? Does the prominence of the care manager's connectivity within the practice's communication network vary by the type of care management structure implemented? Individual written surveys were given to all practice members in the participating practices. Survey questions assessed demographics as well as practice culture, quality improvement, care management activities, and communication regarding chronic disease care. Using social network analysis and other statistical methods, we analyzed the communication dynamics related to chronic disease care for each practice. The structure of chronic disease communication varies greatly from practice to practice. Care managers who were embedded in the practice or co-located were more likely to be in the core of the communication network than were off-site care managers. These care managers also had higher in-degree centrality, indicating that they acted as a hub for communication with team members in many other roles. Social network analysis provided a useful means of examining chronic disease communication in practice, and highlighted the central role of care managers in this communication when their role structure supported such communication. Structuring care managers as embedded team members within the practice has important implications for their role in chronic disease communication within primary care.

Safety management by walking around (SMBWA): a safety intervention program based on both peer and manager participation.

PubMed

Luria, Gil; Morag, Ido

2012-03-01

"Management by walking around" (MBWA) is a practice that has aroused much interest in management science and practice. The purpose of this study is to demonstrate adaptation of this practice to safety management. We describe a three-year long case study that collected empirical data in which a modified MBWA was practiced in order to improve safety in a semiconductor fabrication facility. The main modification involved integrating an information system with the MBWA in order to create a practice that would generate safety leadership development and an organizational safety learning mechanism, while promoting employee safety participation. The results of the case study demonstrate that the SMBWA practice facilitated thousands of tours in which safety leadership behaviors were practiced by managers and by employees (employees performed five times as many tours as managers). The information system collected information about safety behaviors and safety conditions that could not otherwise be obtained. Thus, this study presents a new organizational safety practice SMBWA, and demonstrates the ways in which SMBWA may improve safety in organizations. Copyright © 2011 Elsevier Ltd. All rights reserved.

Practice management companies improve practices' financial position.

PubMed

Dupell, T

1997-11-01

To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.

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

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study

PubMed Central

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-01-01

Objectives To examine the effectiveness of the quality management programme—European Practice Assessment—in primary care in Switzerland. Design Longitudinal study with three points of measurement. Setting Primary care practices in Switzerland. Participants In total, 45 of 91 primary care practices completed European Practice Assessment three times. Outcomes The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: ‘infrastructure’, ‘information’, ‘finance’, and ‘quality and safety’ to examine changes over time. Results Significant improvements were found in three of four domains: ‘quality and safety’ (F=22.81, p<0.01), ‘information’ (F=27.901, p<0.01) and ‘finance’ (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). Conclusions The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. PMID:25900466

40 CFR 260.23 - Petitions to amend 40 CFR part 273 to include additional hazardous wastes.

Code of Federal Regulations, 2014 CFR

2014-07-01

... PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) HAZARDOUS WASTE MANAGEMENT SYSTEM: GENERAL Rulemaking... appropriate for the waste or category of waste; will improve management practices for the waste or category of... waste or category of waste, will improve management practices for the waste or category of waste, and...

40 CFR 260.23 - Petitions to amend 40 CFR part 273 to include additional hazardous wastes.

Code of Federal Regulations, 2012 CFR

2012-07-01

... PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) HAZARDOUS WASTE MANAGEMENT SYSTEM: GENERAL Rulemaking... appropriate for the waste or category of waste; will improve management practices for the waste or category of... waste or category of waste, will improve management practices for the waste or category of waste, and...

40 CFR 260.23 - Petitions to amend 40 CFR part 273 to include additional hazardous wastes.

Code of Federal Regulations, 2013 CFR

2013-07-01

... PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) HAZARDOUS WASTE MANAGEMENT SYSTEM: GENERAL Rulemaking... appropriate for the waste or category of waste; will improve management practices for the waste or category of... waste or category of waste, will improve management practices for the waste or category of waste, and...

40 CFR 260.23 - Petitions to amend 40 CFR part 273 to include additional hazardous wastes.

Code of Federal Regulations, 2010 CFR

2010-07-01

... PROTECTION AGENCY (CONTINUED) SOLID WASTES (CONTINUED) HAZARDOUS WASTE MANAGEMENT SYSTEM: GENERAL Rulemaking... appropriate for the waste or category of waste; will improve management practices for the waste or category of... waste or category of waste, will improve management practices for the waste or category of waste, and...

Structured data quality reports to improve EHR data quality.

PubMed

Taggart, Jane; Liaw, Siaw-Teng; Yu, Hairong

2015-12-01

To examine whether a structured data quality report (SDQR) and feedback sessions with practice principals and managers improve the quality of routinely collected data in EHRs. The intervention was conducted in four general practices participating in the Fairfield neighborhood electronic Practice Based Research Network (ePBRN). Data were extracted from their clinical information systems and summarised as a SDQR to guide feedback to practice principals and managers at 0, 4, 8 and 12 months. Data quality (DQ) metrics included completeness, correctness, consistency and duplication of patient records. Information on data recording practices, data quality improvement, and utility of SDQRs was collected at the feedback sessions at the practices. The main outcome measure was change in the recording of clinical information and level of meeting Royal Australian College of General Practice (RACGP) targets. Birth date was 100% and gender 99% complete at baseline and maintained. DQ of all variables measured improved significantly (p<0.01) over 12 months, but was not sufficient to comply with RACGP standards. Improvement was greatest with allergies. There was no significant change in duplicate records. SDQRs and feedback sessions support general practitioners and practice managers to focus on improving the recording of patient information. However, improved practice DQ, was not sufficient to meet RACGP targets. Randomised controlled studies are required to evaluate strategies to improve data quality and any associated improved safety and quality of care. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Pediatric nurses' beliefs and pain management practices: an intervention pilot.

PubMed

Van Hulle Vincent, Catherine; Wilkie, Diana J; Wang, Edward

2011-10-01

We evaluated feasibility of the Internet-based Relieve Children's Pain (RCP) protocol to improve nurses' management of children's pain. RCP is an interactive, content-focused, and Kolb's experiential learning theory-based intervention. Using a one-group, pretest-posttest design, we evaluated feasibility of RCP and pretest-posttest difference in scores for nurses' beliefs, and simulated and actual pain management practices. Twenty-four RNs completed an Internet-based Pain Beliefs and Practices Questionnaire (PBPQ, alpha=.83) before and after they completed the RCP and an Acceptability Scale afterward. Mean total PBPQ scores significantly improved from pretest to posttest as did simulated practice scores. After RCP in actual hospital practice, nurses administered significantly more ibuprofen and ketorolac and children's pain intensity significantly decreased. Findings showed strong evidence for the feasibility of RCP and study procedures and significant improvement in nurses' beliefs and pain management practices. The 2-hr RCP program is promising and warrants replication with an attention control group and a larger sample.

Fever management in the emergency department of the Children's Hospital of Fudan University: a best practice implementation project.

PubMed

Hu, Fei; Zhang, Jiayan; Shi, Shupeng; Zhou, Zhang

2016-09-01

Febrile illness in young children usually indicates an underlying infection and is a cause of concern for parents and carers. It is very important that healthcare professionals know how to recognize fever, assess children with fever, treat children with fever and role of nurses and parents. This paper outlines a best practice implementation project on the management of fever in children in an emergency department. To audit current practice of fever management for children in an emergency department and to implement strategies to standardize pediatric fever management based on evidence-based practice guidelines. We used the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice to examine compliance with fever management criteria based on the best available evidence before and after the implementation of strategies to spread the use of evidence-based practice protocols. We found significant improvements in pediatric fever management as measured by the knowledge scores of parents (54.5-83.7) and nurses (67.6-90.3). This suggested a need for continuous education. We found a noticeable improvement in compliance across all the five criteria; using correct methods to measure temperature (86-98%), staff education (0-100%), parents education (0-100%), using assessment tools (0-100%) and observed management (0-98%). This best practice implementation project demonstrated the use of effective strategies to standardize the protocol for fever management, implement assessment tool, develop multimedia materials, deliver continuous staff education and update nursing documentation and patient education pamphlets to ensure best practice is delivered by nurses to improve patient outcomes.

Managing hospital doctors and their practice: what can we learn about human resource management from non-healthcare organisations?

PubMed

Trebble, Timothy M; Heyworth, Nicola; Clarke, Nicholas; Powell, Timothy; Hockey, Peter M

2014-11-21

Improved management of clinicians' time and practice is advocated to address increasing demands on healthcare provision in the UK National Health Service (NHS). Human resource management (HRM) is associated with improvements in organisational performance and outcomes within and outside of healthcare, but with limited use in managing individual clinicians. This may reflect the absence of effective and transferrable models. The current systems of managing the performance of individual clinicians in a secondary healthcare organisation were reviewed through the study of practice in 10 successful partnership organisations, including knowledge worker predominant, within commercial, public and voluntary sector operating environments. Reciprocal visits to the secondary healthcare environment were undertaken. Six themes in performance related HRM were identified across the external organisations representing best practice and considered transferrable to managing clinicians in secondary care organisations. These included: performance measurement through defined outcomes at the team level with decision making through local data interpretation; performance improvement through empowered formal leadership with organisational support; individual performance review (IPR); and reward, recognition and talent management. The role of the executive was considered essential to support and implement effective HRM, with management of staff performance, behaviour and development integrated into organisational strategy, including through the use of universally applied values and effective communication. These approaches reflected many of the key aspects of high performance work systems and strategic HRM. There is the potential to develop systems of HRM of individual clinicians in secondary healthcare to improve practice. This should include both performance measurement and performance improvement but also engagement at an organisational level. This suggests that effective HRM and performance management of individual clinicians may be possible but requires an alternative approach for the NHS.

Report: EPA Needs to Improve Management Practices to Ensure a Successful Customer Technology Solutions Project

EPA Pesticide Factsheets

Report #10-P-0194, August 23, 2010. Although EPA indicated it could avoid spending more than $115.4 million over 8.5 years by consolidating the desktop computing environment, improved management practices are needed.

Untangling practice redesign from disease management: how do we best care for the chronically ill?

PubMed

Coleman, Katie; Mattke, Soeren; Perrault, Patrick J; Wagner, Edward H

2009-01-01

In the past 10 years, a wide spectrum of chronic care improvement interventions has been tried and evaluated to improve health outcomes and reduce costs for chronically ill individuals. On one end of the spectrum are disease-management interventions--often organized by commercial vendors--that work with patients but do little to engage medical practice. On the other end are quality-improvement efforts aimed at redesigning the organization and delivery of primary care and better supporting patient self-management. This qualitative review finds that carve-out disease management interventions that target only patients may be less effective than those that also work to redesign care delivery. Imprecise nomenclature and poor study design methodology limit quantitative analysis. More innovation and research are needed to understand how disease-management components can be more meaningfully embedded within practice to improve patient care.

Strategic Information Resources Management: Fundamental Practices.

ERIC Educational Resources Information Center

Caudle, Sharon L.

1996-01-01

Discusses six fundamental information resources management (IRM) practices in successful organizations that can improve government service delivery performance. Highlights include directing changes, integrating IRM decision making into a strategic management process, performance management, maintaining an investment philosophy, using business…

Teacher coaching supported by formative assessment for improving classroom practices.

PubMed

Fabiano, Gregory A; Reddy, Linda A; Dudek, Christopher M

2018-06-01

The present study is a wait-list controlled, randomized study investigating a teacher coaching approach that emphasizes formative assessment and visual performance feedback to enhance elementary school teachers' classroom practices. The coaching model targeted instructional and behavioral management practices as measured by the Classroom Strategies Assessment System (CSAS) Observer and Teacher Forms. The sample included 89 general education teachers, stratified by grade level, and randomly assigned to 1 of 2 conditions: (a) immediate coaching, or (b) waitlist control. Results indicated that, relative to the waitlist control, teachers in immediate coaching demonstrated significantly greater improvements in observations of behavior management strategy use but not for observations of instructional strategy use. Observer- and teacher-completed ratings of behavioral management strategy use at postassessment were significantly improved by both raters; ratings of instructional strategy use were significantly improved for teacher but not observer ratings. A brief coaching intervention improved teachers' use of observed behavior management strategies and self-reported use of behavior management and instructional strategies. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Does a quality management system improve quality in primary care practices in Switzerland? A longitudinal study.

PubMed

Goetz, Katja; Hess, Sigrid; Jossen, Marianne; Huber, Felix; Rosemann, Thomas; Brodowski, Marc; Künzi, Beat; Szecsenyi, Joachim

2015-04-21

To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland. Longitudinal study with three points of measurement. Primary care practices in Switzerland. In total, 45 of 91 primary care practices completed European Practice Assessment three times. The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time. Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. 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.

Safety and compliance-related hazards in the medical practice: Part one.

PubMed

Calway, R C

2001-01-01

Safety and risk management hazards are a fact of life for the medical practice, and the costs of these incidents can place the group at significant risk of liability. Good compliance and risk management programs help minimize these incidents, improve staff morale, increase a practice's visibility in the community, and positively affect the practice's financial and operational bottom line performance. Medical practices that implement effective safety and risk management programs can realize savings in staffing costs, operational efficiency, morale, insurance premiums, and improved third-party relationships while at the same time avoiding embarrassing risks, fines, and liability. This article outlines some of the most common safety and risk management-related deficiencies seen in medical practices today. The author explains how to remedy these deficiencies and provides a self-test tool to enable the reader to assess areas within his or her own practice in need of attention.

Costs associated with data collection and reporting for diabetes quality improvement in primary care practices: a report from SNOCAP-USA.

PubMed

West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry

2012-01-01

Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.

Practice management companies. Creating sound information technology strategies.

PubMed

Cross, M A

1997-10-01

Practice management companies are becoming more prominent players in the health care industry. To improve the performance of the group practices that they acquire, these companies are striving to use updated information technologies.

Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.

PubMed

Sasnett, Bonita; Harris, Susie T; White, Shelly

Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.

Improving the implementation of responsible alcohol management practices by community sporting clubs: A randomised controlled trial.

PubMed

Kingsland, Melanie; Wolfenden, Luke; Tindall, Jennifer; Rowland, Bosco; Sidey, Maree; McElduff, Patrick; Wiggers, John H

2015-07-01

Despite an increased prevalence of risky alcohol consumption and alcohol-related harm among members of sporting groups and at sporting venues, sporting clubs frequently fail to implement alcohol management practices consistent with liquor legislation and best practice guidelines. The aim of this study was to assess the impact of a multi-strategy intervention in improving the implementation of responsible alcohol management practices by sports clubs. A randomised controlled trial was conducted with 87 football clubs, with half randomised to receive a multi-strategy intervention to support clubs to implement responsible alcohol management practices. The 2-year intervention, which was based on implementation and capacity building theory and frameworks, included project officer support, funding, accreditation rewards, printed resources, observational audit feedback, newsletters, training and support from state sporting organisations. Interviews were undertaken with club presidents at baseline and post-intervention to assess alcohol management practice implementation. Post-intervention, 88% of intervention clubs reported implementing '13 or more' of 16 responsible alcohol management practices, which was significantly greater than the proportion of control groups reporting this level of implementation (65%) [odds ratio: 3.7 (95% confidence interval: 1.1-13.2); P = 0.04]. All intervention components were considered highly useful and three-quarters or more of clubs rated the amount of implementation support to be sufficient. The multi-strategy intervention was successful in improving alcohol management practices in community sports clubs. Further research is required to better understand implementation barriers and to assess the long-term sustainability of the change in club alcohol management practices. © 2015 Australasian Professional Society on Alcohol and other Drugs.

Teaching residents practice-management knowledge and skills: an in vivo experience.

PubMed

Williams, Laurel Lyn

2009-01-01

This article explores the relevant data regarding teaching psychiatric residents practice management knowledge and skills. This article also introduces a unique program for teaching practice management to residents. A literature search was conducted through PubMed and Academic Psychiatry. Additionally residents involved in the training program for practice management were given an anonymous survey to complete. There were no randomized, controlled trials in the academic psychiatric field concerning the topic of practice management. The responses to the resident survey (n=10) indicated a modest improvement in residents' perception of receiving adequate training and exposure to practice management knowledge and skills. The available research suggests that many residents and faculty believe that practice management knowledge and skills are still not adequately addressed. The Baylor Clinic practice management program may be one possible solution for integrating the teaching of practice management knowledge and skills. More research on this topic is needed.

Making a Difference: Leading and Managing for Quality Improvement in Adult and Community Learning.

ERIC Educational Resources Information Center

Ravenhall, Mark; Kenway, Mike

This guide looks at demands on leaders and managers in adult and community learning (ACL) in the roles and issues they face in the context of quality improvement (QI). It suggests practical approaches for improving the quality of provision for adults. The guide's design builds on current practice toward the desired state of excellence in all…

Integrated management of depression: improving system quality and creating effective interfaces.

PubMed

Myette, Thomas L

2008-04-01

Depression is a chronic recurrent condition and is a leading cause of work disability. Improving occupational outcomes for depression will require an integrated approach that incorporates best practices from the clinical, community, and workplace systems. This article briefly reviews recent quality improvement initiatives and promising practices in each system and then shifts to the importance of systems integration. An integrated chronic care model uses a sophisticated case management process to support essential relationships, facilitate key plans, and efficiently link the three systems to optimize clinical, economic, and occupational outcomes. An expanded role for employers and their agents in the management of depression and other chronic diseases is seen as fundamental to maintaining a healthy and productive workforce. To improve occupational outcomes for depression by integrating best practices from the clinical, community, and workplace systems. After a brief review of quality improvement initiatives and promising practices in each system, an integrated chronic care model is introduced. A case management process that links critical systems, supports essential relationships, and facilitates key plans is expected to result in improvements in clinical, economic, and occupational outcomes. Employers should be more engaged with clinical and community partners in the prevention and control of depression in affected employees.

A quality improvement project to improve the effectiveness and patient-centredness of management of people with mild-to-moderate kidney disease in primary care.

PubMed

Thomas, Nicola; Gallagher, Hugh; Jain, Neerja

2014-01-01

Chronic kidney disease (CKD) stages 3 to 5, affects 6-7% of the adult population and is an important risk factor for both advanced kidney disease and cardiovascular disease. This paper describes a quality improvement project that aimed to establish consistent implementation of best practice in people with stage 3-5 kidney disease who were managed in primary care. The intervention was a Care Bundle for CKD. The bundle included three evidence-based, high impact interventions based on National Institute for Care Excellence (NICE, 2008) guidance, with an additional and novel self-management element. 29 GP Practices in England and Wales began the study. They undertook training in clinical management of CKD and in facilitation of self-management, with the self-management content designed and led by patients. Practices were asked to report baseline and then monthly outcome data extracted from practice computer systems. The project team provided implementation and ongoing quality improvement support for participating Practices. Ten Practices dropped out of the study following the training. Data submissions were incomplete in six Practices who continued to apply the care bundle. At the project end, a decision was taken by the study team to perform the final analysis on those thirteen Practices which completed the project and submitted at least six sets of monthly Practice-level outcome data. In these Practices the Care Bundle was applied to under 20% of the registered CKD stage 3 to 5 population in 5 Practices, 20-29% in 3 Practices, 30-49% in 2 Practices and ≥50% in 3 Practices (998 patients in total). Of these, 671 patients (75%) agreed to the self-management component of the intervention. The reliability (at project end) in those who received the Bundle was 100%. The Bundle was applied to an additional 315 patients in the six Practices who completed the project but did not submit regular practice-level monthly data. In the thirteen remaining Practices, the achievement of NICE (2008) blood pressure targets at the start of the project was 74.8% in people with CKD stage 3-5 and no diabetes and 48% in people with CKD stage 3-5 and diabetes. At the project end these figures in the same Practices were 76.7% and 49.2% respectively. These improvements were achieved in spite of Practices increasing their recording of prevalence rate (that is, identifying and recording more patients with CKD on the Practice CKD Register). In conclusion, a care bundle can be implemented in primary care. However, maintaining engagement with primary care health care professionals and maximising exposure to an intervention in patients seen infrequently are significant challenges to generalisation and sustainability.

Civil Forensic Psychiatry - part 3: practical aspects of managing a medico-legal practice.

PubMed

Samuels, Anthony H

2018-06-01

This is the third in a series of papers on Civil Forensic Psychiatry and provides practical advice for forensic psychiatrists, general psychiatrists and trainees who are expanding or contemplating a medico-legal aspect to their practice. Attention to the practice setting, office layout, recording of information, management of documentation, screening of briefs and proper timetabling can improve safety, quality, reliability and workload manageability.

EVALUATING AN URBAN STREAM RESTORATION PROGRAM FOR IMPROVING WATER QUALITY, IN-STREAM HABITAT, AND BANK STABILITY

EPA Science Inventory

To improve water quality in urban and suburban areas, watershed managers often incorporate best management practices (BMPs) to reduce the quantity of runoff, as well as minimize pollutants and other stressors contained in stormwater runoff. It is well known that land use practice...

The assessment and management of chemotherapy-induced nausea and vomiting among cancer patients in a chemotherapy ward: a best practice implementation project.

PubMed

Gu, Lingli; Li, Jing

2016-03-01

Chemotherapy-induced nausea and vomiting (CINV) are considered to be two of the most distressing side-effects of chemotherapy. They have a negative impact on a patient's quality of life and can influence the continuance of treatment. Owing to the lack of effective management of CINV, regular assessment and management of CINV is recommended for patients undergoing chemotherapy. The aim of this project was to integrate the available evidence on the assessment and management of CINV into practice, and implement strategies to improve compliance with evidence-based practice. The project carried out a pre- and post-implementation audit procedure using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice programs. Five audit criteria were established according to the best available evidence on the assessment and management of CINV. The program was divided into three phases and conducted over four months in the chemotherapy ward, Fudan University Shanghai Cancer Center, Shanghai, China. Sixty patients and 14 oncology nurses were involved in this project. The results of the follow-up cycle showed that the compliance rates regarding patient education, risk factors evaluation and non-pharmacologic managements were 100%, 100% and 80%, respectively. The rate of validated tools being used by patients and nurses improved by 93% and 97%, respectively. This project demonstrated that the use of pre- and post-best practice audits is an effective method for incorporating evidence into practice in a chemotherapy ward. The practice of assessing and managing CINV was significantly improved. The next step is to develop strategies for sustaining the new procedures of CINV assessment and management.

48 CFR 970.0370 - Management Controls and Improvements.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Improper Business Practices and Personal Conflicts of Interest 970.0370 Management Controls and Improvements. ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false Management Controls and...

Quality improvement in childhood obesity management through the maintenance of certification process.

PubMed

Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura

2013-11-01

To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.

Self-management for patients with inflammatory bowel disease in a gastroenterology ward in China: a best practice implementation project.

PubMed

Chen, Ruo-Bing

2016-11-01

Globally, there is an increasing incidence of inflammatory bowel disease. It is very important for patients to be involved with self-management that can optimize personal heath behavior to control the disease. The aim of this project was to increase nursing staff knowledge of inflammatory bowel disease discharge guidance, and to improve the quality of education for discharged patients, thereby improving their self-management. A baseline audit was conducted by interviewing 30 patients in the gastroenterology ward of Huadong Hospital, Fudan University. The project utilized the Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research Into Practice audit tools for promoting quality of education and self-management of patients with inflammatory bowel disease. Thirty patients were provided with written materials, which included disease education and information regarding self-management. A post-implementation audit was conducted. There was improvement of education prior to discharge and dietary consultancy in the gastroenterology ward. Self-management plans utilizing written materials only were not sufficient for ensuring sustainability of the project. Comprehensive self-management education can make a contribution to improving awareness of the importance of self-management for patients with inflammatory bowel disease.

Management of natural health products in pediatrics: a provider-focused quality improvement project.

PubMed

Gutierrez, Emily; Silbert-Flagg, JoAnne; Vohra, Sunita

2015-01-01

The use of natural health products by pediatric patients is common, yet health care providers often do not provide management guidance. The purpose of this project was to improve management of natural health products by pediatric nurse practitioners. Pediatric nurse practitioners from large metropolitan city were recruited (n = 32). A paired pretest-posttest design was used. Study participants were engaged to improve knowledge of natural health products, and a management toolkit was created and tested. Mean knowledge scores increased from 59.19 to 76.3 (p < .01). Management practices improved with regard to patient guidance (p < .01) and resource utilization (p < .01). Assessments of product use (p = .51) and drug/herb interactions (p = .35) were not significant. This investigation is the first known study to improve knowledge and management of natural health products in pediatric clinical practice. Copyright © 2015 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.

Using data to improve medical practice by measuring processes and outcomes of care.

PubMed

Nelson, E C; Splaine, M E; Godfrey, M M; Kahn, V; Hess, A; Batalden, P; Plume, S K

2000-12-01

The purpose of this article is to help clinicians expand their use of data to improve medical practice performance and to do improvement research. Clinical practices can be viewed as small, complex organizations (microsystems) that produce services for specific patient populations. These services can be greatly improved by embedding measurement into the flow of daily work in the practice. WHY DO IT?: Four good reasons to build measures into daily medical practice are to (1) diagnose strengths and weaknesses in practice performance; (2) improve and innovate in providing care and services using improvement research; (3) manage patients and the practice; and (4) evaluate changes in results over time. It is helpful to have a "physiological" model of a medical practice to analyze the practice, to manage it, and to improve it. One model views clinical practices as microsystems that are designed to generate desired health outcomes for specific subsets of patients and to use resources efficiently. This article provides case study examples to show what an office-based practice might look like if it were using front-line measurement to improve care and services most of the time and to conduct clinical improvement research some of the time. WHAT ARE THE PRINCIPLES FOR USING DATA TO IMPROVE PROCESSES AND OUTCOMES OF CARE?: Principles reflected in the case study examples--such as "Keep Measurement Simple. Think Big and Start Small" and "More Data Is Not Necessarily Better Data. Seek Usefulness, Not Perfection, in Your Measures"--may help guide the development of data to study and improve practice. HOW CAN A PRACTICE START TO USE DATA TO IMPROVE CARE AND CONDUCT IMPROVEMENT RESEARCH?: Practical challenges are involved in starting to use data for enhancing care and improvement research. To increase the odds for success, it would be wise to use a change management strategy to launch the startup plan. Other recommendations include "Establish a Sense of Urgency. (Survival Is Not Mandatory)" and "Create the Guiding Coalition. (A Small, Devoted Group of People Can Change the World)." Over the long term, we must transform thousands of local practice cultures so that useful data are used every day in countless ways to assist clinicians, support staff, patients, families, and communities.

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative

PubMed Central

Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

2015-01-01

Quality problem Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Initial assessment Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼30% were estimated to have suboptimal management according to Public Health Observatory analyses. Choice of solution An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. Implementation A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Evaluation Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. Lessons learned An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. PMID:25525148

Improving the identification and management of chronic kidney disease in primary care: lessons from a staged improvement collaborative.

PubMed

Harvey, Gill; Oliver, Kathryn; Humphreys, John; Rothwell, Katy; Hegarty, Janet

2015-02-01

Undiagnosed chronic kidney disease (CKD) contributes to a high cost and care burden in secondary care. Uptake of evidence-based guidelines in primary care is inconsistent, resulting in variation in the detection and management of CKD. Routinely collected general practice data in one UK region suggested a CKD prevalence of 4.1%, compared with an estimated national prevalence of 8.5%. Of patients on CKD registers, ∼ 30% were estimated to have suboptimal management according to Public Health Observatory analyses. An evidence-based framework for implementation was developed. This informed the design of an improvement collaborative to work with a sample of 30 general practices. A two-phase collaborative was implemented between September 2009 and March 2012. Key elements of the intervention included learning events, improvement targets, Plan-Do-Study-Act cycles, benchmarking of audit data, facilitator support and staff time reimbursement. Outcomes were evaluated against two indicators: number of patients with CKD on practice registers; percentage of patients achieving evidence-based blood pressure (BP) targets, as a marker for CKD care. In Phase 1, recorded prevalence of CKD in collaborative practices increased ∼ 2-fold more than that in comparator local practices; in Phase 2, this increased to 4-fold, indicating improved case identification. Management of BP according to guideline recommendations also improved. An improvement collaborative with tailored facilitation support appears to promote the uptake of evidence-based guidance on the identification and management of CKD in primary care. A controlled evaluation study is needed to rigorously evaluate the impact of this promising improvement intervention. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care.

A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils.

PubMed

Sainju, Upendra M

2016-01-01

Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management practices and combined management practices were even more effective than individual management practices in reducing net GHG emissions from cropland soils. Partial accounting overestimated GWP and GHGI values as sinks or sources of net GHGs compared with full accounting when evaluating the effect of management practices.

A Global Meta-Analysis on the Impact of Management Practices on Net Global Warming Potential and Greenhouse Gas Intensity from Cropland Soils

PubMed Central

Sainju, Upendra M.

2016-01-01

Management practices, such as tillage, crop rotation, and N fertilization, may affect net global warming potential (GWP) and greenhouse gas intensity (GHGI), but their global impact on cropland soils under different soil and climatic conditions need further evaluation. Available global data from 57 experiments and 225 treatments were evaluated for individual and combined effects of tillage, cropping systems, and N fertilization rates on GWP and GHGI which accounted for CO2 equivalents from N2O and CH4 emissions with or without equivalents from soil C sequestration rate (ΔSOC), farm operations, and N fertilization. The GWP and GHGI were 66 to 71% lower with no-till than conventional till and 168 to 215% lower with perennial than annual cropping systems, but 41 to 46% greater with crop rotation than monocroppping. With no-till vs. conventional till, GWP and GHGI were 2.6- to 7.4-fold lower when partial than full accounting of all sources and sinks of greenhouse gases (GHGs) were considered. With 100 kg N ha-1, GWP and GHGI were 3.2 to 11.4 times greater with partial than full accounting. Both GWP and GHGI increased curvilinearly with increased N fertilization rate. Net GWP and GHGI were 70 to 87% lower in the improved combined management that included no-till, crop rotation/perennial crop, and reduced N rate than the traditional combined management that included conventional till, monocopping/annual crop, and recommended N rate. An alternative soil respiration method, which replaces ΔSOC by soil respiration and crop residue returned to soil in the previous year, similarly reduced GWP and GHGI by 133 to 158% in the improved vs. the traditional combined management. Changes in GWP and GHGI due to improved vs. traditional management varied with the duration of the experiment and inclusion of soil and climatic factors in multiple linear regressions improved their relationships. Improved management practices reduced GWP and GHGI compared with traditional management practices and combined management practices were even more effective than individual management practices in reducing net GHG emissions from cropland soils. Partial accounting overestimated GWP and GHGI values as sinks or sources of net GHGs compared with full accounting when evaluating the effect of management practices. PMID:26901827

Combining Project Management Methods: A Case Study of Dlstributed Work Practices

NASA Astrophysics Data System (ADS)

Backlund, Per; Lundell, Björn

The increasing complexity of information systems development (ISD) projects call for improved project management practices. This, together with an endeavour to improve the success rate of ISD projects (Lyytinen and Robey 1999; Cooke-Davies 2002; White and Fortune 2002), has served as drivers for various efforts in process improvement such as the introduction of new development methods (Fitzgerald 1997; Iivari and Maansaari 1998).

Information system support as a critical success factor for chronic disease management: Necessary but not sufficient.

PubMed

Green, Carolyn J; Fortin, Patricia; Maclure, Malcolm; Macgregor, Art; Robinson, Sylvia

2006-12-01

Improvement of chronic disease management in primary care entails monitoring indicators of quality over time and across patients and practices. Informatics tools are needed, yet implementing them remains challenging. To identify critical success factors enabling the translation of clinical and operational knowledge about effective and efficient chronic care management into primary care practice. A prospective case study of positive deviants using key informant interviews, process observation, and document review. A chronic disease management (CDM) collaborative of primary care physicians with documented improvement in adherence to clinical practice guidelines using a web-based patient registry system with CDM guideline-based flow sheet. Thirty community-based physician participants using predominantly paper records, plus a project management team including the physician lead, project manager, evaluator and support team. A critical success factor (CSF) analysis of necessary and sufficient pathways to the translation of knowledge into clinical practice. A web-based CDM 'toolkit' was found to be a direct CSF that allowed this group of physicians to improve their practice by tracking patient care processes using evidence-based clinical practice guideline-based flow sheets. Moreover, the information and communication technology 'factor' was sufficient for success only as part of a set of seven direct CSF components including: health delivery system enhancements, organizational partnerships, funding mechanisms, project management, practice models, and formal knowledge translation practices. Indirect factors that orchestrated success through the direct factor components were also identified. A central insight of this analysis is that a comprehensive quality improvement model was the CSF that drew this set of factors into a functional framework for successful knowledge translation. In complex primary care settings environment where physicians have low adoption rates of electronic tools to support the care of patients with chronic conditions, successful implementation may require a set of interrelated system and technology factors.

Designing the role of the embedded care manager.

PubMed

Hines, Patricia; Mercury, Marge

2013-01-01

: The role of the professional case manager is changing rapidly. Health reform has called upon the industry to ensure that care is delivered in an efficient, effective, and high-quality and low cost manner. As a means to achieve this objective, health plans and health systems are moving the care manager out of a centralized location within their organizations to "embedding" them into physician offices. This move enables the care manager to work alongside the primary care physicians and their high-risk patients. This article discusses the framework for designing and implementing an embedded care manager role into a physician practice. Key elements of the program are discussed. IMPLICATIONS FOR CARE MANAGEMENT:: Historically care management has played a foundational role in improving the quality of care for individuals and populations via the efficient and effective use of resources. Now with the goals of health care reform, a successful transition from a volume-based to value-based reimbursement system requires primary care physicians to welcome care managers into their practices to improve patient care, quality, and costs through care coordination across health care settings and populations. : As patient-centered medical homes and integrated delivery systems formulate their plans for population health management, their efforts have included embedding a care manager in the primary practice setting. Having care managers embedded at the physician offices increases their ability to collaborate with the physician and their staff in the implementation and monitoring care plans for their patients. : Implementing an embedded care manager into an existing physician's practice requires the following:Although the embedded care manager is a highly evolving role, physician groups are beginning to realize the benefits from their care management collaborations. Examples cited include improved outreach and coordination, patient adherence to care plans, and improved quality of life.

In Search of Joy in Practice: A Report of 23 High-Functioning Primary Care Practices

PubMed Central

Sinsky, Christine A.; Willard-Grace, Rachel; Schutzbank, Andrew M.; Sinsky, Thomas A.; Margolius, David; Bodenheimer, Thomas

2013-01-01

We highlight primary care innovations gathered from high-functioning primary care practices, innovations we believe can facilitate joy in practice and mitigate physician burnout. To do so, we made site visits to 23 high-performing primary care practices and focused on how these practices distribute functions among the team, use technology to their advantage, improve outcomes with data, and make the job of primary care feasible and enjoyable as a life’s vocation. Innovations identified include (1) proactive planned care, with previsit planning and previsit laboratory tests; (2) sharing clinical care among a team, with expanded rooming protocols, standing orders, and panel management; (3) sharing clerical tasks with collaborative documentation (scribing), nonphysician order entry, and streamlined prescription management; (4) improving communication by verbal messaging and in-box management; and (5) improving team functioning through co-location, team meetings, and work flow mapping. Our observations suggest that a shift from a physician-centric model of work distribution and responsibility to a shared-care model, with a higher level of clinical support staff per physician and frequent forums for communication, can result in high-functioning teams, improved professional satisfaction, and greater joy in practice. PMID:23690328

Evaluation of a rule base for decision making in general practice.

PubMed Central

Essex, B; Healy, M

1994-01-01

BACKGROUND. Decision making in general practice relies heavily on judgmental expertise. It should be possible to codify this expertise into rules and principles. AIM. A study was undertaken to evaluate the effectiveness, of rules from a rule base designed to improve students' and trainees' management decisions relating to patients seen in general practice. METHOD. The rule base was developed after studying decisions about and management of thousands of patients seen in one general practice over an eight year period. Vignettes were presented to 93 fourth year medical students and 179 general practitioner trainees. They recorded their perception and management of each case before and after being presented with a selection of relevant rules. Participants also commented on their level of agreement with each of the rules provided with the vignettes. A panel of five independent assessors then rated as good, acceptable or poor, the participants' perception and management of each case before and after seeing the rules. RESULTS. Exposure to a few selected rules of thumb improved the problem perception and management decisions of both undergraduates and trainees. The degree of improvement was not related to previous experience or to the stated level of agreement with the proposed rules. The assessors identified difficulties students and trainees experienced in changing their perceptions and management decisions when the rules suggested options they had not considered. CONCLUSION. The rules developed to improve decision making skills in general practice are effective when used with vignettes. The next phase is to transform the rule base into an expert system to train students and doctors to acquire decision making skills. It could also be used to provide decision support when confronted with difficult management decisions in general practice. PMID:8204334

A Clostridium difficile infection (CDI) stewardship initiative improves adherence to practice guidelines for management of CDI.

PubMed

Jury, Lucy A; Tomas, Myreen; Kundrapu, Sirisha; Sitzlar, Brett; Donskey, Curtis J

2013-11-01

A Clostridium difficile infection (CDI) stewardship initiative reduced inappropriate prescription of empirical CDI therapy and improved timeliness of treatment and adherence to clinical practice guidelines for management of CDI. The initiative required minimal resources and could easily be incorporated into traditional antimicrobial stewardship programs.

Can novel management practice improve soil and environmental quality and sustain crop yield simultaneously?

USDA-ARS?s Scientific Manuscript database

Little is known about management practices that can simultaneously improve soil and environmental quality and sustain crop yields. The effect of a combination of tillage, crop rotation, and N fertilization on soil C and N, global warming potential (GWP), greenhouse gas intensity (GHGI), and malt bar...

Ensuring the profitability of acquired physician practices.

PubMed

Ortiz, J P

1997-01-01

Healthcare organizations are aggressively acquiring physician group practices to create primary care networks and broaden their managed care market penetration. However, few are realizing a positive return on investment after acquisition. The odds that acquired practices will be profitable can be improved if healthcare organizations plan carefully by establishing separate acquiring entities, setting clear goals for the practices, forming skilled management teams with strong physician leadership to manage the acquired practices, and carefully structuring their physician incentive compensation plans.

Nursing clinical practice changes to improve self-management in chronic obstructive pulmonary disease.

PubMed

Padilha, J M; Sousa, P A F; Pereira, F M S

2018-03-01

To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. © 2017 International Council of Nurses.

The Comprehensive Primary Care Initiative: Effects On Spending, Quality, Patients, And Physicians.

PubMed

Peikes, Deborah; Dale, Stacy; Ghosh, Arkadipta; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Day, Timothy J; Duda, Nancy; Singh, Pragya; Anglin, Grace; Sessums, Laura L; Brown, Randall S

2018-06-01

The Comprehensive Primary Care Initiative (CPC), a health care delivery model developed by the Centers for Medicare and Medicaid Services (CMS), tested whether multipayer support of 502 primary care practices across the country would improve primary care delivery, improve care quality, or reduce spending. We evaluated the initiative's effects on care delivery and outcomes for fee-for-service Medicare beneficiaries attributed to initiative practices, relative to those attributed to matched comparison practices. CPC practices reported improvements in primary care delivery, including care management for high-risk patients, enhanced access, and improved coordination of care transitions. The initiative slowed growth in emergency department visits by 2 percent in CPC practices, relative to comparison practices. However, it did not reduce Medicare spending enough to cover care management fees or appreciably improve physician or beneficiary experience or practice performance on a limited set of Medicare claims-based quality measures. As CMS and other payers increasingly use alternative payment models that reward quality and value, CPC provides important lessons about supporting practices in transforming care.

The 5C Concept and 5S Principles in Inflammatory Bowel Disease Management

PubMed Central

Hibi, Toshifumi; Panaccione, Remo; Katafuchi, Miiko; Yokoyama, Kaoru; Watanabe, Kenji; Matsui, Toshiyuki; Matsumoto, Takayuki; Travis, Simon; Suzuki, Yasuo

2017-01-01

Abstract Background and Aims The international Inflammatory Bowel Disease [IBD] Expert Alliance initiative [2012–2015] served as a platform to define and support areas of best practice in IBD management to help improve outcomes for all patients with IBD. Methods During the programme, IBD specialists from around the world established by consensus two best practice charters: the 5S Principles and the 5C Concept. Results The 5S Principles were conceived to provide health care providers with key guidance for improving clinical practice based on best management approaches. They comprise the following categories: Stage the disease; Stratify patients; Set treatment goals; Select appropriate treatment; and Supervise therapy. Optimised management of patients with IBD based on the 5S Principles can be achieved most effectively within an optimised clinical care environment. Guidance on optimising the clinical care setting in IBD management is provided through the 5C Concept, which encompasses: Comprehensive IBD care; Collaboration; Communication; Clinical nurse specialists; and Care pathways. Together, the 5C Concept and 5S Principles provide structured recommendations on organising the clinical care setting and developing best-practice approaches in IBD management. Conclusions Consideration and application of these two dimensions could help health care providers optimise their IBD centres and collaborate more effectively with their multidisciplinary team colleagues and patients, to provide improved IBD care in daily clinical practice. Ultimately, this could lead to improved outcomes for patients with IBD. PMID:28981622

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

Peck, T; Sparkman, D; Storch, N

''The LLNL Site-Specific Advanced Simulation and Computing (ASCI) Software Quality Engineering Recommended Practices VI.I'' document describes a set of recommended software quality engineering (SQE) practices for ASCI code projects at Lawrence Livermore National Laboratory (LLNL). In this context, SQE is defined as the process of building quality into software products by applying the appropriate guiding principles and management practices. Continual code improvement and ongoing process improvement are expected benefits. Certain practices are recommended, although projects may select the specific activities they wish to improve, and the appropriate time lines for such actions. Additionally, projects can rely on the guidance ofmore » this document when generating ASCI Verification and Validation (VSrV) deliverables. ASCI program managers will gather information about their software engineering practices and improvement. This information can be shared to leverage the best SQE practices among development organizations. It will further be used to ensure the currency and vitality of the recommended practices. This Overview is intended to provide basic information to the LLNL ASCI software management and development staff from the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I'' document. Additionally the Overview provides steps to using the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I'' document. For definitions of terminology and acronyms, refer to the Glossary and Acronyms sections in the ''LLNL Site-Specific ASCI Software Quality Engineering Recommended Practices VI.I''.« less

78 FR 63491 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-24

... Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are available for review: Westside... project contractors using best available cost-effective technology and best management practices.'' These...

78 FR 21414 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2013-04-10

... Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The following Water Management Plans are available for review... establish and administer an office on Central Valley Project water conservation best management practices...

[Computer-assisted cardiovascular disease management: better implementation of care but no improvement in clinical outcomes].

PubMed

de Wit, Niek J

2012-01-01

Computer support is considered by many to be a promising strategy for improving healthcare interventions, especially in the management of chronic diseases. So far, however, evidence of the effectiveness of ICT support in healthcare is limited. Recently, computer-supported cardiovascular disease management was compared with usual care during an RCT comprised of 1100 primary care patients. This trial demonstrated that neither the clinical outcome nor the cardiovascular morbidity rate improved, even though management of the risk factors improved over 1 year of follow-up. The pragmatic design of the RCT in daily general practice may have restricted implementing the computer support, and may also have hampered the evaluation of the cardiovascular effects. The results demonstrate that although computer support may help improve the performance of disease management, its impact on disease outcomes is questionable. ICT innovations in healthcare require rigorous investigative evaluation before their implementation in daily practice can be justified.

Implementation of sustainable evidence-based practice for the assessment and management of pain in residential aged care facilities.

PubMed

Savvas, Steven; Toye, Christine; Beattie, Elizabeth; Gibson, Stephen J

2014-12-01

Pain is common in residential aged care facilities (RACFs). In 2005, the Australian Pain Society developed 27 recommendations for good practice in the identification, assessment, and management of pain in these settings. This study aimed to address implementation of the standards and evaluate outcomes. Five facilities in Australia participated in a comprehensive evaluation of RACF pain practice and outcomes. Pre-existing pain management practices were compared with the 27 recommendations, before an evidence-based pain management program was introduced that included training and education for staff and revised in-house pain-management procedures. Post-implementation audits evaluated the program's success. Aged care staff teams also were assessed on their reports of self-efficacy in pain management. The results show that before the implementation program, the RACFs demonstrated full compliance on 6 to 12 standards. By the project's completion, RACFs demonstrated full compliance with 10 to 23 standards and major improvements toward compliance in the remaining standards. After implementation, the staff also reported better understanding of the standards (p < .001) or of facility pain management guidelines (p < .001), increased confidence in therapies for pain management (p < .001), and increased confidence in their training to assess pain (p < .001) and recognize pain in residents with dementia who are nonverbal (p = .003). The results show that improved evidence-based practice in RACFs can be achieved with appropriate training and education. Investing resources in the aged care workforce via this implementation program has shown improvements in staff self-efficacy and practice. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Links between Conflict Management Research and Practice

ERIC Educational Resources Information Center

Roloff, Michael E.

2009-01-01

This paper explicates the implications of my research on conflict management for self improvement and for practitioners who work to improve the conflict management of others. I also note how my experiences with practitioners have informed my research.

Assessment of range planting as a conservation practice

Treesearch

Stuart P. Hardegree; Bruce A. Roundy; Nancy L. Shaw; Corey A. Moffet; Thomas A. Monaco; Thomas A. Jones; Edward F. Redente

2009-01-01

NRCS range-planting Conservation Practice standards are used to develop management recommendations for improving vegetation composition an productivity of grazed plant communities. Individual Conservation Practice recommendations are implemented within a Conservation-Management-System in areas where the existing plant-community attributes are insufficient to meet...

Performance Management in Education: Improving Practice. British Educational Management Series.

ERIC Educational Resources Information Center

Reeves, Jenny; Forde, Christine; O'Brien, Jim; Smith, Pauline; Tomlinson, Harry

This book explores managing the performance of education staff in England and Wales and in Scotland. It compares the different policies of performance management as practiced in England and Wales and in Scotland. (The Scottish system of education is independent of that of England and Wales.) Chapter 1 provides an introduction to performance…

Doctor-patient relationships (DPR) in China.

PubMed

Ma, Shaozhuang; Xu, Xuehu; Trigo, Virginia; Ramalho, Nelson J C

2017-03-20

Purpose The purpose of this paper is twofold: first, to develop and test theory on how commitment human resource (HR) practices affect hospital professionals' job satisfaction that motivates them to generate desirable patient care and subsequently improve doctor-patient relationships (DPR) and second, to examine how commitment HR practices influence hospital managers and clinicians in different ways. Design/methodology/approach Using a cross-sectional survey, the authors collected data from 508 clinicians and hospital managers from 33 tertiary public hospitals in China. Structural equation model was employed to test the relationships of the variables in the study. Findings Commitment HR practices positively affect the job satisfaction of the healthcare professionals surveyed and a positive relationship is perceived between job satisfaction and DPR. Overall, the model shows a reversal on the strongest path linking job satisfaction and DPR whereby managers' main association operates through extrinsic job satisfaction while for clinicians it occurs through intrinsic satisfaction only. Practical implications DPR might be improved by applying commitment HR practices to increase healthcare professional's intrinsic and extrinsic satisfaction. In addition, while recognizing the importance of compensation and benefits to address the underpayment issue of Chinese healthcare professionals, empowerment and autonomy in work, and the use of subjects' expertise and skills may serve as stronger motivators for clinicians rather than hard economic incentives in achieving DPR improvements. Originality/value This study contributes to the small but growing body of research on human resource management (HRM) in the healthcare sector with new evidence supporting the link between commitment HR practice and work attitudes, as well as work attitudes and patient care from the perspective of clinicians and hospital managers. This study represents an initial attempt to examine the associations among commitment HR practices, job satisfaction and DPR in the Chinese healthcare sector. The findings provide evidence to support the value of commitment HR practices in Chinese hospital context, and demonstrate the importance of effective HRM in improving both hospital managers and clinicians' work attitudes.

Evaluation of computerized decision support for oral anticoagulation management based in primary care.

PubMed

Fitzmaurice, D A; Hobbs, F D; Murray, E T; Bradley, C P; Holder, R

1996-09-01

Increasing indications for oral anticoagulation has led to pressure on general practices to undertake therapeutic monitoring. Computerized decision support (DSS) has been shown to be effective in hospitals for improving clinical management. Its usefulness in primary care has previously not been investigated. To test the effectiveness of using DSS for oral anticoagulation monitoring in primary care by measuring the proportions of patients adequately controlled, defined as within the appropriate therapeutic range of International Normalised Ratio (INR). All patients receiving warfarin from two Birmingham inner city general practices were invited to attend a practice-based anticoagulation clinic. In practice A all patients were managed using DSS. In practice B patients were randomized to receive dosing advice either through DSS or through the local hospital laboratory. Clinical outcomes, adverse events and patient acceptability were recorded. Forty-nine patients were seen in total. There were significant improvements in INR control from 23% to 86% (P > 0.001) in the practice where all patients received dosing through DSS. In the practice where patients were randomized to either DSS or hospital dosing, logistic regression showed a significant trend for improvement in intervention patients which was not apparent in the hospital-dosed patients (P < 0.001). Mean recall times were significantly extended in patients who were dosed by the practice DSS through the full 12 months (24 days to 36 days) (P = 0.033). Adverse events were comparable between hospital and practice-dosed patients, although a number of esoteric events occurred. Patient satisfaction with the practice clinics was high. Computerized DSS enables the safe and effective transfer of anticoagulation management from hospital to primary care and may result in improved patient outcome in terms of the level of control, frequency of review and general acceptability.

Selecting information technology for physicians' practices: a cross-sectional study.

PubMed

Eden, Karen Beekman

2002-04-05

Many physicians are transitioning from paper to electronic formats for billing, scheduling, medical charts, communications, etc. The primary objective of this research was to identify the relationship (if any) between the software selection process and the office staff's perceptions of the software's impact on practice activities. A telephone survey was conducted with office representatives of 407 physician practices in Oregon who had purchased information technology. The respondents, usually office managers, answered scripted questions about their selection process and their perceptions of the software after implementation. Multiple logistic regression revealed that software type, selection steps, and certain factors influencing the purchase were related to whether the respondents felt the software improved the scheduling and financial analysis practice activities. Specifically, practices that selected electronic medical record or practice management software, that made software comparisons, or that considered prior user testimony as important were more likely to have perceived improvements in the scheduling process than were other practices. Practices that considered value important, that did not consider compatibility important, that selected managed care software, that spent less than 10,000 dollars, or that provided learning time (most dramatic increase in odds ratio, 8.2) during implementation were more likely to perceive that the software had improved the financial analysis process than were other practices. Perhaps one of the most important predictors of improvement was providing learning time during implementation, particularly when the software involves several practice activities. Despite this importance, less than half of the practices reported performing this step.

Implementation of Sustainable Soil Management Practices to Improve Crop Production in the Different Ethiopian Agro Systems

NASA Astrophysics Data System (ADS)

García Moreno, R.; Gameda, S.; Diaz Alvarez, M. C.; Selasie, Y. G.

2012-04-01

Agriculture in Ethiopia is one of first priority since close to 10 In this context, the Ethiopian crop production faces to the following soil management challenges: lack of updated soil data, macro and micro nutrient depletion, acidity, salinity and soil surface erosion and crusting. One of the biggest issues is the loss of arable land, above 137 T/yr, reaching during some particularly dried periods until 300 T/yr. In this context, the authors constituted a working group of experts from Spanish and Ethiopian universities, local producers and international and governmental organisms to analyse the problems related to the different agro ecological zones found in Ethiopia and the management practices of different local producers. The study produced the trends to implement in the different areas to improve soil management practices in order to contribute to increase the crop production mainly to achieve food security problems. The analyse produced different working fields for the next years for addressing soil degradation, improving land resources management practices, increasing agricultural productivity, updating the available soil data, developing an international program of education, transferring of knowledge from similar study cases and implementing economical tools to help producers to assure income after severe edapho-climatic events. The practical work and the projects developed for the next period is addressed to smallholder farms belonging to the different 34 agro ecological zones identified in Ethiopia, each of them with very specific environmental, cultural and soil management practices.

Effectiveness of a quality management program in dental care practices.

PubMed

Goetz, Katja; Campbell, Stephen M; Broge, Björn; Brodowski, Marc; Wensing, Michel; Szecsenyi, Joachim

2014-04-28

Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: 'infrastructure', 'information', 'finance', 'quality and safety' and 'people' were calculated. In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.

The Business Change Initiative: A Novel Approach to Improved Cost and Schedule Management

NASA Technical Reports Server (NTRS)

Shinn, Stephen A.; Bryson, Jonathan; Klein, Gerald; Lunz-Ruark, Val; Majerowicz, Walt; McKeever, J.; Nair, Param

2016-01-01

Goddard Space Flight Center's Flight Projects Directorate employed a Business Change Initiative (BCI) to infuse a series of activities coordinated to drive improved cost and schedule performance across Goddard's missions. This sustaining change framework provides a platform to manage and implement cost and schedule control techniques throughout the project portfolio. The BCI concluded in December 2014, deploying over 100 cost and schedule management changes including best practices, tools, methods, training, and knowledge sharing. The new business approach has driven the portfolio to improved programmatic performance. The last eight launched GSFC missions have optimized cost, schedule, and technical performance on a sustained basis to deliver on time and within budget, returning funds in many cases. While not every future mission will boast such strong performance, improved cost and schedule tools, management practices, and ongoing comprehensive evaluations of program planning and control methods to refine and implement best practices will continue to provide a framework for sustained performance. This paper will describe the tools, techniques, and processes developed during the BCI and the utilization of collaborative content management tools to disseminate project planning and control techniques to ensure continuous collaboration and optimization of cost and schedule management in the future.

Achieving organizational change in pediatric pain management

PubMed Central

Dowden, Stephanie; McCarthy, Maria; Chalkiadis, George

2008-01-01

BACKGROUND: Pain in hospitalized children is often under-treated. Little information exists to guide the process of organizational change with a view to improving pain management practices. OBJECTIVES: To describe the process and results of a hospital-wide review of pain management practices designed to identify deficiencies in service provision and recommend directions for change in a pediatric hospital. DESIGN: Prospective consultation of the clinical staff of a specialist pediatric hospital, using qualitative research methodology involving semistructured individual and group interviews. Recommendations based on the interview findings were made by a hospital-appointed working party. RESULTS: A total of 454 staff (27% of all clinical staff) from a variety of professional backgrounds, representing almost every hospital unit or department, were interviewed. Procedural and persistent (chronic) pain was identified as the area needing the most improvement. Barriers to improving pain management included variability in practice, outmoded beliefs and inadequate knowledge, factors which were seen to contribute to a culture of slow or no change. Recommendations of the working party and changes achieved after the review are described. CONCLUSION: The review process identified deficiencies in the management of pain in children, and barriers to its effective management. With institutional support, the present review has guided improvement. PMID:18719714

75 FR 3753 - Tishomingo National Wildlife Refuge, Comprehensive Conservation Plan, Johnston County, OK

Federal Register 2010, 2011, 2012, 2013, 2014

2010-01-22

... equivalent to existing restoration practices. Recreational opportunities would continue to be limited to... improved or expanded to accommodate more visitors. Current habitat management practices would continue... management practices would contribute to ongoing monitoring and modification of Refuge resources for years to...

What roles do middle managers play in implementation of innovative practices?

PubMed Central

Engle, Ryann L.; Lopez, Emily R.; Gormley, Katelyn E.; Chan, Jeffrey A.; Charns, Martin P.; Lukas, Carol VanDeusen

2017-01-01

Background: Middle managers play key roles in hospitals as the bridge between senior leaders and frontline staff. Yet relatively little research has focused on their role in implementing new practices. Purpose: The aim of this study was to expand the understanding of middle managers’ influence in organizations by looking at their activities through the lens of two complementary conceptual frameworks. Methodology/Approach: We analyzed qualitative data from 17 Veterans Affairs Medical Centers with high and low potential to change organizational practices. We analyzed 98 interviews with staff ranging from senior leaders to frontline staff to identify themes within an a priori framework reflecting middle manager activities. Findings: Analyses yielded 14 emergent themes that allowed us to classify specific expressions of middle manager commitment to implementation of innovative practices (e.g., facilitate improvement innovation, garner staff buy-in). In comparing middle manager behaviors in high and low change potential sites, we found that most emergent themes were present in both groups. However, the activities and interactions described differed between the groups. Practice Implications: Middle managers can use the promising strategies identified by our analyses to guide and improve their effectiveness in implementing new practices. These strategies can also inform senior leaders striving to guide middle managers in those efforts. PMID:26488239

Implementing Quality Improvement in Small, Autonomous Primary Care Practices: Implications for the Patient Centered Medical Home

PubMed Central

Arar, Nedal H.; Noel, Polly H.; Leykum, Luci; Zeber, John E.; Romero, Raquel; Parchman, Michael L.

2012-01-01

Background Implementing improvement programs to enhance quality of care within primary care clinics is complex, with limited practical guidance available to help practices during the process. Understanding how improvement strategies can be implemented in primary care is timely given the recent national movement towards transforming primary care into patient-centered medical homes (PCMH). This study examined practice members’ perceptions of the opportunities and challenges associated with implementing changes in their practice. Methods Semi-structured interviews were conducted with a purposive sample of 56 individuals working in 16 small, community-based primary care practices. The interview consisted of open-ended questions focused on participants’ perceptions of: (1) practice vision, (2) perceived need for practice improvement, and (3) barriers that hinder practice improvement. The interviews were conducted at the participating clinics and were tape-recorded, transcribed, and content analyzed. Results Content analysis identified two main domains for practice improvement related to: (1) the process of care, and (2) patients’ involvement in their disease management. Examples of desired process of care changes included improvement in patient tracking/follow-up system, standardization of processes of care, and overall clinic documentations. Changes related to the patients’ involvement in their care included improving (a) health education, and (b) self care management. Among the internal barriers were: staff readiness for change, poor communication, and relationship difficulties among team members. External barriers were: insurance regulations, finances and patient health literacy. Practice Implications Transforming their practices to more patient-centered models of care will be a priority for primary care providers. Identifying opportunities and challenges associated with implementing change is critical for successful improvement programs. Successful strategy for enhancing the adoption and uptake of PCMH elements should leverage areas of concordance between practice members’ perceived needs and planned improvement efforts. PMID:22186171

Sustainability partnerships and viticulture management in California.

PubMed

Hillis, Vicken; Lubell, Mark; Hoffman, Matthew

2018-07-01

Agricultural regions in the United States are experimenting with sustainability partnerships that, among other goals, seek to improve growers' ability to manage their vineyards sustainably. In this paper, we analyze the association between winegrape grower participation in sustainability partnership activities and practice adoption in three winegrowing regions of California. Using data gathered from a survey of 822 winegrape growers, we find a positive association between participation and adoption of sustainable practices, which holds most strongly for practices in which the perceived private benefits outweigh the costs, and for growers with relatively dense social networks. We highlight the mechanisms by which partnerships may catalyze sustainable farm management, and discuss the implications of these findings for improving sustainability partnerships. Taken together, we provide one of the most comprehensive quantitative analyses to date regarding the effectiveness of agricultural sustainability partnerships for improving farm management. Copyright © 2018 Elsevier Ltd. All rights reserved.

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

PubMed

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

2014-12-01

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

Best Practices for Management of Biocontaminated Waste ...

EPA Pesticide Factsheets

Report The purpose of these best practices is to provide federal, state, territorial, and local waste management entities information on techniques and methodologies that have the potential to improve the handling and management of biocontaminated waste streams after a biological agent incident. These best practices are intended to be general in nature serving as a resource to a variety of biological agents in a variety of situations; however, these best practices also present a specific homeland security scenario – a biological attack with Bacillus anthracis (B. anthracis) – to help illustrate specific waste management considerations.

What can we learn from field experiments about the development of SOC and GHG emissions under different management practices?

NASA Astrophysics Data System (ADS)

Spiegel, Heide; Lehtinen, Taru; Schlatter, Norman; Haslmayr, Hans-Peter; Baumgarten, Andreas; ten Berge, Hein

2015-04-01

Successful agricultural management practices are required to maintain or enhance soil quality; at the same time climate change mitigation is becoming increasingly important. Within the EU project CATCH-C we analysed the effects of different agricultural practices not only on crop productivity, but also on soil quality indicators (e.g. soil organic carbon (SOC)) and climate change (CC) mitigation indicators (e.g. CO2, CH4, N2O emissions). European data sets and associated literature, mainly from long-term experiments were evaluated. This evaluation of agricultural management practices was carried out comparing a set of improved ("best") and often applied ("current") management practices. Positive and negative effects occurred when best management practices are adopted. As expected, none of the investigated practices could comply with all objectives simultaneously, i.e. maintaining high yields, mitigating climate change and improving chemical, physical and biological soil quality. The studied soil management practices "non-inversion tillage", "organic fertilisation" (application of farm yard manure, slurry, compost) and "incorporation of crop residues" represent important management practices for farmers to increase SOC, thus improving soil quality. However, CO2 and, especially, N2O emissions may rise as well. The evaluation of CC mitigation is often limited by the lack of data from - preferably - continuous GHG emission measurements. Thus, more long-term field studies are needed to better assess the CO2, CH4 and, especially, N2O emissions following the above mentioned favorably rated MPs. Only if SOC and GHG emissions are measured in the same field experiments, it will be possible to compute overall balances of necessary CO2-C equivalent emissions. CATCH-C is funded within the 7th Framework Programme for Research, Technological Development and Demonstration, Theme 2 - Biotechnologies, Agriculture & Food. (Grant Agreement N° 289782).

Principals Management Support Practices to Promote Teachers' Instructional Improvement for Sustainable Development in Secondary Education in Anambra State, Nigeria

ERIC Educational Resources Information Center

Victor, Akinfolarin Akinwale; Emetarom, Uche Grace

2017-01-01

This study ascertained the principals management support practices to promote teachers instructional improvement for sustainable development in secondary education in Anambra State. Two specific purposes were formulated and two research questions guided the study. The study adopted a descriptive survey design. The study was conducted in the six…

Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial.

PubMed

Poureslami, Iraj; Kwan, Susan; Lam, Stephen; Khan, Nadia A; FitzGerald, John Mark

2016-01-01

Patient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients. Educational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures. Subjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to achieve goals in managing COPD (P<0.01), and understanding pulmonary rehabilitation procedures (P<0.05). Culturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD. A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies.

Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial

PubMed Central

Poureslami, Iraj; Kwan, Susan; Lam, Stephen; Khan, Nadia A; FitzGerald, John Mark

2016-01-01

Background Patient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients. Methods Educational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures. Results Subjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to achieve goals in managing COPD (P<0.01), and understanding pulmonary rehabilitation procedures (P<0.05). Conclusion Culturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD. Clinical implication A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies. PMID:27536093

The 5C Concept and 5S Principles in Inflammatory Bowel Disease Management.

PubMed

Hibi, Toshifumi; Panaccione, Remo; Katafuchi, Miiko; Yokoyama, Kaoru; Watanabe, Kenji; Matsui, Toshiyuki; Matsumoto, Takayuki; Travis, Simon; Suzuki, Yasuo

2017-10-27

The international Inflammatory Bowel Disease [IBD] Expert Alliance initiative [2012-2015] served as a platform to define and support areas of best practice in IBD management to help improve outcomes for all patients with IBD. During the programme, IBD specialists from around the world established by consensus two best practice charters: the 5S Principles and the 5C Concept. The 5S Principles were conceived to provide health care providers with key guidance for improving clinical practice based on best management approaches. They comprise the following categories: Stage the disease; Stratify patients; Set treatment goals; Select appropriate treatment; and Supervise therapy. Optimised management of patients with IBD based on the 5S Principles can be achieved most effectively within an optimised clinical care environment. Guidance on optimising the clinical care setting in IBD management is provided through the 5C Concept, which encompasses: Comprehensive IBD care; Collaboration; Communication; Clinical nurse specialists; and Care pathways. Together, the 5C Concept and 5S Principles provide structured recommendations on organising the clinical care setting and developing best-practice approaches in IBD management. Consideration and application of these two dimensions could help health care providers optimise their IBD centres and collaborate more effectively with their multidisciplinary team colleagues and patients, to provide improved IBD care in daily clinical practice. Ultimately, this could lead to improved outcomes for patients with IBD. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

Empirical Analysis of Green Supply Chain Management Practices in Indian Automobile Industry

NASA Astrophysics Data System (ADS)

Luthra, S.; Garg, D.; Haleem, A.

2014-04-01

Environmental sustainability and green environmental issues have an increasing popularity among researchers and supply chain practitioners. An attempt has been made to identify and empirically analyze green supply chain management (GSCM) practices in Indian automobile industry. Six main GSCM practices (having 37 sub practices) and four expected performance outcomes (having 16 performances) have been identified by implementing GSCM practices from literature review. Questionnaire based survey has been made to validate these practices and performance outcomes. 123 complete questionnaires were collected from Indian automobile organizations and used for empirical analysis of GSCM practices in Indian automobile industry. Descriptive statistics have been used to know current implementation status of GSCM practices in Indian automobile industry and multiple regression analysis has been carried out to know the impact on expected organizational performance outcomes by current GSCM practices adopted by Indian automobile industry. The results of study suggested that environmental, economic, social and operational performances improve with the implementation of GSCM practices. This paper may play an important role to understand various GSCM implementation issues and help practicing managers to improve their performances in the supply chain.

CONSIDERATIONS IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which in...

CONSIDERATION IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which involve ...

Alignment of Human Resource Practices and Teacher Performance Competency

ERIC Educational Resources Information Center

Heneman III, Herbert G.; Milanowski, Anthony T.

2004-01-01

In this article, we argue that human resource (HR) management practices are important components of strategies for improving student achievement in an accountability environment. We present a framework illustrating the alignment of educational HR management practices to a teacher performance competency model, which in turn is aligned with student…

Improving pain management of abdominal pain in children presenting to the paediatric emergency department: a pre-post interventional study.

PubMed

Williams, Suzanne; Holzhauser, Kerri; Bonney, Donna; Burmeister, Elizabeth; Gilhotra, Yuri; Oliver, Randall; Gordon, Kerry

2012-08-01

In 2007, the Mater Children's Hospital Emergency Department participated in the Emergency Care Pain Management Initiative funded by the National Health and Medical Research Council National Institute of Clinical Studies (NHMRC-NICS). The findings of this NHMRC-NICS research across eleven paediatric emergency departments highlighted deficits in pain management of abdominal pain. Specifically pain assessment, timeliness of analgesia, and pain management guidelines were found to be lacking. In response to the NICS report local practice was reviewed and a pilot research project undertaken to develop a clinical guideline for the pain management of abdominal pain in children presenting to the emergency department. The guideline was developed by an expert panel and trialled using a pre and post intervention design. The results demonstrated improved compliance to assessment and documentation of pain scores and assimilation of the best practice principles recommended in the guideline. This project raised local awareness in the pain management of abdominal pain and provides baseline information for future improvement. The guideline has been trialled in the clinical setting of paediatric emergency and has the potential to improve pain management practices in children presenting to the emergency department with abdominal pain. Copyright © 2012 College of Emergency Nursing Australasia Ltd. Published by Elsevier Ltd. All rights reserved.

The Pain Associates' International Network Initiative: a novel practical approach to the challenge of chronic pain management in Europe.

PubMed

Morlion, Bart; Walch, Heribert; Yihune, Gabriel; Vielvoye-Kerkmeer, Ans; de Jong, Zuzana; Castro-Lopes, José; Stanton-Hicks, Michael

2008-01-01

Chronic pain is a debilitating condition with a multidimensional impact on the lives of patients, their families and communities. The public health burden of chronic pain is gathering recognition as a major healthcare problem in its own right and deserves closer attention. The challenge in treating chronic pain is to provide effective clinical management of a complex, multifaceted set of conditions that require a coordinated strategy of care. Epidemiological data and patient surveys have highlighted the areas of pain management that might be improved. These include a need for better understanding and documentation of the symptoms of chronic pain, standardized levels of care, improved communication among clinical personnel and with patients, and an updated education program for clinicians. For these reasons, new strategies aimed at improving the standards of pain management are needed. The Pain Associates' International Network (P.A.I.N.) Initiative was set up to devise practical methods for improving the quality of pain management for patients. These strategies have recently been put into practice through a number of activities: P.A.I.N. Workshops are meetings of international pain management professionals dedicated to discussing current management strategies and producing consensus recommendations for improving standards of care; P.A.I.N. Quality is a unique software program designed to help treating clinicians to document patient data and derive effective treatment plans; P.A.I.N. Online provides a web site forum for discussion of pain management topics; and P.A.I.N. Management is a clinician education program providing up-to-date training in pain management.

Pain Assessment and Management After a Knowledge Translation Booster Intervention.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Barwick, Melanie; Pinard, Marie

2016-10-01

Inadequate pain treatment leaves hospitalized children vulnerable to immediate and long-term sequelae. A multidimensional knowledge translation intervention (ie, the Evidence-based Practice for Improving Quality [EPIQ]) improved pain assessment, management, and intensity outcomes in 16 units at 8 Canadian pediatric hospitals. The sustained effectiveness of EPIQ over time is unknown, however. The goals of this study were to determine the following: (1) sustainability of the impact of EPIQ on pain assessment, management, and intensity outcomes 12, 24, and 36 months after EPIQ; (2) effectiveness of a pain practice change booster (Booster) intervention to sustain EPIQ outcomes over time; and (3) influence of context on sustainability. A prospective, repeated measures, cluster randomized controlled trial was undertaken in the 16 EPIQ units, 12 months after EPIQ completion, to determine the effectiveness of a practice change booster (Booster) to sustain EPIQ outcomes. Generalized estimating equation models examined outcomes controlling for child and unit contextual factors. Outcomes achieved during EPIQ were sustained in the use of any pain assessment measure (P = .01) and a validated pain assessment measure in the EPIQ units (P = .02) up to 36 months after EPIQ. Statistically significant improvements in pain management practices persisted in EPIQ units; results varied across time. There were no significant differences in outcomes after implementation of the Booster between the Booster and Nonbooster groups. Improved pain assessment and management practices were sustained after EPIQ; however, the Booster did not seem to provide additional impact. Copyright © 2016 by the American Academy of Pediatrics.

e-Learning competency for practice nurses: an evaluation report.

PubMed

Heartfield, Marie; Morello, Andrea; Harris, Melanie; Lawn, Sharon; Pols, Vincenza; Stapleton, Carolyn; Battersby, Malcolm

2013-01-01

Practice nurses in Australia are now funded to facilitate chronic condition management, including self-management support. Chronic disease management requires an established rapport, support and proactivity between general practitioners, patients and the practice nurses. To achieve this, training in shared decision making is needed. e-Learning supports delivery and achievement of such policy outcomes, service improvements and skill development. However, e-learning effectiveness for health care professionals' is determined by several organisational, economic, pedagogical and individual factors, with positive e-learning experience linked closely to various supports. This paper reinforces previous studies showing nurses' expanding role across general practice teams and reports on some of the challenges of e-learning. Merely providing practice nurses with necessary information via web-based learning systems does not ensure successful learning or progress toward improving health outcomes for patients.

Frequency of inadequate chicken cross-contamination prevention and cooking practices in restaurants.

PubMed

Green Brown, Laura; Khargonekar, Shivangi; Bushnell, Lisa

2013-12-01

This study was conducted by the Environmental Health Specialists Network (EHS-Net) of the Centers for Disease Control and Prevention. The purpose was to examine restaurant chicken preparation and cooking practices and kitchen managers' food safety knowledge concerning chicken. EHS-Net members interviewed managers about chicken preparation practices in 448 restaurants. The study revealed that many restaurants were not following U.S. Food and Drug Administration Food Code guidance concerning cross-contamination prevention and proper cooking and that managers lacked basic food safety knowledge about chicken. Forty percent of managers said that they never, rarely, or only sometimes designated certain cutting boards for raw meat (including chicken). One-third of managers said that they did not wash and rinse surfaces before sanitizing them. Over half of managers said that thermometers were not used to determine the final cook temperature of chicken. Only 43% of managers knew the temperature to which raw chicken needed to be cooked for it to be safe to eat. These findings indicate that restaurant chicken preparation and cooking practices and manager food safety knowledge need improvement. Findings from this study could be used by food safety programs and the restaurant industry to target training and intervention efforts to improve chicken preparation and cooking practices and knowledge concerning safe chicken preparation.

Opportunities for improving management of advanced chronic kidney disease.

PubMed

Patwardhan, Meenal B; Matchar, David B; Samsa, Gregory P; Haley, William E

2008-01-01

Evidence suggests that management of advanced chronic kidney disease affects patient outcomes. To identify clinical areas that demand attention from a quality improvement perspective, we sought to examine the extent of conformance to an advanced chronic kidney disease guideline in a range of practices. A total of 237 patient medical records were abstracted from 4 primary care providers and 4 nephrology private practices across the country. In the practices studied, management of advanced chronic kidney disease patients was suboptimal for patients managed by primary care providers as well as those managed by nephrologists (overall conformance 27% and 42%, respectively), specifically for anemia, bone disease, and timing for renal replacement therapy. The current exercise (in conjunction with a literature search and focused and individual interviews with providers and patients) offered valuable information that was used to develop a toolkit for optimizing management of advanced chronic kidney disease.

Benchmarking management practices in Australian public healthcare.

PubMed

Agarwal, Renu; Green, Roy; Agarwal, Neeru; Randhawa, Krithika

2016-01-01

The purpose of this paper is to investigate the quality of management practices of public hospitals in the Australian healthcare system, specifically those in the state-managed health systems of Queensland and New South Wales (NSW). Further, the authors assess the management practices of Queensland and NSW public hospitals jointly and globally benchmark against those in the health systems of seven other countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. In this study, the authors adapt the unique and globally deployed Bloom et al. (2009) survey instrument that uses a "double blind, double scored" methodology and an interview-based scoring grid to measure and internationally benchmark the management practices in Queensland and NSW public hospitals based on 21 management dimensions across four broad areas of management - operations, performance monitoring, targets and people management. The findings reveal the areas of strength and potential areas of improvement in the Queensland and NSW Health hospital management practices when compared with public hospitals in seven countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Together, Queensland and NSW Health hospitals perform best in operations management followed by performance monitoring. While target management presents scope for improvement, people management is the sphere where these Australian hospitals lag the most. This paper is of interest to both hospital administrators and health care policy-makers aiming to lift management quality at the hospital level as well as at the institutional level, as a vehicle to consistently deliver sustainable high-quality health services. This study provides the first internationally comparable robust measure of management capability in Australian public hospitals, where hospitals are run independently by the state-run healthcare systems. Additionally, this research study contributes to the empirical evidence base on the quality of management practices in the Australian public healthcare systems of Queensland and NSW.

77 FR 33240 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-05

... Project water conservation best management practices that shall ``develop criteria for evaluating the... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The...

76 FR 54251 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-31

... and administer an office on Central Valley Project water conservation best management practices that... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The...

75 FR 70020 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-16

... office on Central Valley Project water conservation best management practices that shall ``* * * develop... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior ACTION: Notice of Availability. SUMMARY: The...

77 FR 64544 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2012-10-22

... Central Valley Project water conservation best management practices that shall ``develop criteria for... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The...

76 FR 12756 - Central Valley Project Improvement Act, Water Management Plans

Federal Register 2010, 2011, 2012, 2013, 2014

2011-03-08

... office on Central Valley Project water conservation best management practices that shall ``* * * develop... DEPARTMENT OF THE INTERIOR Bureau of Reclamation Central Valley Project Improvement Act, Water Management Plans AGENCY: Bureau of Reclamation, Interior. ACTION: Notice of availability. SUMMARY: The...

48 CFR 970.5203-2 - Performance improvement and collaboration.

Code of Federal Regulations, 2013 CFR

2013-10-01

... ENERGY AGENCY SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Solicitation Provisions and Contract Clauses for Management and Operating Contracts 970.5203-2 Performance improvement and... practices, where appropriate, that will improve performance in the areas of environmental and health, safety...

Using business analytics to improve outcomes.

PubMed

Rivera, Jose; Delaney, Stephen

2015-02-01

Orlando Health has brought its hospital and physician practice revenue cycle systems into better balance using four sets of customized analytics: Physician performance analytics gauge the total net revenue for every employed physician. Patient-pay analytics provide financial risk scores for all patients on both the hospital and physician practice sides. Revenue management analytics bridge the gap between the back-end central business office and front-end physician practice managers and administrators. Enterprise management analytics allow the hospitals and physician practices to share important information about common patients.

Building an exceptional imaging management team: from theory to practice.

PubMed

Hogan, Laurie

2010-01-01

Building a strong, cohesive, and talented managerial team is a critical endeavor for imaging administrators, as the job will be enhanced if supported by a group of high-performing, well-developed managers. For the purposes of this article, leadership and management are discussed as two separate, yet equally important, components of an imaging administrator's role. The difference between the two is defined as: leadership relates to people, management relates to process. There are abundant leadership and management theories that can help imaging administrators develop managers and ultimately build a better team. Administrators who apply these theories in practical and meaningful ways will improve their teams' leadership and management aptitude. Imaging administrators will find it rewarding to coach and develop managers and witness transformations that result from improved leadership and management abilities.

Collaborating for care: initial experience of embedded case managers across five medical homes.

PubMed

Treadwell, Janet; Giardino, Angelo

2014-01-01

The purpose of this intervention was to answer the following question: Does an embedded nurse case manager from a health plan performing embedded care coordination and supporting a quality improvement project impact medical home service use, role satisfaction, and per member per month expense? The setting for this study was primary care medical home practices with a minimum of 1,000 lives, contracted with a health plan delivering Medicaid and Children's Health Insurance coverage. Five medical home practice sites were selected for the intervention. The study began with case manager training and project permission in 5 medical homes, followed by implementation of care coordination with health plan clients. The nurse case manager performed care coordination functions for clients and initiated a Lean Six Sigma quality improvement project at the medical home site. The analysis strategy was to compare each medical home with itself before and after the intervention, as well as to obtain satisfaction information from medical home staff and care coordinators. Reductions in expense, as demonstrated by decreased per member per month claim cost, admissions per thousand, and reduced variation in days per thousand, were documented. Quality projects attained significant improvements in 4 out of 5 sites, and practice staff as well as case managers described satisfaction with the embedded nurse case manager role. These findings support medical homes as being an effective delivery model of the Affordable Care Act. Case managers who practice in primary care sites can make a significant difference in patient outcomes and practice efficiencies. Embedded case managers have the ability to impact the population being served through modeling and supporting interprofessional relationships and case management expertise. Use of motivational interviewing, assessment skills, advocacy, and joint care planning engage patients in their own care, whereas quality initiatives bring efficiencies and effectiveness to overall operations. There is need for research to be conducted across a larger number of practice sites and diverse populations to substantiate the effect of embedded case management in medical home.

DoD Major Automated Information Systems: Improvements Can Be Made in Applying Leading Practices for Managing Risk and Testing

DTIC Science & Technology

2017-03-01

Government Accountability Office Highlights of GAO-17-322, a report to congressional committees March 2017 DOD MAJOR AUTOMATED INFORMATION ...DOD MAJOR AUTOMATED INFORMATION SYSTEMS Improvements Can Be Made in Applying Leading Practices for Managing Risk and...Testing Report to Congressional Committees March 2017 GAO-17-322 United States Government Accountability Office United States

Timber productivity research gaps for extensive forest management

Treesearch

L.C. Irland

2011-01-01

On extensive areas of small scale forests, significant opportunities for improving the value of future timber harvests while also improving other resource values are now being missed. A new focus on practical extensive management research is needed, especially as implementation of intensive practices has been declining in many areas, and new ‘‘close to nature’’...

Building managed primary care practice networks to deliver better clinical care: a qualitative semi-structured interview study.

PubMed

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

Primary care practices are increasingly working in larger groups. In 2009, all 36 primary care practices in the London borough of Tower Hamlets were grouped geographically into eight managed practice networks to improve the quality of care they delivered. Quantitative evaluation has shown improved clinical outcomes. To provide insight into the process of network implementation, including the aims, facilitating factors, and barriers, from both the clinical and managerial perspectives. A qualitative study of network implementation in the London borough of Tower Hamlets, which serves a socially disadvantaged and ethnically diverse population. Nineteen semi-structured interviews were carried out with doctors, nurses, and managers, and were informed by existing literature on integrated care and GP networks. Interviews were recorded and transcribed, and thematic analysis used to analyse emerging themes. Interviewees agreed that networks improved clinical care and reduced variation in practice performance. Network implementation was facilitated by the balance struck between 'a given structure' and network autonomy to adopt local solutions. Improved use of data, including patient recall and peer performance indicators, were viewed as critical key factors. Targeted investment provided the necessary resources to achieve this. Barriers to implementing networks included differences in practice culture, a reluctance to share data, and increased workload. Commissioners and providers were positive about the implementation of GP networks as a way to improve the quality of clinical care in Tower Hamlets. The issues that arose may be of relevance to other areas implementing similar quality improvement programmes at scale. © British Journal of General Practice 2017.

Development, Implementation, and Evaluation of a Strategic Plan for Improving Physical Plant Management at Southwest Texas Junior College.

ERIC Educational Resources Information Center

Box, Wilford Winston

A study was conducted at Southwest Texas Junior College (STJC) to assess current management practices used by the physical plant maintenance department (PPMD) and to develop a strategic plan for physical plant management. Procedures included an analysis of current management practices and systems that affect physical resources, and periodic and…

Overcoming the ten most common barriers to effective team communication.

PubMed

Hills, Laura

2013-01-01

Communication is at the heart of medical practice management. Yet there are many barriers to effective communication that can interfere with the smooth running of the practice. This article describes the 10 most common barriers to effective medical practice team communication and offers six steps the practice manager can take to break them down. This article also suggests that the practice develop a team communication strategy. It suggests 10 communication principles readers can share directly with their teams and describes three hallmarks of effective team communication. Finally, this article provides a list of 25 practical questions practice managers can use to improve their team's communication.

Diagnosis and Design for School Improvement: Using a Distributed Perspective to Lead and Manage Change

ERIC Educational Resources Information Center

Spillane, James P.; Coldren, Amy Franz

2011-01-01

This practical resource highlights the critical importance of diagnosis and design in the work of leading and managing for school improvement. The authors maintain that today's school leaders and managers, under intense pressure to improve student learning, cannot simply adopt and implement pre-packaged reforms manufactured outside the school.…

Improving the Effectiveness of Program Managers

DTIC Science & Technology

2006-05-03

Improving the Effectiveness of Program Managers Systems and Software Technology Conference Salt Lake City, Utah May 3, 2006 Presented by GAO’s...Companies’ best practices Motorola Caterpillar Toyota FedEx NCR Teradata Boeing Hughes Space and Communications Disciplined software and management...and total ownership costs Collection of metrics data to improve software reliability Technology readiness levels and design maturity Statistical

Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach

PubMed Central

MONTANO, Diego

2016-01-01

The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787

Certifying leaders? high-quality management practices and healthy organisations: an ISO-9000 based standardisation approach.

PubMed

Montano, Diego

2016-08-05

The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.

Predictors of Success for Community-Driven Water Quality Management--Lessons from Three Catchments in New Zealand

ERIC Educational Resources Information Center

Tyson, Ben; Unson, Christine; Edgar, Nick

2017-01-01

Three community engagement projects on the South Island of New Zealand are enacting education and communication initiatives to improve the uptake of best management practices on farms regarding nutrient management for improving water quality. Understanding the enablers and barriers to effective community-based catchment management is fundamental…

Implementing chronic care for COPD: planned visits, care coordination, and patient empowerment for improved outcomes.

PubMed

Fromer, Len

2011-01-01

Current primary care patterns for chronic obstructive pulmonary disease (COPD) focus on reactive care for acute exacerbations, often neglecting ongoing COPD management to the detriment of patient experience and outcomes. Proactive diagnosis and ongoing multifactorial COPD management, comprising smoking cessation, influenza and pneumonia vaccinations, pulmonary rehabilitation, and symptomatic and maintenance pharmacotherapy according to severity, can significantly improve a patient's health-related quality of life, reduce exacerbations and their consequences, and alleviate the functional, utilization, and financial burden of COPD. Redesign of primary care according to principles of the chronic care model, which is implemented in the patient-centered medical home, can shift COPD management from acute rescue to proactive maintenance. The chronic care model and patient-centered medical home combine delivery system redesign, clinical information systems, decision support, and self-management support within a practice, linked with health care organization and community resources beyond the practice. COPD care programs implementing two or more chronic care model components effectively reduce emergency room and inpatient utilization. This review guides primary care practices in improving COPD care workflows, highlighting the contributions of multidisciplinary collaborative team care, care coordination, and patient engagement. Each primary care practice can devise a COPD care workflow addressing risk awareness, spirometric diagnosis, guideline-based treatment and rehabilitation, and self-management support, to improve patient outcomes in COPD.

Effective and Innovative Practices for Stronger Facilities Management.

ERIC Educational Resources Information Center

Banick, Sarah

2002-01-01

Describes the five winners of the APPA's Effective & Innovative Practices Award. These facilities management programs and processes were recognized for enhancing service delivery, lowering costs, increasing productivity, improving customer service, generating revenue, or otherwise benefiting the educational institution. (EV)

Ranking agricultural practices on soil water improvements: a meta-analysis

NASA Astrophysics Data System (ADS)

Basche, A.; DeLonge, M. S.; Gonzalez, J.

2016-12-01

Increased rainfall variability is well documented in the historic record and predicted to intensify with future climate change. Managing excess water in periods of heavy rain and a lack of water in periods of inadequate precipitation will continue to be a challenge. Improving soil resiliency through increased water storage is a promising strategy to combat effects of both rainfall extremes. The goal of this research is to quantify to what extent various conservation and ecological practices can improve soil hydrology. We are conducting a global meta-analysis focused on studies where conservation and ecological practices are compared to more conventional management. To date we have analyzed 100 studies with more than 450 paired comparisons to understand the effect of management on water infiltration rates, a critical process that ensures water enters the soil profile for crop use, water storage and runoff prevention. The database will be expanded to include studies measuring soil porosity and the water retained at field capacity. Statistical analysis has been done both with both a bootstrap method and a mixed model that weights studies based on precision while accounting for between-study variation. We find that conservation and ecological practices, ranging from no-till, cover crops, crop rotation, perennial crops and agroforestry, on average significantly increased water infiltration rates relative to more conventional practice controls (mean of 75%, standard error 25%). There were significant differences between practices, where perennial and agroforestry systems show the greatest potential for improving water infiltration rates (> 100% increase). Cover crops also lead to a significant increase in water infiltration rates (> 60%) while crop rotations and no-till systems did not consistently demonstrate increases. We also found that studies needed to include alternative management for more than two years to detect a significant increase. Overall this global meta-analysis improves understanding of how alternative management, notably the use of continuous cover in agricultural systems, improves water dynamics. Policies should be designed in a way that allows agricultural producers to prioritize and implement practices that offer greater water conservation while maintaining crop productivity.

High-performance work systems in health care management, part 1: development of an evidence-informed model.

PubMed

Garman, Andrew N; McAlearney, Ann Scheck; Harrison, Michael I; Song, Paula H; McHugh, Megan

2011-01-01

: Although management practices are recognized as important factors in improving health care quality and efficiency, most research thus far has focused on individual practices, ignoring or underspecifying the contexts within which these practices are operating. Research from other industries, which has increasingly focused on systems rather than individual practices, has yielded results that may benefit health services management. : Our goal was to develop a conceptual model on the basis of prior research from health care as well as other industries that could be used to inform important contextual considerations within health care. : Using theoretical frameworks from A. Donabedian (1966), P. M. Wright, T. M. Gardner, and L. M. Moynihan (2003), and B. Schneider, D. B. Smith, and H. W. Goldstein (2000) and review methods adapted from R. Pawson (2006b), we reviewed relevant research from peer-reviewed and other industry-relevant sources to inform our model. The model we developed was then reviewed with a panel of practitioners, including experts in quality and human resource management, to assess the applicability of the model to health care settings. : The resulting conceptual model identified four practice bundles, comprising 14 management practices as well as nine factors influencing adoption and perceived sustainability of these practices. The mechanisms by which these practices influence care outcomes are illustrated using the example of hospital-acquired infections. In addition, limitations of the current evidence base are discussed, and an agenda for future research in health care settings is outlined. : Results may help practitioners better conceptualize management practices as part of a broader system of work practices. This may, in turn, help practitioners to prioritize management improvement efforts more systematically.

A review on effectiveness of best management practices in improving hydrology and water quality: Needs and opportunities

USDA-ARS?s Scientific Manuscript database

Best management practices (BMPs) have been widely used to address hydrology and water quality issues in both agricultural and urban areas. Increasing numbers of BMPs have been studied in research projects and implemented in watershed management projects, but a gap remains in quantifying their effect...

Leading to Learn: Knowledge Management Enables Administrators to Excel as Instructional Leaders

ERIC Educational Resources Information Center

Weischadle, David E.

2005-01-01

The article discusses knowledge management as a means of changing the way administrators carry out their role as instructional leaders. Knowledge management utilizes many concepts from learning organizations, encourages the formation of communities of practice, and employs best practices as a means of leading others to improve learning. Instead of…

Frequency of Inadequate Chicken Cross-Contamination Prevention and Cooking Practices in Restaurants

PubMed Central

Brown, Laura Green; Khargonekar, Shivangi; Bushnell, Lisa

2017-01-01

This study was conducted by the Environmental Health Specialists Network (EHS-Net) of the Centers for Disease Control and Prevention. The purpose was to examine restaurant chicken preparation and cooking practices and kitchen managers’ food safety knowledge concerning chicken. EHS-Net members interviewed managers about chicken preparation practices in 448 restaurants. The study revealed that many restaurants were not following U.S. Food and Drug Administration Food Code guidance concerning cross-contamination prevention and proper cooking and that managers lacked basic food safety knowledge about chicken. Forty percent of managers said that they never, rarely, or only sometimes designated certain cutting boards for raw meat (including chicken). One-third of managers said that they did not wash and rinse surfaces before sanitizing them. Over half of managers said that thermometers were not used to determine the final cook temperature of chicken. Only 43% of managers knew the temperature to which raw chicken needed to be cooked for it to be safe to eat. These findings indicate that restaurant chicken preparation and cooking practices and manager food safety knowledge need improvement. Findings from this study could be used by food safety programs and the restaurant industry to target training and intervention efforts to improve chicken preparation and cooking practices and knowledge concerning safe chicken preparation. PMID:24290693

Policy-into-practice for rheumatoid arthritis: randomized controlled trial and cohort study of e-learning targeting improved physiotherapy management.

PubMed

Fary, Robyn E; Slater, Helen; Chua, Jason; Ranelli, Sonia; Chan, Madelynn; Briggs, Andrew M

2015-07-01

To examine the effectiveness of a physiotherapy-specific, web-based e-learning platform, "RAP-el," in best-practice management of rheumatoid arthritis (RA) using a single-blind, randomized controlled trial (RCT) and prospective cohort study. Australian-registered physiotherapists were electronically randomized into intervention and control groups. The intervention group accessed RAP-eL over 4 weeks. Change in self-reported confidence in knowledge and skills was compared between groups at the end of the RCT using linear regression conditioned for baseline scores by a blinded assessor, using intent-to-treat analysis. Secondary outcomes included physiotherapists' satisfaction with RA management and responses to RA-relevant clinical statements and practice-relevant vignettes. Retention was evaluated in a cohort study 8 weeks after the RCT. Eighty physiotherapists were randomized into the intervention and 79 into the control groups. Fifty-six and 48, respectively, provided baseline data. Significant between-group differences were observed for change in confidence in knowledge (mean difference 8.51; 95% confidence interval [95% CI] 6.29, 10.73; effect size 1.62) and skills (mean difference 7.26; 95% CI 5.1, 9.4; effect size 1.54), with the intervention group performing better. Satisfaction in ability to manage RA, 4 of the 6 clinical statements, and responses to vignettes demonstrated significant improvement in the intervention group. Although 8-week scores showed declines in most outcomes, their clinical significance remains uncertain. RAP-eL can improve self-reported confidence, likely practice behaviors and satisfaction in physiotherapists' ability to manage people with RA, and improve their clinical knowledge in several areas of best-practice RA management in the short term. © 2015, American College of Rheumatology.

Family physicians' attitude and practice of infertility management at primary care--Suez Canal University, Egypt.

PubMed

Eldein, Hebatallah Nour

2013-01-01

The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians' attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians' practice. Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management.

Family physicians’ attitude and practice of infertility management at primary care - Suez Canal University, Egypt

PubMed Central

Eldein, Hebatallah Nour

2013-01-01

Introduction The very particular natures of infertility problem and infertility care make them different from other medical problems and services in developing countries. Even after the referral to specialists, the family physicians are expected to provide continuous support for these couples. This place the primary care service at the heart of all issues related to infertility. The aim of the work: to improve family physicians' attitude and practice about the approach to infertility management within primary care setting. Methods This study was conducted in the between June and December 2010. The study sample comprised 100 family physician trainees in the family medicine department and working in family practice centers or primary care units. They were asked to fill a questionnaire about their personal characteristics, attitude, and practice towards support, investigations, and treatment of infertile couples. Results Hundred family physicians were included in the study. They were previously received training in infertility management. Favorable attitude scores were detected among (68%) of physicians and primary care was considered a suitable place for infertility management among (77%) of participants. There was statistically significant difference regarding each of age groups, gender and years of experience with the physicians′ attitude. There was statistically significant difference regarding gender, perceiving PHC as an appropriate place to manage infertility and attitude towards processes of infertility management with the physicians′ practice. Conclusion Favorable attitude and practice were determined among the study sample. Supporting the structure of primary care and evidence-based training regarding infertility management are required to improve family physicians' attitude and practice towards infertility management. PMID:24244792

Thriving and Not Just Surviving: New Directions for Tomorrow's Performance-Improvement Managers.

ERIC Educational Resources Information Center

Kaufman, Roger

2000-01-01

Examines popular approaches to performance and organizational improvement to see what flaws they contain and how continued practice will impede progress. Discusses benchmarking; quality management/continuous improvement; needs assessment; training; downsizing; reengineering; system(s) approach; and strategic planning. Describes the Organizational…

Perceptions of work stress causes and effective interventions in employees working in public, private and non-governmental organisations: a qualitative study

PubMed Central

Bhui, Kamaldeep; Dinos, Sokratis; Galant-Miecznikowska, Magdalena; de Jongh, Bertine; Stansfeld, Stephen

2016-01-01

Aims and method To identify causes of stress at work as well as individual, organisational and personal interventions used by employees to manage stress in public, private and non-governmental organizations (NGOs). Qualitative interviews were conducted with 51 employees from a range of organisations. Results Participants reported adverse working conditions and management practices as common causes of work stress. Stress-inducing management practices included unrealistic demands, lack of support, unfair treatment, low decision latitude, lack of appreciation, effort–reward imbalance, conflicting roles, lack of transparency and poor communication. Organisational interventions were perceived as effective if they improved management styles, and included physical exercise, taking breaks and ensuring adequate time for planning work tasks. Personal interventions used outside of work were important to prevent and remedy stress. Clinical implications Interventions should improve management practices as well as promoting personal interventions outside of the work setting. PMID:28377811

Soil biodiversity and human health

NASA Astrophysics Data System (ADS)

Wall, Diana H.; Nielsen, Uffe N.; Six, Johan

2015-12-01

Soil biodiversity is increasingly recognized as providing benefits to human health because it can suppress disease-causing soil organisms and provide clean air, water and food. Poor land-management practices and environmental change are, however, affecting belowground communities globally, and the resulting declines in soil biodiversity reduce and impair these benefits. Importantly, current research indicates that soil biodiversity can be maintained and partially restored if managed sustainably. Promoting the ecological complexity and robustness of soil biodiversity through improved management practices represents an underutilized resource with the ability to improve human health.

Nurses' reflections on pain management in a nursing home setting.

PubMed

Clark, Lauren; Fink, Regina; Pennington, Karen; Jones, Katherine

2006-06-01

Achieving optimal and safe pain-management practices in the nursing home setting continues to challenge administrators, nurses, physicians, and other health care providers. Several factors in nursing home settings complicate the conduct of clinical process improvement research. The purpose of this qualitative study was to explore the perceptions of a sample of Colorado nursing home staff who participated in a study to develop and evaluate a multifaceted pain-management intervention. Semistructured interviews were conducted with 103 staff from treatment and control nursing homes, audiotaped, and content analyzed. Staff identified changes in their knowledge and attitudes about pain and their pain-assessment and management practices. Progressive solutions and suggestions for changing practice include establishing an internal pain team and incorporating nursing assistants into the care planning process. Quality improvement strategies can accommodate the special circumstances of nursing home care and build the capacity of the nursing homes to initiate and monitor their own process-improvement programs using a participatory research approach.

Applying Best Business Practices from Corporate Performance Management to DoD

DTIC Science & Technology

2013-01-01

leading or governing large, complex corporations and are experienced in creating reliable solutions to complex management issues guided by best business ...recommendations and effective solutions aimed at improving DoD. Defense Business Board Corporate Performance Management REPORT FY13-03 Task...Group 1 Applying Best Business Practices from Corporate Performance Management to DoD TASK The Deputy Secretary of Defense (DEPSECDEF

Stress Management: Positive Thinking

MedlinePlus

Healthy Lifestyle Stress management Positive thinking helps with stress management and can even improve your health. Practice overcoming negative self-talk ... with optimism is a key part of effective stress management. And effective stress management is associated with ...

Mathematical Methods of Managing Economic Sustainability of the Construction Company

NASA Astrophysics Data System (ADS)

Kostuchenko, Vasiliy; Zdanov, Andrej; Rodionov, Anatolij

2017-10-01

This article presents a long-term research in developing innovative mathematical techniques of managing the contractor’s economic sustainability proven by some experimental studies. The article aims at presenting some practical results of applying these techniques to the scientific community. This research presents a description of some applied mathematical models, views, and some results of their practical application in the applied field for the purposes of evaluating operational sustainability and minimizing losses in the process of managing the company. The authors have put the technology they have developed to practical use, and the article presents the results of such application. The authors have put the developed technology to practical use. Company management also means the management of power consumption, which is highly vital both for the construction and maintenance of buildings and structures. The articles also dwell on some possible improvements of managing energy consumption within the framework of the general management of company’s economic sustainability, because these phenomena have a tight organic interdependence. The authors continue researching this direction in order to improve the production efficiency of the proposed technologies as well as to eliminate some drawbacks they have spotted.

Teacher Progress Monitoring of Instructional and Behavioral Management Practices: An Evidence-Based Approach to Improving Classroom Practices

ERIC Educational Resources Information Center

Reddy, Linda A.; Dudek, Christopher M.

2014-01-01

In the era of teacher evaluation and effectiveness, assessment tools that identify and monitor educators' instruction and behavioral management practices are in high demand. The Classroom Strategies Scale (CSS) Observer Form is a multidimensional teacher progress monitoring tool designed to assess teachers' usage of instructional and behavioral…

A community hospital acute pain service.

PubMed

Musclow, Shirley L

2005-11-01

This article provides readers with a guide to developing and implementing an acute pain service in a community hospital. Kanter's theory of innovative diffusion is used to frame the author's experiences as a lead nurse in two community hospital acute pain services. Health-care providers recognize the importance of quality pain assessment and management. One initiative for improving pain management has been the implementation of an acute pain service (APS). In Canada, most university-affiliated teaching hospitals have now developed an APS to improve pain management. Community hospitals, however, have only recently begun to adopt the concept. Improving pain management through an APS provides an excellent opportunity for nursing leadership at all levels. Nursing administration may take the lead in proposing the idea and benefits of acquiring an APS. An advanced practice nurse can provide leadership through the coordination and provision of enhanced pain management as a lead nurse in an APS. Staff nurses can provide leadership in improving pain management on a daily basis and ensuring that quality pain care reaches the bedside, Nursing practice is at the core of making a difference in pain management.

Role of the registered nurse in primary health care: meeting health care needs in the 21st century.

PubMed

Smolowitz, Janice; Speakman, Elizabeth; Wojnar, Danuta; Whelan, Ellen-Marie; Ulrich, Suzan; Hayes, Carolyn; Wood, Laura

2015-01-01

There is widespread interest in the redesign of primary health care practice models to increase access to quality health care. Registered nurses (RNs) are well positioned to assume direct care and leadership roles based on their understanding of patient, family, and system priorities. This project identified 16 exemplar primary health care practices that used RNs to the full extent of their scope of practice in team-based care. Interviews were conducted with practice representatives. RN activities were performed within three general contexts: episodic and preventive care, chronic disease management, and practice operations. RNs performed nine general functions in these contexts including telephone triage, assessment and documentation of health status, chronic illness case management, hospital transition management, delegated care for episodic illness, health coaching, medication reconciliation, staff supervision, and quality improvement leadership. These functions improved quality and efficiency and decreased cost. Implications for policy, practice, and RN education are considered. Copyright © 2015 Elsevier Inc. All rights reserved.

The ABC's required for establishing a practical computerized plant engineering management data base system

NASA Technical Reports Server (NTRS)

Maiocco, F. R.; Hume, J. P.

1976-01-01

A system's approach is outlined in the paper to assist facility and Plant Engineers improve their organization's data management system. The six basic steps identified may appear somewhat simple; however, adequate planning, proper resources, and the involvement of management will determine the success of a computerized facility management data base. Helpful suggestions are noted throughout the paper to insure the development of a practical computerized data management system.

A comparative analysis of occupational health and safety risk prevention practices in Sweden and Spain.

PubMed

Morillas, Rosa María; Rubio-Romero, Juan Carlos; Fuertes, Alba

2013-12-01

Scandinavian countries such as Sweden implemented the occupational health and safety (OHS) measures in the European Directive 89/391/EEC earlier than other European counties, including Spain. In fact, statistics on workplace accident rates reveal that between 2004 and 2009, there were considerably fewer accidents in Sweden than in Spain. The objective of the research described in this paper was to reduce workplace accidents and to improve OHS management in Spain by exploring the OHS practices in Sweden. For this purpose, an exploratory comparative study was conducted, which focused on the effectiveness of the EU directive in both countries. The study included a cross-sectional analysis of workplace accident rates and other contextual indicators in both national contexts. A case study of 14 Swedish and Spanish companies identified 14 differences in the preventive practices implemented. These differences were then assessed with a Delphi study to evaluate their contribution to the reduction of workplace accidents and their potential for improving health and safety management in Spain. The results showed that there was agreement concerning 12 of the 14 practices. Finally, we discuss opportunities of improvement in Spanish companies so that they can make their risk management practices more effective. The findings of this comparative study on the implementation of the European Directive 89/391/EEC in both Sweden and Spain have revealed health and safety managerial practices which, if properly implemented, could contribute to improved work conditions and accident statistics of Spanish companies. In particular, the results suggest that Spanish employers, safety managers, external prevention services, safety deputies and Labour Inspectorates should consider implementing streamlined internal preventive management, promoting the integration of prevention responsibilities to the chain of command, and preventing health and safety management from becoming a mere exchange of documents. The authors also encourage future research studies to use the methodology presented to compare and assess the European Directive 89/391/EEC implementation in other European countries. © 2013.

Assessment of a quality improvement intervention to strengthen pharmaceutical human resources and improve availability and use of HIV medicines in Uganda.

PubMed

Byabagambi, John B; Broughton, Edward; Heltebeitel, Simon; Wuliji, Tana; Karamagi, Esther

2017-01-01

Inadequate medication dispensing and management by healthcare providers can contribute to poor outcomes among HIV-positive patients. Gaps in medication availability, often associated with pharmacy workforce shortages, are an important barrier to retention in HIV care in Uganda. An intervention to address pharmacy staffing constraints through strengthening pharmaceutical management, dispensing practices, and general competencies of facility clinical and pharmacy staff was implemented in 14 facilities in three districts in eastern Uganda. Teams of staff were organised in each facility and supported to apply quality improvement (QI) methods to address deficits in availability and rational use of HIV drugs. To evaluate the intervention, baseline and end line data were collected 24 months apart. Dispensing practices, clinical wellness and adherence to antiretrovirals improved by 45%, 28% and 20% from baseline to end line, respectively. All clients at end line received the medications prescribed, and medications were correctly, completely and legibly labelled more often. Clients better understood when, how much and for how long they were supposed to take their prescribed medicines at end line. Pharmaceutical management practices also improved from baseline in most categories by statistically significant margins. Facilities significantly improved on correctly recording stock information about antiretroviral drugs (53%vs100%, P<0.0001). Coinciding with existing staff taking on pharmaceutical roles, facilities improved management of unwanted and expired drugs, notably by optimising use of existing health workers and making pharmaceutical management processes more efficient. Implementation of this improvement intervention in the 14 facilities appeared to have a positive impact on client outcomes, pharmacy department management and providers' self-reported knowledge of QI methods. These results were achieved at a cost of about US$5.50 per client receiving HIV services at participating facilities.

Development and integration of pharmacist clinical services into the patient-centered medical home.

PubMed

Berdine, Hildegarde J; Skomo, Monica L

2012-01-01

To describe the development of pharmacist clinical services within a primary care physician practice using a standardized business plan, the extent of clinical pharmacy service integration into the patient-centered medical home (PCMH), and the clinical changes in the pharmacist's patient cohort. A two-physician primary care/occupational care practice in Pittsburgh, PA, from May 2007 to December 2011. Pharmacist-led clinic receives physician referrals for medication management, adherence, and disease management services. Pharmacist practice in a primary care setting with emphasis on integration of clinical services into the medical home model designed by the American Academy of Family Physicians. Characterization of the patient's pharmacist and services provided by the pharmacist. Glycosylated hemoglobin (A1C), body mass index (BMI), low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides, and blood pressure. The top five primary referral reasons were diabetes self-management, weight management, medication adherence, hypertension, and dyslipidemia management. Improvements in clinical parameters were demonstrated for lipids and A1C at 1 and 2 years after baseline. Statistically significant improvements in BMI also were observed. The pharmacist developed and integrated clinical services into a primary care practice, became an integral member of the clinical team in the two-physician PCMH, and improved patient outcomes.

A Qualitative Study of Hospitalists' Perceptions of Patient Satisfaction Metrics on Pain Management.

PubMed

Calcaterra, Susan L; Drabkin, Anne D; Doyle, Reina; Leslie, Sarah E; Binswanger, Ingrid A; Frank, Joseph W; Reich, Jennifer A; Koester, Stephen

2017-01-01

Hospital initiatives to promote pain management may unintentionally contribute to excessive opioid prescribing. To better understand hospitalists' perceptions of satisfaction metrics on pain management, the authors conducted 25 interviews with hospitalists. Transcribed interviews were systematically analyzed to identify emergent themes. Hospitalists felt institutional pressure to earn high satisfaction scores for pain, which they perceived influenced practices toward opioid prescribing. They felt tying compensation to satisfaction scores commoditized pain. Hospitalists believed satisfaction would improve with increased time spent at the bedside. Focusing on methods to improve patient-physician communication, while maintaining efficiency in clinical practice, may promote both patient-centered pain management and satisfaction.

NTL Data Management Planning "Greenout" Bingo Self Assessment Tool

DOT National Transportation Integrated Search

2016-08-11

This tool is designed to help assess your current data management practices. Pick a dataset or research project, sit down with your data collection team, and discuss each prompt below. This tool can guide DMP improvement by revealing best practices t...

ISSUES OF BEST MANAGEMENT PRACTICE DESIGN TO IMPROVE WATER QUALITY

EPA Science Inventory

Today, many municipalities are implementing low-cost best management practices (BMPs). Structural control BMPs involve building a structure of some kind to store stormwater until it can be discharged into a nearby receiving water. Commonly used structural treatment BMPs include...

Evaluation of Soil Media for Stormwater Infiltration Best Management Practices (BMPs)

EPA Science Inventory

This project will improve the performance of structural management practices, and provide guidance that will allow designers to balance infiltration rates with sorption capacity. This project will also perform a standard column test procedure for evaluating candidate soil media.

Implementing Role-Changing Versus Time-Changing Innovations in Health Care: Differences in Helpfulness of Staff Improvement Teams, Management, and Network for Learning.

PubMed

Nembhard, Ingrid M; Morrow, Christopher T; Bradley, Elizabeth H

2015-12-01

Health care organizations often fail in their effort to implement care-improving innovations. This article differentiates role-changing innovations, altering what workers do, from time-changing innovations, altering when tasks are performed or for how long. We examine our hypothesis that the degree to which access to groups that can alter organizational learning--staff, management, and external network--facilitates implementation depends on innovation type. Our longitudinal study using ordinal logistic regression and survey data on 517 hospitals' implementation of evidence-based practices for treating heart attack confirmed our thesis for factors granting access to each group: improvement team's representativeness (of affected staff), senior management engagement, and network membership. Although team representativeness and network membership were positively associated with implementing role-changing practices, senior management engagement was not. In contrast, senior management engagement was positively associated with implementing time-changing practices, whereas team representativeness was not, and network membership was not unless there was limited management engagement. These findings advance implementation science by explaining mixed results across past studies: Nature of change for workers alters potential facilitators' effects on implementation. © The Author(s) 2015.

Extravasation management in the pediatric oncology ward of Children's Hospital of Fudan University: a best practice implementation project.

PubMed

Wang, Yingwen; Kong, Meijing; Ge, Youhong

2016-12-01

Extravasation in a pediatric patient can cause a serious adverse event, but many nurses have insufficient experience to deal with it during intravenous administration. Our division implemented a best practice project, which included extravasation kit instruction preparation, staff education and an update of institutional policy and procedures. The project focused on auditing the extent to which the protocol was implemented and promoting its implementation. The objective of the project was to establish an evidence-based policy and procedure for extravasation management, improve knowledge regarding best practice of extravasation management among staff and formalize the documentation template for extravasation events. The Joanna Briggs Institute's Practical Application of Clinical Evidence System and Getting Research into Practice were used to examine compliance with criteria based on the best available evidence before and after the implementation of strategies to promote the use of the evidence-based practice protocol. Four criteria showed a noticeable improvement in compliance: increased use of extravasation kit (0-100%), updated policies and procedure (0-94%), staff education (19-94%) and documented outcomes (13-88%). The project successfully established effective strategies for establishing an extravasation kit instruction sheet, updating policies and procedures, continuous staff education and nursing documentation to ensure best practice and improve patient outcomes.

Postoperative electrolyte management: Current practice patterns of surgeons and residents.

PubMed

Angarita, Fernando A; Dueck, Andrew D; Azouz, Solomon M

2015-07-01

Managing postoperative electrolyte imbalances often is driven by dogma. To identify areas of improvement, we assessed the practice pattern of postoperative electrolyte management among surgeons and residents. An online survey was distributed among attending surgeons and surgical residents at the University of Toronto. The survey was designed according to a systematic approach for formulating self-administered questionnaires. Questions addressed workload, decision making in hypothetical clinical scenarios, and improvement strategies. Of 232 surveys distributed, 156 were completed (response rate: 67%). The majority stated that junior residents were responsible for managing electrolytes at 13 University of Toronto-affiliated hospitals. Supervision was carried out predominately by senior residents (75%). Thirteen percent reported management went unsupervised. Approximately 59% of residents were unaware how often attending surgeons assessed patients' electrolytes. Despite the majority of residents (53.7%) reporting they were never given tools or trained in electrolyte replacement, they considered themselves moderately or extremely confident. The management of hypothetical clinical scenarios differed between residents and attending surgeons. The majority (50.5%) of respondents considered that an electrolyte replacement protocol is the most appropriate improvement strategy. Electrolyte replacement represents an important component of surgeons' workload. Despite reporting that formal training in electrolyte management is limited, residents consider themselves competent; however, their practice is highly variable and often differs from pharmacologic-directed recommendations. Optimizing how postoperative electrolytes are managed in surgical wards requires building a framework that improves knowledge, training, and limits unnecessary interventions. Copyright © 2015 Elsevier Inc. All rights reserved.

Recommended Feeding and Dietary Practices To Improve Infant and Maternal Nutrition.

ERIC Educational Resources Information Center

Academy for Educational Development, Washington, DC.

The LINKAGES Project is intended to improve breastfeeding and related complementary feeding and maternal dietary practices. The project, in consultation with technical experts and program managers, identified a set of recommended feeding and dietary practices intended to break the cycle of poor health and nutrition that passes from generation to…

Improving the health care work environment: implications for research, practice, and policy.

PubMed

Harrison, Michael I; Henriksen, Kerm; Hughes, Ronda G

2007-11-01

Despite the gains to date, we need better understanding of practices for implementing and sustaining improvements in health care work environments and further study of organizational conditions affecting implementation of improvements. Limiting work hours, improving schedules, and providing sleep hygiene training will help combat clinician fatigue. Hospital crowding can be reduced through systemwide improvement of patient flow and capacity management, coupled with management support, measurement, and reporting on crowding. Long-term solutions to nurse staffing shortfalls include process redesign to enhance efficiency. Improvement of organizational climate, human resource management, and interoccupational relations will also contribute to staff retention. Evidence-based enhancements to patient rooms and other physical features in hospitals contribute directly to safety and quality and also affect staff performance. POLICY: Landrigan and his colleagues call for external restrictions on residents' work shifts. Clarke examines prospects for mandated nursing-staff ratios. Public reporting on staffing, crowding, and other risks may incent change. Reporting and pay for performance require standardized measures of targeted conditions. Organizations promoting care quality can help spread safe work practices; they can also support collaborative learning and other strategies that may enhance implementation of improvements in work environments.

Student Receivables Management: Opportunities for Improved Practices.

ERIC Educational Resources Information Center

Jacquin, Jules C.; Goyal, Anil K.

1995-01-01

The college or university's business office can help reduce problems with student receivables through procedural review of the tuition revenue process, application of analytical methods, and improved operating practices. Admissions, financial aid, and billing offices must all be involved. (MSE)

Recapturing time: a practical approach to time management for physicians.

PubMed

Gordon, Craig E; Borkan, Steven C

2014-05-01

Increasing pressures on physicians demand effective time management and jeopardise professional satisfaction. Effective time management potentially increases productivity, promotes advancement, limits burnout and improves both professional and personal satisfaction. However, strategies for improving time management are lacking in the current medical literature. Adapting time management techniques from the medical and non-medical literature may improve physician time management habits. These techniques can be divided into four categories: (1) setting short and long-term goals; (2) setting priorities among competing responsibilities; (3) planning and organising activities; and (4) minimising 'time wasters'. Efforts to improve time management can increase physician productivity and enhance career satisfaction.

7 CFR 1466.23 - Payment rates.

Code of Federal Regulations, 2010 CFR

2010-01-01

... conservation practice cost-effectiveness, implementation efficiency, and innovation, (2) The degree and...) Residue management; (B) Nutrient management; (C) Air quality management; (D) Invasive species management; (E) Pollinator habitat development or improvement; (F) Animal carcass management technology; or (G...

Physicians with MBA degrees: change agents for healthcare improvement.

PubMed

Lazarus, Arthur

2010-01-01

Increasingly, physicians gravitating toward the fields of quality improvement and healthcare management are seeking MBA degrees to supplement their medical training. Approximately half of all U.S. medical schools offer combined MD-MBA degrees, and numerous executive MBA programs exist for physicians in practice. Physicians who enter management are considered change agents for healthcare improvement, yet they receive little support and encouragement from their medical teachers and practicing colleagues. This situation can be rectified by placing greater value on the role of business-trained physicians and subsidizing their tuition for business school.

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship

PubMed Central

Ford, Bradley A.; Klutts, J. Stacey; Jensen, Chris S.; Briggs, Angela S.; Robinson, Robert A.; Bruch, Leslie A.; Karandikar, Nitin J.

2017-01-01

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output. PMID:28913416

Using Focused Laboratory Management and Quality Improvement Projects to Enhance Resident Training and Foster Scholarship.

PubMed

Krasowski, Matthew D; Ford, Bradley A; Klutts, J Stacey; Jensen, Chris S; Briggs, Angela S; Robinson, Robert A; Bruch, Leslie A; Karandikar, Nitin J

2017-01-01

Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.

Implementation of a protocol for the prevention and management of extravasation injuries in the neonatal intensive care patient.

PubMed

Warren, Diane

2011-06-01

This project sought to determine nurses' understanding and management of infants with intravenous (IV) therapy. There were three specific aims: • To improve identification and management of extravasation injuries in neonates • To ensure management of extravasation injuries in neonates is classified according to IV extravasation staging guidelines • To develop a protocol that outlined actions required to manage extravasation injuries. This project utilised a pre- and post-implementation audit strategy using the Joanna Briggs Institute (JBI) Getting Research into Practice (GRIP) program. This method has been used to improve clinical practice by utilising an audit, feedback and re-audit sequence. The project was implemented in four stages over a 7-month period from 21 October 2009 to 30 May 2010. Initially, there was poor compliance with all four criteria, ranging from zero to 63%. The GRIP phase of the project identified five barriers which were addressed throughout this project. These related to education of staff and the development of a protocol for the prevention and management of extravasation injuries in the neonatal population. Following implementation of best practice, the second audit showed a marked improvement in all four criteria, ranging from 70 to 100% compliance. Overall, this project has led to improvements in clinical practice in line with current evidence. This has resulted in enhanced awareness of the risks associated with IV therapy and of measures to prevent an injury occurring within this clinical setting. © 2011 The Author. International Journal of Evidence-Based Healthcare © 2011 The Joanna Briggs Institute.

Teaching Laboratory Management Principles and Practices Through Mentorship and Graduated Responsibility: The Assistant Medical Directorship.

PubMed

Hanley, Timothy; Sowder, Aleksandra M; Palmer, Cheryl Ann; Weiss, Ronald L

2016-01-01

With the changing landscape of medicine in general, and pathology in particular, a greater emphasis is being placed on laboratory management as a means of controlling spiraling medical costs and improving health-care efficiency. To meet this challenge, pathology residency programs have begun to incorporate formal laboratory management training into their curricula, using institutional curricula and/or online laboratory management courses offered by professional organizations. At the University of Utah, and its affiliated national reference laboratory, ARUP Laboratories, Inc, interested residents are able to supplement the departmental lecture-based and online laboratory management curriculum by participating in assistant medical directorship programs in one of several pathology subspecialty disciplines. The goals of many of the assistant medical directorship positions include the development of laboratory management skills and competencies. A survey of current and recent assistant medical directorship participants revealed that the assistant medical directorship program serves as an excellent means of improving laboratory management skills, as well as improving performance as a fellow and practicing pathologist.

Dysphagia management in a 3-year dental hygiene education programme in Japan.

PubMed

Sato, Yoko; Miura, Ai; Saito, Atsushi

2005-11-01

This paper reports the development and evaluation of a dysphagia management course taught to the third year dental hygiene students during 2004-2005 as one framework of the new curriculum. The course consisted of lectures by specialists in each field, basic practice and clinical practice at a facility for the elderly. Evaluation of the course showed that improvements were found in students' understanding in certain subjects when compared with that during 2003-2004. Scores on the post-test were statistically significantly higher than those on the pre-test, showing that basic knowledge of the students had been improved. Introductory and follow-up lectures by dental hygiene instructors and appropriate basic practice enhanced the learning process of the students. In the clinical practice, the concept of 'dental hygiene process of care' was incorporated. The dental hygiene process facilitated the students in planning and implementing dental hygiene care that meets the needs of the individual clients. This active learning experience enhanced the students' understanding of dysphagia management. Although further improvements are necessary, this dysphagia management course should help dental hygienists in playing a greater role in the field of oral care and dysphagia rehabilitation.

Patient-centered blood management.

PubMed

Hohmuth, Benjamin; Ozawa, Sherri; Ashton, Maria; Melseth, Richard L

2014-01-01

Transfusions are common in hospitalized patients but carry significant risk, with associated morbidity and mortality that increases with each unit of blood received. Clinical trials consistently support a conservative over a liberal approach to transfusion. Yet there remains wide variation in practice, and more than half of red cell transfusions may be inappropriate. Adopting a more comprehensive approach to the bleeding, coagulopathic, or anemic patient has the potential to improve patient care. We present a patient-centered blood management (PBM) paradigm. The 4 guiding principles of effective PBM that we present include anemia management, coagulation optimization, blood conservation, and patient-centered decision making. PBM has the potential to decrease transfusion rates, decrease practice variation, and improve patient outcomes. PBM's value proposition is highly aligned with that of hospital medicine. Hospitalists' dual role as front-line care providers and quality improvement leaders make them the ideal candidates to develop, implement, and practice PBM. © 2013 Society of Hospital Medicine.

Translating knowledge into best practice care bundles: a pragmatic strategy for EBP implementation via moving postprocedural pain management nursing guidelines into clinical practice.

PubMed

Saunders, Hannele

2015-07-01

To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.

Impact of the 5As Team study on clinical practice in primary care obesity management: a qualitative study

PubMed Central

Asselin, Jodie; Salami, Eniola; Osunlana, Adedayo M.; Ogunleye, Ayodele A.; Cave, Andrew; Johnson, Jeffrey A.; Sharma, Arya M.; Campbell-Scherer, Denise L.

2017-01-01

Background: The 5As [Ask, Assess, Advise, Agree, Assist] of Obesity Management Team study was a randomized controlled trial of an intervention that was implemented and evaluated to help primary care providers improve clinical practice for obesity management. This paper presents health care provider perspectives of the impacts of the intervention on individual provider and team practices. Methods: This study reports a thematic network analysis of qualitative data collected during the 5As Team study, which involved 24 chronic disease teams affiliated with family practices in a Primary Care Network in Alberta. Qualitative data from 28 primary care providers (registered nurses/nurse practitioners [n = 14], dietitians [n = 7] and mental health workers [n = 7]) in the intervention arm were collected through semistructured interviews, field notes, practice facilitator diaries and 2 evaluation workshop questionnaires. Results: Providers internalized 5As Team intervention concepts, deepening self-evaluation and changing clinical reasoning around obesity. Providers perceived that this internalization changed the provider-patient relationship positively. The intervention changed relations between providers, increasing interdisciplinary understanding, collaboration and discovery of areas for improvement. This personal and interpersonal evolution effected change to the entire Primary Care Network. Interpretation: The 5As Team intervention had multiple impacts on providers and teams to improve obesity management in primary care. Improved provider confidence and capability is a precondition of developing effective patient interventions. Trial registration: ClinicalTrials.gov, no.: NCT01967797. PMID:28450428

Factors Influencing Farmers’ Adoption of Best Management Practices: A Review and Synthesis

EPA Science Inventory

Best management practices (BMPs) for reducing agricultural non-point source pollution are widely available. However, agriculture remains a major global contributor to degradation of waters because farmers often do not adopt BMPs. To improve water quality, it is necessary to under...

Classroom Management with Exceptional Learners

ERIC Educational Resources Information Center

Myers, Diane; Freeman, Jennifer; Simonsen, Brandi; Sugai, George

2017-01-01

Effective and engaging instruction is the cornerstone of any well-managed classroom. Even the best behavior support practices will not lead to academic achievement if the academic instruction is ineffective. Specific teacher practices associated with improved student behavior include high rates of opportunities to respond, direct instruction, and…

Assessment of the Orion-SLS Interface Management Process in Achieving the EIA 731.1 Systems Engineering Capability Model Generic Practices Level 3 Criteria

NASA Technical Reports Server (NTRS)

Jellicorse, John J.; Rahman, Shamin A.

2016-01-01

NASA is currently developing the next generation crewed spacecraft and launch vehicle for exploration beyond earth orbit including returning to the Moon and making the transit to Mars. Managing the design integration of major hardware elements of a space transportation system is critical for overcoming both the technical and programmatic challenges in taking a complex system from concept to space operations. An established method of accomplishing this is formal interface management. In this paper we set forth an argument that the interface management process implemented by NASA between the Orion Multi-Purpose Crew Vehicle (MPCV) and the Space Launch System (SLS) achieves the Level 3 tier of the EIA 731.1 System Engineering Capability Model (SECM) for Generic Practices. We describe the relevant NASA systems and associated organizations, and define the EIA SECM Level 3 Generic Practices. We then provide evidence for our compliance with those practices. This evidence includes discussions of: NASA Systems Engineering Interface (SE) Management standard process and best practices; the tailoring of that process for implementation on the Orion to SLS interface; changes made over time to improve the tailored process, and; the opportunities to take the resulting lessons learned and propose improvements to our institutional processes and best practices. We compare this evidence against the practices to form the rationale for the declared SECM maturity level.

Sound management may sequester methane in grazed rangeland ecosystems

PubMed Central

Wang, Chengjie; Han, Guodong; Wang, Shiping; Zhai, Xiajie; Brown, Joel; Havstad, Kris M.; Ma, Xiuzhi; Wilkes, Andreas; Zhao, Mengli; Tang, Shiming; Zhou, Pei; Jiang, Yuanyuan; Lu, Tingting; Wang, Zhongwu; Li, Zhiguo

2014-01-01

Considering their contribution to global warming, the sources and sinks of methane (CH4) should be accounted when undertaking a greenhouse gas inventory for grazed rangeland ecosystems. The aim of this study was to evaluate the mitigation potential of current ecological management programs implemented in the main rangeland regions of China. The influences of rangeland improvement, utilization and livestock production on CH4 flux/emission were assessed to estimate CH4 reduction potential. Results indicate that the grazed rangeland ecosystem is currently a net source of atmospheric CH4. However, there is potential to convert the ecosystem to a net sink by improving management practices. Previous assessments of capacity for CH4 uptake in grazed rangeland ecosystems have not considered improved livestock management practices and thus underestimated potential for CH4 uptake. Optimal fertilization, rest and light grazing, and intensification of livestock management contribute mitigation potential significantly. PMID:24658176

Sound management may sequester methane in grazed rangeland ecosystems.

PubMed

Wang, Chengjie; Han, Guodong; Wang, Shiping; Zhai, Xiajie; Brown, Joel; Havstad, Kris M; Ma, Xiuzhi; Wilkes, Andreas; Zhao, Mengli; Tang, Shiming; Zhou, Pei; Jiang, Yuanyuan; Lu, Tingting; Wang, Zhongwu; Li, Zhiguo

2014-03-24

Considering their contribution to global warming, the sources and sinks of methane (CH4) should be accounted when undertaking a greenhouse gas inventory for grazed rangeland ecosystems. The aim of this study was to evaluate the mitigation potential of current ecological management programs implemented in the main rangeland regions of China. The influences of rangeland improvement, utilization and livestock production on CH4 flux/emission were assessed to estimate CH4 reduction potential. Results indicate that the grazed rangeland ecosystem is currently a net source of atmospheric CH4. However, there is potential to convert the ecosystem to a net sink by improving management practices. Previous assessments of capacity for CH4 uptake in grazed rangeland ecosystems have not considered improved livestock management practices and thus underestimated potential for CH4 uptake. Optimal fertilization, rest and light grazing, and intensification of livestock management contribute mitigation potential significantly.

Periodontal Management by Risk Assessment: A Pragmatic Approach.

PubMed

Mullins, Joanna M; Even, Joshua B; White, Joel M

2016-06-01

An evidence-based periodontal disease risk assessment and diagnosis system has been developed and combined with a clinical decision support and management program to improve treatment and measure patient outcomes. There is little agreement on a universally accepted periodontal risk assessment, periodontal diagnosis, and treatment management tool and their incorporation into dental practice to improve patient care. This article highlights the development and use of a practical periodontal management and risk assessment program that can be implemented in dental settings. The approach taken by Willamette Dental Group to develop a periodontal disease risk assessment, periodontal diagnosis, and treatment management tool is described using evidence-based best practices. With goals of standardized treatment interventions while maintaining personalized care and improved communication, this process is described to facilitate its incorporation into other dental settings. Current electronic health records can be leveraged to enhance patient-centered care through the use of risk assessments and standardized guidelines to more effectively assess, diagnose, and treat patients to improve outcomes. Dental hygienists, and other committed providers, with their emphasis on prevention of periodontal disease can be principal drivers in creation and implementation of periodontal risk assessments and personalized treatment planning. Willamette Dental Group believes that such evidence-based tools can advance dentistry to new diagnostic and treatment standards. Copyright © 2016 Elsevier Inc. All rights reserved.

As good as it gets? Managing risks of cardiovascular disease in California's top-performing physician organizations.

PubMed

Rodriguez, Hector P; Ivey, Susan L; Raffetto, Brian J; Vaughn, Jennifer; Knox, Margae; Hanley, Hattie Rees; Mangione, Carol M; Shortell, Stephen M

2014-04-01

The California Right Care Initiative (RCI) accelerates the adoption of evidence-based guidelines and improved care management practices for conditions for which the gap between science and practice is significant, resulting in preventable disability and death. Medical directors and quality improvement leaders from 11 of the 12 physician organizations that met the 2010 national 90th percentile performance benchmarks for control of hyperlipidemia and glycated hemoglobin in 2011 were interviewed in 2012. Interviews, as well as surveys, assessed performance reporting and feedback to individual physicians; medication management protocols; team-based care management; primary care team huddles; coordination of care between primary care clinicians and specialists; implementation of shared medical appointments; and telephone visits for high-risk patients. All but 1 of 11 organizations implemented electronic health records. Electronic information exchange between primary care physicians and specialists, however, was uncommon. Few organizations routinely used interdisciplinary team approaches, shared medical appointments, or telephonic strategies for managing cardiovascular risks among patients. Implementation barriers included physicians' resistance to change, limited resources and reimbursement for team approaches, and limited organizational capacity for change. Implementation facilitators included routine use of reliable data to guide improvement, leadership facilitation of change, physician buy-in, health information technology use, and financial incentives. To accelerate improvements in managing cardiovascular risks, physician organizations may need to implement strategies involving extensive practice reorganization and work flow redesign.

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-12-01

Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children.

Improving Soil Seed Bank Management.

PubMed

Haring, Steven C; Flessner, Michael L

2018-05-08

Problems associated with simplified weed management motivate efforts for diversification. Integrated weed management uses fundamentals of weed biology and applied ecology to provide a framework for diversified weed management programs; the soil seed bank comprises a necessary part of this framework. By targeting seeds, growers can inhibit the propagule pressure on which annual weeds depend for agricultural invasion. Some current management practices affect weed seed banks, such as crop rotation and tillage, but these tools are often used without specific intention to manage weed seeds. Difficulties quantifying the weed seed bank, understanding seed bank phenology, and linking seed banks to emerged weed communities challenge existing soil seed bank management practices. Improved seed bank quantification methods could include DNA profiling of the soil seed bank, mark and recapture, or 3D LIDAR mapping. Successful and sustainable soil seed bank management must constrain functionally diverse and changing weed communities. Harvest weed seed controls represent a step forward, but over-reliance on this singular technique could make it short-lived. Researchers must explore tools inspired by other pest management disciplines, such as gene drives or habitat modification for predatory organisms. Future weed seed bank management will combine multiple complementary practices that enhance diverse agroecosystems. This article is protected by copyright. All rights reserved.

Collaboration of hospital case managers and home care liaisons when transitioning patients.

PubMed

Kelly, Margaret M; Penney, Erika D

2011-01-01

Hospital case managers frequently collaborate with home care liaisons when coordinating special discharge plans. This article focuses on the collaborative relationship between the hospital case manager and on-site liaison whose primary role centers around care coordination and patient teaching. Ineffective collaboration between hospital case managers and these clinical on-site liaisons can lead to serious lapses in care and services for patients, families, and the health care team when transitioning from hospital to home care. In a review of literature, little detail was found about the collaborative practice between hospital case managers and home care liaisons. This article discusses how collegiality, collaboration, and role clarification between hospital case managers and on-site home care liaisons can improve coordination of care and services for patients and their families in the transition from hospital to home care. Included is a set of guidelines developed by case managers at a major metropolitan acute care hospital to inform and improve their practice with home care liaisons. The authors are nursing case managers who practice in a major metropolitan teaching hospital. They met by telephone and in person with case managers from 3 metropolitan medical centers as well as on-site liaisons from 2 skilled nursing facilities and 5 home care agencies to develop practice recommendations for their department regarding work with home care liaisons. Conversations between hospital case managers and on-site home care liaisons revealed that all had experiences in which suboptimal collaboration negatively impacted home care coordination for patients and their families. Furthermore, outcomes in similar patient scenarios varied widely based on the individual practices of the case managers and liaisons involved in discharge coordination. Multiple issues were discussed, including blurred role and responsibility delineations, variations in communication styles and practices, and different levels of experience and training. Consensus regarding the implementation of the hospital's guidelines was achieved through a series of discussions within the workgroup in developing practice guidelines. Multiple revisions and secondary reviews by colleagues and directors took place before the guidelines were accepted and implemented. Recommendations for improving collaboration with liaisons included (1) taking time to become familiar with one another's practices and backgrounds; (2) ensuring clear discussions of roles, responsibilities, and expectations with liaisons related to individual cases and organizational requirements and limitations; (3) providing time and forums for ongoing communication and follow-up; and (4) recognizing that responsibility for certain aspects of the discharge planning process may be shared but that the case manager, in partnership with the multidisciplinary team, is ultimately accountable for the effectiveness and outcomes of the discharge plan.

1989 Report to Congress: Management of Hazardous Wastes from Educational Institutions

EPA Pesticide Factsheets

Report identifying the statutory and regulatory requirements, examining current hazardous waste management practices, and identifying possible ways for educational institutions to improve hazardous waste management.

Leading clinical handover improvement: a change strategy to implement best practices in the acute care setting.

PubMed

Clarke, Christina M; Persaud, Drepaul David

2011-03-01

Many contemporary acute care facilities lack safe and effective clinical handover practices resulting in patient transitions that are vulnerable to discontinuities in care, medical errors, and adverse patient safety events. This article is intended to supplement existing handover improvement literature by providing practical guidance for leaders and managers who are seeking to improve the safety and the effectiveness of clinical handovers in the acute care setting. A 4-stage change model has been applied to guide the application of strategies for handover improvement. Change management and quality improvement principles, as well as concepts drawn from safety science and high-reliability organizations, were applied to inform strategies. A model for handover improvement respecting handover complexity is presented. Strategies targeted to stages of change include the following: 1. Enhancing awareness of handover problems and opportunities with the support of strategic directions, accountability, end user involvement, and problem complexity recognition. 2. Identifying solutions by applying and adapting best practices in local contexts. 3. Implementing locally adapted best practices supported by communication, documentation, and training. 4. Institutionalizing practice changes through integration, monitoring, and active dissemination. Finally, continued evaluation at every stage is essential. Although gaps in handover process and function knowledge remain, efforts to improve handover safety and effectiveness are still possible. Continued evaluation is critical in building this understanding and to ensure that practice changes lead to improvements in patient safety, organizational effectiveness, and patient and provider satisfaction. Through handover knowledge building, fundamental changes in handover policies and practices may be possible.

Promoting Instructional Improvement: A Strategic Human Resource Management Perspective

ERIC Educational Resources Information Center

Smylie, Mark A.; Wenzel, Stacy A.

2006-01-01

This report argues that instructional improvement, which goes hand-in-hand with efforts at education reform, can be promoted through the strategic use of human resource management (HRM) practices at the school, district, and state levels. The authors present information from the organizational and management literatures on how firms in several…

The Heartland Region P-Index Conservation Innovation Grant: protecting water quality through improved phosphorus management

USDA-ARS?s Scientific Manuscript database

Reducing phosphorus loss from agricultural land is important for improvement and protection of surface water quality. Agricultural models can be used to determine management impacts on P loss and therefore serve as a guide for recommending best management practices. However, the models must be comp...

Informal care and the self-management partnership: implications for Australian health policy and practice.

PubMed

Essue, Beverley M; Jowsey, Tanisha; Jeon, Yun-Hee; Mirzaei, Masoud; Pearce-Brown, Carmen L; Aspin, Clive; Usherwood, Tim P

2010-11-01

The Serious and Continuing Illness Policy and Practice Study (SCIPPS) aims to improve the care and support for patients with chronic illness and their family carers. Here we describe the carers' contribution to the self-management partnership and discuss the policy and practice implications that are relevant to improving the support available for informal care in Australia. A secondary analysis of SCIPPS data. Fourteen carers of patients between 45 and 85 years with chronic heart failure, chronic obstructive pulmonary disease and diabetes were conveniently sampled from western Sydney and the Australian Capital Territory. Semi-structured interviews were conducted. Data were analysed using qualitative content analysis. Key roles that carers perform in the self-management partnership included: home helper; lifestyle coach; advocate; technical care manager; and health information interpreter. Two negative consequences of juggling these roles included: self-neglect and conflict. Rigid eligibility criteria limit carers' access to essential support programs which underestimates and undervalues their contributions to the self-management partnership. Support services should focus on the development of practical skills to perform the caregiving roles. In addition, health professionals require support to work more effectively with carers to minimise the conflict that can overshadow the care and self-management partnership.

Green supply chain management in China

NASA Astrophysics Data System (ADS)

Zhu, Qinghua; Sarkis, Joseph

2004-02-01

Globalization results in both pressure and drivers for Chinese enterprise to improve their environmental performance. As a developing country, China has to balance economic and environmental performance. Green supply chain management (GSCM) is emerging to be an important approach for Chinese enterprises to improve performance, possibly on both these dimensions. Using empirical results from 89 respondents on GSCM practice in Chinese manufacturing enterprises, we examine the relationships between pressures, practice and performance. The results will look at multiple dimensions of GSCM practice and performance, as well as various pressures they face. Discussion of the results will include practical implications for organizations, not only in China, but internationally who face similar pressures and seek to implement similar programs.

Education Management Organizations' Collaborative Leadership Practices for Low-Performing Urban Charter Schools

ERIC Educational Resources Information Center

Cupidore, Calvin C., Jr.

2017-01-01

Educators have regarded building leader-member relationships using collaboration as a fundamental component to successfully improve students' academic achievement. Ineffective collaborative leadership practices may lead to achievement deficits particularly for many urban charter schools operated by educational management organizations. The purpose…

Assessment of range planting as a conservation practice [Chapter 4

Treesearch

Stuart P. Hardegree; Thomas A. Jones; Bruce A. Roundy; Nancy L. Shaw; Thomas A. Monaco

2011-01-01

The Range Planting Conservation Practice Standard is used to inform development of Natural Resource Conservation Service (NRCS) management recommendations for improving vegetation composition and productivity of grazed plant communities. Range planting recommendations are generally implemented within an integrated conservation management system in conjunction with...

Long term management practices influenced soil aggregation and carbon dynamics

USDA-ARS?s Scientific Manuscript database

Soil aggregation protects soil organic C (SOC) against rapid decomposition, improves soil quality, and reduces soil erosion potential. The objectives of this study are to evaluate the effects of long-term (21 yrs.) management practices on SOC, water stable aggregate (WSA), and aggregate-associated ...

Competency in health care management: a training model in epidemiologic methods for assessing and improving the quality of clinical practice through evidence-based decision making.

PubMed

Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H

1997-01-01

This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.

Using FTE and RVU performance measures to assess financial viability of academic nurse-managed centers.

PubMed

Vonderheid, Susan; Pohl, Joanne; Schafer, Patricia; Forrest, Kathy; Poole, Michele; Barkauskas, Violet; Mackey, Thomas A

2004-01-01

Financial performance measures are essential to improve the fiscal management of academic nurse-managed centers (ANMCs). Measures are compared among six ANMCs in a consortium and against an external, self-sustainable, profitable ANMC and national data for family practice physicians. Performance measures help identify a center's strengths and weaknesses facilitating the development of strategies aimed at a variety of targets (business practices related to revenue and costs) to improve financial viability. Using a variety of financial performance measures to inform decision making will aid ANMCs in keeping their doors open for business.

Best Practice in Motivation and Management in the Classroom. Second Edition

ERIC Educational Resources Information Center

Wiseman, Dennis G.; Hunt, Gilbert H.

2008-01-01

This text offers practical information and vicarious practice for both beginning as well as veteran teachers to become more knowledgeable, skilled, and effective in their work. Through study, application of what has been studied, and the analysis and evaluation of the end result of this application, teachers who care to improve can improve. And,…

Reflective practice: a framework for case manager development.

PubMed

Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia

2011-01-01

The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.

Improve compliance and financial performance at the same time.

PubMed

Sinaiko, Jeff

2002-01-01

Contrary to conventional wisdom, which holds that compliance is often a net negative to a practice's financial performance, the fact is that compliance, operations, and the financial performance of a medical practice can all be simultaneously improved. This article will illustrate that the basic drivers of effective compliance are often the same fundamental business principles that lead to outstanding operations and enhanced financial performance. The lesson for medical practice managers is that if you improve compliance, you should actually improve your bottom line, not harm it.

Developing an advanced practice nurse-led liver clinic.

PubMed

McAfee, Jean L

2012-01-01

End-stage liver disease (ESLD) is a leading cause of digestive disease deaths in the United States and continues to increase exponentially every year. Best practice does not currently recognize or utilize a clinic practice model for ESLD management. Advanced practice registered nurses (APRNs) can impact ESLD disease management by implementing an outpatient clinic care model to focus on treatment compliance, patient education, improvement of patient outcomes, and reduction in hospital admission rates for ESLD patients. A review of 15 research articles was completed to determine the impact APRNs can make on chronic care of ESLD patients. Results from the review support APRN analysis, assessment, diagnosis, treatment, intervention, and evaluation of ESLD patients. The literature reviewed also demonstrates that ESLD patients have improved symptom management when maintained in an outpatient setting, allowing for decreased hospital and insurance expenditures. Following evaluation of the evidence, it was concluded that an APRN-led ESLD clinic merits further study.

Digital technologies and chronic disease management.

PubMed

Georgeff, Michael

2014-12-01

Digital technologies will become a major part of our healthcare system, with particular impact in primary care. However, many healthcare professionals are not sufficiently informed of the digital technologies available today and how they and their patients can gain substantial benefit from adoption of these technologies. To raise awareness of the potential benefits of using digital technologies for improving practice efficiencies and patient health outcomes. Implementing best practice care for patients with chronic and complex conditions is one of the greatest challenges facing general practice and other primary care providers. It has been suggested that digital technologies could assist by decreasing the administrative burden of care delivery, improving quality of care, increasing practice efficiencies and better supporting patient self-management. In this paper, we consider some areas in the management of chronic and long-term conditions where digital and mobile health solutions can make a difference today.

Organisational capacity and chronic disease care: an Australian general practice perspective.

PubMed

Proudfoot, Judith; Infante, Fernando; Holton, Christine; Powell-Davies, Gawaine; Bubner, Tanya; Beilby, Justin; Harris, Mark

2007-04-01

Although we are rapidly improving our understanding of how to manage patients with chronic illness in Australian general practice, many patients are still receiving suboptimal care. General practices have limited organisational capacity to provide the structured care that is required for managing chronic conditions: regular monitoring, decision support, patient recall, supporting patient self management, team work, and information management. This requires a shift away from episodic, acute models. Overseas research has shown that areas such as team work, clinical information systems, decision support, linkages and leadership are also important in managing chronic illness, but we do not know which of these are most important in Australia.

Two-Year Costs and Quality in the Comprehensive Primary Care Initiative.

PubMed

Dale, Stacy B; Ghosh, Arkadipta; Peikes, Deborah N; Day, Timothy J; Yoon, Frank B; Taylor, Erin Fries; Swankoski, Kaylyn; O'Malley, Ann S; Conway, Patrick H; Rajkumar, Rahul; Press, Matthew J; Sessums, Laura; Brown, Randall

2016-06-16

The 4-year, multipayer Comprehensive Primary Care Initiative was started in October 2012 to determine whether several forms of support would produce changes in care delivery that would improve the quality and reduce the costs of care at 497 primary care practices in seven regions across the United States. Support included the provision of care-management fees, the opportunity to earn shared savings, and the provision of data feedback and learning support. We tracked changes in the delivery of care by practices participating in the initiative and used difference-in-differences regressions to compare changes over the first 2 years of the initiative in Medicare expenditures, health care utilization, claims-based measures of quality, and patient experience for Medicare fee-for-service beneficiaries attributed to initiative practices and a group of matched comparison practices. During the first 2 years, initiative practices received a median of $115,000 per clinician in care-management fees. The practices reported improvements in approaches to the delivery of primary care in areas such as management of the care of high-risk patients and enhanced access to care. Changes in average monthly Medicare expenditures per beneficiary did not differ significantly between initiative and comparison practices when care-management fees were not taken into account (-$11; 95% confidence interval [CI], -$23 to $1; P=0.07; negative values indicate less growth in spending at initiative practices) or when these fees were taken into account ($7; 95% CI, -$5 to $19; P=0.27). The only significant differences in other measures were a 3% reduction in primary care visits for initiative practices relative to comparison practices (P<0.001) and changes in two of the six domains of patient experience--discussion of decisions regarding medication with patients and the provision of support for patients taking care of their own health--both of which showed a small improvement in initiative practices relative to comparison practices (P=0.006 and P<0.001, respectively). Midway through this 4-year intervention, practices participating in the initiative have reported progress in transforming the delivery of primary care. However, at this point these practices have not yet shown savings in expenditures for Medicare Parts A and B after accounting for care-management fees, nor have they shown an appreciable improvement in the quality of care or patient experience. (Funded by the Department of Health and Human Services, Centers for Medicare and Medicaid Services; ClinicalTrials.gov number, NCT02320591.).

Interactive effects among ecosystem services and management practices on crop production: pollination in coffee agroforestry systems.

PubMed

Boreux, Virginie; Kushalappa, Cheppudira G; Vaast, Philippe; Ghazoul, Jaboury

2013-05-21

Crop productivity is improved by ecosystem services, including pollination, but this should be set in the context of trade-offs among multiple management practices. We investigated the impact of pollination services on coffee production, considering variation in fertilization, irrigation, shade cover, and environmental variables such as rainfall (which stimulates coffee flowering across all plantations), soil pH, and nitrogen availability. After accounting for management interventions, bee abundance improved coffee production (number of berries harvested). Some management interventions, such as irrigation, used once to trigger asynchronous flowering, dramatically increased bee abundance at coffee trees. Others, such as the extent and type of tree cover, revealed interacting effects on pollination and, ultimately, crop production. The effects of management interventions, notably irrigation and addition of lime, had, however, far more substantial positive effects on coffee production than tree cover. These results suggest that pollination services matter, but managing the asynchrony of flowering was a more effective tool for securing good pollination than maintaining high shade tree densities as pollinator habitat. Complex interactions across farm and landscape scales, including both management practices and environmental conditions, shape pollination outcomes. Effective production systems therefore require the integrated consideration of management practices in the context of the surrounding habitat structure. This paper points toward a more strategic use of ecosystem services in agricultural systems, where ecosystem services are shaped by the coupling of management interventions and environmental variables.

Survey of facility and management characteristics of large, Upper Midwest dairy herds clustered by Dairy Herd Improvement records.

PubMed

Brotzman, R L; Döpfer, D; Foy, M R; Hess, J P; Nordlund, K V; Bennett, T B; Cook, N B

2015-11-01

A survey of management practices was conducted to investigate potential associations with groupings of herds formed by cluster analysis (CA) of Dairy Herd Improvement (DHI) data of 557 Upper Midwest herds of 200 cows or greater. Differences in herd management practices were identified between the groups, despite underlying similarities; for example, freestall housing and milking in a parlor. Group 6 comprised larger herds with a high proportion of primiparous cows and most frequently utilized practices promoting increased production [e.g., 84.4% used recombinant bovine somatotropin (rbST)], decreased lameness (e.g., 96.9% used routine hoof trimming for cows), and improved efficiency in reproduction [e.g., 93.8% synchronized the first breeding in cows (SYNCH)] and labor (e.g., mean ± SD, 67 ± 19 cows per 50-h per week full-time equivalent worker). Group 1 had the best mean DHI performances and followed most closely group 6 for the rate of adoption of intensive management practices while tending to outperform group 6 despite a generally smaller mean herd size (e.g., 42.3 ± 3.6 kg vs. 39.9 ± 3.6 kg of energy-corrected milk production; 608 ± 352 cows vs. 1,716 ± 1,405 cows). Group 2 were smaller herds with relatively high levels of performance that used less intensive management (e.g., 100% milked twice daily) and less technology (33.3 vs. 73.0% of group 1 used rbST). Group 4 were smaller but poorer-performing herds with low turnover and least frequently used intensive management practices (e.g., 39.1% SYNCH; 30.4% allowed mature, high-producing cows access to pasture). Group 5 used modern technologies and practices associated with improved production, yet had the least desirable mean DHI performance of all 6 groups. This group had the lowest proportion of deep loose-bedded stalls (only 52.2% used sand bedding) and the highest proportion (34.8%) of herds not using routine hoof trimming. The survey of group 3 herds did not reveal strong trends in management. The differences identified between herd groupings confirm significant variation in management practices linked to variation in overall herd performance measured by DHI variables. This approach provides an opportunity for consultants and outreach educators to better tailor efforts toward a certain type of dairy management philosophy, rather than taking a blanket approach to applying recommendations to farms simply because of their larger herd size. Copyright © 2015 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Evidence-Based Best Practices for Outpatient Management of Warfarin.

PubMed

Rose, Adam J; Vaiana, Mary

2018-06-01

Many best practices have been described for organizing a clinic to manage warfarin. Although these practices may have face validity, they may not be based on empirical analysis. Here, we describe our decade-long effort to apply the Structure-Process-Outcome model of quality measurement as a basis for measuring and improving outpatient warfarin management in the Veterans Health Administration. The purpose of the article is to raise awareness of this body of work with pharmacists who could potentially incorporate the findings of this work into their own practice settings. We conclude with concrete suggestions for immediate implementation in clinical settings.

Combating Obesity at Community Health Centers (COACH): A Quality Improvement Collaborative for Weight Management Programs

PubMed Central

Wilkes, Abigail E.; John, Priya M.; Vable, Anusha M.; Campbell, Amanda; Heuer, Loretta; Schaefer, Cynthia; Vinci, Lisa; Drum, Melinda L.; Chin, Marshall H.; Quinn, Michael T.; Burnet, Deborah L.

2013-01-01

Community health centers (CHCs) seek effective strategies to address obesity. MidWest Clinicians’ Network partnered with [an academic medical center] to test feasibility of a weight management quality improvement (QI) collaborative. MidWest Clinicians’ Network members expressed interest in an obesity QI program. This pilot study aimed to determine whether the QI model can be feasibly implemented with limited resources at CHCs to improve weight management programs. Five health centers with weight management programs enrolled with CHC staff as primary study participants; this study did not attempt to measure patient outcomes. Participants attended learning sessions and monthly conference calls to build QI skills and share best practices. Tailored coaching addressed local needs. Topics rated most valuable were patient recruitment/retention strategies, QI techniques, evidence-based weight management, motivational interviewing. Challenges included garnering provider support, high staff turnover, and difficulty tracking patient-level data. This paper reports practical lessons about implementing a weight management QI collaborative in CHCs. PMID:23727964

The importance of human resources management in health care: a global context.

PubMed

Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond

2006-07-27

This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. We explored the published literature and collected data through secondary sources. Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world.

The importance of human resources management in health care: a global context

PubMed Central

Kabene, Stefane M; Orchard, Carole; Howard, John M; Soriano, Mark A; Leduc, Raymond

2006-01-01

Background This paper addresses the health care system from a global perspective and the importance of human resources management (HRM) in improving overall patient health outcomes and delivery of health care services. Methods We explored the published literature and collected data through secondary sources. Results Various key success factors emerge that clearly affect health care practices and human resources management. This paper will reveal how human resources management is essential to any health care system and how it can improve health care models. Challenges in the health care systems in Canada, the United States of America and various developing countries are examined, with suggestions for ways to overcome these problems through the proper implementation of human resources management practices. Comparing and contrasting selected countries allowed a deeper understanding of the practical and crucial role of human resources management in health care. Conclusion Proper management of human resources is critical in providing a high quality of health care. A refocus on human resources management in health care and more research are needed to develop new policies. Effective human resources management strategies are greatly needed to achieve better outcomes from and access to health care around the world. PMID:16872531

Improvement Technology Classification and Composition in Multimodel Environments

DTIC Science & Technology

2008-03-01

ISO 15504, ISO 12207 , and others COBIT, ITIL, SOX, and...Practice Elements CMMI PAs and PLA ISO 15504 and ISO 12207 COBIT EFQM ISO 9001 Improvement Method Elements Change management techniques: IDEAL and Six...others EFQM and others ISO 9001, ISO 61508, ISO 16949, and others Improvement Method Elements Change management techniques: IDEAL, Six Sigma,

Downstream approaches to phosphorus management in agricultural landscapes: regional applicability and use.

PubMed

Kröger, R; Dunne, E J; Novak, J; King, K W; McLellan, E; Smith, D R; Strock, J; Boomer, K; Tomer, M; Noe, G B

2013-01-01

This review provides a critical overview of conservation practices that are aimed at improving water quality by retaining phosphorus (P) downstream of runoff genesis. The review is structured around specific downstream practices that are prevalent in various parts of the United States. Specific practices that we discuss include the use of controlled drainage, chemical treatment of waters and soils, receiving ditch management, and wetlands. The review also focuses on the specific hydrology and biogeochemistry associated with each of those practices. The practices are structured sequentially along flowpaths as you move through the landscape, from the edge-of-field, to adjacent aquatic systems, and ultimately to downstream P retention. Often practices are region specific based on geology, cropping practices, and specific P related problems and thus require a right practice, and right place mentality to management. Each practice has fundamental P transport and retention processes by systems that can be optimized by management with the goal of reducing downstream P loading after P has left agricultural fields. The management of P requires a system-wide assessment of the stability of P in different biogeochemical forms (particulate vs. dissolved, organic vs. inorganic), in different storage pools (soil, sediment, streams etc.), and under varying biogeochemical and hydrological conditions that act to convert P from one form to another and promote its retention in or transport out of different landscape components. There is significant potential of hierarchically placing practices in the agricultural landscape and enhancing the associated P mitigation. But an understanding is needed of short- and long-term P retention mechanisms within a certain practice and incorporating maintenance schedules if necessary to improve P retention times and minimize exceeding retention capacity. Copyright © 2012 Elsevier B.V. All rights reserved.

Improved low-level radioactive waste management practices for hospitals and research institutions

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

Not Available

1983-07-01

This report provides a general overview and a compendium of source material on low-level radioactive waste management practices in the institutional sector. Institutional sector refers to hospitals, universities, clinics, and research facilities that use radioactive materials in scientific research and the practice of medicine, and the manufacturers of radiopharmaceuticals and radiography devices. This report provides information on effective waste management practices for institutional waste to state policymakers, regulatory agency officials, and waste generators. It is not intended to be a handbook for actual waste management, but rather a sourcebook of general information, as well as a survey of the moremore » detailed analysis.« less

Returning to Work

MedlinePlus

... to improve your documentation. Children & Youth Health & Wellness Mental Health Productive Aging Rehabilitation & Disability Work & Industry Manage Your Practice Evidence-Based Practice & Research Ethics Occupational Therapy Assistants ...

Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria

PubMed Central

Ogbuanya, Theresa Chinyere; Eseadi, Chiedu; Orji, Chibueze Tobias; Ede, Moses Onyemaechi; Ohanu, Ifeanyi Benedict; Bakare, Jimoh

2017-01-01

Abstract Background: Improving employees’ perception of organizational climate, and coaching them to remain steadfast when managing occupational risks associated with their job, might have an important effect on their psychosocial wellbeing and occupational health. This study examined the effects of a rational emotive occupational health therapy intervention program on the perceptions of organizational climate and occupational risk management practices. Methods: The participants were 77 electronics technology employees in the south-east of Nigeria. The study used a pretest–posttest control group design. Results: The rational emotive occupational health therapy intervention program significantly improved perceptions of the organizational climate for the people in the treatment group compared to those in the waitlist control group at post-intervention and follow-up assessments. Occupational risk management practices of the employees in the treatment group were also significantly better than those in the waitlist control group at the same 2 assessments. Conclusions: Corporate application of a rational emotive behavior therapy as an occupational health therapy intervention program is essential for improving the perceptions of organizational climate and promoting the adoption of feasible occupational risk management strategies in the workplace. PMID:28471971

Effects of rational emotive occupational health therapy intervention on the perceptions of organizational climate and occupational risk management practices among electronics technology employees in Nigeria.

PubMed

Ogbuanya, Theresa Chinyere; Eseadi, Chiedu; Orji, Chibueze Tobias; Ede, Moses Onyemaechi; Ohanu, Ifeanyi Benedict; Bakare, Jimoh

2017-05-01

Improving employees' perception of organizational climate, and coaching them to remain steadfast when managing occupational risks associated with their job, might have an important effect on their psychosocial wellbeing and occupational health. This study examined the effects of a rational emotive occupational health therapy intervention program on the perceptions of organizational climate and occupational risk management practices. The participants were 77 electronics technology employees in the south-east of Nigeria. The study used a pretest-posttest control group design. The rational emotive occupational health therapy intervention program significantly improved perceptions of the organizational climate for the people in the treatment group compared to those in the waitlist control group at post-intervention and follow-up assessments. Occupational risk management practices of the employees in the treatment group were also significantly better than those in the waitlist control group at the same 2 assessments. Corporate application of a rational emotive behavior therapy as an occupational health therapy intervention program is essential for improving the perceptions of organizational climate and promoting the adoption of feasible occupational risk management strategies in the workplace.

Selected accounts receivable performance statistics for radiology practices: an analysis of the adjusted collection percentage and days charges in accounts receivable.

PubMed

Cergnul, John J; Russell, Philip J; Sunshine, Jonathan H

2005-12-01

To provide comparative data and analysis with respect to accounts receivable management performance criteria. Data from 3 sources were analyzed: the Radiology Business Management Association's (RBMA) 2003 Accounts Receivable Performance Survey; the RBMA's 2003 Accounts Receivable Survey; and Hogan and Sunshine's 2004 Radiology article "Financial Ratios in Diagnostic Radiology Practices: Variability and Trends," the data for which were drawn primarily from the ACR's 1999 Survey of Practices. The RBMA surveyed (via e-mail and postal mail) only its members, with response rates of 15% and 9%, respectively. The ACR's survey response rate was 66%, via postal mail, and was distributed without regard to the RBMA membership status of the practice manager or even whether the practice employed a practice manager. Comparison among the survey results provided information on trends. Median practice professional component adjusted collection percentage (ACP) deteriorated from 87.3% to 85.1% between the RBMA surveys. Practices limited to global fee billing faired much better when performing their billing in house, as opposed to using a billing service, with mean ACPs of 91.2% and 79.4%, respectively. Days charges in accounts receivable 2004 mean results for professional component billing and global fee billing were nearly identical at 56.11 and 55.54 days, respectively. The 2003 RBMA survey reported 63.74 days for professional component billing and 77.33 days for global fee billing. The improvement from 2003 to 2004 was highly significant for both professional component billing and global fee billing. The 2004 RBMA survey also reflected a rather dramatic improvement in days charges in accounts receivable compared with Hogan and Sunshine's results, which showed a mean of 69 days charges in accounts receivable. The conflicting trends between ACP performance and days charges in accounts receivable performance may be explained by the increasing sophistication of accounts receivable management processes (improving days charges in accounts receivable) and the deterioration in the general economy between survey periods (decreasing ACPs). Additionally, generally better accounts receivable management performance was experienced by practices employing RBMA members (RBMA survey participants) compared with those that may or may not have employed RBMA members (ACR survey participants).

Simulating soil organic carbon in a wheat–fallow system using the Daycent model

USDA-ARS?s Scientific Manuscript database

Crop management practices that contribute to soil organic carbon (SOC) sequestration can improve productivity and long-term sustainability. We present a modeling study on influence of (>80 years) various long-term crop residue and nutrient management practices on SOC dynamics under conventional and ...

Responsible Student Affairs Practice: Merging Student Development and Quality Management.

ERIC Educational Resources Information Center

Whitner, Phillip A.; And Others

The merging of Total Quality Management (TQM) and Involvement Theory into a managerial philosophy can assist student affairs professionals with an approach for conducting work that improves student affairs practice. When merged or integrated, accountability can easily be obtained because the base philosophies of qualitative research, TQM, and…

Better long-term management enhances soil C and N stocks

USDA-ARS?s Scientific Manuscript database

Traditional practices, such as conventional tillage with crop–fallow, have reduced dryland soil carbon and nitrogen over the last several decades by 30 to 50% of their original levels in the northern Great Plains. Improved management practices are needed to restore carbon and nitrogen levels and sus...

Constructing a Patient Education System: A Performance Technology Project

ERIC Educational Resources Information Center

Bell, Edith E.

2009-01-01

The purpose of the patient education system described here was to distribute patient education material to and within medical practices managed by a small medical practice management company. The belief was that patient education opportunities improved health care outcomes and increased patient participation in health care decisions and compliance…

Water quality effects and placement of pasture best management practices in the Spring Creek Watershed (Centre County, PA)

USDA-ARS?s Scientific Manuscript database

Pasture-based best management practices (BMPs), including stream bank fencing, stream crossings, and bank stabilization, improved water quality ten years after installation by reducing sediment, but did not affect nitrogen concentration. Abundance and diversity of aquatic macroinvertebrates increas...

Vegetation management practices: Past and present

Treesearch

Peter F. Ffolliott; Gerald J. Gottfried; William H. Kruse

2003-01-01

Improving management practices have been at the core of most research conducted in the semidesert grass-shrub vegetation on the Santa Rita Experimental Range. Much of this research has been directed to sustaining forage resources through proper livestock grazing and controlling the invasion of competing woody plants, primarily mesquite. Both research orientations...

75 FR 32201 - Tennessee National Wildlife Refuge, Henry, Benton, Decatur, and Humphreys Counties, TN

Federal Register 2010, 2011, 2012, 2013, 2014

2010-06-07

... Big Sandy peninsula. The cooperative farming and refuge staff (force account) program would continue... Alternative A in aiming to maintain existing habitat management programs, practices, and actions. Under... intensify existing habitat management programs, practices, and actions. We would improve the moist-soil...

Improving watershed management practices in humid regions

USDA-ARS?s Scientific Manuscript database

Understanding the basic hydrology and erosion is vital for effective management and utilization of water resources and soil conservation planning. To improve the understanding we used watershed studies on three continents. The results show that in well vegetated (sub) humid and temperate watersheds ...

Seven Ways to Make Your Training Department One of the Best.

ERIC Educational Resources Information Center

Vander Linde, Karen; And Others

1997-01-01

Explains how training organizations in high-performance companies such as Motorola are different from those in low-performing ones. Identifies management practices: customer focus, training closer to customers, leadership, employee involvement, innovation, process improvement, improvement measurement, and change management. (JOW)

48 CFR 211.274-1 - General.

Code of Federal Regulations, 2010 CFR

2010-10-01

... delivered to DoD that will enhance logistics, contracting, and financial business transactions supporting... on leading practices and embraces open standards, DoD can— (a) Achieve lower life-cycle cost of item management and improve life-cycle property management; (b) Improve operational readiness; (c) Provide...

A decision-support system for the analysis of clinical practice patterns.

PubMed

Balas, E A; Li, Z R; Mitchell, J A; Spencer, D C; Brent, E; Ewigman, B G

1994-01-01

Several studies documented substantial variation in medical practice patterns, but physicians often do not have adequate information on the cumulative clinical and financial effects of their decisions. The purpose of developing an expert system for the analysis of clinical practice patterns was to assist providers in analyzing and improving the process and outcome of patient care. The developed QFES (Quality Feedback Expert System) helps users in the definition and evaluation of measurable quality improvement objectives. Based on objectives and actual clinical data, several measures can be calculated (utilization of procedures, annualized cost effect of using a particular procedure, and expected utilization based on peer-comparison and case-mix adjustment). The quality management rules help to detect important discrepancies among members of the selected provider group and compare performance with objectives. The system incorporates a variety of data and knowledge bases: (i) clinical data on actual practice patterns, (ii) frames of quality parameters derived from clinical practice guidelines, and (iii) rules of quality management for data analysis. An analysis of practice patterns of 12 family physicians in the management of urinary tract infections illustrates the use of the system.

A guideline for interpersonal capabilities enhancement to support sustainable facility management practice

NASA Astrophysics Data System (ADS)

Sarpin, Norliana; Kasim, Narimah; Zainal, Rozlin; Noh, Hamidun Mohd

2018-04-01

Facility management is the key phase in the development cycle of an assets and spans over a considerable length of time. Therefore, facility managers are in a commanding position to maximise the potential of sustainability through the development phases from construction, operation, maintenance and upgrade leading to decommission and deconstruction. Sustainability endeavours in facility management practices will contribute to reducing energy consumption, waste and running costs. Furthermore, it can also help in improving organisational productivity, financial return and community standing of the organisation. Facility manager should be empowered with the necessary knowledge and capabilities at the forefront facing sustainability challenge. However, literature studies show a gap between the level of awareness, specific knowledge and the necessary skills required to pursue sustainability in the facility management professional. People capability is considered as the key enabler in managing the sustainability agenda as well as being central to the improvement of competency and innovation in an organisation. This paper aims to develop a guidelines for interpersonal capabilities to support sustainability in facility management practice. Starting with a total of 7 critical interpersonal capabilities factors identified from previous questionnaire survey, the authors conducted an interview with 3 experts in facility management to assess the perceived importance of these factors. The findings reveal a set of guidelines for the enhancement of interpersonal capabilities among facility managers by providing what can be done to acquire these factors and how it can support the application of sustainability in their practice. The findings of this paper are expected to form the basis of a mechanism framework developed to equip facility managers with the right knowledge, to continue education and training and to develop new mind-sets to enhance the implementation of sustainability measures in FM practices.

Chronic disease management for depression in US medical practices: results from the Health Tracking Physician Survey.

PubMed

Zafar, Waleed; Mojtabai, Ramin

2011-07-01

Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.

Balancing the Ecological Function of Residential Stormwater Ponds with Homeowner Landscaping Practices.

PubMed

Monaghan, Paul; Hu, Shangchun; Hansen, Gail; Ott, Emily; Nealis, Charles; Morera, Maria

2016-11-01

Stormwater ponds are installed in urban developments to provide the ecosystem services of flood control and water treatment. In coastal areas, these ponds are connected to watersheds that can drain directly into protected estuaries, making their design, function, and maintenance critical to environmental protection. However, stormwater ponds in residential areas are increasingly managed as aesthetic amenities that add value to real estate rather than as engineered devices with special maintenance requirements. To help extend the life of neighborhood stormwater systems and improve ecosystem services, homeowners should follow best management practices for nutrient management and add shoreline plantings and non-invasive, beneficial aquatic plants to their ponds. This study used focus group and survey research to document the knowledge, behaviors, and attitudes of homeowners living near stormwater ponds in a master-planned community in Florida. The study was designed to use a social marketing research approach to promote Extension best practices. Findings indicate that many residents were aware of the functional components of stormwater systems and respondents' receptivity to best management practices was mediated by age, their attitudes about water quality and whether their home was adjacent to a pond. These findings can be used to target Extension audiences and improve adoption of stormwater pond best management practices for increased protection of water quality.

Balancing the Ecological Function of Residential Stormwater Ponds with Homeowner Landscaping Practices

NASA Astrophysics Data System (ADS)

Monaghan, Paul; Hu, Shangchun; Hansen, Gail; Ott, Emily; Nealis, Charles; Morera, Maria

2016-11-01

Stormwater ponds are installed in urban developments to provide the ecosystem services of flood control and water treatment. In coastal areas, these ponds are connected to watersheds that can drain directly into protected estuaries, making their design, function, and maintenance critical to environmental protection. However, stormwater ponds in residential areas are increasingly managed as aesthetic amenities that add value to real estate rather than as engineered devices with special maintenance requirements. To help extend the life of neighborhood stormwater systems and improve ecosystem services, homeowners should follow best management practices for nutrient management and add shoreline plantings and non-invasive, beneficial aquatic plants to their ponds. This study used focus group and survey research to document the knowledge, behaviors, and attitudes of homeowners living near stormwater ponds in a master-planned community in Florida. The study was designed to use a social marketing research approach to promote Extension best practices. Findings indicate that many residents were aware of the functional components of stormwater systems and respondents' receptivity to best management practices was mediated by age, their attitudes about water quality and whether their home was adjacent to a pond. These findings can be used to target Extension audiences and improve adoption of stormwater pond best management practices for increased protection of water quality.

Adherence To Diabetes Mellitus Treatment Guidelines From Theory To Practice: The Missing Link.

PubMed

Hashmi, Noreen Rahat; Khan, Shahzad Ali

2016-01-01

Diabetes mellitus is a complex multisystem disease that requires high quality care. Clinical practice guidelines help physicians and patients make the best possible health care decisions and improve health care management of diabetic patients. These guidelines provide the norms for clinical management as well as monitoring of diabetes care. They are not simple algorithms but are based on structured evidence based diabetic management protocols developed from randomized controlled trials. Despite the widespread availability of this diabetic guideline, their use is suboptimal at best. There are several factors blamed for contributing to this missing link from available theoretical guideline recommendations to practical applications of these guidelines. We present a brief review based on available literature review for an ongoing interventional study being done by authors in two tertiary care hospital in Lahore Pakistan for improving adherence to diabetes guidelines. We will discuss guideline implementation cycle and also present a framework encompassing various factors involved in adherence to guidelines. Until recently the emphasis to improve the guideline adherence targeted the factors relating to individual health care professionals in reference to their knowledge, attitude practice of the guidelines. However, we will discuss that broader range of health care systems, organizational factors, and factors relating to patients which may also significantly impact the adherence to the guidelines. The framework emphasises that it is important to understand the factors that act as barriers and contribute to the missing link between theory and practice of diabetic guidelines. This will help plan appropriate strategies in the pre-implementation stage for effective and improved diabetes guidelines adherence and management.

Incident management successful practices : a cross-cutting study : improving mobility and saving lives

DOT National Transportation Integrated Search

2000-04-01

Incident management is the process of managing multi-agency, multi-jurisdictional responses to highway traffic disruptions. Efficient and coordinated management of incidents reduces their adverse impacts on public safety, traffic conditions, and the ...

The QICKD study protocol: a cluster randomised trial to compare quality improvement interventions to lower systolic BP in chronic kidney disease (CKD) in primary care

PubMed Central

de Lusignan, Simon; Gallagher, Hugh; Chan, Tom; Thomas, Nicki; van Vlymen, Jeremy; Nation, Michael; Jain, Neerja; Tahir, Aumran; du Bois, Elizabeth; Crinson, Iain; Hague, Nigel; Reid, Fiona; Harris, Kevin

2009-01-01

Background Chronic kidney disease (CKD) is a relatively newly recognised but common long-term condition affecting 5 to 10% of the population. Effective management of CKD, with emphasis on strict blood pressure (BP) control, reduces cardiovascular risk and slows the progression of CKD. There is currently an unprecedented rise in referral to specialist renal services, which are often located in tertiary centres, inconvenient for patients, and wasteful of resources. National and international CKD guidelines include quality targets for primary care. However, there have been no rigorous evaluations of strategies to implement these guidelines. This study aims to test whether quality improvement interventions improve primary care management of elevated BP in CKD, reduce cardiovascular risk, and slow renal disease progression Design Cluster randomised controlled trial (CRT) Methods This three-armed CRT compares two well-established quality improvement interventions with usual practice. The two interventions comprise: provision of clinical practice guidelines with prompts and audit-based education. The study population will be all individuals with CKD from general practices in eight localities across England. Randomisation will take place at the level of the general practices. The intended sample (three arms of 25 practices) powers the study to detect a 3 mmHg difference in systolic BP between the different quality improvement interventions. An additional 10 practices per arm will receive a questionnaire to measure any change in confidence in managing CKD. Follow up will take place over two years. Outcomes will be measured using anonymised routinely collected data extracted from practice computer systems. Our primary outcome measure will be reduction of systolic BP in people with CKD and hypertension at two years. Secondary outcomes will include biomedical outcomes and markers of quality, including practitioner confidence in managing CKD. A small group of practices (n = 4) will take part in an in-depth process evaluation. We will use time series data to examine the natural history of CKD in the community. Finally, we will conduct an economic evaluation based on a comparison of the cost effectiveness of each intervention. Clinical Trials Registration ISRCTN56023731. ClinicalTrials.gov identifier. PMID:19602233

Action learning: an effective way to improve cancer-related pain management.

PubMed

Kasasbeh, Mohammed Ali Mohammed; McCabe, Catherine; Payne, Sheila

2017-11-01

To evaluate the efficacy of action learning for improving cancer related pain management in the acute healthcare settings. Despite the prevalent use of action learning in private, public, clinical and non-clinical settings, no studies were found in the literature that either examined cancer pain management or used action learning as an approach to improve patient care in acute healthcare settings. An intervention pre - posttest design was adopted using an action learning programme (ALPs) as the intervention. Healthcare professionals' knowledge, attitudes and practice were assessed and evaluated before and after the implementation of the six-month ALPs. A pre and post audit and survey were conducted for data collection. The data were collected from the entire population of 170 healthcare professionals in one healthcare organisation. The management of cancer related pain improved significantly following the intervention. Significant improvement were also seen in healthcare professionals' knowledge, attitudes with improved cancer related pain management as a consequence of this. Despite many organisational challenges to practice development and collaborative working in healthcare settings there is evidence that action learning can achieve positive outcomes for improving CRP and supporting collaborative working. Action learning needs to be considered as a strategy for achieving high quality standards. © 2016 John Wiley & Sons Ltd.

Correlation Research of Medical Security Management System Network Platform in Medical Practice

NASA Astrophysics Data System (ADS)

Jie, Wang; Fan, Zhang; Jian, Hao; Li-nong, Yu; Jun, Fei; Ping, Hao; Ya-wei, Shen; Yue-jin, Chang

Objective-The related research of medical security management system network in medical practice. Methods-Establishing network platform of medical safety management system, medical security network host station, medical security management system(C/S), medical security management system of departments and sections, comprehensive query, medical security disposal and examination system. Results-In medical safety management, medical security management system can reflect the hospital medical security problem, and can achieve real-time detection and improve the medical security incident detection rate. Conclusion-The application of the research in the hospital management implementation, can find hospital medical security hidden danger and the problems of medical disputes, and can help in resolving medical disputes in time and achieve good work efficiency, which is worth applying in the hospital practice.

Assessment and management of burn pain at the Komfo Anokye Teaching Hospital: a best practice implementation project.

PubMed

Bayuo, Jonathan; Munn, Zachary; Campbell, Jared

2017-09-01

Pain management is a significant issue in health facilities in Ghana. For burn patients, this is even more challenging as burn pain has varied facets. Despite the existence of pharmacological agents for pain management, complaints of pain still persist. The aim of this project was to identify pain management practices in the burns units of Komfo Anokye Teaching Hospital, compare these approaches to best practice, and implement strategies to enhance compliance to standards. Ten evidence-based audit criteria were developed from evidence summaries. Using the Joanna Briggs Institute Practical Application of Clinical Evidence Software (PACES), a baseline audit was undertaken on a convenience sample of ten patients from the day of admission to the seventh day. Thereafter, the Getting Research into Practice (GRiP) component of PACES was used to identify barriers, strategies, resources and outcomes. After implementation of the strategies, a follow-up audit was undertaken using the same sample size and audit criteria. The baseline results showed poor adherence to best practice. However, following implementation of strategies, including ongoing professional education and provision of assessment tools and protocols, compliance rates improved significantly. Atlhough the success of this project was almost disrupted by an industrial action, collaboration with external bodies enabled the successful completion of the project. Pain management practices in the burns unit improved at the end of the project which reflects the importance of an audit process, education, providing feedback, group efforts and effective collaboration.

Differences in healthy food supply and stocking practices between small grocery stores, gas-marts, pharmacies and dollar stores.

PubMed

Caspi, Caitlin Eicher; Pelletier, Jennifer E; Harnack, Lisa; Erickson, Darin J; Laska, Melissa N

2016-02-01

Little is known about the practices for stocking and procuring healthy food in non-traditional food retailers (e.g., gas-marts, pharmacies). The present study aimed to: (i) compare availability of healthy food items across small food store types; and (ii) examine owner/manager perceptions and stocking practices for healthy food across store types. Descriptive analyses were conducted among corner/small grocery stores, gas-marts, pharmacies and dollar stores. Data from store inventories were used to examine availability of twelve healthy food types and an overall healthy food supply score. Interviews with managers assessed stocking practices and profitability. Small stores in Minneapolis and St. Paul, MN, USA, not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children. One hundred and nineteen small food retailers and seventy-one store managers. Availability of specific items varied across store type. Only corner/small grocery stores commonly sold fresh vegetables (63% v. 8% of gas-marts, 0% of dollar stores and 23% of pharmacies). More than half of managers stocking produce relied on cash-and-carry practices to stock fresh fruit (53%) and vegetables (55%), instead of direct store delivery. Most healthy foods were perceived by managers to have at least average profitability. Interventions to improve healthy food offerings in small stores should consider the diverse environments, stocking practices and supply mechanisms of small stores, particularly non-traditional food retailers. Improvements may require technical support, customer engagement and innovative distribution practices.

Differences in healthy food supply and stocking practices between small grocery stores, gas-marts, pharmacies and dollar stores

PubMed Central

Caspi, Caitlin Eicher; Pelletier, Jennifer E.; Harnack, Lisa; Erikson, Darin J.; Laska, Melissa N.

2015-01-01

Objective Little is known about the practices for stocking and procuring healthy food in non-traditional food retailers (e.g., gas-marts, pharmacies). This study aimed to: (i) compare availability of healthy food items across small food store types, and (ii) examine owner/manager perceptions and stocking practices for healthy food across store types. Design Descriptive analyses were conducted among corner/small grocery stores, gas-marts, pharmacies, and dollar stores. Data from store inventories were used to examine availability of 12 healthy food types and an overall healthy food supply score. Interviews with managers assessed stocking practices and profitability. Setting Small stores in Minneapolis and St. Paul, MN not participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) Subjects 119 small food retailers and 71 store managers Results Availability of specific items varied across store types. Only corner/small grocery stores commonly sold fresh vegetables (63%, versus 8% of food-gas marts, 0% dollar stores, and 23% pharmacies). More than half of managers stocking produce relied on cash and carry practices to stock fresh fruit (53%) and vegetables (55%), instead of direct store delivery. Most healthy foods were perceived by managers to have at least average profitability. Conclusions Interventions to improve healthy food offerings in small stores should consider the diverse environments, stocking practices and supply mechanisms of small stores, particularly non-traditional food retailers. Improvements may require technical support, customer engagement, and innovative distribution practices. PMID:26411535

Management of non-adherence to fluid intake restrictions in hemodialysis patients in a tertiary hospital: a best practice implementation project.

PubMed

Jia, Shoumei; Huang, Bihong; Chu, Yuanqian; Lu, Yuhua; McArthur, Alexa

2016-08-01

Non-adherence to fluid-intake restrictions is one of the most common problems for hemodialysis (HD) patients. A combined approach that involves patients, healthcare professionals and caregiver inputs based on best practice is important for enhancing adherence within a busy health system. The aim of this project was to promote evidence-based practice in the management of fluid-intake restrictions among HD patients in a HD center. Six evidence-based criteria developed by the Joanna Briggs Institute were used as a basis for audits undertaken in the Hemodialysis Center of Huashan Hospital, Shanghai, mainly focusing on nurse education, fluid-intake management by patients and the role of caregivers in assisting with fluid-intake management by patients. The project included three phases and was conducted over 5 months. The Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice audit tools for promoting change in health practice were used to examine compliance with the criteria before and after the implementation of best practice. Results from pre- and post implementation audits indicated that the compliance rates of four criteria reached 100% after the implementation of various strategies. One criterion (patients' self-monitoring) resulted in a compliance rate of 73.33%. One other criterion (patients' medical documentation) was maintained at 100% compliance. Patients' adherence to fluid intake, knowledge and attitude to self-management also improved significantly in the post implementation audit. This project achieved a significant improvement in evidence-based practice for the management of non-adherence to fluid-intake restrictions in HD patients. An increase in the number of HD patients found to be adherent to fluid-intake restrictions was reported during this process.

Qualitative insights into practice time management: does 'patient-centred time' in practice management offer a portal to improved access?

PubMed Central

Buetow, S; Adair, V; Coster, G; Hight, M; Gribben, B; Mitchell, E

2002-01-01

BACKGROUND: Different sets of literature suggest how aspects of practice time management can limit access to general practitioner (GP) care. Researchers have not organised this knowledge into a unified framework that can enhance understanding of barriers to, and opportunities for, improved access. AIM: To suggest a framework conceptualising how differences in professional and cultural understanding of practice time management in Auckland, New Zealand, influence access to GP care for children with chronic asthma. DESIGN OF STUDY: A qualitative study involving selective sampling, semi-structured interviews on barriers to access, and a general inductive approach. SETTING: Twenty-nine key informants and ten mothers of children with chronic, moderate to severe asthma and poor access to GP care in Auckland. METHOD: Development of a framework from themes describing barriers associated with, and needs for, practice time management. The themes were independently identified by two authors from transcribed interviews and confirmed through informant checking. Themes from key informant and patient interviews were triangulated with each other and with published literature. RESULTS: The framework distinguishes 'practice-centred time' from 'patient-centred time.' A predominance of 'practice-centred time' and an unmet opportunity for 'patient-centred time' are suggested by the persistence of five barriers to accessing GP care: limited hours of opening; traditional appointment systems; practice intolerance of missed appointments; long waiting times in the practice; and inadequate consultation lengths. None of the barriers is specific to asthmatic children. CONCLUSION: A unified framework was suggested for understanding how the organisation of practice work time can influence access to GP care by groups including asthmatic children. PMID:12528583

Practices, Concerns, and Willingness to Participate in Solid Waste Management in Two Urban Slums in Central Uganda

PubMed Central

Ndejjo, Rawlance; Musoke, David; Musinguzi, Geofrey; Halage, Abdullah Ali; Carpenter, David O.; Ssempebwa, John C.

2016-01-01

Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums. Methods. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12. Results. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes. Conclusion. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices. PMID:27066081

Practices, Concerns, and Willingness to Participate in Solid Waste Management in Two Urban Slums in Central Uganda.

PubMed

Mukama, Trasias; Ndejjo, Rawlance; Musoke, David; Musinguzi, Geofrey; Halage, Abdullah Ali; Carpenter, David O; Ssempebwa, John C

2016-01-01

Poor solid waste management is among the major challenges facing urban slums in developing countries including Uganda. Understanding community concerns and willingness towards involvement in solid waste management improvement initiatives is critical for informing interventions in slums. We used a cross-sectional study to collect quantitative data from 435 residents in two urban slums in central Uganda. A semistructured questionnaire was used which assessed waste collection practices, separation and disposal methods, concerns regarding solid wastes, and willingness to participate in waste separation and composting. Data was analysed using STATA 12. Food remains (38%) and plastics (37%) formed the biggest proportion of wastes generated in households. Most households (35.9%) disposed of general wastes by open dumping while 27% disposed of plastics by burning. Only 8.8% of households conducted composting while 55% carried out separation for some decomposable wastes. Separation was carried out for only banana peelings and leftover foods for feeding animals. Respondents expressed high willingness to separate (76.6%) and compost (54.9%) solid wastes. Practices in waste disposal and separation were poor despite high willingness to participate in initiatives to improve waste management, highlighting a need for authorities to engage residents of slums to improve their practices.

Developing a Web-Based Nursing Practice and Research Information Management System: A Pilot Study.

PubMed

Choi, Jeeyae; Lapp, Cathi; Hagle, Mary E

2015-09-01

Many hospital information systems have been developed and implemented to collect clinical data from the bedside and have used the information to improve patient care. Because of a growing awareness that the use of clinical information improves quality of care and patient outcomes, measuring tools (electronic and paper based) have been developed, but most of them require multiple steps of data collection and analysis. This necessitated the development of a Web-based Nursing Practice and Research Information Management System that processes clinical nursing data to measure nurses' delivery of care and its impact on patient outcomes and provides useful information to clinicians, administrators, researchers, and policy makers at the point of care. This pilot study developed a computer algorithm based on a falls prevention protocol and programmed the prototype Web-based Nursing Practice and Research Information Management System. It successfully measured performance of nursing care delivered and its impact on patient outcomes successfully using clinical nursing data from the study site. Although Nursing Practice and Research Information Management System was tested with small data sets, results of study revealed that it has the potential to measure nurses' delivery of care and its impact on patient outcomes, while pinpointing components of nursing process in need of improvement.

Practical Recommendations for Long-term Management of Modifiable Risks in Kidney and Liver Transplant Recipients: A Guidance Report and Clinical Checklist by the Consensus on Managing Modifiable Risk in Transplantation (COMMIT) Group.

PubMed

Neuberger, James M; Bechstein, Wolf O; Kuypers, Dirk R J; Burra, Patrizia; Citterio, Franco; De Geest, Sabina; Duvoux, Christophe; Jardine, Alan G; Kamar, Nassim; Krämer, Bernhard K; Metselaar, Herold J; Nevens, Frederik; Pirenne, Jacques; Rodríguez-Perálvarez, Manuel L; Samuel, Didier; Schneeberger, Stefan; Serón, Daniel; Trunečka, Pavel; Tisone, Giuseppe; van Gelder, Teun

2017-04-01

Short-term patient and graft outcomes continue to improve after kidney and liver transplantation, with 1-year survival rates over 80%; however, improving longer-term outcomes remains a challenge. Improving the function of grafts and health of recipients would not only enhance quality and length of life, but would also reduce the need for retransplantation, and thus increase the number of organs available for transplant. The clinical transplant community needs to identify and manage those patient modifiable factors, to decrease the risk of graft failure, and improve longer-term outcomes.COMMIT was formed in 2015 and is composed of 20 leading kidney and liver transplant specialists from 9 countries across Europe. The group's remit is to provide expert guidance for the long-term management of kidney and liver transplant patients, with the aim of improving outcomes by minimizing modifiable risks associated with poor graft and patient survival posttransplant.The objective of this supplement is to provide specific, practical recommendations, through the discussion of current evidence and best practice, for the management of modifiable risks in those kidney and liver transplant patients who have survived the first postoperative year. In addition, the provision of a checklist increases the clinical utility and accessibility of these recommendations, by offering a systematic and efficient way to implement screening and monitoring of modifiable risks in the clinical setting.

Improving outcomes for patients with type 2 diabetes using general practice networks: a quality improvement project in east London.

PubMed

Hull, Sally; Chowdhury, Tahseen A; Mathur, Rohini; Robson, John

2014-02-01

Structured diabetes care can improve outcomes and reduce risk of complications, but improving care in a deprived, ethnically diverse area can prove challenging. This report evaluates a system change to enhance diabetes care delivery in a primary care setting. All 35 practices in one inner London Primary Care Trust were geographically grouped into eight networks of four to five practices, each supported by a network manager, clerical staff and an educational budget. A multidisciplinary team developed a 'care package' for type 2 diabetes management, with financial incentives based on network achievement of targets. Monthly electronic performance dashboards enabled networks to track and improve performance. Network multidisciplinary team meetings including the diabetic specialist team supported case management and education. Key measures for improvement included the number of diabetes care plans completed, proportion of patients attending for digital retinal screen and proportions of patients achieving a number of biomedical indices (blood pressure, cholesterol, glycated haemoglobin). Between 2009 and 2012, completed care plans rose from 10% to 88%. The proportion of patients attending for digital retinal screen rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤ 140/80 mm Hg and cholesterol ≤ 4 mmol/L rose from 35.3% to 46.1%. Mean glycated haemoglobin dropped from 7.80% to 7.66% (62-60 mmol/mol). Investment of financial, organisational and education resources into primary care practice networks can achieve clinically important improvements in diabetes care in deprived, ethnically diverse communities. This success is predicated on collaborative working between practices, purposively designed high-quality information on network performance and engagement between primary and secondary care clinicians.

Supplier Relationship Management at Army Life Cycle Management Commands: Gap Analysis of Best Practices

DTIC Science & Technology

2012-01-01

307–308) define kaizen as “continuous, incremental improvement of an activity to create more value with less muda.” They define muda as “any activity...approaches, kaizen events, Six Sigma, total quality management (TQM) for continuous improvement, kaikaku,6 process reengineering for discontinuous...them fix problems and develop capabilities. These efforts may include kaizen (i.e., continuous, incremental improvement) events, process mapping, work

Aggressive behaviour - prevention and management in the general practice environment.

PubMed

Sim, Moira G; Wain, Toni; Khong, Eric

2011-11-01

Aggressive behaviour is commonly encountered in the general practice setting and can often be de-escalated using good communication skills. This article provides strategies to reduce and manage early aggression in the general practice environment. Aggressive behaviour usually occurs when a person feels unfairly treated. Having a systematic approach to the problem can improve safety for both staff and patients. This includes patient centred practice, identifying and managing the early signs of aggression to prevent escalation, having a plan to seek assistance if required, setting limits using a calm respectful manner and reinforcing limits using behaviour contracts when required. The physical layout of the practice and restraint of aggressive people are beyond the scope of this article.

Impact of the "Guidelines for infection prevention in dentistry" (2006) by the Commission of Hospital Hygiene and Infection Prevention at the Robert Koch-Institute (KRINKO) on hygiene management in dental practices - analysis of a survey from 2009.

PubMed

Hübner, Nils-Olaf; Handrup, Stephan; Meyer, Georg; Kramer, Axel

2012-01-01

To assess trends in hygiene management in dental practices in comparison to an earlier survey in 2002/2003 and to point out key aspects for future efforts. The infection prevention management of all dental practices in Greifswald (n=35) was determined by a questionnaire in a personal interview in 2008/2009. 26% of the dentists did not use sufficient personal protective equipment during the general examination of the patient. In conservative and prosthetic dentistry, 15% still did not use adequate measures and 9% did not even in surgical interventions. Vaccination coverage was clearly too low, as only 35% of dentists were vaccinated against influenza and coverage with other vaccinations was also quite low. 11% of the dentists did not perform a documented anamnesis and in 29% of the dental practices no appointment system for risk patients existed.There were significant deficiencies in the reprocessing of medical devices and in the equipment needed for reprocessing. The opportunity to participate in further training in this field was rejected by 23% of the dentists.In 10 dental practices, the colony count in the dental unit water-conducting system was five times higher than the limit. A contamination with P. aeruginosa was discovered in 4 practices. All units were renovated. Overall, both the hygiene management and hygiene equipment in the practices have improved considerably compared to the previous survey in 2002/2003. This demonstrates the positive effect of the KRINKO guidelines from 2006. However, the survey again showed relevant deficiences in the hygiene management of dental practices, which agrees with a Germany-wide online survey from 2009. While the study revealed persistent deficiencies in hygiene management, especially in reprocessing, it confirms that the KRINKO guidelines for dental practices from 2006 led to significant improvements in hygiene management. Doubts about the impact of the guidelines are not backed by evidence.

Hospital management practices and availability of surgery in sub-Saharan Africa: a pilot study of three hospitals.

PubMed

Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A

2013-11-01

Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001). It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.

Implementing clinical process management of vascular wounds in a tertiary facility: impact evaluation of a performance improvement project.

PubMed

Avruscio, Giampiero; Tocco-Tussardi, Ilaria; Bordignon, Greta; Vindigni, Vincenzo

2017-01-01

Chronic vascular wounds have a significant economic and social impact on our society calling for allocation of a great deal of attention and resources. Efforts should be oriented toward the achievement of the most effective and efficient clinical management. The Angiology Unit at the University Hospital of Padova, Italy, developed a performance improvement project to enhance the quality of practice for vascular ulcers. The project consisted in a multistep process comprising a critical revision of the previous clinical process management, staff education, tightening connections between operators and services, and creation of a position for a wound care nurse. The previous standard of practice was modified according to the results of revision and the current evidence-based practice. The new standard of practice reached its full application in September 2015. The number of patients treated and the number of visits in 2015 remained almost unvaried from 2014. However, the total annual expenditure for treating vascular ulcers was reduced by ~60% from the previous year. Standardization of guidelines and practice is effective in creating an efficient clinical management and in reducing the economic burden of vascular ulcers.

Effect of care management program structure on implementation: a normalization process theory analysis.

PubMed

Holtrop, Jodi Summers; Potworowski, Georges; Fitzpatrick, Laurie; Kowalk, Amy; Green, Lee A

2016-08-15

Care management in primary care can be effective in helping patients with chronic disease improve their health status, however, primary care practices are often challenged with implementation. Further, there are different ways to structure care management that may make implementation more or less successful. Normalization process theory (NPT) provides a means of understanding how a new complex intervention can become routine (normalized) in practice. In this study, we used NPT to understand how care management structure affected how well care management became routine in practice. Data collection involved semi-structured interviews and observations conducted at 25 practices in five physician organizations in Michigan, USA. Practices were selected to reflect variation in physician organizations, type of care management program, and degree of normalization. Data were transcribed, qualitatively coded and analyzed, initially using an editing approach and then a template approach with NPT as a guiding framework. Seventy interviews and 25 observations were completed. Two key structures for care management organization emerged: practice-based care management where the care managers were embedded in the practice as part of the practice team; and centralized care management where the care managers worked independently of the practice work flow and was located outside the practice. There were differences in normalization of care management across practices. Practice-based care management was generally better normalized as compared to centralized care management. Differences in normalization were well explained by the NPT, and in particular the collective action construct. When care managers had multiple and flexible opportunities for communication (interactional workability), had the requisite knowledge, skills, and personal characteristics (skill set workability), and the organizational support and resources (contextual integration), a trusting professional relationship (relational integration) developed between practice providers and staff and the care manager. When any of these elements were missing, care management implementation appeared to be affected negatively. Although care management can introduce many new changes into delivery of clinical practice, implementing it successfully as a new complex intervention is possible. NPT can be helpful in explaining differences in implementing a new care management program with a view to addressing them during implementation planning.

Consensus statement on the anticipation and prevention of acute postoperative pain: multidisciplinary RADAR approach.

PubMed

Vickers, A; Bali, S; Baxter, A; Bruce, G; England, J; Heafield, R; Langford, R; Makin, R; Power, I; Trim, J

2009-10-01

There has been considerable investment in efforts to improve postoperative pain management, including the introduction of acute pain teams. There have also been a number of guidelines published on postoperative pain management and there is widespread agreement on how pain should be practically managed. Despite these advances, there is no apparent improvement in the number of patients experiencing moderately severe or extreme pain after surgery. This highlights significant scope for improvement in acute postoperative pain management. In January 2009, a multidisciplinary UK expert panel met to define and agree a practical framework to encourage implementation of the numerous guidelines and fundamentals of pain management at a local level. The panel recognised that to do this, there was a need to organise the information and guidelines into a simplified, accessible and easy-to-implement system based on their practical clinical experience. Given the volume of literature in this area, the Chair recommended that key international guidelines from professional bodies should be distributed and then reviewed during the meeting to form the basis of the framework. Consensus was reached by unanimous agreement of all ten participants. This report provides a framework for the key themes, including consensus recommendations based upon practical experience agreed during the meeting, with the aim of consolidating the key guidelines to provide a fundamental framework which is simple to teach and implement in all areas. Key priorities that emerged were: Responsibility, Anticipation, Discussion, Assessment and Response. This formed the basis of RADAR, a novel framework to help pain specialists educate the wider care team on understanding and prioritising the management of acute pain. Acute postoperative pain can be more effectively managed if it is prioritised and anticipated by a well-informed care team who are educated with regard to appropriate analgesic options and understand what the long-term benefits of pain relief are. The principles of RADAR provide structure to help with training and implementation of good practice, to achieve effective postoperative pain management.

Implementing and Sustaining Data Lifecycle best Practices: a Framework for Researchers and Repositories

NASA Astrophysics Data System (ADS)

Stall, S.

2016-02-01

Emerging data management mandates in conjunction with cross-domain international interoperability are posing new challenges for researchers and repositories. Domain repositories are serving in this critical, growing role monitoring and leading data management standards and capability within their own repository and working on mappings between repositories internationally. Leading research institutions and companies will also be important as they develop and expand data curation efforts. This landscape poses a number of challenges for developing and ensuring the use of best practices in curating research data, enabling discovery, elevating quality across diverse repositories, and helping researchers collect and organize it through the full data life cycle. This multidimensional challenge will continue to grow in complexity. The American Geophysical Union (AGU) is developing two programs to help researchers and data repositories develop and elevate best practices and address these challenges. The goal is to provide tools for the researchers and repositories, whether domain, institutional, or other, that improve performance throughout the data lifecycle across the Earth and space science community. For scientists and researchers, AGU is developing courses around handling data that can lead toward a certification in geoscience data management. Course materials will cover metadata management and collection, data analysis, integration of data, and data presentation. The course topics are being finalized by the advisory board with the first one planned to be available later this year. AGU is also developing a program aimed at helping data repositories, large and small, domain-specific to general, assess and improve data management practices. AGU has partnered with the CMMI® Institute to adapt their Data Management Maturity (DMM)SM framework within the Earth and space sciences. A data management assessment using the DMMSM involves identifying accomplishments and weaknesses compared to leading practices for data management. Recommendations can help improve quality and consistency across the community that will facilitate reuse in the data lifecycle. Through governance, quality, and architecture process areas the assessment can measure the ability for data to be discoverable and interoperable.

48 CFR 211.274-1 - General.

Code of Federal Regulations, 2012 CFR

2012-10-01

... on leading practices and embraces open standards, DoD can— (a) Achieve lower life-cycle cost of item management and improve life-cycle property management; (b) Improve operational readiness; (c) Provide reliable accountability of property and asset visibility throughout the life cycle; and (d) Reduce the...

48 CFR 211.274-1 - General.

Code of Federal Regulations, 2011 CFR

2011-10-01

... on leading practices and embraces open standards, DoD can— (a) Achieve lower life-cycle cost of item management and improve life-cycle property management; (b) Improve operational readiness; (c) Provide reliable accountability of property and asset visibility throughout the life cycle; and (d) Reduce the...

48 CFR 211.274-1 - General.

Code of Federal Regulations, 2013 CFR

2013-10-01

... on leading practices and embraces open standards, DoD can— (a) Achieve lower life-cycle cost of item management and improve life-cycle property management; (b) Improve operational readiness; (c) Provide reliable accountability of property and asset visibility throughout the life cycle; and (d) Reduce the...

7 CFR 1437.402 - Carrying capacity.

Code of Federal Regulations, 2012 CFR

2012-01-01

... management and maintenance practices are improvements over those practices generally associated with the... practice was completed at least 1 time in the previous 5 crop years and such practice can be expected to...; (2) Five percent when 2 or more practices were completed at least 1 time in the previous 5 crop years...

7 CFR 1437.402 - Carrying capacity.

Code of Federal Regulations, 2014 CFR

2014-01-01

... management and maintenance practices are improvements over those practices generally associated with the... practice was completed at least 1 time in the previous 5 crop years and such practice can be expected to...; (2) Five percent when 2 or more practices were completed at least 1 time in the previous 5 crop years...

Do disease management programs for patients with coronary heart disease make a difference? Experiences of nine practices.

PubMed

Walsh, Mary N; Simpson, Ross J; Wan, George J; Weiss, Thomas W; Alexander, Charles M; Markson, Leona E; Berger, Marc L; Pearson, Thomas A

2002-11-01

To observe the experience of 9 practice sites in implementing provider-defined disease management programs for coronary heart disease patients. Observational study of provider-defined practice improvement programs. Practices chose from a variety of interventions that included provider- and patient-based disease management tools. Data were collected at baseline, 6, and 12 months. Complete baseline, 6-month, and 12-month data were available for 586 patients (58% of the 1013 patients enrolled). Compared with baseline, 6-month data showed more patients whose total cholesterol was less than 200 mg/dL (56% to 76%; P < or = .001), whose low-density lipoprotein (LDL) cholesterol was less than 100 mg/dL (30% to 54%; P < or = .001), and whose high-density lipoprotein cholesterol was at least 35 mg/dL (75% to 81%; P < or = .001); who exercised rigorously for 30 minutes, 3 times a week (40% to 53%; P < or = .001); who used lipid medication (74% to 80%; P < or = .01); and who used aspirin (84% to 92%; P < or = .001). There were no significant improvements in triglyceride levels, blood pressure control, glycemic control among diabetes patients, smoking cessation, body mass index, and beta-blocker use. The 12-month results were similar to the 6-month results. Sites with a practice coordinator had the highest number of patients achieving their LDL goal (72% to 89%). There may be an opportunity to improve patient care by applying disease management principles with a variety of interventions. Dedicated personnel to help coordinate disease management programs may be critical to the success of such programs.

KC-46 Tanker Aircraft: Program Generally Stable but Improvements in Managing Schedule Are Needed

DTIC Science & Technology

2013-02-27

testing, and supplier management. An important contractual requirement (and best practice ) is for Boeing to release 90 percent of the total engineering...design is stable, and manufacturing processes are mature. As we reported last year, while the program has implemented many acquisition best practices ...assessed the program’s acquisition plan to determine compliance with acquisition legislation and acquisition best practices . What GAO Recommends GAO

Translating Knowledge Into Practice Through an Academic-Practice Partnership for Exploring Barriers That Impact Management of Homebound Patients With Heart Failure.

PubMed

Echevarria, Mercedes

A knowledge translation project involving an academic-practice partnership and guided by action-oriented research was used for exploring barriers that impact management of homebound heart failure patients. The intervention process followed an action research model of interaction, self-reflection, response, and change in direction. External facilitators (academia) and internal facilitators (practice) worked with clinicians to identify a topic for improvement, explore barriers, locate the evidence compare current practice against evidence-based practice recommendations, introduce strategies to "close the gap" between actual practice and the desired practice, develop audit criteria, and reevaluate the impact.

Improving Care Transitions Management: Examining the Role of Accountable Care Organization Participation and Expanded Electronic Health Record Functionality.

PubMed

Huber, Thomas P; Shortell, Stephen M; Rodriguez, Hector P

2017-08-01

Examine the extent to which physician organization participation in an accountable care organization (ACO) and electronic health record (EHR) functionality are associated with greater adoption of care transition management (CTM) processes. A total of 1,398 physician organizations from the third National Study of Physician Organization survey (NSPO3), a nationally representative sample of medical practices in the United States (January 2012-May 2013). We used data from the third National Study of Physician Organization survey (NSPO3) to assess medical practice characteristics, including CTM processes, ACO participation, EHR functionality, practice type, organization size, ownership, public reporting, and pay-for-performance participation. Multivariate linear regression models estimated the extent to which ACO participation and EHR functionality were associated with greater CTM capabilities, controlling for practice size, ownership, public reporting, and pay-for-performance participation. Approximately half (52.4 percent) of medical practices had a formal program for managing care transitions in place. In adjusted analyses, ACO participation (p < .001) and EHR functionality (p < .001) were independently associated with greater use of CTM processes among medical practices. The growth of ACOs and similar provider risk-bearing arrangements across the country may improve the management of care transitions by physician organizations. © Health Research and Educational Trust.

AHCPR clinical practice guideline on surgical pain management: adoption and outcomes.

PubMed

Devine, E C; Bevsek, S A; Brubakken, K; Johnson, B P; Ryan, P; Sliefert, M K; Rodgers, B

1999-04-01

Pain management practices and short-term patient outcomes in nine acute care hospitals in Milwaukee, Wisconsin, were studied at two points in time. One-and-a-half years after the Agency for Health Care Policy and Research's (AHCPR) Clinical Practice Guideline on Acute Pain Management was published, data from 330 adult surgical patients were collected (Time I). These data were contrasted with data from 373 adult surgical patients collected 2 years later (Time II). There were significant increases in the percentage of patients who reported being taught how to report pain using a pain rating scale and about setting a pain goal preoperatively; in the percentage of patient hospital records with at least one documented numeric pain rating; and in the percentage of patients who received analgesics by intravenous administration. However, pain management practices continued to differ from recommendations in the AHCPR guideline. No significant improvement was noted in the short-term outcomes of patient-rated pain or patient satisfaction with pain management. Availability of well-published guidelines alone may be insufficient to ensure comprehensive adoption of guidelines that are multidimensional in nature and to obtain improvements in patient outcome.

Achieving Coherence in District Improvement: Managing the Relationship between the Central Office and Schools

ERIC Educational Resources Information Center

Johnson, Susan Moore; Marietta, Geoff; Higgins, Monica C.; Mapp, Karen L.; Grossman, Allen

2015-01-01

"Achieving Coherence in District Improvement" focuses on a problem of practice faced by educational leaders across the nation: how to effectively manage the relationship between the central office and schools. The book is based on a study of five large urban districts that have demonstrated improvement in student achievement. The…

48 CFR 970.0370-2 - Contract clause.

Code of Federal Regulations, 2010 CFR

2010-10-01

... SUPPLEMENTARY REGULATIONS DOE MANAGEMENT AND OPERATING CONTRACTS Improper Business Practices and Personal....5203-1, Management Controls, in all management and operating contracts. (b) The contracting officer shall insert the clause at 970.5203-2, Performance Improvement and Collaboration, in all management and...

COLLABORATE©, Part IV: Ramping Up Competency-Based Performance Management.

PubMed

Treiger, Teresa M; Fink-Samnick, Ellen

The purpose of this fourth part of the COLLABORATE© article series provides an expansion and application of previously presented concepts pertaining to the COLLABORATE paradigm of professional case management practice. The model is built upon a value-driven foundation that: PRIMARY PRACTICE SETTING(S):: Applicable to all health care sectors where case management is practiced. As an industry, health care continues to evolve. Terrain shifts and new influences continually surface to challenge professional case management practice. The need for top-performing and nimble professionals who are knowledgeable and proficient in the workplace continues to challenge human resource departments. In addition to care setting knowledge, professional case managers must continually invest in their practice competence toolbox to grow skills and abilities that transcend policies and processes. These individuals demonstrate agility in framing (and reframing) their professional practice to facilitate the best possible outcomes for their clients. Therefore, the continued emphasis on practice competence conveyed through the performance management cycle is an essential ingredient to performance management focused on customer service excellence and organizational improvement. Professional case management transcends professional disciplines, educational levels, and practice settings. Business objectives continue to drive work process and priorities in many practice settings. However, competencies that align with regulatory and accreditation requirements should be the critical driver for consistent, high-quality case management practice. Although there is inherent value in what various disciplines bring to the table, this advanced model unifies behind case management's unique, strengths-based identity instead of continuing to align within traditional divisions (e.g., discipline, work setting, population served). This model fosters case management's expanding career advancement opportunities.

Lean practices for quality results: a case illustration.

PubMed

Hwang, Pauline; Hwang, David; Hong, Paul

2014-01-01

Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific organisations and inter-organisational networks. Healthcare managers are adopting business practices that improve efficiency and productivity while ensuring their healthcare mission and guaranteeing that customer values are achieved. Shared understanding about complex goals (e.g. reducing waste and enhancing customer value) at the front-end is crucial for implementing successful lean practices. In particular, this study shows that nursing practices, which are both labour intensive and technology enabled, are good candidates for lean practice.

Improvement in Diagnosis and Treat-to-Target Management of Hyperuricemia in Gout: Results from the GEMA-2 Transversal Study on Practice.

PubMed

Perez Ruiz, Fernando; Sanchez-Piedra, Carlos A; Sanchez-Costa, Jesus T; Andrés, Mariano; Diaz-Torne, Cesar; Jimenez-Palop, Mercedes; De Miguel, Eugenio; Moragues, Carmen; Sivera, Francisca

2018-06-01

The objective of the study was to evaluate changes regarding main European League Against Rheumatism (EULAR) recommendations on diagnosis and treatment of gout compared to a previous assessment. The GEMA-2 (Gout Evaluation and MAnagement) is a transversal assessment of practice for gout by rheumatologists. Main outcome variables were improvement of the previous GEMA assessment regarding the rate of crystal-proven diagnosis and that reaching therapeutic serum urate target below 6 mg/dl at last visit. Other management variables (prophylaxis, treatment of flares, lifestyle change advice) were also evaluated along with general characteristics. The sample was powered to include at least 483 patients for up to 50% change. Data on management of 506 patients were retrieved from 38 out of 41 rheumatology units that participated in the previous GEMA audit. Crystal-proved diagnosis rate increased from 26% to 32% (31% improvement) and was higher in gout-dedicated practices; ultrasonography contributed to diagnosis in less than 1% of cases. Therapeutic serum urate at last visit improved from 41% to 64% of all patients (66% of patients on urate-lowering medications), in any case over 50% improvement from the previous assessment. The use of any urate-lowering medication available was not prescribed as per label dosing in patients who failed to achieve target serum urate. Clinical inertia to increase doses of either allopurinol or febuxostat was still present in clinical practice. Over 50% improvement in targeting therapeutic serum urate has been observed, but clinical inertia is still present. Diagnosis is still mostly clinically based, ultrasonography not being commonly contributive. Menarini España.

Organizational management practices for achieving software process improvement

NASA Technical Reports Server (NTRS)

Kandt, Ronald Kirk

2004-01-01

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

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study.

PubMed

Campmans-Kuijpers, Marjo J E; Lemmens, Lidwien C; Baan, Caroline A; Gorter, Kees J; Groothuis, Jolanda; van Vuure, Klementine H; Rutten, Guy E H M

2013-04-05

Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries as well.

Study of Current Practice and Future Advancements in Blood Management and Effectiveness of a Multimodality Training Program on Improving Transfusion Knowledge, Practice and Outcomes

DTIC Science & Technology

2012-08-01

to trauma, surgery or blood diseases such as anemia, hemophilia or sickle- cell disease. But transfusions carry risks. Current practices are often...Blood Management Topic 4: Diagnosis of Red cell disorders and oxygen carrying capacity Topic 5: Diagnosis of Disorders in homeostasis Topic 6...the Clinical Transfusion Medicine Committee of the AABB. Red Blood Cell Transfusion: A Clinical Practice Guideline From the AABB. Ann Intern Med

Doctors as managers of healthcare resources in Nigeria: Evolving roles and current challenges

PubMed Central

Ojo, Temitope Olumuyiwa; Akinwumi, Adebowale Femi

2015-01-01

Over the years, medical practice in Nigeria has evolved in scope and practice, in terms of changing disease patterns, patients' needs, and social expectations. In addition, there is a growing sentiment especially among the general public and some health workers that most doctors are bad managers. Besides drawing examples from some doctors in top management positions that have performed less creditably, critics also harp on the fact that more needs to be done to improve the training of doctors in health management. This article describes the role of doctors in this changing scene of practice and highlights the core areas where doctors' managerial competencies are required to improve the quality of healthcare delivery. Areas such as health care financing, essential drugs and supplies management, and human resource management are emphasized. Resources to be managed and various skills needed to function effectively at the different levels of management are also discussed. To ensure that doctors are well-skilled in managerial competencies, the article concludes by suggesting a curriculum review at undergraduate and postgraduate levels of medical training to include newer but relevant courses on health management in addition to the existing ones, whereas also advocating that doctors be incentivized to go for professional training in health management and not only in the core clinical specialties. PMID:26903692

Feasibility of a virtual learning collaborative to implement an obesity QI project in 29 pediatric practices.

PubMed

John, Tamara; Morton, Michaela; Weissman, Mark; O'Brien, Ellen; Hamburger, Ellen; Hancock, Yolandra; Moon, Rachel Y

2014-04-01

Quality improvement (QI) activities are required to maintain board certification in pediatrics. However, because of lack of training and resources, pediatricians may feel overwhelmed by the need to implement QI activities. Pediatricians also face challenges when caring for overweight and obese children. To create a virtual (online) QI learning collaborative through which pediatric practices could easily develop and implement a continuous QI process. Prospective cohort. Pediatric practices that were part of the Children's National Health Network were invited to participate, with the option to receive continuing medical education and maintenance of certification credits. s) Practices conducted baseline and monthly chart audits, participated in educational webinars and selected monthly practice changes, using Plan-Do-Study-Act cycles. Practices reported activities monthly and periodic feedback was provided to practices about their performance. s) Improvement in (i) body mass index (BMI) percentile documentation, (ii) appropriate nutritional and activity counseling and (iii) follow-up management for high-risk patients. Twenty-nine practices (120 providers) participated, and 24 practices completed all program activities. Monthly chart audits demonstrated continuous improvement in documentation of BMI, abnormal weight diagnosis, nutrition and activity screening and counseling, weight-related health messages and follow-up management of overweight and obese patients. Impact of QI activities on visit duration and practice efficiency was minimal. A virtual learning collaborative was successful in providing a framework for pediatricians to implement a continuous QI process and achieve practice improvements. This format can be utilized to address multiple health issues.

Design in Practice: Scenarios for Improving Management Education

ERIC Educational Resources Information Center

Schlenker, Lee; Chantelot, Sébastien

2014-01-01

Despite the increasing attention given to design in business, Design Thinking has had little impact on the quality of business school education. Building upon the foundations of long-standing critiques of management education and the potential for student-centric learning, the authors propose that the use of Design in Practice can significantly…

How the Organizational Learning Process Mediates the Impact of Strategic Human Resource Management Practices on Performance in Korean Organizations

ERIC Educational Resources Information Center

Cho, Sei Hyoung; Song, Ji Hoon; Yun, Suk Chun; Lee, Cheol Ki

2013-01-01

The primary purpose of this research is to examine the structural relationships among several workplace-related constructs, including strategic human resource management (HRM) practices, organizational learning processes, and performance improvement in the Korean business context. More specifically, the research examined the mediating effect of…

Is primary care a neglected piece of the jigsaw in ensuring optimal stroke care? Results of a national study

PubMed Central

Whitford, David L; Hickey, Anne; Horgan, Frances; O'Sullivan, Bernadette; McGee, Hannah; O'Neill, Desmond

2009-01-01

Background Stroke is a major cause of mortality and morbidity with potential for improved care and prevention through general practice. A national survey was undertaken to determine current resources and needs for optimal stroke prevention and care. Methods Postal survey of random sample of general practitioners undertaken (N = 204; 46% response). Topics included practice organisation, primary prevention, acute management, secondary prevention, long-term care and rehabilitation. Results Service organisation for both primary and secondary prevention was poor. Home management of acute stroke patients was used at some stage by 50% of responders, accounting for 7.3% of all stroke patients. Being in a structured cardiovascular management scheme, a training practice, a larger practice, or a practice employing a practice nurse were associated with structures and processes likely to support stroke prevention and care. Conclusion General practices were not fulfilling their potential to provide stroke prevention and long-term management. Systems of structured stroke management in general practice are essential to comprehensive national programmes of stroke care. PMID:19402908

The Principal's Role in Helping Teachers Manage Their Classrooms.

ERIC Educational Resources Information Center

Klitgaard, Guy C.

1987-01-01

The principal should lead in instructional improvement and have a good understanding of the principles and practices of classroom management and a good classroom management system. Discusses instructional supervision and assessing teacher performance. (MD)

Risk Stratification Methods and Provision of Care Management Services in Comprehensive Primary Care Initiative Practices.

PubMed

Reddy, Ashok; Sessums, Laura; Gupta, Reshma; Jin, Janel; Day, Tim; Finke, Bruce; Bitton, Asaf

2017-09-01

Risk-stratified care management is essential to improving population health in primary care settings, but evidence is limited on the type of risk stratification method and its association with care management services. We describe risk stratification patterns and association with care management services for primary care practices in the Comprehensive Primary Care (CPC) initiative. We undertook a qualitative approach to categorize risk stratification methods being used by CPC practices and tested whether these stratification methods were associated with delivery of care management services. CPC practices reported using 4 primary methods to stratify risk for their patient populations: a practice-developed algorithm (n = 215), the American Academy of Family Physicians' clinical algorithm (n = 155), payer claims and electronic health records (n = 62), and clinical intuition (n = 52). CPC practices using practice-developed algorithm identified the most number of high-risk patients per primary care physician (282 patients, P = .006). CPC practices using clinical intuition had the most high-risk patients in care management and a greater proportion of high-risk patients receiving care management per primary care physician (91 patients and 48%, P =.036 and P =.128, respectively). CPC practices used 4 primary methods to identify high-risk patients. Although practices that developed their own algorithm identified the greatest number of high-risk patients, practices that used clinical intuition connected the greatest proportion of patients to care management services. © 2017 Annals of Family Medicine, Inc.

Evaluating the Performance Improvement Preferences of Disability Service Managers: An Exploratory Study Using Gilbert's Behavior Engineering Model

ERIC Educational Resources Information Center

Wooderson, John R.; Cuskelly, Monica; Meyer, Kim A.

2017-01-01

Background: Front-line managers play an important role in managing the performance of staff working in services for people with intellectual disability, but little is known about the practices they prefer to use to improve staff performance and whether these align with what research has shown to be effective. Method: This study comprised two…

Commentary: Launch of a quality improvement network for evidence-based management of uncommon pediatric endocrine disorders: Turner syndrome as a prototype.

PubMed

Rosenfield, Robert L; DiMeglio, Linda A; Mauras, Nelly; Ross, Judith; Shaw, Natalie D; Greeley, Siri A W; Haymond, Morey; Rubin, Karen; Rhodes, Erinn T

2015-04-01

Traditional, hypothesis-oriented research approaches have thus far failed to generate sufficient evidence to achieve consensus about the management of children with many endocrine disorders, partly because of the rarity of these disorders and because of regulatory burdens unique to research in children. The Pediatric Endocrine Society is launching a quality improvement network in spring 2015 for the management of pediatric endocrine disorders that are relatively uncommon in any single practice and/or for which there is no consensus on management. The first of the quality improvement programs to be implemented seeks to improve the care of 11- to 17-year-old girls with Turner syndrome who require initiation of estrogen replacement therapy by providing a standardized clinical assessment and management plan (SCAMP) for transdermal estradiol treatment to induce pubertal development. The SCAMP algorithm represents a starting point within current best practice that is meant to undergo refinement through an iterative process of analysis of deidentified data collected in the course of clinical care by a network of pediatric endocrinologists. It is anticipated that this program will not only improve care, but will also result in actionable data that will generate new research hypotheses and changes in management of pediatric endocrine disorders.

A mapping review of international guidance on the management and care of amyotrophic lateral sclerosis (ALS).

PubMed

Janssens, Astrid I W A; Ruytings, Marijke; Al-Chalabi, Ammar; Chio, Adriano; Hardiman, Orla; Mcdermott, Christopher J; Meyer, Thomas; Mora, Gabriele; Van Damme, Philip; Van Den Berg, Leonard H; Vanhaecht, Kris; Winkler, Andrea S; Sermeus, Walter

2016-01-01

Management of ALS is suboptimal. Consequently, quality improvement interventions are needed to improve ALS care. An evidence-based insight into how patients should be managed is essential when developing quality improvement interventions. Therefore, this study aimed to map, categorize and summarize international guidance on the management and care of ALS and to identify gaps in this guidance by means of a mapping review. Literature was searched for clinical practice guidelines, quality indicators and evidence-based clinical summaries. A content analysis and meta-synthesis of the included literature was performed. Interventions and outcomes used in the management and care of ALS were identified and categorized. Furthermore, the amount of guidance underpinning these interventions and outcomes was analysed. Six clinical practice guidelines, one set of quality indicators and three evidence-based clinical summaries were identified. The results demonstrated that certain domains in ALS care, mainly disease-specific domains such as breathing and swallowing, are extensively addressed in the literature whereas other subjects, such as care coordination, receive little attention. In conclusion, this mapping review provides a scientific basis for targeting and developing the clinical content of a quality improvement intervention for the management of ALS.

Management of perineal pain among postpartum women in an obstetric and gynecological hospital in China: a best practice implementation project.

PubMed

Zhang, Yu; Huang, Li; Ding, Yan; Shi, Yajing; Chen, Jiaying; McArthur, Alexa

2017-01-01

Perineal pain is a serious condition that may negatively impact a significant number of postpartum women. Healthcare professionals, including midwives and nurses, are available to support women 24 hours a day during this period in hospital and are in an ideal position to assist in the management of perineal pain for postpartum women. The aim of this evidence implementation project was to improve management of perineal pain among postpartum women in Ward 21 of the Obstetric and Gynecological Hospital, Fudan University. This evidence implementation project utilized the Joanna Briggs Institute Practical Application of Clinical Evidence System, and Getting Research into Practice audit and feedback tools. Six best practice recommendations were used for the audit cycle. A total of 18 nurses, three midwives and 30 female patients participated in the project. A baseline audit was conducted, followed by the implementation of strategies targeted to address the identified barriers. A follow-up audit was then conducted to evaluate change in practice. Improvements in practice were observed for all six criteria. Significant improvements were found for the following: staff education increased compliance by 76% (from 24% to 100%). Education regarding antenatal perineal massage technique increased by 97% (from 3% to 100%). Compliance rates for use of ice packs increased by 63% (from 17 to 80%). Compliance rates for daily perineal pain assessment conducted for three days following childbirth increased by 100%, and analgesia administration rates increased by 27% (from 1% to 40%). Compliance rates for women's acceptance of postnatal perineal care education increased by 70% (from 30 to 100%). The current clinical audit project has made a significant improvement in establishing evidence-based practice of management of perineal pain among postpartum women in the gynecologic and obstetric hospital in Shanghai. It has been effective in increasing staff compliance and reducing the perineal pain among postpartum women.

A social media intervention to improve hypoglycemia management at a multicenter hospital: a quality improvement pilot for clinical nurses.

PubMed

De Sousa, Filomena; Jackson, Jennifer; Knight, Ruth; Cloutier, Edith; Basa, Rosemary; Fourney, Anne; Devecseri, Kathleen

2018-02-01

Hypoglycemia poses significant risk to inpatients. Nursing management of hypoglycemia is a challenge, despite established best practice guidelines. Social media is an effective tool for sharing information and could overcome barriers to clinical education at a multicenter hospital. The purpose of this quality improvement intervention was to create and disseminate social media posts about best practices in hypoglycemia management. An unmatched pre-and post-survey assessed nursing knowledge of hypoglycemia management. Social media posts were created to visually outline the steps for hypoglycemia management over 2 weeks, across a nursing social media platform. We assessed the reach of the posts via Facebook and a survey. The posts reached 2962 users during the first week, and 1491 users the second week. A social media intervention can have a substantial reach and distribute information across a multicenter hospital. Additional study is needed to determine what factors could support an increase in nursing knowledge through a social media campaign.

7 CFR 1437.402 - Carrying capacity.

Code of Federal Regulations, 2011 CFR

2011-01-01

... factors, such as soil type, elevation, and topography, result in a significant difference of carrying... management and maintenance practices are improvements over those practices generally associated with the...

7 CFR 1437.402 - Carrying capacity.

Code of Federal Regulations, 2010 CFR

2010-01-01

... factors, such as soil type, elevation, and topography, result in a significant difference of carrying... management and maintenance practices are improvements over those practices generally associated with the...

48 CFR 970.5203-2 - Performance improvement and collaboration.

Code of Federal Regulations, 2011 CFR

2011-10-01

... in the communication of the success of improvements to other management and operating contractors in... management and operation of the contract. This may entail the alteration of existing practices or the... approaches consistent with the statement of work and performance measures of this contract. (b) The...

48 CFR 970.5203-2 - Performance improvement and collaboration.

Code of Federal Regulations, 2010 CFR

2010-10-01

... in the communication of the success of improvements to other management and operating contractors in... management and operation of the contract. This may entail the alteration of existing practices or the... approaches consistent with the statement of work and performance measures of this contract. (b) The...

Interactive effects among ecosystem services and management practices on crop production: Pollination in coffee agroforestry systems

PubMed Central

Boreux, Virginie; Kushalappa, Cheppudira G.; Vaast, Philippe; Ghazoul, Jaboury

2013-01-01

Crop productivity is improved by ecosystem services, including pollination, but this should be set in the context of trade-offs among multiple management practices. We investigated the impact of pollination services on coffee production, considering variation in fertilization, irrigation, shade cover, and environmental variables such as rainfall (which stimulates coffee flowering across all plantations), soil pH, and nitrogen availability. After accounting for management interventions, bee abundance improved coffee production (number of berries harvested). Some management interventions, such as irrigation, used once to trigger asynchronous flowering, dramatically increased bee abundance at coffee trees. Others, such as the extent and type of tree cover, revealed interacting effects on pollination and, ultimately, crop production. The effects of management interventions, notably irrigation and addition of lime, had, however, far more substantial positive effects on coffee production than tree cover. These results suggest that pollination services matter, but managing the asynchrony of flowering was a more effective tool for securing good pollination than maintaining high shade tree densities as pollinator habitat. Complex interactions across farm and landscape scales, including both management practices and environmental conditions, shape pollination outcomes. Effective production systems therefore require the integrated consideration of management practices in the context of the surrounding habitat structure. This paper points toward a more strategic use of ecosystem services in agricultural systems, where ecosystem services are shaped by the coupling of management interventions and environmental variables. PMID:23671073

Impact of an educational program on knowledge and practice of health care staff toward pharmaceutical waste management in Gaza, Palestine.

PubMed

Tabash, Mohammed I; Hussein, Rim A; Mahmoud, Aleya H; El-Borgy, Mohamed D; Abu-Hamad, Bassam A

2016-04-01

In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. Poor knowledge about their potential downstream impacts may be a primary factor for improper disposal behavior. The objective of this study was to determine the impact of an intervention program on knowledge and practice of health care staff regarding pharmaceutical waste management. The study was designed as a pre/posttest intervention study. Total sample size was 530 in the pre-intervention phase, and then a subsample of 69 individuals was selected for the intervention and the post-intervention phases. Paired-sample t test was used to assess the difference between pretest and follow-up test results. A statistically significant improvement in knowledge and practice was achieved (P<0.001). Poor knowledge and poor practice levels (scores<50%) were found to improve to satisfactory levels (scores≥75%). Therefore, educational programs could be considered as an effective tool for changing health care staff practice in pharmaceutical waste management. In health care facilities, pharmaceutical waste is generally discharged down the drain or sent to landfill. A lack of knowledge about the potential impacts of this type of waste may be a leading factor in improper disposal behavior. Following an educational program, statistically significant improvement in knowledge and practice of health care staff as regards to pharmaceutical waste management (PWM) was achieved. It is thus recommended that authorities implement training-of-trainers (TOT) programs to educate health care staff on PWM and organize refreshment workshops regularly.

Provider Experiences with Chronic Care Management (CCM) Services and Fees: A Qualitative Research Study.

PubMed

O'Malley, Ann S; Sarwar, Rumin; Keith, Rosalind; Balke, Patrick; Ma, Sai; McCall, Nancy

2017-12-01

Support for ongoing care management and coordination between office visits for patients with multiple chronic conditions has been inadequate. In January 2015, Medicare introduced the Chronic Care Management (CCM) payment policy, which reimburses providers for CCM activities for Medicare beneficiaries occurring outside of office visits. To explore the experiences, facilitators, and challenges of practices providing CCM services, and their implications going forward. Semi-structured telephone interviews from January to April 2016 with 71 respondents. Sixty billing and non-billing providers and practice staff knowledgeable about their practices' CCM services, and 11 professional society representatives. Practice respondents noted that most patients expressed positive views of CCM services. Practice respondents also perceived several patient benefits, including improved adherence to treatment, access to care team members, satisfaction, care continuity, and care coordination. Facilitators of CCM provision included having an in-practice care manager, patient-centered medical home recognition, experience developing care plans, patient trust in their provider, and supplemental insurance to cover CCM copayments. Most billing practices reported few problems obtaining patients' consent for CCM, though providers felt that CMS could better facilitate consent by marketing CCM's goals to beneficiaries. Barriers reported by professional society representatives and by billing and non-billing providers included inadequacy of CCM payments to cover upfront investments for staffing, workflow modification, and time needed to manage complex patients. Other barriers included inadequate infrastructure for health information exchange with other providers and limited electronic health record capabilities for documenting and updating care plans. Practices owned by hospital systems and large medical groups faced greater bureaucracy in implementing CCM than did smaller, independent practices. Improving providers' experiences with and uptake of CCM will require addressing several challenges, including the upfront investment for CCM set-up and the time required to provide CCM to more complex patients.

Evidence-based financial management.

PubMed

Finkler, Steven A; Henley, Richard J; Ward, David M

2003-10-01

Like the practice of evidence-based medicine, evidence-based financial management can be used by providers to improve results. The concept provides a framework that managers and researchers can use to help direct efforts in gathering and using evidence to support management decisions in health care.

[Application of information management system about medical equipment].

PubMed

Hang, Jianjin; Zhang, Chaoqun; Wu, Xiang-Yang

2011-05-01

Based on the practice of workflow, information management system about medical equipment was developed and its functions such as gathering, browsing, inquiring and counting were introduced. With dynamic and complete case management of medical equipment, the system improved the management of medical equipment.

The chronic care model versus disease management programs: a transaction cost analysis approach.

PubMed

Leeman, Jennifer; Mark, Barbara

2006-01-01

The present article applies transaction cost analysis as a framework for better understanding health plans' decisions to improve chronic illness management by using disease management programs versus redesigning care within physician practices.

An Overview of Practice Facilitation Programs in Canada: Current Perspectives and Future Directions

PubMed Central

Liddy, Clare; Laferriere, Dianne; Baskerville, Bruce; Dahrouge, Simone; Knox, Lyndee; Hogg, William

2013-01-01

Practice facilitation has proven to be effective in improving the quality of primary care. A practice facilitator is a health professional, usually external to the practice, who regularly visits the practice to provide support in change management that targets improvements in the delivery of care. Our environmental scan shows that several initiatives across Canada utilize practice facilitation as a quality improvement method; however, many are conducted in isolation as there is a lack of coordinated effort, knowledge translation and dissemination in this field across the country. We recommend that investments be made in capacity building, knowledge exchange and facilitator training, and that partnership building be considered a priority in this field. PMID:23968627

The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

PubMed

Hughes, Roger; Margetts, Barrie

2012-11-01

The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

On becoming a coach: a pilot intervention study with managers in long-term care.

PubMed

Cummings, Greta; Mallidou, Anastasia A; Masaoud, Elmabrok; Kumbamu, Ashok; Schalm, Corinne; Spence Laschinger, Heather K; Estabrooks, Carole A

2014-01-01

Health care leaders have called for the development of communication and leadership skills to improve manager-employee relationships, employee job satisfaction, quality care, and work environments. The aim of the study reported here was to pilot how a 2-day coaching workshop ("Coaching for Impressive CARE") conducted as a leadership development strategy influenced frontline care managers' coaching practices in residential long-term care (LTC) settings. We had four objectives: (a) to identify managers' perceptions of their role as a coach of employee performance in LTC facilities, (b) to understand managers' intentions to coach employee performance, (c) to examine opportunities and factors that contributed to or challenged implementation of workshop coaching skills in daily leadership/management practice, and (d) to examine managers' reports of using coaching practices and employee responses after the workshop. We used an exploratory/descriptive design involving pre-/post-workshop surveys, e-mail reminders, and focus groups to examine participation of 21 LTC managers in a 2-day coaching workshop and their use of coaching practices in the workplace. Focus group findings provided examples of how participants used their coaching skills in practice (e.g., communicating empathy) and how staff responded. Factors contributing to and challenging implementation of these coaching skills in the workplace were identified. Attitudes and intentions to be a coach increased significantly, and some coaching skills were used more frequently after the workshop, specifically planning for performance change with employees. The coaching workshop was feasible to implement, well received by participants, influenced their willingness to become coaches, and had some noted impact on their use of coaching behaviors in the workplace. Coaching skills by managers to improve staff performance with residents in LTC facilities can be learned.

Management in general practice: the challenge of the new General Medical Services contract.

PubMed

Checkland, Kath

2004-10-01

Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Three general practices in England, chosen using purposeful sampling. Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role.

Management in general practice: the challenge of the new General Medical Services contract

PubMed Central

Checkland, Kath

2004-01-01

Background: Managers in general practice perform a variety of roles, from purely administrative to higher-level strategic planning. There has been little research investigating in detail how they perform these roles and the problems that they encounter. The new General Medical Services (GMS) contract contains new management challenges and it is not clear how practices will meet these. Aim: To improve understanding of the roles performed by managers in general practice and to consider the implications of this for the implementation of the new GMS contract. Design of study: In-depth qualitative case studies covering the period before and immediately after the vote in favour of the new GMS contract. Setting: Three general practices in England, chosen using purposeful sampling. Method: Semi-structured interviews with all clinical and managerial personnel in each practice, participant and non-participant observation, and examination of documents. Results: Understanding about what constitutes the legitimate role of managers in general practice varies both within and between practices. Those practices in the study that employed a manager to work at a strategic level with input into the direction of the organisation demonstrated significant problems with this in practice. These included lack of clarity about what the legitimate role of the manager involved, problems relating to the authority of managers in the context of a partnership, and lack of time available to them to do higher-level work. In addition, general practitioners (GPs) were not confident about their ability to manage their managers' performance. Conclusion: The new GMS contract will place significant demands on practice management. These results suggest that it cannot be assumed that simply employing a manager with high-level skills will enable these demands to be met; there must first be clarity about what the manager should be doing, and attention must be directed at questions about the legitimacy enjoyed by such a manager, the limits of his or her authority, and the management of performance in this role. PMID:15469672

Incentives to improve farm management: EMS, supply-chains and civil society.

PubMed

Gunningham, Neil

2007-02-01

This paper focuses on impediments to environmentally sound management practices and how these might be overcome, with an emphasis on the role of environmental management systems, supply chains and civil society. It argues that: Farmers are under increased pressure to cut costs and improve production but with little opportunity to increase prices. Commonly short-term economic interest has damaging environmental implications. Current government policy, in Australia and in many other jurisdictions, relies heavily on voluntary arrangements, education and information, as the main policy instruments through which to persuade farmers to adopt better environmental farm management - e.g. the recent push to encourage the use of voluntary environmental management systems. However, there is good evidence to suggest that these can only make a valuable contribution when combined with a range of other policy instruments, including positive and negative incentives, intervention by third parties and in some cases, an underpinning of regulation. Arguably, what is needed is a strategy that builds on the strengths of voluntary environmental management arrangements while compensating for their weaknesses by combining them with other, complementary policy instruments. If so, we must engage with a range of questions that have not so far figured substantially in the policy debate. Although the principal focus has been on the role of government in bringing about on-farm change in management practices, supply chain pressure (at least in respect of agricultural chemicals and practices which threaten food safety) and civil society action are also potentially powerful mechanisms for bringing about change. Government can and should play a role in harnessing such forces in the interests of improved environmental on-farm practices.

Management Documentation: Indicators & Good Practice at Cultural Heritage Places

NASA Astrophysics Data System (ADS)

Eppich, R.; Garcia Grinda, J. L.

2015-08-01

Documentation for cultural heritage places usually refers to describing the physical attributes, surrounding context, condition or environment; most of the time with images, graphics, maps or digital 3D models in their various forms with supporting textural information. Just as important as this type of information is the documentation of managerial attributes. How do managers of cultural heritage places collect information related to financial or economic well-being? How are data collected over time measured, and what are significant indicators for improvement? What quality of indicator is good enough? Good management of cultural heritage places is essential for conservation longevity, preservation of values and enjoyment by the public. But how is management documented? The paper will describe the research methodology, selection and description of attributes or indicators related to good management practice. It will describe the criteria for indicator selection and why they are important, how and when they are collected, by whom, and the difficulties in obtaining this information. As importantly it will describe how this type of documentation directly contributes to improving conservation practice. Good practice summaries will be presented that highlight this type of documentation including Pamplona and Ávila, Spain and Valletta, Malta. Conclusions are drawn with preliminary recommendations for improvement of this important aspect of documentation. Documentation of this nature is not typical and presents a unique challenge to collect, measure and communicate easily. However, it is an essential category that is often ignored yet absolutely essential in order to conserve cultural heritage places.

ESIP Information Quality Cluster (IQC)

NASA Technical Reports Server (NTRS)

Ramapriyan, H. K.; Peng, Ge; Moroni, David F.

2016-01-01

The Information Quality Cluster (IQC) within the Federation of Earth Science Information Partners (ESIP) was initially formed in 2011 and has evolved significantly over time. The current objectives of the IQC are to: 1. Actively evaluate community data quality best practices and standards; 2. Improve capture, description, discovery, and usability of information about data quality in Earth science data products; 3. Ensure producers of data products are aware of standards and best practices for conveying data quality, and data providers distributors intermediaries establish, improve and evolve mechanisms to assist users in discovering and understanding data quality information; and 4. Consistently provide guidance to data managers and stewards on how best to implement data quality standards and best practices to ensure and improve maturity of their data products. The activities of the IQC include: 1. Identification of additional needs for consistently capturing, describing, and conveying quality information through use case studies with broad and diverse applications; 2. Establishing and providing community-wide guidance on roles and responsibilities of key players and stakeholders including users and management; 3. Prototyping of conveying quality information to users in a more consistent, transparent, and digestible manner; 4. Establishing a baseline of standards and best practices for data quality; 5. Evaluating recommendations from NASA's DQWG in a broader context and proposing possible implementations; and 6. Engaging data providers, data managers, and data user communities as resources to improve our standards and best practices. Following the principles of openness of the ESIP Federation, IQC invites all individuals interested in improving capture, description, discovery, and usability of information about data quality in Earth science data products to participate in its activities.

7 CFR 205.203 - Soil fertility and crop nutrient management practice standard.

Code of Federal Regulations, 2010 CFR

2010-01-01

... (CONTINUED) ORGANIC FOODS PRODUCTION ACT PROVISIONS NATIONAL ORGANIC PROGRAM Organic Production and Handling... materials. (c) The producer must manage plant and animal materials to maintain or improve soil organic... fertility to maintain or improve soil organic matter content in a manner that does not contribute to...

Expert advice provided through telemedicine improves healing of chronic wounds: prospective cluster controlled study.

PubMed

Zarchi, Kian; Haugaard, Vibeke B; Dufour, Deirdre N; Jemec, Gregor B E

2015-03-01

Telemedicine is widely considered as an efficient approach to manage the growing problem of chronic wounds. However, to date, there is no convincing evidence to support the clinical efficacy of telemedicine in wound management. In this prospective cluster controlled study, we tested the hypothesis that advice on wound management provided by a team of wound-care specialists through telemedicine would significantly improve the likelihood of wound healing compared with the best available conventional practice. A total of 90 chronic wound patients in home care met all study criteria and were included: 50 in the telemedicine group and 40 in the conventional group. Patients with pressure ulcers, surgical wounds, and cancer wounds were excluded. During the 1-year follow-up, complete wound healing was achieved in 35 patients (70%) in the telemedicine group compared with 18 patients (45%) in the conventional group. After adjusting for important covariates, offering advice on wound management through telemedicine was associated with significantly increased healing compared with the best available conventional practice (telemedicine vs. conventional practice: adjusted hazard ratio 2.19; 95% confidence interval: 1.15-4.17; P=0.017). This study strongly supports the use of telemedicine to connect home-care nurses to a team of wound experts in order to improve the management of chronic wounds.

Diagnosis of poor safety culture as a major shortcoming in OHSAS 18001-certified companies.

PubMed

Ghahramani, Abolfazl

2017-04-07

The evaluation of safety performance in occupational health and safety assessment series (OHSAS) 18001-certified companies provides useful information about the quality of the management system. A certified organization should employ an adequate level of safety management and a positive safety culture to achieve a satisfactory safety performance. The present study conducted in six manufacturing companies: three OHSAS 18001-certified, and three non-certified to assess occupational health and safety (OHS) as well as OHSAS 18001 practices. The certified companies had a better OHS practices compared with the non-certified companies. The certified companies slightly differed in OHS and OHSAS 18001 practices and one of the certified companies had the highest activity rates for both practices. The results indicated that the implemented management systems have not developed and been maintained appropriately in the certified companies. The in-depth analysis of the collected evidence revealed shortcomings in safety culture improvement in the certified companies. This study highlights the importance of safety culture to continuously improve the quality of OHSAS 18001 and to properly perform OHS/OHSAS 18001 practices in the certified companies.

Diagnosis of poor safety culture as a major shortcoming in OHSAS 18001-certified companies

PubMed Central

GHAHRAMANI, Abolfazl

2016-01-01

The evaluation of safety performance in occupational health and safety assessment series (OHSAS) 18001-certified companies provides useful information about the quality of the management system. A certified organization should employ an adequate level of safety management and a positive safety culture to achieve a satisfactory safety performance. The present study conducted in six manufacturing companies: three OHSAS 18001-certified, and three non-certified to assess occupational health and safety (OHS) as well as OHSAS 18001 practices. The certified companies had a better OHS practices compared with the non-certified companies. The certified companies slightly differed in OHS and OHSAS 18001 practices and one of the certified companies had the highest activity rates for both practices. The results indicated that the implemented management systems have not developed and been maintained appropriately in the certified companies. The in-depth analysis of the collected evidence revealed shortcomings in safety culture improvement in the certified companies. This study highlights the importance of safety culture to continuously improve the quality of OHSAS 18001 and to properly perform OHS/OHSAS 18001 practices in the certified companies. PMID:28025422

Parent involvement in novice teen driving: a review of the literature

PubMed Central

Simons‐Morton, B; Ouimet, M C

2006-01-01

Motor vehicle crashes remain elevated among novice teen drivers for at least several years after licensure. Licensing policies and driver education are the two primary countermeasures employed to decrease young driver crash risks. Graduated driver licensing policies have proved to be effective in reducing crash rates where evaluated. Driver education is an essential part of teaching teens the rules of the road and operating a vehicle, but requires few hours of professional driver training, relying mainly on parents to provide most of the supervised practice driving teens obtain before independent driving licensure. The few studies that have been conducted to increase parent supervised practice driving have not shown positive results. Moreover, it is unclear that increases in practice would improve independent driving safety. Recent research has shown that parent management of the early independent driving experience of novice teens improves safety outcomes, and other research has shown that it is possible to increase parent management practices. This paper provides a review of the literature on parent involvement in supervised practice and independent driving, and efforts to increase parental management. PMID:16788109

Parent involvement in novice teen driving: a review of the literature.

PubMed

Simons-Morton, B; Ouimet, M C

2006-06-01

Motor vehicle crashes remain elevated among novice teen drivers for at least several years after licensure. Licensing policies and driver education are the two primary countermeasures employed to decrease young driver crash risks. Graduated driver licensing policies have proved to be effective in reducing crash rates where evaluated. Driver education is an essential part of teaching teens the rules of the road and operating a vehicle, but requires few hours of professional driver training, relying mainly on parents to provide most of the supervised practice driving teens obtain before independent driving licensure. The few studies that have been conducted to increase parent supervised practice driving have not shown positive results. Moreover, it is unclear that increases in practice would improve independent driving safety. Recent research has shown that parent management of the early independent driving experience of novice teens improves safety outcomes, and other research has shown that it is possible to increase parent management practices. This paper provides a review of the literature on parent involvement in supervised practice and independent driving, and efforts to increase parental management.

Evaluation of a practice-based intervention to improve the management of pediatric asthma.

PubMed

Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie

2011-02-01

Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.

Development of the Champlain primary care cardiovascular disease prevention and management guideline

PubMed Central

Montoya, Lorraine; Liddy, Clare; Hogg, William; Papadakis, Sophia; Dojeiji, Laurie; Russell, Grant; Akbari, Ayub; Pipe, Andrew; Higginson, Lyall

2011-01-01

Abstract Problem addressed A well documented gap remains between evidence and practice for clinical practice guidelines in cardiovascular disease (CVD) care. Objective of program As part of the Champlain CVD Prevention Strategy, practitioners in the Champlain District of Ontario launched a large quality-improvement initiative that focused on increasing the uptake in primary care practice settings of clinical guidelines for heart disease, stroke, diabetes, and CVD risk factors. Program description The Champlain Primary Care CVD Prevention and Management Guideline is a desktop resource for primary care clinicians working in the Champlain District. The guideline was developed by more than 45 local experts to summarize the latest evidence-based strategies for CVD prevention and management, as well as to increase awareness of local community-based programs and services. Conclusion Evidence suggests that tailored strategies are important when implementing specific practice guidelines. This article describes the process of creating an integrated clinical guideline for improvement in the delivery of cardiovascular care. PMID:21673196

Utilization of Collaborative Practice Agreements between Physicians and Pharmacists as a Mechanism to Increase Capacity to Care for Hematopoietic Stem Cell Transplant Recipients

PubMed Central

Merten, Julianna A.; Shapiro, Jamie F.; Gulbis, Alison M.; Rao, Kamakshi V.; Bubalo, Joseph; Lanum, Scott; Engemann, Ashley Morris; Shayani, Sepideh; Williams, Casey; Leather, Helen; Walsh-Chocolaad, Tracey

2013-01-01

Survival following hematopoietic stem cell transplantation (HSCT) has improved and the number of allogeneic HSCTs performed annually in the United States is expected to reach 10,000 by 2015. The National Marrow Donor Program created the System Capacity Initiative to formulate mechanisms to care for the growing number of HSCT recipients. One proposed method to increase capacity is utilization of pharmacists to manage drug therapy via collaborative practice agreements (CPAs). Pharmacists have managed drug therapy in oncology patients with CPAs for decades; however, there are limited HSCT centers that employ this practice. Engaging in collaborative practice and billing agreements with credentialed pharmacists to manage therapeutic drug monitoring, chronic medical conditions and supportive care in HSCT recipients may be cost-effective and enable physicians to spend more time on new or more complex patients. The goal of this paper is to provide a framework for implementation of a CPA and address how it may improve HSCT program capacity. PMID:23419976

Smart dental practice: capitalising on smart mobile technology.

PubMed

Plangger, K; Bredican, J; Mills, A J; Armstrong, J

2015-08-14

To keep pace with consumer adoption of smart mobile devices, such as smartphones and tablets, and the applications ('apps') developed for these devices, dental professionals should consider how this technology could be used to simultaneously improve both patient service experiences and dental practice management. Using U-Commerce as a theoretical lens, this article discusses the potential value of smart mobile technology to the dental practice context, with a particular focus on the unique and customisable capabilities of apps. To take full advantage of this technology, a process is outlined for identifying and designing bespoke dental apps that takes into account the unique advantages of these devices. Dental practices, with increasing financial and competitive pressures, may improve the efficiency and profitability of operations and better manage patients, employees and stakeholders by integrating smart mobile technology.

Enhancing a rainfall-runoff model to assess the impacts of BMPs and LID practices on storm runoff.

PubMed

Liu, Yaoze; Ahiablame, Laurent M; Bralts, Vincent F; Engel, Bernard A

2015-01-01

Best management practices (BMPs) and low impact development (LID) practices are increasingly being used as stormwater management techniques to reduce the impacts of urban development on hydrology and water quality. To assist planners and decision-makers at various stages of development projects (planning, implementation, and evaluation), user-friendly tools are needed to assess the effectiveness of BMPs and LID practices. This study describes a simple tool, the Long-Term Hydrologic Impact Assessment-LID (L-THIA-LID), which is enhanced with additional BMPs and LID practices, improved approaches to estimate hydrology and water quality, and representation of practices in series (meaning combined implementation). The tool was used to evaluate the performance of BMPs and LID practices individually and in series with 30 years of daily rainfall data in four types of idealized land use units and watersheds (low density residential, high density residential, industrial, and commercial). Simulation results were compared with the results of other published studies. The simulated results showed that reductions in runoff volume and pollutant loads after implementing BMPs and LID practices, both individually and in series, were comparable with the observed impacts of these practices. The L-THIA-LID 2.0 model is capable of assisting decision makers in evaluating environmental impacts of BMPs and LID practices, thereby improving the effectiveness of stormwater management decisions. Copyright © 2014 Elsevier Ltd. All rights reserved.

Empowering European communities to improve natural resource management for human well-being: the OPPLA web portal & communities of practice

NASA Astrophysics Data System (ADS)

Metzger, M.; Brown, C.; Pérez-Soba, M.; Rounsevell, M.; Verweij, P.; Delbaere, B.; Cojocaru, G.; Saarikoski, H.; Harrison, P.; Zellmer, K.

2014-12-01

The ecosystem services concept is seen by many as a useful paradigm to support decision-making at the complex interface between science, policy and practice. However, to be successful, it requires a strong willingness for collaboration and joint understanding. In support of this aspiration, OPPLA is being developed as a web portal to enable European communities to better manage ecosystems for human well-being and livelihoods. OPPLA will provide access to a variety of online resources such as tools, case studies, lessons learned, videos, manuals and training and educational materials. It will also provide expert forums and spaces for discussions between researchers, practitioners and decision makers. Hence a critical aspect of the success of OPPLA is the co-evolution of communities of practice. An example of a community of practice is the recently launched Ecosystem Services Community - Scotland (ESCom-Scotland; escomscotland.wordpress.com). ESCom-Scotland aims to support better management of Scotland's natural resources by helping to establish a community of practice between individuals and groups involved in the science, policy and practice behind sustainable ecosystem management. It aspires to encourage the sharing of ideas, increase collaboration and to initiate a support network for those engaging with the ecosystem services concept and it will use the OPPLA resources to support these activities. OPPLA is currently at the developmental stage and was instigated by two large European Commission funded research projects: OPERAs (www.operas-project.eu) and OpenNESS (www.openness-project.eu), with a combined budget of ca. €24m. These projects aim to improve understanding of how ecosystem services contribute to human well-being in different social-ecological systems. Research will establish whether, how and under what conditions the ecosystem services concept can move beyond the academic domain towards practical implementation in support of sustainable ecosystem management. New insights, and improved or novel tools and instruments, will be tested in practice in case studies that cover a range of socio-ecological systems across locales, sectors, scales and time. This presentation will discuss the development of OPPLA and the communities of practice that are emerging around it.

77 FR 59399 - The President's Management Advisory Board (PMAB); Notification of Upcoming Public Advisory Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-09-27

... Information Technology (IT) portfolio and project management, IT vendor performance management, Senior Executive Service (SES) leadership development and SES performance appraisal systems. More detailed... for the implementation of best business practices to improve Federal Government management and...

Best management practices for reducing nutrient loads in a sub-watershed of Chesapeake Bay

USDA-ARS?s Scientific Manuscript database

Water quality improvement in the Chesapeake Bay is a grave concern. An initiative to reduce the nutrient loads to stream has been undertaken to attain a target total maximum daily load (TMDL) at Chesapeake Bay. A general guideline with a set of best management practices (BMPs) has been in place for ...

Best management practices for reducing nutrient loads in a sub-watershed of Chesapeake Bay area

USDA-ARS?s Scientific Manuscript database

Water quality improvement in the Chesapeake Bay is a grave concern. An initiative to reduce the nutrient loads to stream has been undertaken to attain a target total maximum daily load (TMDL) at Chesapeake Bay. A general guideline with a set of best management practices (BMPs) has been in place for ...

Concussion Management in Community College Athletics: Revealing and Understanding the Gap between Knowledge and Practice

ERIC Educational Resources Information Center

Chinn, Nancy Resendes; Porter, Paul

2013-01-01

The seriousness of concussions in athletics is only recently becoming fully understood and appreciated. There are significant implications for the concussed student-athlete both in returning to the playing field and the classroom. Although practices are now in place to improve identification and management of concussions in professional sports,…

Improving work-life balance: what can employers and employees do?

PubMed

Herrera, Manuela

2013-12-14

Effective time management can play a big part in reducing stress for busy vets, but too often miscommunication between practice employers and employees can make it harder to achieve a good work-life balance. Manuela Herrera reports on a session at the BVA Congress which considered what vets can do to facilitate better time management in practice.

Improving waste segregation while reducing costs in a tertiary-care hospital in a lower-middle-income country in Central America.

PubMed

Johnson, Kyle M; González, Miriam L; Dueñas, Lourdes; Gamero, Mario; Relyea, George; Luque, Laura E; Caniza, Miguela A

2013-07-01

Healthcare waste (HCW) management and segregation are essential to ensure safety, environmental protection and cost control. Poor HCW management increase risks and costs for healthcare institutions. On-going surveillance and training are important to maintain good HCW practices. Our objectives were to evaluate and improve HCW practices at Hospital Bloom, San Salvador, El Salvador. We studied HCW disposal practices by observing waste containers, re-segregating waste placed in biohazardous waste bags, and administering a seven-itemsknowledge survey before and after training in waste management at Hospital Bloom. The training was based on national and international standards. We followed total biohazardous waste production before and after the training. The hospital staff was knowledgeable about waste segregation practices, but had poor compliance with national policies. Re-segregating waste in biohazardous waste bags showed that 61% of this waste was common waste, suggesting that the staff was possibly unaware of the cost of mis-segregating healthcare waste. After staff training in HCW management, the correct responses increased by 44% and biohazardous waste disposal at the hospital reduced by 48%. Better segregation of biohazardous waste and important savings can be obtained by HCW management education of hospital staff. Hospitals can benefit from maximising the use of available resources by sustaining best practices of HCW, especially those in hospitals in lower-middle-income countries.

Application of Strategic Management Principles as Tool to Improve Quality of Construction Technological Process

NASA Astrophysics Data System (ADS)

Kluchnikova, O.; Pobegaylov, O.

2017-11-01

The article focuses on the basic theory and practical aspects of the strategic management improving in terms of enhancing the quality of a technological process: these aspects have been proven experimentally by their introduction in company operations. The authors have worked out some proposals aimed at the selection of an optimal supplier for building companies as well as the algorithm for the analysis and optimization of a construction company basing on scientific and practical research as well as on the experimental data obtained in the experiment.

Integrated Practice Improvement Solutions-Practical Steps to Operating Room Management.

PubMed

Chernov, Mikhail; Pullockaran, Janet; Vick, Angela; Leyvi, Galina; Delphin, Ellise

2016-10-01

Perioperative productivity is a vital concern for surgeons, anesthesiologists, and administrators as the OR is a major source of hospital elective admissions and revenue. Based on elements of existing Practice Improvement Methodologies (PIMs), "Integrated Practice Improvement Solutions" (IPIS) is a practical and simple solution incorporating aspects of multiple management approaches into a single open source framework to increase OR efficiency and productivity by better utilization of existing resources. OR efficiency was measured both before and after IPIS implementation using the total number of cases versus room utilization, OR/anesthesia revenue and staff overtime (OT) costs. Other parameters of efficiency, such as the first case on-time start and the turnover time (TOT) were measured in parallel. IPIS implementation resulted in increased numbers of surgical procedures performed by an average of 10.7%, and OR and anesthesia revenue increases of 18.5% and 6.9%, respectively, with a simultaneous decrease in TOT (15%) and OT for anesthesia staff (26%). The number of perioperative adverse events was stable during the two-year study period which involved a total of 20,378 patients. IPIS, an effective and flexible practice improvement model, was designed to quickly, significantly, and sustainably improve OR efficiency by better utilization of existing resources. Success of its implementation directly correlates with the involvement of and acceptance by the entire OR team and hospital administration.

Information Resources Management.

ERIC Educational Resources Information Center

Bergeron, Pierrette

1996-01-01

Information, like other organizational resources, needs to be managed to help organizations improve productivity, competitiveness, and overall performance. Reviews developments (1986-96) in Information Resources Management (IRM). Examines the concept of IRM; IRM from information technology and integrative perspectives; IRM practices; IRM in the…

Manager's handbook for aspen in the north-central states.

Treesearch

Donald A. Perala

1977-01-01

Summarizes information on silvicultural practices to improve yields of timber, water, and wildlife, while minimizing unsightly manipulation of the landscape, for the aspen forest type. A management key outlines recommendations for given stand conditions and management objectives.

Increasing nursing treatment for pediatric procedural pain.

PubMed

Bice, April A; Gunther, Mary; Wyatt, Tami

2014-03-01

Procedural pain management is an underused practice in children. Despite the availability of efficacious treatments, many nurses do not provide adequate analgesia for painful interventions. Complementary therapies and nonpharmacologic interventions are additionally essential to managing pain. Owing to the increasing awareness of inadequate nursing utilization of pharmacologic measures for procedural pain, this paper focuses only on analgesic treatments. The aim of this review was to examine how varying degrees of quality improvement affect nursing utilization of treatments for routine pediatric procedural pain. A comprehensive search of databases including Cinahl, Medline/Pubmed, Web of Science, Google Scholar, Psycinfo, and Cochrane Library was performed. Sixty-two peer-reviewed research articles were examined. Ten articles focusing on quality improvement in pediatric pain management published in English from 2001 to 2011 were included. Three themes emerged: 1) increasing nursing knowledge; 2) nursing empowerment; and 3) protocol implementation. Research critique was completed with the use of guidelines and recommendations from Creswell (2009) and Garrard (2011). The literature reveals that nurses still think that pediatric pain management is essential. Quality improvement increases nursing utilization of procedural pain treatments. Although increasing nursing knowledge improves pediatric pain management, it appears that nursing empowerment and protocol implementation increase nursing compliance more than just education alone. Nurses providing pain management can enhance their individual practice with quality improvement measures that may increase nursing adherence to institutional and nationally recommended pediatric procedural pain management guidelines. Copyright © 2014 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

Health information technology: transforming chronic disease management and care transitions.

PubMed

Rao, Shaline; Brammer, Craig; McKethan, Aaron; Buntin, Melinda B

2012-06-01

Adoption of health information technology (HIT) is a key effort in improving care delivery, reducing costs of health care, and improving the quality of health care. Evidence from electronic health record (EHR) use suggests that HIT will play a significant role in transforming primary care practices and chronic disease management. This article shows that EHRs and HIT can be used effectively to manage chronic diseases, that HIT can facilitate communication and reduce efforts related to transitions in care, and that HIT can improve patient safety by increasing the information available to providers and patients, improving disease management and safety. Copyright © 2012 Elsevier Inc. All rights reserved.

Effectiveness of community-based mangrove management for sustainable resource use and livelihood support: A case study of four villages in Central Java, Indonesia.

PubMed

Damastuti, Ekaningrum; de Groot, Rudolf

2017-12-01

Community-Based Mangrove Management (CBMM) is implemented with different approaches and outcomes. This study examined the effectiveness of various CBMM practices to achieve sustainable management of mangrove resources. We analyzed local mangrove resource management strategies in four coastal villages (e.g. Sriwulan, Bedono, Timbulsloko, and Surodadi) on Central Java, Indonesia. Local data on institutions, socio-economic conditions and mangrove resources utilization was collected through participatory resource mapping and interviews with 16 key actors and 500 households. The main differences in CBMM-practices that affect the outcomes in each village were the type of community participation, the level of organizational and economic assistance from external institutions, the magnitude of the rehabilitation project, the time selected for rehabilitation and the maintenance strategies applied in each village. Surodadi achieved most in terms of both efficient resource utilization and local livelihood improvement. Bedono's management strategy was most effective in extending and maintaining the rehabilitated mangrove areas but less in terms of livelihood support while the strategy applied in Timbulsloko resulted in higher resource utilization compared to Surodadi. Sriwulan failed on most criteria. This study suggests that combining the management strategies practiced in Bedono and Surodadi and adding external scientific and technological assistance, income diversification, institutional reinforcement and continuous monitoring of the functioning of local institutions can improve the CBMM performance to sustainably manage mangrove resources and improve livelihoods. Copyright © 2017 Elsevier Ltd. All rights reserved.

Successful long-term maintenance following Nutrition Care Process Terminology implementation across a state-wide health-care system.

PubMed

Vivanti, Angela; O'Sullivan, Therese A; Porter, Jane; Hogg, Marion

2017-09-01

Three years following a state-wide Nutrition Care Process Terminology (NCPT) implementation project, the present study aimed to (i) assess changes in NCPT knowledge and attitudes, (ii) identify implementation barriers and enablers and (iii) seek managers' opinions post-implementation. Pre-implementation and three years post-implementation, all Queensland Government hospitals state-wide were invited to repeat a validated NCPT survey. Additionally, a separate survey sought dietetic managers' opinions regarding NCPT's use and acceptance, usefulness for patient care, role in service planning and continued use. A total of 238 dietitians completed the survey in 2011 and 82 dietitians in 2014. Use of diagnostic statement in the previous six months improved (P < 0.001). Perceptions of NCPT's importance (P < 0.020) and benefits of incorporating NCPT into practice (P = 0.029) increased. Time to complete NCPT documentation (P < 0.013) and access to mentors decreased (P < 0.001). Other areas including enhanced attitudes, familiarity, confidence, views, knowledge and incorporation into practice were sustained (P > 0.05). Key elements in sustaining NCPT implementation over three years included ongoing management support, workshops/tutorials, discussion and mentor and peer support. The most valued resources were pocket guides, ongoing workshops/tutorials and mentor support. Dietetic managers held many positive NCPT views, however, opinions differed around the usefulness of service planning, safer practice, improving patient care and facilitating communication. Some managers would not support NCPT unless it was recommended for practice. Immediate improvements following the NCPT implementation project were sustained over three years. Moving forward, a professional focus on continuing to incorporate NCPT into standard practice will provide structure for process and outcomes assessment. © 2017 State of Queensland. Nutrition and Dietetics © 2017 Dietitians Association of Australia.

[Opinion of the primary care veterinarians of Andalusia concerning the management of their professional practice].

PubMed

Conti Cuesta, F; Baena Parejo, M I; Pinzón Pulido, S A

1999-01-01

This study describes the opinion of the veterinarians in Andalusia regarding the organization and management of their professional practice and pinpoints solutions to the problems found for the purpose of providing planning and management aspects in view of the reforms undertaken in the Andalusian Health Service Strategy Plan. Descriptive opinion poll employing a questionnaire filled out by each individual among all of the Primary Care (PC) veterinarians in Andalusia (including those who have been currently employed who possess at least one year's experience, except substitutes). A description was provided of their personal traits, their opinion of the management-related factors involved in their professional practice. A description was also provided of the suggestions for improving the problems found to exist. Over 70% said they were aware of the objectives, although only the coordinators found them to be clearly motivating the practice. Their opinion was that the indicators of activity neither include any quality-related criteria nor afford the possibility of evaluating the activity they are carrying out. They believed that the contributions from other members of the multidisciplinary team improve their work and are in favor of continuing their involvement therein. They were satisfied with doing their work (the coordinators to a greater degree). They found the productivity pay to be too low and not useful as regards providing them with any incentive. They were not satisfied with the training with which they are provided and thought that what they are offered is far less than their other colleagues in the health care field. Most were of the opinion that they should remain under the authority of the Andalusian Health Service. This group prefers to continue working for the same organization, but improving the following management aspects: training offer, practice incentives and activity indicators.

Closing the gap-cardiovascular risk and primary prevention: results from the American College of Physicians quality improvement program.

PubMed

Snow, Vincenza; Reynolds, Cara Egan; Bennett, Lia; Weiss, Kevin B; Snooks, Qianna; Qaseem, Amir

2010-01-01

The objective was to study the impact of a practice-based quality improvement program on practice teams' care for patients who have increased risk of cardiovascular disease. A total of 54 team members from 18 internal medicine practices participated in an educational program that used a pre-post intervention study design and focused on measures related to cardiovascular risk factors. The program involved live instruction, faculty-led conference calls, practice data collection, and progress reports detailing practices' improvement strategies. Data on 817 patients were reported. Practices showed significant improvement in counseling for diet (70% to 78%), exercise (67% to 74%), and weight loss (64% to 72%). Use of aspirin (53% to 64%) and statins (83% to 89%) also showed significant improvement. Administration of flu vaccine increased significantly from 51% to 54%. Improvements in patient counseling and medication management, if sustained, should lead to fewer cardiovascular events. However, program duration did not allow the capture of outcomes measures improvement.

[The Aim and Scope of "Clinical Practice Guidelines for the Management of Kidney Disease in Cancer Survivors"].

PubMed

Horie, Shigeo

2017-03-01

Drug-induced nephron-toxicity hampers the effective cancer chemotherapy and impairs the quality of life of the patients. Now eGFR has substituted Ccr for the estimation of renal function. The concepts and clinical significance of CKD and AKI have been established. These progress of clinical nephrology can improve the management of cancer chemotherapy. Clinical practice guidelines for the management of kidney disease in cancer survivors supports health-related professional to practice based on the evidence, which will enhance the efficacy of the treatment and QOL of the cancer survivors.

Improvement in the management of gout is vital and overdue: an audit from a UK primary care medical practice

PubMed Central

2013-01-01

Background Gout is estimated to affect 1.4% of adults in the UK. Appropriate and timely management is essential to reduce the risk of further flares, complications, and to reduce cardiovascular disease risk. The British Society for Rheumatology and British Health Professionals in Rheumatology (BSR/BHPR) and the European League Against Rheumatism (EULAR) have published guidance regarding the management of gout, thereby providing standards against which performance can be measured. This audit was designed to assess the extent to which patients diagnosed with gout in one primary care medical practice in North Staffordshire, UK, are managed in accordance with current best practice guidelines, and to identify strategies for improvement where appropriate. Methods Audit criteria were derived from the EULAR and BSR/BHPR guidelines; standards were set arbitrarily, but with consideration of patient comorbidity and other factors which may influence concordance. An electronic search of the practice records was performed to identify adults with a diagnosis of gout. Medical record review with a descriptive analysis was undertaken to assess the extent to which medical management adhered to the predefined standards. Results Of the total ≥18 year-old practice population (n = 8686), 305 (3%) patient records included a diagnosis of gout. Of these, 74% (n = 226) had an electronic record of serum uric acid (SUA), and 11% (n = 34) and 53% (n = 162) a measure of estimated glomerular filtration rate (eGFR) ever and serum glucose since diagnosis respectively. 34% (n = 105) of patients had ever taken urate-lowering therapy with 25% (n = 77) currently prescribed this at the time of data extraction. Dose adjustment and monitoring of treatment according to SUA was found to be inadequate. Provision of lifestyle advice and consideration of comorbidities was also lacking. Conclusions The primary care management of gout in this practice was not concordant with national and international guidance, a finding consistent with previous studies. This demonstrates that the provision of guidelines alone is not sufficient to improve the quality of gout management and we identify possible strategies to increase guideline adherence. PMID:24225170

Problems and Opportunities in School Financial Management: A Consultant's Perspective.

ERIC Educational Resources Information Center

Chabotar, Kent John

1987-01-01

Summarizes major problems in school financial management and suggests practical improvements to aid external reporting of financial data and internal management. Sections of the article describe these categories of problems: (1) budget presentation; (2) management control; (3) cost accounting; and (4) financial reporting. (PS)

Relationships between evidence-based practice, quality improvement and clinical error experience of nurses in Korean hospitals.

PubMed

Hwang, Jee-In; Park, Hyeoun-Ae

2015-07-01

This study investigated individual and work-related factors associated with nurses' perceptions of evidence-based practice (EBP) and quality improvement (QI), and the relationships between evidence-based practice, quality improvement and clinical errors. Understanding the factors affecting evidence-based practice and quality improvement activities and their relationships with clinical errors is important for designing strategies to promote evidence-based practice, quality improvement and patient safety. A cross-sectional survey was conducted with 594 nurses in two Korean teaching hospitals using the evidence-based practice Questionnaire and quality improvement scale developed in this study. Four hundred and forty-three nurses (74.6%) returned the completed survey. Nurses' ages and educational levels were significantly associated with evidence-based practice scores whereas age and job position were associated with quality improvement scores. There were positive, moderate correlations between evidence-based practice and quality improvement scores. Nurses who had not made any clinical errors during the past 12 months had significantly higher quality improvement skills scores than those who had. The findings indicated the necessity of educational support regarding evidence-based practice and quality improvement for younger staff nurses who have no master degrees. Enhancing quality improvement skills may reduce clinical errors. Nurse managers should consider the characteristics of their staff when implementing educational and clinical strategies for evidence-based practice and quality improvement. © 2013 John Wiley & Sons Ltd.

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.

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community

PubMed Central

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-01-01

Problem Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Design and setting Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. Key measures for improvement The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a speciality clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Strategies for change Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. Effects of change A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. Lessons learnt A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders. PMID:16456203

Integrating clinical performance improvement across physician organizations: the PhyCor experience.

PubMed

Loeppke, R; Howell, J W

1999-02-01

There is a paucity of literature describing the implementation of clinical performance improvement (CPI) efforts across geographically dispersed multispecialty group practices and independent practice associations. PhyCor, a physician management company based in Nashville, Tennessee, has integrated CPI initiatives into its operating infrastructure. PhyCor CPI INITIATIVES: The strategic framework guiding PhyCor's CPI initiatives is built around a physician-driven, patient-centered model. Physician/administrator leadership teams develop and implement a clinical and financial strategic plan for performance improvement; adopt local clinical and operational performance indicators; and agree on and gain consensus with local physician champions to engage in CPI initiatives. The area/regional leadership councils integrate and coordinate regional medical management and CPI initiatives among local groups and independent practice associations. In addition to these councils and a national leadership council, condition-specific care management councils have also been established. These councils develop condition-specific protocols and outcome measures and lead the implementation of CPI initiatives at their own clinics. Key resources supporting CPI initiatives include information/knowledge management, education and training, and patient education and consumer decision support. Localized efforts in both the asthma care and diabetes management initiatives have led to some preliminary improvements in quality of care indicators. Physician leadership and strategic vision, CPI-oriented organizational infrastructure, broad-based physician involvement in CPI, providing access to performance data, parallel incentives, and creating a sense of urgency for accelerated change are all critical success factors to the implementation of CPI strategies at the local, regional, and national levels.

Consolidation of medical groups into physician practice management organizations.

PubMed

Robinson, J C

1998-01-14

Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality assurance. Physician practice management organizations and their affiliated medical groups face the challenge of continuing rapid growth, sustaining stock values, and improving practice efficiencies while maintaining the loyalty of physicians and patients.

Effects of a team-based assessment and intervention on patient safety culture in general practice: an open randomised controlled trial.

PubMed

Hoffmann, B; Müller, V; Rochon, J; Gondan, M; Müller, B; Albay, Z; Weppler, K; Leifermann, M; Mießner, C; Güthlin, C; Parker, D; Hofinger, G; Gerlach, F M

2014-01-01

The measurement of safety culture in healthcare is generally regarded as a first step towards improvement. Based on a self-assessment of safety culture, the Frankfurt Patient Safety Matrix (FraTrix) aims to enable healthcare teams to improve safety culture in their organisations. In this study we assessed the effects of FraTrix on safety culture in general practice. We conducted an open randomised controlled trial in 60 general practices. FraTrix was applied over a period of 9 months during three facilitated team sessions in intervention practices. At baseline and after 12 months, scores were allocated for safety culture as expressed in practice structure and processes (indicators), in safety climate and in patient safety incident reporting. The primary outcome was the indicator error management. During the team sessions, practice teams reflected on their safety culture and decided on about 10 actions per practice to improve it. After 12 months, no significant differences were found between intervention and control groups in terms of error management (competing probability=0.48, 95% CI 0.34 to 0.63, p=0.823), 11 further patient safety culture indicators and safety climate scales. Intervention practices showed better reporting of patient safety incidents, reflected in a higher number of incident reports (mean (SD) 4.85 (4.94) vs 3.10 (5.42), p=0.045) and incident reports of higher quality (scoring 2.27 (1.93) vs 1.49 (1.67), p=0.038) than control practices. Applied as a team-based instrument to assess safety culture, FraTrix did not lead to measurable improvements in error management. Comparable studies with more positive results had less robust study designs. In future research, validated combined methods to measure safety culture will be required. In addition, more attention should be paid to evaluation of process parameters. Implemented actions and incident reporting may be more appropriate target endpoints. German Clinical Trials Register (Deutsches Register Klinischer Studien, DRKS) No. DRKS00000145.

Illusion or delusion--Lean management in the health sector.

PubMed

McIntosh, Bryan; Sheppy, Bruce; Cohen, Ivan

2014-01-01

There has been considerable interest in the implementation of practices imported from manufacturing into healthcare as a solution to rising healthcare spending and disappointing patient safety indicators. One approach that has attracted particular interest is Lean management and the purpose of this paper is to engage with this topic. Secondary research. Despite widespread enthusiasm about the potential of Lean management processes, evidence about its contribution to higher organisational performance remains inconsistent. This paper engages with the major Lean concepts of operations management and human resource management, including just-in-time, total quality management, total productive maintenance and does not engage in-depth with concepts related to employee empowerment, and training This paper contributes to the organisational management literature in healthcare by showing that although Lean management seems to have the potential to improve organisational performance it is far from a panacea against under performing hospitals. It informs policy making by suggesting that a progressive managerial philosophy has a stronger impact on healthcare performance than the adoption of practices from any particular managerial approach. This paper provides a critical evaluation of the impact of Lean practices in informing healthcare policy. The paper contributes to the organisational management literature in healthcare by showing that even though Lean management in healthcare appears to have the potential to improve organisational performance; there remain problems with its application.

Management in the Ministry of Health: what are the vital signs?

PubMed

Benjamin, S; Ahmed, A A; al-Darazi, F

1997-01-01

Effective and efficient management of health services is becoming more and more important in all countries and in all organizations whether profit or non-profit. Management practices and attitudes which may have been accepted in previous years are no longer appropriate. A study was conducted in the Ministry of Health, State of Bahrain to determine the current status of management skills and attitudes. Participants were asked to identify the best and the worst practices of managers. Eight key areas of concern were identified: participative vs. non-participative style, communication, motivation, delegation, human relations skills, style of supervision, goal-oriented behavior, and use of supervisory power. In each of these management-related skill areas, examples of best and worst practices are provided in order to aid the manager/leader in self-assessing his/her abilities as a first step toward improving management.

From blood transfusion to patient blood management: a new paradigm for patient care and cost assessment of blood transfusion practice.

PubMed

Leahy, M F; Mukhtar, S A

2012-03-01

The ageing population in developed countries, including Australia, is putting increasing demands on blood transfusion services. With a falling donor pool there is likely to be a shortage of blood and blood products in the next 20 to 30 years unless there are significant changes in medical practice. The National Health and Medical Research Council/Australasian Society of Blood Transfusion Clinical Practice Guidelines on the Use of Blood Components from 2001 are being redeveloped by the National Health and Medical Research Council/Australian and New Zealand Society of Blood Transfusion as evidence-based patient-focused Patient Blood Management guidelines with the aim of improving patient outcomes by reducing inappropriate blood and blood product use and targeting therapies for improving the management of anaemia and coagulopathies. © 2012 The Authors. Internal Medicine Journal © 2012 Royal Australasian College of Physicians.

Resilient Practices in Maintaining Safety of Health Information Technologies

PubMed Central

Ash, Joan S.; Sittig, Dean F.; Singh, Hardeep

2014-01-01

Electronic health record systems (EHRs) can improve safety and reliability of health care, but they can also introduce new vulnerabilities by failing to accommodate changes within a dynamic EHR-enabled health care system. Continuous assessment and improvement is thus essential for achieving resilience in EHR-enabled health care systems. Given the rapid adoption of EHRs by many organizations that are still early in their experiences with EHR safety, it is important to understand practices for maintaining resilience used by organizations with a track record of success in EHR use. We conducted interviews about safety practices with 56 key informants (including information technology managers, chief medical information officers, physicians, and patient safety officers) at two large health care systems recognized as leaders in EHR use. We identified 156 references to resilience-related practices from 41 informants. Framework analysis generated five categories of resilient practices: (a) sensitivity to dynamics and interdependencies affecting risks, (b) basic monitoring and responding practices, (c) management of practices and resources for monitoring and responding, (d) sensitivity to risks beyond the horizon, and (e) reflecting on risks with the safety and quality control process itself. The categories reflect three functions that facilitate resilience: reflection, transcending boundaries, and involving sharp-end practitioners in safety management. PMID:25866492

Supporting chronic disease self-management: translating policies and principles into clinical practice.

PubMed

Higgins, Rosemary; Murphy, Barbara; Worcester, Marian; Daffey, Angela

2012-01-01

To support self-management, health professionals need to adopt a client-centred approach and learn to deliver evidence-based behaviour change interventions. This paper reports on the evaluation of 1- and 2-day training programs developed to improve health professionals' capacity to support chronic disease self-management (CDSM). The 321 participants attended one of eighteen supporting CDSM courses held in urban and rural settings. Participants included nurses, allied health professionals, Aboriginal health workers and general practitioners. Data were collected at three time points: before participation; immediately after the training; and, for a sub-sample of 37 participants, 2 months after the training. Results revealed a significant and sustained increase in CDSM self-efficacy following training regardless of participants' gender, age or qualifications. A thematic analysis of the responses concerning intended practice revealed four main areas of intended practice change, namely: use behavioural strategies; improve communication with clients; adopt a client-centred approach; and improve goal setting. The number of practice changes at 2 months reported by a sub-sample of participants ranged from 1 to 20 with a mean of 14 (s.d.=4). The three most common areas of practice change point to the adoption by health professionals of a collaborative approach with chronic disease patients. Lack of staff trained in CDSM was seen as a major barrier to practice change, with lack of support and finance also named as barriers to practice change. Participants identified that increased training, support and awareness of the principles of supporting CDSM would help to overcome barriers to practice change. These results indicate a readiness among health professionals to adopt a more collaborative approach given the skills and the tools to put this approach into practice.

Structural capabilities in small and medium-sized patient-centered medical homes.

PubMed

Alidina, Shehnaz; Schneider, Eric C; Singer, Sara J; Rosenthal, Meredith B

2014-07-01

1) Evaluate structural capabilities associated with the patient-centered medical home (PCMH) model in PCMH pilots in Colorado, Ohio, and Rhode Island; 2) evaluate changes in capabilities over 2 years in the Rhode Island pilot; and 3) evaluate facilitators and barriers to the adoption of capabilities. We assessed structural capabilities in the 30 pilot practices using a cross-sectional study design and examined changes over 2 years in 5 Rhode Island practices using a pre/post design. We used National Committee for Quality Assurance's Physician Practice Connections-Patient-Centered Medical Home (PPC/PCMH) accreditation survey data to measure capabilities. We stratified by high and low performance based on total score and by practice size. We analyzed change from baseline to 24 months for the Rhode Island practices. We analyzed qualitative data from interviews with practice leaders to identify facilitators and barriers to building capabilities. On average, practices scored 73 points (out of 100 points) for structural capabilities. High and low performers differed most on electronic prescribing, patient self-management, and care-management standards. Rhode Island practices averaged 42 points at baseline, and reached 90 points by the end of year 2. Some of the key facilitators that emerged were payment incentives, "transformation coaches," learning collaboratives, and data availability supporting performance management and quality improvement. Barriers to improvement included the extent of transformation required, technology shortcomings, slow cultural change, change fatigue, and lack of broader payment reform. For these early adopters, prevalence of structural capabilities was high, and performance was substantially improved for practices with initially lower capabilities. We conclude that building capabilities requires payment reform, attention to implementation, and cultural change.

Use of antipsychotic medications for the management of delirium: an audit of current practice in the acute care setting.

PubMed

Tropea, J; Slee, J; Holmes, A C N; Gorelik, A; Brand, C A

2009-02-01

Despite delirium being common in older hospitalized people, little is known about its management. The aims of this study are (1) to describe the pharmacological management of delirium in an acute care setting as a baseline measure prior to the implementation of newly developed Australian guidelines; and (2) to determine what areas of delirium pharmacological management need to be targeted for future practical guideline implementation and quality improvement activities. A medical record audit was conducted using a structured audit form. All patients aged 65 years and over who were admitted to a general medical or orthopaedic unit of the Royal Melbourne Hospital between 1 March 2006 and 28 February 2007 and coded with delirium were included. Data on the use of antipsychotic medications for the management of delirium in relation to best practice recommendations were assessed. Overall 174 episodes of care were included in the analysis. Antipsychotic medications were used for the management of most patients with severe behavioral and or emotional disturbance associated with delirium. There was variation in the prescribing patterns of antipsychotic agents and the documentation of medication management plans. Less than a quarter of patients prescribed antipsychotic medication were started on a low dose and very few were reviewed on a regular basis. A wide range of practice is seen in the use of antipsychotic agents to manage older patients with severe symptoms associated with delirium. The findings highlight the need to implement evidence-based guideline recommendations with a focus on improving the consistency in the pharmacological management and documentation processes.

The Relationship Between Provider Competence, Content Exposure, and Consumer Outcomes in Illness Management and Recovery Programs.

PubMed

McGuire, Alan B; White, Dominique A; Bartholomew, Tom; Flanagan, Mindy E; McGrew, John H; Rollins, Angela L; Mueser, Kim T; Salyers, Michelle P

2017-01-01

Provider competence may affect the impact of a practice. The current study examined this relationship in sixty-three providers engaging in Illness Management and Recovery with 236 consumers. Improving upon previous research, the present study utilized a psychometrically validated competence measure in the ratings of multiple Illness Management and Recovery sessions from community providers, and mapped outcomes onto the theory underlying the practice. Provider competence was positively associated with illness self-management and adaptive coping. Results also indicated baseline self-management skills and working alliance may affect the relationship between competence and outcomes.

A system of safety management practices and worker engagement for reducing and preventing accidents: an empirical and theoretical investigation.

PubMed

Wachter, Jan K; Yorio, Patrick L

2014-07-01

The overall research objective was to theoretically and empirically develop the ideas around a system of safety management practices (ten practices were elaborated), to test their relationship with objective safety statistics (such as accident rates), and to explore how these practices work to achieve positive safety results (accident prevention) through worker engagement. Data were collected using safety manager, supervisor and employee surveys designed to assess and link safety management system practices, employee perceptions resulting from existing practices, and safety performance outcomes. Results indicate the following: there is a significant negative relationship between the presence of ten individual safety management practices, as well as the composite of these practices, with accident rates; there is a significant negative relationship between the level of safety-focused worker emotional and cognitive engagement with accident rates; safety management systems and worker engagement levels can be used individually to predict accident rates; safety management systems can be used to predict worker engagement levels; and worker engagement levels act as mediators between the safety management system and safety performance outcomes (such as accident rates). Even though the presence of safety management system practices is linked with incident reduction and may represent a necessary first-step in accident prevention, safety performance may also depend on mediation by safety-focused cognitive and emotional engagement by workers. Thus, when organizations invest in a safety management system approach to reducing/preventing accidents and improving safety performance, they should also be concerned about winning over the minds and hearts of their workers through human performance-based safety management systems designed to promote and enhance worker engagement. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Skills to Pay the Bills: An Evaluation of an Effort to Help Nonprofits Manage Their Finances

ERIC Educational Resources Information Center

Walker, Karen; Grossman, Jean; Andrews, Kristine; Carrington, Nicholas; Rojas, Angela

2015-01-01

This study examines a Wallace Foundation-sponsored initiative aimed at improving the financial management skills and practices of 25 Chicago afterschool providers through training and coaching. Two models for this professional development were provided and each produced long-lasting improvements. Moreover, organizations receiving the…

Management of Hypertension in Private Practice: A Randomized Controlled Trial in Continuing Medical Education.

ERIC Educational Resources Information Center

Gullion, David S.; And Others

1988-01-01

A randomized control trial was used to evaluate a physician education program designed to improve physician management of patients' hypertension, hypertension-related behaviors, and diastolic blood pressure. It was suggested that more intensive continuing medical education programs are needed to improve physician performance and patient outcome.…

Improving the Resilience of Best Management Practices in a Changing Environment: Urban Stormwater Modeling Studies (Final Report)

EPA Science Inventory

The purpose of this report is to respond to EPA's identified need for an improved understanding of the potential impacts of changes in long term weather conditions on the occurrence and management of urban stormwater runoff. EPA conducted continuous simulation modeling of the hy...

Hypertension management initiative: qualitative results from implementing clinical practice guidelines in primary care through a facilitated practice program.

PubMed

Tobe, Sheldon W; Moy Lum-Kwong, Margaret; Von Sychowski, Shirley; Kandukur, Kishan

2013-05-01

The goal of the Hypertension Management Initiative (HMI) is to improve the management and control of hypertension by both primary care providers and patients. The HMI was in effect in 11 primary care sites across the province of Ontario, Canada. This was a qualitative study. Focus groups and a lobby survey were completed with a total of 199 of the 3934 patients enrolled in the study. Interviews with 41 participating health care providers from all sites were performed. A qualitative description approach was used to give a rich description of each informant's experiences. Patients expressed motivation and engagement in their own health care and became more knowledgeable about hypertension and how to manage it with their health care providers. Most reported satisfaction with the discipline of regular appointments and ongoing monitoring and counseling of the program including identifying and working on goals for their modifiable risk factors. Their health care providers felt the HMI program had a positive impact on the treatment and management of hypertension and also that it improved the functioning of the interprofessional team. The HMI helped to improve patient self-empowerment and self-management and also improved physicians' and nurses' confidence in diagnosing accurately and in hypertension management. Physician buy-in is key to maintaining clinical hypertension management. Interprofessional collaboration was improved for physicians and nurses but less so for pharmacists. Greater confidence among the nurses to manage hypertension more independently reduced demands on physician time. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

Best practices: applying management analysis of excellence to immunization.

PubMed

Wishner, Amy; Aronson, Jerold; Kohrt, Alan; Norton, Gary

2005-01-01

The authors applied business management tools to analyze and promote excellence and to evaluate differences between average and above-average immunization peformers in private practices. The authors conducted a pilot study of 10 private practices in Pennsylvania using tools common in management to assess practices' organizational climate and managerial style. Authoritative and coaching styles of physician leaders were common to both groups. Managerial styles that emphasized higher levels of clarity and responsibility managerial styles were evident in the large practices; and rewards and flexibility styles were higher in the small above-average practices. The findings of this pilot study match results seen in high performers in other industries. It concludes that the authoritative style appears to have the most impact on performance. It has interesting implications for training/behavior change to improve immunization rates, along with traditional medical interventions.

Development of a Repeatable Regional Protocol for Performance-Based Monitoring of Forestry Best Management Practices

Treesearch

Roger Ryder; Pamela J. Edwards; Pamela J. Edwards

2005-01-01

There has been a long-standing interest in improving Best Management Practice (BMP) monitoring within and among states. States monitoring the implementation and effectiveness of BMPs for forest operations take a variety of approaches. This creates inconsistencies in data collection and how results are reported. Since 1990 attempts have been made to develop a consistent...

Communicating Knowing through Communities of Practice: Exploring Internal Communicative Processes and Differences among CoPs

ERIC Educational Resources Information Center

Iverson, Joel O.; McPhee, Robert D.

2008-01-01

Knowing is an enacted, communicated process that is difficult to observe, let alone manage, in organizations. Communities of practice (CoPs) offer a productive solution for improving knowledge and knowledge management, but the communicative processes that enact CoPs have not been explored, leaving CoPs as an organizational black box. This research…

Modeling framework for representing long-term effectiveness of best management practices in addressing hydrology and water quality problems: Framework development and demonstraton using a Bayesian method

USDA-ARS?s Scientific Manuscript database

Best management practices (BMPs) are popular approaches used to improve hydrology and water quality. Uncertainties in BMP effectiveness over time may result in overestimating long-term efficiency in watershed planning strategies. To represent varying long-term BMP effectiveness in hydrologic/water q...

Water Management of Noninsulating and Insulating Sheathings

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

Smegal, J.; Lstiburek, J.

2012-04-01

There is an increasing market in liquid (or fluid) applied water management barriers for residential applications that could be used in place of tapes and other self-adhering membranes if applied correctly, especially around penetrations in the enclosure. This report discusses current best practices, recommends ways in which the best practices can be improved, and looks at some current laboratory testing and testing standards.

The Design of Management Practices To Improve the Physical Plant Maintenance of Southwest Texas Junior College.

ERIC Educational Resources Information Center

Box, Wilford Winston

A study was conducted of the physical plant maintenance department (PPMD) of Southwest Texas Junior College (SWTJC), in order to determine if the department was structured as a functional organization, if maintenance control procedures were in place, and if efficient management practices were being used. Consultations with the director of the PPMD…

Social acceptability of forest conditions and management practices: a problem analysis.

Treesearch

Bruce A. Shindler; Mark Brunson; George H. Stankey

2002-01-01

The purpose of this report is to improve understanding of the complex sociopolitical processes related to resource management and to help structure management response to conflict and contentiousness, misunderstanding among participants, and failed citizen-agency interactions. Public acceptance is essential to every resource management decision public agencies must...

Improving Field-Based Experimental Research to Compliment Contemporary Management

USDA-ARS?s Scientific Manuscript database

Rangeland management has long been described as both a science and an art (Stoddart et al. 1975). Certainly, the management of rangeland resources, especially during the last half of the 20th century, can be characterized as practices commonly informed by science. There are a number of management...

Managing Change To Improve Learning.

ERIC Educational Resources Information Center

Busher, Hugh

This document is a chapter in "The Principles and Practice of Educational Management," which aims to provide a systematic and analytical introduction to the study of educational management. The structure of the book reflects the main substantive areas of educational leadership and management, and most of the major themes are covered in the…

Personnel Management. Universities.

ERIC Educational Resources Information Center

Ohio Board of Regents, Columbus. Management Improvement Program.

This manual is one of 10 completed in the Ohio Management Improvement Program (MIP) during the 1971-73 biennium. In this project, Ohio's 34 public universities and colleges, in an effort directed and staffed by the Ohio Board of Regents, have developed manuals of management practices, in this case, concerning personnel management. Emphasis in this…

25 CFR 161.204 - How are carrying capacities and stocking rates established?

Code of Federal Regulations, 2010 CFR

2010-04-01

... be based on forage production, range utilization, the application of land management practices, and range improvements in place to achieve uniformity of grazing under sustained yield management principles... agricultural resource management plan and range unit management plan. (b) BIA, with the concurrence of the...

Defining a Progress Metric for CERT RMM Improvement

DTIC Science & Technology

2017-09-14

Table 1) should be used along with clear guidance on what is to be measured, to avoid subjective interpretations by different project managers . In some...products for each CERT-RMM practice. Project managers should be trained to help the organization improve the accuracy and consistency of its reporting...and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington, DC 20503. 1. AGENCY USE ONLY (Leave Blank) 2

Proceedings of the AMCP Partnership Forum: Breaking the Link Between Pain Management and Opioid Use Disorder.

PubMed

2015-12-01

Prescription drug misuse and abuse, especially with opioid analgesics, is the fastest growing drug problem in the United States. Addressing this public health crisis demands the coordinated efforts and actions of all stakeholders to establish a process of improving patient care and decreasing misuse and abuse. On September 9, 2014, the Academy of Managed Care Pharmacy (AMCP) convened a meeting of multiple stakeholders to recommend activities and programs that AMCP can promote to improve pain management, prevent opioid use disorder (OUD), and improve medication-assisted treatment outcomes. The speakers and panelists recommended that efforts to improve pain management outcomes and reduce the potential for OUD should rely on demonstrated evidence and best practices. It was recommended that AMCP promote a more holistic and evidence-based approach to pain management and OUD treatment that actively engages the patient in the decision-making process and includes care coordination with medical, pharmacy, behavioral, and mental health aspects of organizations, all of which is seamlessly supported by a technology infrastructure. To accomplish this, it was recommended that AMCP work to collaborate with organizations representing these stakeholders. Additionally, it was recommended that AMCP conduct continuing pharmacy education programs, develop a best practices toolkit on pain management, and actively promote quality standards for OUD prevention and treatment.

Ergonomic design for dental offices.

PubMed

Ahearn, David J; Sanders, Martha J; Turcotte, Claudia

2010-01-01

The increasing complexity of the dental office environment influences productivity and workflow for dental clinicians. Advances in technology, and with it the range of products needed to provide services, have led to sprawl in operatory setups and the potential for awkward postures for dental clinicians during the delivery of oral health services. Although ergonomics often addresses the prevention of musculoskeletal disorders for specific populations of workers, concepts of workflow and productivity are integral to improved practice in work environments. This article provides suggestions for improving workflow and productivity for dental clinicians. The article applies ergonomic principles to dental practice issues such as equipment and supply management, office design, and workflow management. Implications for improved ergonomic processes and future research are explored.

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.

Mutilating Procedures, Management Practices, and Housing Conditions That May Affect the Welfare of Farm Animals: Implications for Welfare Research.

PubMed

Nordquist, Rebecca E; van der Staay, Franz Josef; van Eerdenburg, Frank J C M; Velkers, Francisca C; Fijn, Lisa; Arndt, Saskia S

2017-02-21

A number of mutilating procedures, such as dehorning in cattle and goats and beak trimming in laying hens, are common in farm animal husbandry systems in an attempt to prevent or solve problems, such as injuries from horns or feather pecking. These procedures and other practices, such as early maternal separation, overcrowding, and barren housing conditions, raise concerns about animal welfare. Efforts to ensure or improve animal welfare involve adapting the animal to its environment, i.e., by selective breeding (e.g., by selecting "robust" animals) adapting the environment to the animal (e.g., by developing social housing systems in which aggressive encounters are reduced to a minimum), or both. We propose adapting the environment to the animals by improving management practices and housing conditions, and by abandoning mutilating procedures. This approach requires the active involvement of all stakeholders: veterinarians and animal scientists, the industrial farming sector, the food processing and supply chain, and consumers of animal-derived products. Although scientific evidence about the welfare effects of current practices in farming such as mutilating procedures, management practices, and housing conditions is steadily growing, the gain in knowledge needs a boost through more scientific research. Considering the huge number of animals whose welfare is affected, all possible effort must be made to improve their welfare as quickly as possible in order to ban welfare-compromising procedures and practices as soon as possible.

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

PubMed

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

Improvement of nuclear power plants within the perspective of applications of lean manufacturing practices

NASA Astrophysics Data System (ADS)

Malek, A. K.; Muhammad, H. I.; Rosmaini, A.; Alaa, A. S.; Falah, A. M.

2017-09-01

Development and improvement process are essential to the companies and factories of various kinds and this necessity is related aspects of cost, time and risk that can be avoided, these aspects are available at the nuclear power stations essential demands cannot be ignored. The lean management technique is one of the recent trends in the management system. Where the lean management is stated as the system increases the customer value and reduces the wastage process in an industry or in a power plants. Therefore, there is an urgent necessity to ensure the development and improvement in nuclear power plants in the pre-established in process of being established and stage of the management and production. All of these stages according to the study are closely related to the necessity operationalize and apply lean manufacturing practices that these applications are ineffective and clear contribution to reduce costs and control of production processes and the process of reducing future risks that could be exposed to the station.

Improving nurses' perceptions of competency in diabetes self-management education through the use of simulation and problem-based learning.

PubMed

Tschannen, Dana; Aebersold, Michelle; Sauter, Cecilia; Funnell, Martha M

2013-06-01

Nurses who provide case management can improve care practice and outcomes among patients who have type 2 diabetes through appropriate training and systems of care. This study was conducted to improve ambulatory care nurses' perceptions of competency in empowerment-based skills required for diabetes self-management education after participation in a multifaceted educational session that included problem-based learning and simulation. After participation in the multifaceted educational session, nurses (n = 21) perceived that the education provided an excellent opportunity for knowledge uptake and applicability to their respective work settings. The learning strategies provided opportunities for engagement in a safe and relaxed atmosphere. The simulation experience allowed participants to deliberately practice the competencies. These nurses considered this a very effective learning activity. Through the use of problem-based learning and simulation, nurses may be able to more efficiently and effectively develop the necessary skills to provide effective case management of chronic disease. Copyright 2013, SLACK Incorporated.

A tale of four practices.

PubMed

Miller-Day, Michelle; Applequist, Janelle; Zabokrtsky, Keri; Dalton, Alexandra; Kellom, Katherine; Gabbay, Robert; Cronholm, Peter F

2017-09-18

Purpose The Patient-Centered Medical Home (PCMH) has become a dominant model of primary care re-design. This transformation presents a challenge to many care delivery organizations. The purpose of this paper is to describe attributes shaping successful and unsuccessful practice transformation within four medical practice groups. Design/methodology/approach As part of a larger study of 25 practices transitioning into a PCMH, the current study focused on diabetes care and identified high- and low-improvement medical practices in terms of quantitative patient measures of glycosylated hemoglobin and qualitative assessments of practice performance. A subset of the top two high-improvement and bottom two low-improvement practices were identified as comparison groups. Semi-structured interviews were conducted with diverse personnel at these practices to investigate their experiences with practice transformation and data were analyzed using analytic induction. Findings Results show a variety of key attributes facilitating more successful PCMH transformation, such as empanelment, shared goals and regular meetings, and a clear understanding of PCMH transformation purposes, goals, and benefits, providing care/case management services, and facilitating patient reminders. Several barriers also exist to successful transformation, such as low levels of resources to handle financial expense, lack of understanding PCMH transformation purposes, goals, and benefits, inadequate training and management of technology, and low team cohesion. Originality/value Few studies qualitatively compare and contrast high and low performing practices to illuminate the experience of practice transformation. These findings highlight the experience of organizational members and their challenges in practice transformation while providing quality diabetes care.

Quality-Focused Management.

ERIC Educational Resources Information Center

Needham, Robbie Lee

1993-01-01

Presents the quality-focused management (QFM) system and explains the departure QFM makes from established community college management practices. Describes the system's self-directed teams engaged in a continuous improvement process driven by customer demand and long-term commitment to quality and cost control. (13 references.) (MAB)

75 FR 13429 - Unfair Labor Practice Proceedings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-22

...-Management Relations Statute (Statute). The revisions also clarify certain administrative matters relating to... strengthen labor-management relationships that will aid in resolving disputes short of litigation. These... Creating Labor-Management Forums to Improve Delivery of Government Services, issued on December 9, 2009 by...

75 FR 5003 - Unfair Labor Practice Proceedings

Federal Register 2010, 2011, 2012, 2013, 2014

2010-02-01

...-Management Relations Statute (Statute). The revisions also clarify certain administrative matters relating to... strengthen labor-management relationships that will aid in resolving disputes short of litigation. These... Creating Labor-Management Forums to Improve Delivery of Government Services, issued on December 9, 2009, by...

Translating Change into Improved Practice: Analysis of Teachers' Attempts to Generate a New Emerging Pedagogy in Scotland

ERIC Educational Resources Information Center

Thorburn, Malcolm; Carse, Nicola; Jess, Mike; Atencio, Matthew

2011-01-01

In Scotland, substantial changes in the management of education at national, local authority and school/community levels are afoot. Central to future improvements are how teachers translate curriculum guidelines, with an increased focus on health and wellbeing and holistic learning experiences, into constructivist inclined pedagogical practices.…

Data Use Practices for Improved Mathematics Teaching and Learning: The Importance of Productive Dissonance and Recurring Feedback Cycles

ERIC Educational Resources Information Center

Christman, Jolley Bruce; Ebby, Caroline B.; Edmunds, Kimberly A.

2016-01-01

Background: A growing number of studies argue that data use practices in schools have not sufficiently attended to teachers' learning about students, subject matter, and instruction. The result has been changes in instructional management (e.g., student grouping, assignment of students to tutoring) rather than instructional improvement. Further,…

The research and practice of spacecraft software engineering

NASA Astrophysics Data System (ADS)

Chen, Chengxin; Wang, Jinghua; Xu, Xiaoguang

2017-06-01

In order to ensure the safety and reliability of spacecraft software products, it is necessary to execute engineering management. Firstly, the paper introduces the problems of unsystematic planning, uncertain classified management and uncontinuous improved mechanism in domestic and foreign spacecraft software engineering management. Then, it proposes a solution for software engineering management based on system-integrated ideology in the perspective of spacecraft system. Finally, a application result of spacecraft is given as an example. The research can provides a reference for executing spacecraft software engineering management and improving software product quality.

A social-ecological systems approach for environmental management.

PubMed

Virapongse, Arika; Brooks, Samantha; Metcalf, Elizabeth Covelli; Zedalis, Morgan; Gosz, Jim; Kliskey, Andrew; Alessa, Lilian

2016-08-01

Urgent environmental issues are testing the limits of current management approaches and pushing demand for innovative approaches that integrate across traditional disciplinary boundaries. Practitioners, scholars, and policy-makers alike call for increased integration of natural and social sciences to develop new approaches that address the range of ecological and societal impacts of modern environmental issues. From a theoretical perspective, social-ecological systems (SES) science offers a compelling approach for improved environmental management through the application of transdisciplinary and resilience concepts. A framework for translating SES theory into practice, however, is lacking. In this paper, we define the key components of an SES-based environmental management approach. We offer recommendations for integrating an SES approach into existing environmental management practices. Results presented are useful for management professionals that seek to employ an SES environmental management approach and scholars aiming to advance the theoretical foundations of SES science for practical application. Published by Elsevier Ltd.

Comparing Practice Management Courses in Canadian Dental Schools.

PubMed

Schonwetter, Dieter J; Schwartz, Barry

2018-05-01

Practice management has become an increasingly important aspect of dental education over the years in order to better prepare students for the reality of practice. The aim of this study was to quantify and describe practice management courses taught at the ten Canadian dental schools in order to identify common approaches, compare hours, determine types of instructors, and assess the relationship between courses' learning objectives and the Association of Canadian Faculties of Dentistry (ACFD) competencies and Bloom's cognitive levels. The academic deans at these ten schools were surveyed in 2016; all ten schools responded for a 100% response rate. The authors also gathered syllabi and descriptions of the courses and analyzed them for themes. The results showed a total of 22 practice management courses in the ten Canadian dental schools. The courses provided 27 to 109 hours of teaching and were mostly taught in the third and fourth years and by dentists on three main topics: ethics, human resource management, and running a private practice. The courses were correlated to the ACFD competencies related to ethics, professionalism, application of basic principles of business practices, and effective interpersonal communication. Most of the courses' learning objectives addressed comprehension and knowledge in Bloom's cognitive levels of learning. These results can help to guide discussions on how practice management courses can be developed, improved, and refined to meet the challenges of preparing students for dental practice.

Maternal-Fetal Medicine Physician and Fellow Perceptions of Business in Medicine.

PubMed

Porter, Blake; Iriye, Brian; Ghamsary, Mark

2018-01-01

 Principles of practice management provide a foundation for clinical success and performance improvement. Scant data exist regarding maternal-fetal medicine (MFM) physicians' knowledge of these topics. We hypothesize that physicians enter practice with inadequate education in practice management.  Surveys were emailed to members of the Society for Maternal-Fetal Medicine rating their knowledge and capabilities in practice management topics, and respondents assessed their current institution's business in the medical curriculum.  A total of 325 (14.4%) physicians responded: 63 fellows in training and 262 MFM physician subspecialists. Practicing physicians reported learning most of their knowledge "in practice after fellowship" (85%) or "never at all" (10%). Only 3% of respondents had adequate business education during fellowship, and only 5% felt prepared to teach business principles. However, 85% of those surveyed agreed that this material should be taught during the fellowship. Among MFM subspecialists and fellows in training at institutions with fellowships, 60% reported no current curriculum for practice management, and those with current curricula reported it had "limited" or "no value" (76%).  There is a significant desire for practice management curricula during MFM fellowship, and current training is insufficient. With many MFM physicians ill-prepared to teach these principles, professional education from other financial fields, and standardized education in practice management from current expert sources is needed. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Improving EHR Capabilities to Facilitate Stage 3 Meaningful Use Care Coordination Criteria.

PubMed

Cross, Dori A; Cohen, Genna R; Nong, Paige; Day, Anya-Victoria; Vibbert, Danielle; Naraharisetti, Ramya; Adler-Milstein, Julia

Primary care practices have been limited in their ability to leverage electronic health records (EHRs) and health information exchange (HIE) to improve care coordination, but will soon be incentivized to do so under proposed Stage 3 meaningful use criteria. We use mixed methods to understand how primary care practices manage, share and reconcile electronic patient information across care settings, and identify innovations in EHR design to support enhanced care coordination. Opportunities identified by practices focused on availability and usability of features that facilitate (1) generation of customized summary of care records, (2) team-based care approaches, and (3) management of the increased volume of electronic information generated and exchanged during care transitions. More broadly, vendors and policymakers need to continue to work together to improve interoperability as the key to effective care coordination. If these EHR innovations were widespread, the value of meeting the proposed Stage 3 care coordination criteria would be substantially enhanced.

Implementation of cold risk management in occupational safety, occupational health and quality practices. Evaluation of a development process and its effects at the finnish maritime administration.

PubMed

Risikko, Tanja; Remes, Jouko; Hassi, Juhani

2008-01-01

Cold is a typical environmental risk factor in outdoor work in northern regions. It should be taken into account in a company's occupational safety, health and quality systems. A development process for improving cold risk management at the Finnish Maritime Administration (FMA) was carried out by FMA and external experts. FMA was to implement it. Three years after the development phase, the outcomes and implementation were evaluated. The study shows increased awareness about cold work and few concrete improvements. Concrete improvements in occupational safety and health practices could be seen in the pilot group. However, organization-wide implementation was insufficient, the main reasons being no organization-wide practices, unclear process ownership, no resources and a major reorganization process. The study shows a clear need for expertise supporting implementation. The study also presents a matrix for analyzing the process.

Partnering with patients to promote holistic diabetes management: changing paradigms.

PubMed

Lorenzo, Lenora

2013-07-01

To provide a review of best practice for clinical management of diabetes mellitus (DM) for nurse practitioners (NPs) and accelerate incorporation of key findings into current practice. A search was conducted in Pub Med, Ovid, CINAHL, and Cochrane's Database of Systematic Reviews. There are many challenges for DM care identified in the current health system. There is a great need to change care paradigms to engage patients in partnership for enhanced management and self-management in DM. A review of the best practice evidence revealed numerous models of care, strategies, and tools available to enhance diabetes care and promote health and well-being. The primary focus of this article is to engage NP clinicians to incorporate new strategies to augment management and improve clinical outcomes. Incorporation of best practice for DM management may accelerate the paradigm shift to more patient-focused care. Engaged, informed, and activated patients along with clinicians working in partnerships may enhance clinical outcomes. ©2013 The Author ©2013 American Association of Nurse Practitioners.

Improving the management and referral of patients with transient ischaemic attacks: a change strategy for a health community.

PubMed

Wright, J; Harrison, S; McGeorge, M; Patterson, C; Russell, I; Russell, D; Small, N; Taylor, M; Walsh, M; Warren, E; Young, J

2006-02-01

Rapid referral and management of patients with transient ischaemic attacks is a key component in the national strategy for stroke prevention. However, patients with transient ischaemic attacks are poorly identified and undertreated. Before and after evaluation of quality improvement programme with controlled comparison in three primary care trusts reflecting diverse populations and organisational structures in an urban district in the North of England. The proportion of patients receiving antiplatelet drugs and safe driving advice on referral to a specialty clinic, and the numbers of referrals, adjusted for age, to the specialist clinic before and after the improvement programme. Interviews with patient and professionals to identify gaps and barriers to good practice; development of evidence based guidelines for the management of patients with transient ischaemic attacks; interactive multidisciplinary workshops for each primary care trust with feedback of individual audit results of referral practice; outreach visits to teams who were unable to attend the workshops; referral templates and desktop summaries to provide reminders of the guidelines to clinicians; incorporation of standards into professional contracts. A significant improvement occurred in identification and referral of patients with transient ischaemic attacks to specialist clinics, with a 41% increase in referrals from trained practices compared with control practices. There were also significant improvements in the early treatment and safety advice provided to patients before referral. A strategic approach to effective quality improvement across a diverse health community is feasible and achievable. Careful planning with patient and professional involvement to develop a tailored and multifaceted quality improvement programme to implement evidence based practice can work in very different primary care settings. Key components of the effectiveness of the model include contextual analysis, strong professional support, clear recommendations based on robust evidence, simplicity of adoption, good communication, and use of established networks and opinion leaders.

Defining and improving quality management in Dutch diabetes care groups and outpatient clinics: design of the study

PubMed Central

2013-01-01

Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries as well. PMID:23561032

A regional programme to improve skin cancer management.

PubMed

McGeoch, Graham R; Sycamore, Mark J; Shand, Brett I; Simcock, Jeremy W

2015-12-01

In 2008, public specialist and general practice services in Canterbury were unable to manage demand for skin cancer treatment. Local clinicians decided the solution was to develop a see-and-treat skin excision clinic staffed by plastic surgeons and general practitioners (GPs), and the introduction of subsidised excisions in general practice. This paper describes the collaboration between clinicians, managers and funders and the results and quality management measures of these initiatives. There is an increasing incidence of skin cancer. GPs in Canterbury were unable to meet increasing demand for skin cancer treatment because some lacked confidence and competence in skin cancer management. There was no public funding for primary care management of skin cancer, driving patients to fully funded secondary care services. Secondary care services were at capacity, with no coordinated programme across primary and secondary care. The programme has resulted in a greater number of skin cancers being treated by the public health system, a reduction in waiting times for treatment, and fewer minor skin lesions being referred to secondary care. Quality measures have been achieved and are improving steadily. Development of the programme has improved working relationships between primary and secondary care clinicians. The strategy was to facilitate the working relationship between primary and secondary care and increase the capacity for skin lesion excisions in both sectors. Skin cancer management can be improved by a coordinated approach between primary and secondary care.

A study of the effects of implementing agricultural best management practices and in-stream restoration on suspended sediment, stream habitat, and benthic macroinvertebrates at three stream sites in Surry County, North Carolina, 2004-2007-Lessons learned

USGS Publications Warehouse

Smith, Douglas G.; Ferrell, G.M.; Harned, Douglas A.; Cuffney, Thomas F.

2011-01-01

The effects of agricultural best management practices and in-stream restoration on suspended-sediment concentrations, stream habitat, and benthic macroinvertebrate assemblages were examined in a comparative study of three small, rural stream basins in the Piedmont and Blue Ridge Physiographic Provinces of North Carolina and Virginia between 2004 and 2007. The study was designed to assess changes in stream quality associated with stream-improvement efforts at two sites in comparison to a control site (Hogan Creek), for which no improvements were planned. In the drainage basin of one of the stream-improvement sites (Bull Creek), several agricultural best management practices, primarily designed to limit cattle access to streams, were implemented during this study. In the drainage basin of the second stream-improvement site (Pauls Creek), a 1,600-foot reach of the stream channel was restored and several agricultural best management practices were implemented. Streamflow conditions in the vicinity of the study area were similar to or less than the long-term annual mean streamflows during the study. Precipitation during the study period also was less than normal, and the geographic distribution of precipitation indicated drier conditions in the southern part of the study area than in the northern part. Dry conditions during much of the study limited opportunities for acquiring high-flow sediment samples and streamflow measurements. Suspended-sediment yields for the three basins were compared to yield estimates for streams in the southeastern United States. Concentrations of suspended sediment and nutrients in samples from Bull Creek, the site where best management practices were implemented, were high compared to the other two sites. No statistically significant change in suspended-sediment concentrations occurred at the Bull Creek site following implementation of best management practices. However, data collected before and after channel stabilization at the Pauls Creek site indicated a statistically significant (p<0.05) decrease in suspended-sediment discharge following in-stream restoration. Stream habitat characteristics were similar at the Bull Creek and Hogan Creek reaches. However, the Pauls Creek reach was distinguished from the other two sites by a lack of pools, greater bankfull widths, greater streamflow and velocity, and larger basin size. Historical changes in the stream channel in the vicinity of the Pauls Creek streamgage are evident in aerial photographs dating from 1936 to 2005 and could have contributed to stream-channel instability. The duration of this study likely was inadequate for detecting changes in stream habitat characteristics. Benthic macroinvertebrate assemblages differed by site and changed during the course of the study. Bull Creek, the best management practices site, stood out as the site having the poorest overall conditions and the greatest improvement in benthic macroinvertebrate communities during the study period. Richness and diversity metrics indicated that benthic macroinvertebrate community conditions at the Hogan Creek and Pauls Creek sites declined during the study, although the status was excellent based on the North Carolina Index of Biotic Integrity. Experiences encountered during this study exemplify the difficulties of attempting to assess the short-term effects of stream-improvement efforts on a watershed scale and, in particular, the difficulty of finding similar basins for a comparative study. Data interpretation was complicated by dry climatic conditions and unanticipated land disturbances that occurred during the study in each of the three study basins. For example, agricultural best management practices were implemented in the drainage basin of the control site prior to and during the study. An impoundment on Bull Creek upstream from the streamgaging station probably influenced water-quality conditions and streamflow. Road construction in the vicinity of the Pauls Creek site potentially masked changes related to stream-improvement efforts. In addition, stream-improvement activities occurred in each of the three study basins over a period of several years prior to and during the study so that there were no discrete before and after periods available for meaningful comparisons. Historical and current land-use activities in each of the three study basins likely affected observed stream conditions. The duration of this study probably was insufficient to detect changes associated with agricultural best management practices and stream-channel restoration.

78 FR 9917 - The President's Management Advisory Board (PMAB); Notification of Upcoming Public Advisory Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

...) portfolio and project management; Senior Executive Service (SES) leadership development and SES performance... effective strategies for the implementation of best business practices to improve Federal Government...

Integrating Emerging Data Sources Into Operational Practice

DOT National Transportation Integrated Search

2018-05-15

Agencies have the potential to collect, use, and share data from connected and automated vehicles (CAV), connected travelers, and connected infrastructure elements to improve the performance of their traffic management systems and traffic management ...

Farmer Heroes Manage Nutrients On Farm

EPA Pesticide Factsheets

These featured farmers have been identified by the National Association of Conservation Districts and EPA for implementing specific best management practices to reduce pollution while also improving or sustaining their profits, soil quality or yields.

[Benchmarking in ambulatory care practices--The European Practice Assessment (EPA)].

PubMed

Szecsenyi, Joachim; Broge, Björn; Willms, Sara; Brodowski, Marc; Götz, Katja

2011-01-01

The European Practice Assessment (EPA) is a comprehensive quality management which consists of 220 indicators covering 5 domains (infrastructure, people, information, finance, and quality and safety). The aim of the project presented was to evaluate EPA as an instrument for benchmarking in ambulatory care practices. A before-and-after design with a comparison group was chosen. One hundred and two practices conducted EPA at baseline (t1) and at the 3-year follow-up (t2). A further 209 practices began EPA at t2 (comparison group). Since both practice groups differed in several variables (age of GP, location and size of practice), a matched-pair design based on propensity scores was applied leading to a subgroup of 102 comparable practices (out of the 209 practices). Data analysis was carried out using Z scores of the EPA domains. The results showed significant improvements in all domains between t1 and t2 as well as between the comparison group and t2. Furthermore, the results demonstrate that the implementation of total quality management and the re-assessment of the EPA procedure can lead to significant improvements in almost all domains. Copyright © 2011. Published by Elsevier GmbH.

Outsourcing your medical practice call center: how to choose a vendor to ensure regulatory compliance.

PubMed

Johnson, Bill

2014-01-01

Medical practices receive hundreds if not thousands of calls every week from patients, payers, pharmacies, and others. Outsourcing call centers can be a smart move to improve efficiency, lower costs, improve customer care, ensure proper payer management, and ensure regulatory compliance. This article discusses how to know when it's time to move to an outsourced call center, the benefits of making the move, how to choose the right call center, and how to make the transition. It also provides tips on how to manage the call center to ensure the objectives are being met.

Respiratory therapies for amyotrophic lateral sclerosis: a primer.

PubMed

Gruis, Kirsten L; Lechtzin, Noah

2012-09-01

Respiratory complications are a common cause of morbidity and mortality in amyotrophic lateral sclerosis (ALS). Treatment of respiratory insufficiency with noninvasive ventilation (NIV) improves ALS patients' quality of life and survival. Evidence-based practice guidelines for the management of ALS patients recommend treatment of respiratory insufficiency with NIV as well as consideration of insufflation/exsufflation to improve clearance of airway secretions. Despite these recommendations respiratory therapies remain underused. In this review we provide a practical guide for the clinician to prescribe and manage respiratory therapies for the patient with ALS. Copyright © 2012 Wiley Periodicals, Inc.

Developing effective child psychiatry collaboration with primary care: leadership and management strategies.

PubMed

Sarvet, Barry D; Wegner, Lynn

2010-01-01

By working in collaboration with pediatric primary care providers, child and adolescent psychiatrists have the opportunity to address significant levels of unmet need for the majority of children and teenagers with serious mental health problems who have been unable to gain access to care. Effective collaboration with primary care represents a significant change from practice-as-usual for many child and adolescent psychiatrists. Implementation of progressive levels of collaborative practice, from the improvement of provider communication through the development of comprehensive collaborative systems, may be possible with sustained management efforts and application of process improvement methodology.

Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles

2014-11-25

Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies. Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

Organization, management, implementation and value of ehr implementation in a solo pediatric practice.

PubMed

Cooper, Jeffrey D

2004-01-01

This case study-based on this practice's application for the 2003 HIMSS Davies Award for Primary Care-describes the processes, costs and benefits of the implementation of an EHR in a solo practice. The organization, management and value of an EHR implementation is described, as well as a description of the physician's 15 business objectives, which shows how each objective was met and to what degree and gives specific financial data. An EHR that is implemented in a small practice improves quality of patient care, office efficiency and patient safety. A small practice can realize significant ROI from an EHR.

Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.

PubMed

Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao

2018-02-01

To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.

Effects of flow sheet implementation on physician performance in the management of asthmatic patients.

PubMed

Ruoff, Gary

2002-01-01

This project focused on increasing compliance, in a large family practice group, with quality indicators for the management of asthma. The objective was to determine if use of a flow sheet incorporating the Global Initiative for Asthma (GINA) guidelines could improve compliance with those guidelines if the flow sheet was placed in patients' medical records. After review and selection of 14 clinical quality indicators, physicians in the practice implemented a flow sheet as an intervention. These flow sheets were inserted into the records of 122 randomly selected patients with asthma. Medical records were reviewed before the flow sheets were placed in the records, and again approximately 6 months later, to determine if there was a change in compliance with the quality indicators. Improvement of documentation was demonstrated in 13 of the 14 quality indicators. The results indicate that compliance with asthma management quality indicators can improve with the use of a flow sheet.

Evaluating the green practice of food service supply chain management based on fuzzy DEMATEL-ANP model

NASA Astrophysics Data System (ADS)

Li, Xiaoying; Zhu, Qinghua

2017-01-01

The question on how to evaluate a company's green practice has recently become a key strategic consideration for the food service supply chain management. This paper proposed a novel hybrid model that combines a fuzzy Decision Making Trial And Evaluation Laboratory(DEMATEL) and Analysis Network Process(ANP) methods, which developed the green restaurant criteria and demonstrated the complicated relations among various criteria to help the food service operation to better analyze the real-world situation and determine the different weight value of the criteria .The analysis of the evaluation of green practices will help the food service operation to be clear about the key measures of green practice to improve supply chain management.

Tools of the trade: Improving nurses' ability to access and evaluate research.

PubMed

Sleutel, Martha R; Bullion, John W; Sullivan, Ronnie

2018-03-01

To evaluate the effect of a manager-required RN competency on staff nurses' perceived knowledge, ability and frequency of information-seeking activities. Basing clinical practice on research and standards of care is essential to delivering appropriate care with optimal outcomes. Nurses' information-seeking abilities are critical for acquiring evidence-based answers to aid clinical decision-making, yet nurses under-utilize library resources and report barriers. A unit manager sought to test the effect of an innovative competency for acquiring and appraising evidence for practice. This longitudinal descriptive study evaluated 28 nurses before and after a 1-hr class, as well as 5 months later. The class covered library information services and the basics of critiquing research articles. Nurses had statistically significant improvements in four of five items measuring knowledge/ability and four of five items measuring frequency of information-seeking activities. At 5 months, most knowledge/ability items increased. There was no effect of nurse characteristics on outcomes. A required competency improved nurses' knowledge, ability and frequency of acquiring and appraising evidence with a single 1-hr class and a hands-on practice activity. Unit managers can have great impact on nurses' use of evidence for practice. © 2018 John Wiley & Sons Ltd.

Management Attitudes toward Productivity.

ERIC Educational Resources Information Center

Chamber of Commerce of the United States, Washington, DC.

In an attempt to discover management attitudes toward productivity, including management's views about worker attitudes and their motivation, managerial practices and organization, and possible changes to effect improvements in productivity, the United States Chamber of Commerce surveyed a sample of 1,870 top business executives across the country…

Turning Knowledge into Success: The Role of Collaboration in Knowledge Management Implementation

ERIC Educational Resources Information Center

Hizmetli, Handan

2014-01-01

This case study describes five phases that a community college went through in developing its use of knowledge management practices to improve their student outcomes and recommends how other colleges can similarly benefit from knowledge management in meeting their goals.

Use of Online Self-Management Diaries in Asthma and COPD: A Qualitative Study of Subjects' and Professionals' Perceptions and Behaviors.

PubMed

van Kruijssen, Valerie; van Staa, AnneLoes; Dwarswaard, Jolanda; In 't Veen, Johannes Ccm; Mennema, Bianka; Adams, Samantha A

2015-08-01

Online self-management diaries are used to support patients' self-management skills and facilitate associated behavioral changes. Although web-based diaries are well-known as a potential self-management tool, reasons that patients use (or do not use) self-management diaries, as well as perceptions and behaviors related to diary use, remain largely unknown. Semistructured interviews (n = 30) were conducted with health-care professionals and subjects to understand perceptions and behaviors related to self-management diary use for asthma and COPD in 2 hospitals in Rotterdam, The Netherlands. Subjects in this study used self-management diaries to improve their knowledge of the disease, cope more consciously with their disease, feel in control, and discuss outcomes from the self-management diaries with their health-care professionals. Two subjects reported that they used the self-management diary to cope more effectively with their disease and recognized an exacerbation and acted by adjusting their medications. Both health-care professionals and subjects experienced practical barriers in integrating self-management diaries into their regular practices. Subjects' reasons for nonuse were related to the intervention, the disease, and subject-provider contact. Health-care professionals should help patients use self-management diaries by collaboratively developing an individual treatment plan and by showing patients how to use the diaries to recognize and act on an exacerbation. Together with the suggestions made for improving the self-management diaries, this will aid in the integration of self-management diaries into regular health-care practice and enhance patients' self-management of their disease. Copyright © 2015 by Daedalus Enterprises.

Determining the barriers and facilitators to adopting best practices in the management of poststroke unilateral spatial neglect: results of a qualitative study.

PubMed

Petzold, Anita; Korner-Bitensky, Nicol; Salbach, Nancy M; Ahmed, Sara; Menon, Anita; Ogourtsova, Tatiana

2014-01-01

A gap exists between best and actual management of poststroke unilateral spatial neglect (USN). Given the negative impact of USN on poststroke recovery, knowledge translation efforts are needed to optimize USN management. To date, no study has investigated the specific barriers and facilitators affecting USN management during the acute care process. To identify the facilitators and barriers that affect evidence-based practice use by occupational therapists (the primary discipline managing USN) when treating individuals with acute poststroke USN. Focus group methodology elicited information from 9 acute care occupational therapists. Key barriers identified included lack of basic evidence-based practice skills specific to USN treatment and personal motivation to change current practices and engrained habits. Key facilitators included the presence of a multidisciplinary stroke team, recent graduation, and an environment with access to learning time and resources. Synthesized Web-based learning was also seen as important to uptake of best practices. It is estimated that upwards of 40% of patients experience poststroke USN in the acute phase, and we have evidence of poor early management. This study identified several modifiable factors that prepare the ground for the creation and testing of a multimodal knowledge translation intervention aimed at improving clinicians' best practice management of poststroke USN.

Water management for a megacity: Mexico City Metropolitan Area.

PubMed

Tortajada, Cecilia; Castelán, Enrique

2003-03-01

The paper presents an overview of the present situation of the Mexico City Metropolitan Area (MCMA). The analysis indicates an urgent need to radically improve the current water supply and wastewater management practices, to become sustainable. The MCMA is one of the most rapidly growing urban centers of the world, with a population of about 21 million people, a very high rate of immigration and numerous illegal settlements. In order to meet the increasing water demand, successive governments have focused almost exclusively on supply management and engineering solutions, which have resulted in investments of hundreds of millions of USD and the construction of major infrastructure projects for interbasin water transfer. Environmental, economic and social policies associated with water management are mostly inadequate and insufficient, which is resulting in increasing deterioration in the environment, health and socioeconomic conditions of a population living in one of the largest urban agglomerations of the world. Surprisingly, however, no long-term strategies on demand-management, reuse, conservation, and improved water-management practices have been developed so far.

Web-based classroom data collection in ADHD: a best practices case study.

PubMed

Bhatara, Vinod; Vogt, H Bruce; Ellis, Roland; Alshari, Ghyath; Patrick, Sarah

2003-09-01

Best practices research identifies and disseminates effective clinical strategies developed and refined by clinicians for their practices. As opposed to the content of health care, medical students and residents are typically not trained in the process of its provision. This paper illustrates a best practices approach to development of a Web-based classroom data collection method to improve medication management in attention deficit hyperactivity disorder (ADHD). 1) To increase Primary Care Physician (PCP) awareness of the process of best practices research, and; 2) to highlight the use of the World Wide Web as a tool for integration of care of children with ADHD. Based on the review of a large national study in ADHD, the key ingredients for the best pharmacotherapy practices were identified. The lessons from the literature were adapted for local practice using the framework and steps for best practices outlined by Mold and Gregory. A conceptual model of managing information provided by parents/caregivers and teachers to PCPs was developed. Several steps were identified, including Web-based classroom behavioral data collection by a care manager and feedback reports to PCPs from a child psychiatrist based on the data collected. This model is currently being tested. Our preliminary experience suggests that a best practices approach has potential applications to a variety of primary care settings in South Dakota. We encourage PCPs to consider best practice strategies for their own practices. The practice-based research network (Rush Net) being developed by the Center for Rural Health Improvement of the University of South Dakota School of Medicine's Department of Family Medicine can be helpful in this regard.

Turning Continuous Quality Improvement into Institutional Practice: The Tools and Techniques.

ERIC Educational Resources Information Center

Cornesky, Robert A.

This manual is intended to assist managers of support units at institutions of higher education in the implementation of Continuous Quality Improvement (CQI). The purpose is to describe a cooperative model for CQI which will permit managers to evaluate the quality of their units and institution, and by using the described tools and techniques, to…

Establishment and outcomes of a model primary care pharmacy service system.

PubMed

Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

2004-03-01

The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

Management Practices. U.S. Companies Improve Performance through Quality Efforts. Report to the Honorable Donald Ritter, House of Representatives.

ERIC Educational Resources Information Center

General Accounting Office, Washington, DC. National Security and International Affairs Div.

The General Accounting Office (GAO) examined the impact of formal total quality management (TQM) practices on the performance of 20 selected U.S. companies that were among the highest-scoring applicants in 1988 and 1989 for the Malcolm Baldridge National Quality Award. Several key indicators used by companies to measure performance were analyzed.…

Analyzing Cases of Resilience Success and Failure - A Research Study

DTIC Science & Technology

2012-12-01

controls [NIST 2012, NIST 2008] ISO 27002 and ISO 27004 Guidelines for initiating, implementing, maintaining, and improving information security...Commission ( ISO /IEC). Information technology—Security techniques—Code of practice for information security management ( ISO /IEC 27002 :2005). ISO /IEC, 2005...security management system and controls or groups of controls [ ISO /IEC 2005, ISO /IEC 2009] CIS Security Metrics Outcome and practice metrics measuring

Conservation Agriculture Improves Soil Quality, Crop Yield, and Incomes of Smallholder Farmers in North Western Ghana

PubMed Central

Naab, Jesse B.; Mahama, George Y.; Yahaya, Iddrisu; Prasad, P. V. V.

2017-01-01

Conservation agriculture (CA) practices are being widely promoted in many areas in sub-Saharan Africa to recuperate degraded soils and improve ecosystem services. This study examined the effects of three tillage practices [conventional moldboard plowing (CT), hand hoeing (MT) and no-tillage (NT)], and three cropping systems (continuous maize, soybean–maize annual rotation, and soybean/maize intercropping) on soil quality, crop productivity, and profitability in researcher and farmer managed on-farm trials from 2010 to 2013 in northwestern Ghana. In the researcher managed mother trial, the CA practices of NT, residue retention and crop rotation/intercropping maintained higher soil organic carbon, and total soil N compared to conventional tillage practices after 4 years. Soil bulk density was higher under NT than under CT soils in the researcher managed mother trails or farmers managed baby trials after 4 years. In the researcher managed mother trial, there was no significant difference between tillage systems or cropping systems in maize or soybean yields in the first three seasons. In the fourth season, crop rotation had the greatest impact on maize yields with CT maize following soybean increasing yields by 41 and 49% compared to MT and NT maize, respectively. In the farmers’ managed trials, maize yield ranged from 520 to 2700 kg ha-1 and 300 to 2000 kg ha-1 for CT and NT, respectively, reflecting differences in experience of farmers with NT. Averaged across farmers, CT cropping systems increased maize and soybean yield ranging from 23 to 39% compared with NT cropping systems. Partial budget analysis showed that the cost of producing maize or soybean is 20–29% cheaper with NT systems and gives higher returns to labor compared to CT practice. Benefit-to-cost ratios also show that NT cropping systems are more profitable than CT systems. We conclude that with time, implementation of CA practices involving NT, crop rotation, intercropping of maize and soybean along with crop residue retention presents a win–win scenario due to improved crop yield, increased economic return, and trends of increasing soil fertility. The biggest challenge, however, remains with producing enough biomass and retaining same on the field. PMID:28680427

Technical Elements, Demonstration Projects, and Fiscal Models in Medicaid Managed Care for People with Developmental Disabilities.

ERIC Educational Resources Information Center

Kastner, Theodore A.; Walsh, Kevin K.; Criscione, Teri

1997-01-01

Presents a general model of the structure and functioning of managed care and describes elements (provider networks, fiscal elements, risk estimation, case-mix, management information systems, practice parameters, and quality improvement) critical to people with developmental disabilities. Managed care demonstration projects and a hypothetical…

Healthy Choices for Every Body Adult Curriculum Improves Participants' Food Resource Management Skills and Food Safety Practices.

PubMed

Adedokun, Omolola A; Plonski, Paula; Jenkins-Howard, Brooke; Cotterill, Debra B; Vail, Ann

2018-06-01

To evaluate the impact of the University of Kentucky's Healthy Choices for Every Body (HCEB) adult nutrition education curriculum on participants' food resource management (FRM) skills and food safety practices. A quasi-experimental design was employed using propensity score matching to pair 8 intervention counties with 8 comparison counties. Independent-samples t tests and ANCOVA models compared gains in FRM skills and food safety practices between the intervention and comparison groups (n = 413 and 113, respectively). Propensity score matching analysis showed a statistical balance and similarities between the comparison and intervention groups. Food resource management and food safety gain scores were statistically significantly higher for the intervention group (P < .001), with large effect sizes (d = 0.9) for both variables. The group differences persisted even after controlling for race and age in the ANCOVA models. The HCEB curriculum was effective in improving the FRM skills and food safety practices of participants. Copyright © 2018 Society for Nutrition Education and Behavior. Published by Elsevier Inc. All rights reserved.

A randomized trial of an acid-peptic disease management program in a managed care environment.

PubMed

Ofman, Joshua J; Segal, Richard; Russell, Wayne L; Cook, Deborah J; Sandhu, Meenu; Maue, Susan K; Lowenstein, Edward H; Pourfarzib, Ray; Blanchette, Erv; Ellrodt, Gray; Weingarten, Scott R

2003-06-01

To study the effectiveness of a disease management program for patients with acid-related disorders. A cluster-randomized clinical trial of 406 patients comparing a disease management program with "usual practice." Enrolled patients included those presenting with new dyspepsia and chronic users of antisecretory drugs in 8 geographically separate physician offices associated with the Orlando Health Care Group. There were 35 providers in the intervention group and 48 in the control group. The disease management program included evidence-based practice guidelines implemented by using physician champions, academic detailing, and multidisciplinary teams. Processes of care, patient symptoms, quality of life, costs, and work days lost were measured 6 months after patient enrollment. Compared with usual practice, disease management was associated with improvements in Helicobacter pylori testing (61% vs 9%; P = .001), use of recommended H pylori treatment regimens (96% vs 10%; P = .001), and discontinuation rates of proton pump therapy after treatment (70% vs 36%; P = .04). There were few differences in patient quality of life or symptoms between the 2 study groups. Disease management resulted in fewer days of antisecretory therapy (71.7 vs 88.1 days; P = .02) but no difference in total costs. This disease management program for patients with acid-related disorders led to improved processes of care. The effectiveness of such a program in other settings requires further study.

Evaluation of a quality improvement intervention for diabetes management.

PubMed

Schmidt, Siegfried O F; Burns, Cathy; Feller, David B; Chang, Ku-Lang; Hernandez, Betsy; McCarthy, Jen; Burg, Mary Ann

2003-01-01

The purpose of this study was to develop and test two interventions designed to improve provider compliance with diabetes management guidelines: the use of a diabetes management flowsheet inserted into patient charts and the use of a diabetes management flowsheet plus quarterly provider feedback about compliance levels. Diabetic patient charts from six family practice clinics were randomly selected and audited at baseline and at 12 months. The analysis indicated that the use of the flowsheet was associated with improved provider compliance in the completion of foot examinations only. Providers involved in the study believed that the process of the flowsheet plus feedback contributed to their greater awareness of diabetes management guidelines.

Concussion Care Practices and Utilization of Evidence-Based Guidelines in the Evaluation and Management of Concussion: A Survey of New England Emergency Departments.

PubMed

Stern, Robert A; Seichepine, Daniel; Tschoe, Christine; Fritts, Nathan G; Alosco, Michael L; Berkowitz, Oren; Burke, Peter; Howland, Jonathan; Olshaker, Jonathan; Cantu, Robert C; Baugh, Christine M; Holsapple, James W

2017-02-15

Evidence-based clinical practice guidelines can facilitate proper evaluation and management of concussions in the emergency department (ED), often the initial and primary point of contact for concussion care. There is no universally adopted set of guidelines for concussion management, and extant evidence suggests that there may be variability in concussion care practices and limited application of clinical practice guidelines in the ED. This study surveyed EDs throughout New England to examine current practices of concussion care and utilization of evidence-based clinical practice guidelines in the evaluation and management of concussions. In 2013, a 32-item online survey was e-mailed to 149/168 EDs throughout New England (Connecticut, Rhode Island, Massachusetts, Vermont, New Hampshire, Maine). Respondents included senior administrators asked to report on their EDs use of clinical practice guidelines, neuroimaging decision-making, and discharge instructions for concussion management. Of the 72/78 respondents included, 35% reported absence of clinical practice guidelines, and 57% reported inconsistency in the type of guidelines used. Practitioner preference guided neuroimaging decision-making for 57%. Although 94% provided written discharge instructions, there was inconsistency in the recommended time frame for follow-up care (13% provided no specific time frame), the referral specialist to be seen (25% did not recommend any specialist), and return to activity instructions were inconsistent. There is much variability in concussion care practices and application of evidence-based clinical practice guidelines in the evaluation and management of concussions in New England EDs. Knowledge translational efforts will be critical to improve concussion management in the ED setting.

Soft skill appraisal for dentistry: a tool for positive practice management.

PubMed

Jawale, Bhushan Arun; Bendgude, Vikas; Husain, Nadeem; Thosar, Nilima; Tandon, Piyush

2011-11-01

Soft skills adoption is a learning experience for every practitioner and every academician. Author has expressed his opinion for success through educational and real values of soft skill. Soft skills behavior of individual and institution help in achieving desirable goals in general and specialty practices. Author also focused on some realistic soft skill methods for improvisation of practices for all doctor. These skills indulge positive energy in human relationship for working in symbiosis and explore infinite capabilities at institutional and doctoral level. Here, some optimistic suggestions are given for improving dental practices and academic fulfillments. These soft skills help to organize, plan and manage, and track changes during the course of the growing dental practices. However, understanding of the soft skills in practice management, its simplicity and complexity and also, its contributing factors, helps practitioners to understand the dynamic, social and complex contexts of practices. It is really helpful to all practitioners to grow their practices using soft skills.

Best Practices for Environmental Site Management: A Practical Guide for Applying Environmental Sequence Stratigraphy to Improve Conceptual Site Models

EPA Science Inventory

Presented here is a practical guide on the application of the geologic principles of sequence stratigraphy and facies models to the characterization of stratigraphic heterogeneity at hazardous waste sites. This technology is applicable to sites underlain by clastic aquifers (int...

Pilot of a Learning Management System to Enhance Counselors' Relational Qualities through Mindfulness-Based Practices

ERIC Educational Resources Information Center

Ballinger, Julie Ann

2013-01-01

Mindfulness-based practices are associated with increased attentional qualities, improved self-focus styles, enhanced empathic understanding, and strengthened self-compassion, making these practices a viable addition to counselor training programs. However, current mindfulness training models are primarily designed for relief of psychological…

Internet research: improving traditional community analysis before launching a practice.

PubMed

Barresi, B; Scott, C

2000-01-01

Optometric practice management experts have always recommended that optometrists thoroughly research the communities in which they are considering practicing. Until the Internet came along, demographic research was possible but often daunting. Today, say these authors, it's becoming quite a bit easier ... and they show us how.

Governance, Accountability, and Organizational Development: Eldercare Unit Managers' and Local Politicians' Experiences of and Responses to State Supervision of Swedish Eldercare.

PubMed

Andersson, Katarina; Hanberger, Anders; Nygren, Lennart

2018-02-22

This article explores how local politicians and care unit managers in Swedish eldercare experience and respond to state supervision (SSV). Twelve politicians and twelve managers in 15 previously inspected municipalities were interviewed about their experiences of and reactions to SSV in relation to their views of care quality and routines in eldercare practice. The findings indicate that local managers and political chairs perceived SSV in eldercare positively at a superficial level but were critical of and disappointed with specific aspects of it. In terms of (a) governance, chairs and managers said SSV strengthened implementation of national policies via local actors, but they were critical of SSV's narrow focus on control and flaws in eldercare practice. With regard to (b) accountability, SSV was seen as limited to accountability for finances and systemic performance, and regarding (c) organizational development, SSV was seen as limited to improving routines and compliance with legislation, while local definitions of quality are broader than that. In general, local actors regarded SSV as improving administrative aspects and routines in practice but ignoring the relational content of eldercare quality.

Previous Webinars about Integrated Pest Management in Schools

EPA Pesticide Factsheets

The EPA Center of Expertise for School IPM hosts a webinar series featuring national experts from across the country relaying educational and practical strategies for establishing and improving integrated pest management programs in schools.

Improving freight crash incident management.

DOT National Transportation Integrated Search

2015-06-01

The objective of this study was to determine the most effective way to mitigate the effect of freight : crash incidents on Louisiana freeways. Candidate incident management strategies were reviewed from : practice in other states and from those publi...

Microcomputer Applications in the Management of Paratransit Operations

DOT National Transportation Integrated Search

1981-08-01

The technological advances in the field of microcomputer systems offer some real opportunities to assist in the improvement of small paratransit operations and management in practical and readily implementable terms. The retail outlet availability an...

Primary Care Providers' Knowledge and Practices of Diabetes Management During Ramadan.

PubMed

Ali, Mujtaba; Adams, Alexandra; Hossain, Md Anwar; Sutin, David; Han, Benjamin Hyun

2016-01-01

There are an estimated 3.5 million Muslims in North America. During the holy month of Ramadan, healthy adult Muslims are to fast from predawn to after sunset. While there are exemptions for older and sick adults, many adults with diabetes fast during Ramadan. However, there are risks associated with fasting and specific management considerations for patients with diabetes. We evaluated provider practices and knowledge regarding the management of patients with diabetes who fast during Ramadan. A 15-question quality improvement survey based on a literature review and the American Diabetes Association guidelines was developed and offered to providers at the outpatient primary care and geriatric clinics at an inner-city hospital in New York City. Forty-five providers completed the survey. Most respondents did not ask their Muslim patients with diabetes if they were fasting during the previous Ramadan. Knowledge of fasting practices during Ramadan was variable, and most felt uncomfortable managing patients with diabetes during Ramadan. There is room for improvement in educating providers about specific cultural and medical issues regarding fasting for patients with diabetes during Ramadan. © The Author(s) 2015.

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Treating without Seeing: Pain Management Practice in a Thai Context.

PubMed

Chatchumni, Manaporn; Namvongprom, Ampaporn; Eriksson, Henrik; Mazaheri, Monir

2016-01-01

Pain management is a core nursing function, and it plays a key role in postoperative care. It is important to understand the cultural context of nursing practices and how this affects effective pain management. The aim of this study was to describe the professional and cultural framework within which pain management is practiced on a Thai surgical ward. Spradley's ethnographic methodology was used. Data were collected through 98.5 hours of field observations and interviews at a surgical ward in Thailand. Three themes were constructed that describe the way Thai nurses practiced pain management: (i) complex communications system to address pain and to respond to it, (ii) the essence of Thai-ness, and (iii) a passive approach to pain management. The results indicate that, in the response to discomfort and pain, better pain management will result if there is a shift from functional to patient-centered care. The nursing culture needs to be further researched and discussed, in order to set priorities in line with the goals of national and international organizations for improving postoperative care and promoting patient comfort.

It's there if you look. Get value out of technology to improve operations.

PubMed

Nelson, Rosemarie

2003-01-01

Is your group missing out on practice-management system functions critical to efficient operations and reduced overhead? Most practices don't maximize the capabilities of their office systems, hampering operational efficiency.

[Quality assurance and quality improvement in medical practice. Part 1. Definition and importance of quality in medical practice].

PubMed

Godény, Sándor

2012-01-22

In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.

Wildlife responses to brush management: a contemporary evaluation

USDA-ARS?s Scientific Manuscript database

Brush management has been widely practiced with the general intent of curtailing or reversing the proliferation of shrubs and trees in grasslands and savannas. The traditional aim of brush management has been to increase livestock forage or to improve water yield. Its potential role for restoring h...

Assessment of multiple management systems in the Upper Midwest

USDA-ARS?s Scientific Manuscript database

Reduced tillage, multi-crop rotations and use of organic fertilizers are characteristically expected to improve soil quality. As measures of soil quality, microbial and soluble C and N were evaluated in an nine-year assessment of management practices alternative to a conventionally managed two-year ...

Report: EPA Should Improve Management Practices and Security Controls for Its Network Directory Service System and Related Servers

EPA Pesticide Factsheets

Report #12-P-0836, September 20, 2012. EPA's OEI is not managing key system management documentation, system administration functions, the granting and monitoring of privileged accounts, and the application of security controls associated with its DSS.

Personnel Management: Two Year Colleges.

ERIC Educational Resources Information Center

Ohio Board of Regents, Columbus. Management Improvement Program.

This document is one of five manuals designed to improve management practices in Ohio two-year colleges. A chapter on organizing for personnel management discusses basic personnel functions, roles and responsibilities of administrators, and the need for a central statewide office of personnel affairs. A chapter on planning, policies, and…

Putting resilience and resistance concepts into practice

Treesearch

Jeanne C. Chambers; Jeremy D. Maestas; Mike Pellant

2015-01-01

Land managers are increasingly interested in improving resilience to disturbances, such as wildfire, and resistance to invasive species, such as cheatgrass and medusahead. This factsheet is designed to assist land managers in using resilience and resistance concepts to assess risks, prioritize management activities, and select appropriate treatments.

Educational Resource Management: An International Perspective

ERIC Educational Resources Information Center

Glover, Derek; Levacic, Rosalind

2007-01-01

This book offers practical guidance on management of financial and real resources in schools and college, and critically evaluates current tensions involved in the area of educational resource management. It is essential reading for educational leaders who wish to improve the effectiveness, efficiency and equity of their resource utilisation…

Managed care strategy for mental health services.

PubMed

Jones, A

In the UK, managed care is beginning to be recognized as a cost effective, quality-driven system which can be used to structure patient care. This article examines the potential use of managed care pathways in mental health services, focusing on clients with schizophrenia. The strengths of managed care include the effective coordination of healthcare resources, the clear accountable audit of mental health practice and the re-engineering of mental health practice to improve patient outcomes. Problems in designing representative care pathways and encouraging healthcare providers to implement care pathways are some of the disadvantages of this system.

[Interest of evaluation of professional practice for the improvement of the management of postoperative pain with patient controlled analgesia (PCA)].

PubMed

Baumann, A; Cuignet-Royer, E; Cornet, C; Trueck, S; Heck, M; Taron, F; Peignier, C; Chastel, A; Gervais, P; Bouaziz, H; Audibert, G; Mertes, P-M

2010-10-01

To evaluate the daily practice of postoperative PCA in Nancy University Hospital, in continuity with a quality program of postoperative pain (POP) care conducted in 2003. A retrospective audit of patient medical records. A review of all the medical records of consecutive surgical patients managed by PCA over a 5-week period in six surgical services. Criteria studied: Evaluation of hospital means (eight criteria) and of medical and nursing staff practice (16 criteria). A second audit was conducted 6 months after the implementation of quality improvement measures. Assessment of the hospital means: temperature chart including pain scores and PCA drug consumption, patient information leaflet, PCA protocol, postoperative pre-filled prescription form (PFPF) for post-anaesthesia care including PCA, and optional training of nurses in postoperative pain management. EVALUATION OF PRACTICES: One hundred and fifty-nine files of a total of 176 patients were analyzed (88%). Improvements noted after 6 months: trace of POP evaluation progressed from 73 to 87%, advance prescription of PCA adjustment increased from 56 to 68% and of the treatment of adverse effects from 54 to 68%, trace of PCA adaptation by attending nurse from 15 to 43%, trace of the administration of the treatment of adverse effects by attending nurse from 24% to 64%, as did the use of PFPF from 59 to 70%. The usefulness of a pre-filled prescription form for post-anaesthesia care including PCA prescription is demonstrated. Quality improvement measures include: poster information and pocket guides on PCA for nurses, training of 3 nurses per service to act as "PCA advisers" who will in turn train their ward colleagues in PCA management and the use of equipment until an acute pain team is established. Copyright © 2010 Elsevier Masson SAS. All rights reserved.

Advancing the application of systems thinking in health: exploring dual practice and its management in Kampala, Uganda

PubMed Central

2014-01-01

Background Many full-time Ugandan government health providers take on additional jobs – a phenomenon called dual practice. We describe the complex patterns that characterize the evolution of dual practice in Uganda, and the local management practices that emerged in response, in five government facilities. An in-depth understanding of dual practice can contribute to policy discussions on improving public sector performance. Methods A multiple case study design with embedded units of analysis was supplemented by interviews with policy stakeholders and a review of historical and policy documents. Five facility case studies captured the perspective of doctors, nurses, and health managers through semi-structured in-depth interviews. A causal loop diagram illustrated interactions and feedback between old and new actors, as well as emerging roles and relationships. Results The causal loop diagram illustrated how feedback related to dual practice policy developed in Uganda. As opportunities for dual practice grew and the public health system declined over time, government providers increasingly coped through dual practice. Over time, government restrictions to dual practice triggered policy resistance and protest from government providers. Resulting feedback contributed to compromising the supply of government providers and, potentially, of service delivery outcomes. Informal government policies and restrictions replaced the formal restrictions identified in the early phases. In some instances, government health managers, particularly those in hospitals, developed their own practices to cope with dual practice and to maintain public sector performance. Management practices varied according to the health manager’s attitude towards dual practice and personal experience with dual practice. These practices were distinct in hospitals. Hospitals faced challenges managing internal dual practice opportunities, such as those created by externally-funded research projects based within the hospital. Private wings’ inefficiencies and strict fee schedule made them undesirable work locations for providers. Conclusions Dual practice prevails because public and private sector incentives, non-financial and financial, are complementary. Local management practices for dual practice have not been previously documented and provide learning opportunities to inform policy discussions. Understanding how dual practice evolves and how it is managed locally is essential for health workforce policy, planning, and performance discussions in Uganda and similar settings. PMID:25134522

Toward A Science of Sustainable Water Management

NASA Astrophysics Data System (ADS)

Brown, C.

2016-12-01

Societal need for improved water management and concerns for the long-term sustainability of water resources systems are prominent around the world. The continued susceptibility of society to the harmful effects of hydrologic variability, pervasive concerns related to climate change and the emergent awareness of devastating effects of current practice on aquatic ecosystems all illustrate our limited understanding of how water ought to be managed in a dynamic world. The related challenges of resolving the competition for freshwater among competing uses (so called "nexus" issues) and adapting water resources systems to climate change are prominent examples of the of sustainable water management challenges. In addition, largely untested concepts such as "integrated water resources management" have surfaced as Sustainable Development Goals. In this presentation, we argue that for research to improve water management, and for practice to inspire better research, a new focus is required, one that bridges disciplinary barriers between the water resources research focus on infrastructure planning and management, and the role of human actors, and geophysical sciences community focus on physical processes in the absence of dynamical human response. Examples drawn from climate change adaptation for water resource systems and groundwater management policy provide evidence of initial progress towards a science of sustainable water management that links improved physical understanding of the hydrological cycle with the socioeconomic and ecological understanding of water and societal interactions.

Legal risk management and injury in the fitness industry: the outcomes of focus group research and a national survey of fitness professionals.

PubMed

Keyzer, Patrick; Coyle, Ian R; Dietrich, Joachim; Norton, Kevin; Sekendiz, Betul; Jones, Veronica; Finch, Caroline F

2014-06-01

The Australian Fitness Industry Risk Management (AFIRM) Project was set up to explore the operation of rules and regulations for the delivery of safe fitness services. This article summarises the results of recent focus group research and a national survey of risk management practices by the AFIRM Project. Our focus group research in four States identified the following most important concerns: (1) the competency of fitness professionals; (2) the effectiveness of pre-exercise screening and the management of de-conditioned clients; (3) poor supervision of fitness service users and incorrect use of equipment; (4) fitness trainers failing to remain within their scope of practice; (5) equipment misuse (as distinct from incorrect use); and (6) poor fitness training environments. This information was then used to develop 45 specific items for a questionnaire that was disseminated throughout the fitness industry. The survey, which is the largest ever conducted in the Australian fitness industry (n = 1,178), identified similar concerns. Our research indicates that efforts to improve risk management in the fitness industry should focus, first and foremost, on the development and monitoring of safety policy, and improvements in the education and training of fitness instructors to ensure that they can incorporate risk management practices.

A Novel Approach to Improving Utilization of Laboratory Testing.

PubMed

Zhou, Yaolin; Procop, Gary W; Riley, Jacquelyn D

2018-02-01

- The incorporation of best practice guidelines into one's institution is a challenging goal of utilization management, and the successful adoption of such guidelines depends on institutional context. Laboratorians who have access to key clinical data are well positioned to understand existing local practices and promote more appropriate laboratory testing. - To apply a novel approach to utilization management by reviewing international clinical guidelines and current institutional practices to create a reliable mechanism to improve detection and reduce unnecessary tests in our patient population. - We targeted a frequently ordered genetic test for HFE-related hereditary hemochromatosis, a disorder of low penetrance. After reviewing international practice guidelines, we evaluated 918 HFE tests and found that all patients with new diagnoses had transferrin saturation levels that were significantly higher than those of patients with nonrisk genotypes (72% versus 42%; P < .001). - Our "one-button" order that restricts HFE genetic tests to patients with transferrin saturation greater than 45% is consistent with published practice guidelines and detected 100% of new patients with HFE-related hereditary hemochromatosis. - Our proposed algorithm differs from previously published approaches in that it incorporates both clinical practice guidelines and local physician practices, yet requires no additional hands-on effort from pathologists or clinicians. This novel approach to utilization management embraces the role of pathologists as leaders in promoting high-quality patient care in local health care systems.

Middle Managers' Experiences and Role in Implementing an Interactive Tailored Patient Assessment eHealth Intervention in Clinical Practice.

PubMed

Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Børøsund, Elin; Ruland, Cornelia M

2015-06-01

The role of nurse and physician managers is considered crucial for implementing eHealth interventions in clinical practice, but few studies have explored this. The aim of the current study was to examine the perceptions of nurse and physician managers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physician managers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice.

Fuels planning: science synthesis and integration; social issues fact sheet 13: Strategies for managing fuels and visual quality

Treesearch

Christine Esposito

2006-01-01

The public's acceptance of forest management practices, including fuels reduction, is heavily based on how forests look. Fuels managers can improve their chances of success by considering aesthetics when making management decisions. This fact sheet reviews a three-part general strategy for managing fuels and visual quality: planning, implementation, and monitoring...

The Management Review and Analysis Program: An Assisted Self-Study to Secure Constructive Change in the Management of Research Libraries

ERIC Educational Resources Information Center

Webster, Duane E.

1974-01-01

The Management Review and Analysis Program, an assisted self-study strategy for large academic and research libraries, assists libraries in reviewing and analyzing their current management policies and practices, and provides guidelines for the application of contemporary principles of management for the improvement of library programs. (Author/LS)

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

PubMed

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

A quality improvement approach to reducing use of meperidine.

PubMed

Gordon, D B; Jones, H D; Goshman, L M; Foley, D K; Bland, S E

2000-12-01

In 1991 the University of Wisconsin Hospital and Clinics formed a pain management QI team whose goal was to improve pain management through education, outcome monitoring, and the development of programs intended to improve clinical practice. Longitudinal monitoring mechanisms were established to audit medical records and survey patients to examine both staff practice patterns and patient outcomes. The QI team targeted use of meperidine, one of the most widely used opioid analgesics for the treatment of moderate to severe pain, which is now discouraged as a first-line agent for most painful conditions. A QI process was implemented using a traditional plan-do-check-act (PDCA) model, resulting in a successful and sustained reduction of inappropriate meperidine use. A cause-and-effect diagram helped highlight the multiple factors contributing to the drug's overuse and was used to prioritize targets for action. A flow chart helped to uncover some of the interrelationships between the myths about meperidine and the resultant customary prescribing and administration practices. While most of the strategies were implemented in 1996 (formulary guideline release, change in stock supply and physician orders, staff education and feedback), a significant impact in practice was not seen until late 1997. Ongoing tracking and feedback loops were established to ensure continued low use of meperidine. Use of a QI approach in pain management has been shown to affect the visibility of pain as a clinical priority, enhance interdisciplinary collaboration, facilitate the implementation of clinical guidelines at the bedside, and improve the quality of care for patients.

Environmental improvement of product supply chains: proposed best practice techniques, quantitative indicators and benchmarks of excellence for retailers.

PubMed

Styles, David; Schoenberger, Harald; Galvez-Martos, Jose-Luis

2012-11-15

Retailers are strategically positioned to leverage environmental improvement over product supply chains through actions targeted at suppliers and consumers. Informed by scientific evidence on environmental hotspots and control points across 14 priority product groups, and a review of 25 major European retailers' actions, this paper proposes a framework to guide and assess retailer best practice in supply chain environmental improvement. Commonly used product standards and improvement measures are classified into "basic" or "good" levels of environmental protection. A hierarchy of eight Best Environmental Management Practices (BEMPs) is proposed to systematically identify and improve the most environmentally damaging supply chains across retail assortments. Widespread third party environmental certification is the most transparent and verifiable mechanism of improvement but may not be appropriate for some supply chains. The enforcement of retailer-defined environmental requirements, and supplier improvement programmes based on performance benchmarking and dissemination of better management practices, are alternative BEMPs that may be used in combination with third party certification. Facilitating consumer selection of frontrunner ecological products is a lower priority BEMP owing to the well documented limitations of this approach. From available data, the highest current or credible-target sales shares of products improved according to the highest priority BEMP and environmental protection level were used to derive "benchmarks of excellence" for each of the 14 product groups. The assessment framework is demonstrated through application to three retailers. Copyright © 2012 Elsevier Ltd. All rights reserved.

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

PubMed

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

Stakeholder engagement in diabetes self-management: patient preference for peer support and other insights.

PubMed

Kwan, Bethany M; Jortberg, Bonnie; Warman, Meredith K; Kane, Ilima; Wearner, Robyn; Koren, Romona; Carrigan, Thomas; Martinez, Vincent; Nease, Donald E

2017-06-01

Self-management support (SMS) for patients with diabetes can improve adherence to treatment, mitigate disease-related distress, and improve health outcomes. Translating this evidence into real-world practice is needed, as it is not clear which SMS models are acceptable to patients, and feasible and sustainable for primary care practices. To use the Boot Camp Translation (BCT) method to engage patient, practice, community resource and research stakeholders in translation of evidence about SMS and diabetes distress into mutually acceptable care models and to inform patient-centred outcomes research (PCOR). Twenty-seven diabetes care stakeholders, including patients and providers from a local network of federally qualified health centres participated. Stakeholders met in-person and by conference call over the course of 8 months. Subject matter experts provided education on the diabetes SMS evidence. Facilitators engaged the group in discussions about barriers to self-management and opportunities for improving delivery of SMS. BCT participants identified lack of social support, personal resources, trust, knowledge and confidence as barriers to diabetes self-management. Intervention opportunities emphasized peer support, use of multidisciplinary care teams and centralized systems for sharing information about community and practice resources. BCT informed new services and a PCOR study proposal. Patients and family engaged in diabetes care research value peer support, group visits, and multidisciplinary care teams as key features of SMS models. SMS should be tailored to an individual patient's health literacy. BCT can be used to engage multiple stakeholders in translation of evidence into practice and to inform PCOR. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Engaging Clinical Nurses in Quality Improvement Projects.

PubMed

Moore, Susan; Stichler, Jaynelle F

2015-10-01

Clinical nurses have the knowledge and expertise required to provide efficient and proficient patient care. Time and knowledge deficits can prevent nurses from developing and implementing quality improvement or evidence-based practice projects. This article reviews a process for professional development of clinical nurses that helped them to define, implement, and analyze quality improvement or evidence-based practice projects. The purpose of this project was to educate advanced clinical nurses to manage a change project from inception to completion, using the Six Sigma DMAIC (Define, Measure, Analyze, Improve, Control) Change Acceleration Process as a framework. One-to-one mentoring and didactic in-services advanced the knowledge, appreciation, and practice of advanced practice clinicians who completed multiple change projects. The projects facilitated clinical practice changes, with improved patient outcomes; a unit cultural shift, with appreciation of quality improvement and evidence-based projects; and engagement with colleagues. Project outcomes were displayed in poster presentations at a hospital exposition for knowledge dissemination. Copyright 2015, SLACK Incorporated.

Translating Cholesterol Guidelines Into Primary Care Practice: A Multimodal Cluster Randomized Trial

PubMed Central

Eaton, Charles B.; Parker, Donna R.; Borkan, Jeffrey; McMurray, Jerome; Roberts, Mary B.; Lu, Bing; Goldman, Roberta; Ahern, David K.

2011-01-01

PURPOSE We wanted to determine whether an intervention based on patient activation and a physician decision support tool was more effective than usual care for improving adherence to National Cholesterol Education Program guidelines. METHODS A 1-year cluster randomized controlled trial was performed using 30 primary care practices (4,105 patients) in southeastern New England. The main outcome was the percentage of patients screened for hyperlipidemia and treated to their low-density lipoprotein (LDL) and non–high-density lipoprotein (HDL) cholesterol goals. RESULTS After 1 year of intervention, both randomized practice groups improved screening (89% screened), and 74% of patients in both groups were at their LDL and non-HDL cholesterol goals (P <.001). Using intent-to-treat analysis, we found no statistically significant differences between practice groups in screening or percentage of patients who achieved LDL and non-HDL cholesterol goals. Post hoc analysis showed practices who made high use of the patient activation kiosk were more likely to have patients screened (odds ratio [OR] = 2.54; 95% confidence interval [CI], 1.97–3.27) compared with those who made infrequent or no use. Additionally, physicians who made high use of decision support tools were more likely to have their patients at their LDL cholesterol goals (OR = 1.27; 95% CI, 1.07–1.50) and non-HDL goals (OR = 1.23; 95% CI, 1.04–1.46) than low-use or no-use physicians. CONCLUSION This study showed null results with the intent-to-treat analysis regarding the benefits of a patient activation and a decision support tool in improving cholesterol management in primary care practices. Post hoc analysis showed a potential benefit in practices that used the e-health tools more frequently in screening and management of dyslipidemia. Further research on how to incorporate and increase adoption of user-friendly, patient-centered e-health tools to improve screening and management of chronic diseases and their risk factors is warranted. PMID:22084264

Developments in weather responsive traffic management strategies.

DOT National Transportation Integrated Search

2011-06-01

This report provides a comprehensive overview of weather-responsive traffic management practices. It focuses on what WRTM strategies exist, where they have been used, the benefits realized, what improvements are needed, and how to implement and evalu...

Taking Care of You: Body, Mind, Spirit--A Unique Stress Management Program That Improves Lifestyle Behaviors

ERIC Educational Resources Information Center

Vetter-Smith, Molly; Massey, Vera; Rellergert, Linda; Wissmann, Mary

2014-01-01

Taking Care of You: Body, Mind, Spirit is a multi-session group program developed by University of Missouri Extension that provides a unique and practical approach to helping adults better managing their stress and bounce back from life's challenges while improving lifestyle behaviors. The program combines mindfulness and a variety of other…

The Relationship among Training Policy, Knowledge Transfer, and Performance Improvement: A Study of Private Sector Organizations in the Kingdom of Saudi Arabia

ERIC Educational Resources Information Center

Shafloot, Fayez M.

2012-01-01

The purpose of this study was to explore human resource (HR) managers' perceptions of training practices (i.e., needs assessment, trainee preparation, training program review, accountability, management support, knowledge transfer, and performance improvement) in Saudi private sector organizations. The research questions were: (1) How do HR…

Electronic mail communication--management strategies.

PubMed

Strasser, Patricia B

2003-12-01

Electronic communication has come a long way in the past 30 years. It will no doubt continue to improve and remain the primary communication vehicle for businesses. Occupational health nurses, like other business professionals, must use email to their advantage to improve their practice. However, electronic mail communication must be managed in the same manner as records and documents produced in any form or media.

Patient empowerment, an additional characteristic of the European definitions of general practice/family medicine.

PubMed

Mola, Ernesto

2013-06-01

Growing evidence supports the inclusion of patient empowerment as a key ingredient of care for patients with chronic conditions. In recent years, several studies based on patient empowerment, have been carried out in different European countries in the context of general practice and primary care to improve management of chronic diseases. These studies have shown good results of the care model, increasing patient and health professionals' satisfaction, adherence to guidelines and to treatment, and improving clinical outcomes. In 2011, the Wonca European Council included as the twelfth characteristic of the European definitions of general practice/family medicine: 'promote patient empowerment'. The aim of this paper is to clarify the meaning of 'patient empowerment' and to explain why family medicine should be considered the most suitable setting to promote it. The inclusion of patient empowerment as one of the essential characteristics of general practice fills a conceptual gap and clearly suggests to the European health care systems a tested model to face chronic diseases: involving and empowering patients in managing their own conditions to improve health and well-being.

The evaluation of a mental health facilitator in general practice: effects on recognition, management, and outcome of mental illness.

PubMed

Bashir, K; Blizard, B; Bosanquet, A; Bosanquet, N; Mann, A; Jenkins, R

2000-08-01

Facilitation uses personal contact between the facilitator and the professional to encourage good practice and better service organisation. The model has been applied to physical illness but not to psychiatric disorders. To determine if a non-specialist facilitator can improve the recognition, management, and outcome of psychiatric illness presenting to general practitioners (GPs). Six practices were visited over an 18-month period by a facilitator whose activities included providing guidelines and organising training initiatives. Six other practices acted as controls. Recognition (identification index of family doctors), management (psychotropic prescribing, psychological consultations with the GP, specialist mental health treatment, and the use of medical interventions and investigations), and patient outcome at four months were assessed before and after intervention. The mean identification index of facilitator GPs rose from 0.51 to 0.64 following intervention, while that of the control GPs fell from 0.67 to 0.59 (P = 0.046). The facilitator had no detectable effect on management or patient outcome. The facilitator improved recognition of psychiatric illness by GPs. Generic facilitators can be trained to take on a mental health role; however, the failure to achieve more fundamental changes in treatment and outcome implies that facilitator intervention requires development.

Population management, systems-based practice, and planned chronic illness care: integrating disease management competencies into primary care to improve composite diabetes quality measures.

PubMed

Kimura, Joe; DaSilva, Karen; Marshall, Richard

2008-02-01

The increasing prevalence of chronic illnesses in the United States requires a fundamental redesign of the primary care delivery system's structure and processes in order to meet the changing needs and expectations of patients. Population management, systems-based practice, and planned chronic illness care are 3 potential processes that can be integrated into primary care and are compatible with the Chronic Care Model. In 2003, Harvard Vanguard Medical Associates, a multispecialty ambulatory physician group practice based in Boston, Massachusetts, began implementing all 3 processes across its primary care practices. From 2004 to 2006, the overall diabetes composite quality measures improved from 51% to 58% for screening (HgA1c x 2, low-density lipoprotein, blood pressure in 12 months) and from 13% to 17% for intermediate outcomes (HgA1c

New Partnerships for Improvement.

ERIC Educational Resources Information Center

Bell, Les

This document is a chapter in "The Principles and Practice of Educational Management," which aims to provide a systematic and analytical introduction to the study of educational management. The structure of the book reflects the main substantive areas of educational leadership and management, and most of the major themes are covered in the…

The Management Development Needs of Front-Line Managers: Voices from the Field.

ERIC Educational Resources Information Center

Longenecker, Clinton O.; Neubert, Mitchell

2003-01-01

A survey of 524 managers identified key practices to improve performance in a changing environment: clarifying roles, goals, and expectations; ongoing performance evaluation, feedback, and coaching; mentoring; challenging assignments; formal career planning; customer contact; cross-training; and 360-degree feedback. (Contains 31 references.) (SK)

Classroom Management Strategies and Behavioral Interventions to Support Academic Achievement

ERIC Educational Resources Information Center

Gilpatrick, Robin Sue Holzworth

2010-01-01

This mixed method project study identified the need for effective classroom management strategies to dissuade student noncompliant behavior and to ensure academic success for all students. Enhancing classroom management practices is vital to improved student achievement and teacher self-efficacy. Within a constructivist framework, it is critical…

Impacts of forest and land management on biodiversity and carbon

Treesearch

Valerie Kapos; Werner A. Kurz; Toby Gardner; Joice Ferreira; Manuel Guariguata; Lian Pin Koh; Stephanie Mansourian; John A. Parrotta; Nokea Sasaki; Christine B. Schmitt; Jos Barlow; Markku Kanninen; Kimiko Okabe; Yude Pan; Ian D. Thompson; Nathalie van Vliet

2012-01-01

Changes in the management of forest and non-forest land can contribute significantly to reducing emissions from deforestation and forest degradation. Such changes can include both forest management actions - such as improving the protection and restoration of existing forests, introducing ecologically responsible logging practices and regenerating forest on degraded...

Improving the Performance of Educational Managers. Working Paper Series.

ERIC Educational Resources Information Center

Lavin, Richard J.; Sanders, Jean E.

The Educational Management Development Center (EMDC) seeks to build the organizational capability for problem-solving through a process offered in the context of a dynamic, operating system. The problem-oriented school manager is helped by support staff to take administrative theory, successful practices, personal experiences, and leadership…

Ponderosa pine managed-yield simulator: PPSIM users guide.

Treesearch

D.J. DeMars; J.W. Barrett

1987-01-01

PPSIM simulates yields of natural and managed ponderosa pine stands. Management practices and effects that can be simulated include commercial thinning, fertilization, genetic improvement, and presence of dwarf mistletoe. An option is available that adjusts growth to simulate local conditions. Equations used in PPSIM describe growth of natural...

Total Quality Management: Public Sector Applications for Training Programs.

ERIC Educational Resources Information Center

Davis, David S.

Total quality management (TQM) is based on the fundamental philosophy that it is always more effective to do something right the first time than it is to correct deficiencies. It seeks to improve quality and increase customer satisfaction by restructuring traditional management and organizational practices. Common characteristics of TQM include…

Online Resources to Support Professional Development for Managing and Preserving Geospatial Data

NASA Astrophysics Data System (ADS)

Downs, R. R.; Chen, R. S.

2013-12-01

Improved capabilities of information and communication technologies (ICT) enable the development of new systems and applications for collecting, managing, disseminating, and using scientific data. New knowledge, skills, and techniques are also being developed to leverage these new ICT capabilities and improve scientific data management practices throughout the entire data lifecycle. In light of these developments and in response to increasing recognition of the wider value of scientific data for society, government agencies are requiring plans for the management, stewardship, and public dissemination of data and research products that are created by government-funded studies. Recognizing that data management and dissemination have not been part of traditional science education programs, new educational programs and learning resources are being developed to prepare new and practicing scientists, data scientists, data managers, and other data professionals with skills in data science and data management. Professional development and training programs also are being developed to address the need for scientists and professionals to improve their expertise in using the tools and techniques for managing and preserving scientific data. The Geospatial Data Preservation Resource Center offers an online catalog of various open access publications, open source tools, and freely available information for the management and stewardship of geospatial data and related resources, such as maps, GIS, and remote sensing data. Containing over 500 resources that can be found by type, topic, or search query, the geopreservation.org website enables discovery of various types of resources to improve capabilities for managing and preserving geospatial data. Applications and software tools can be found for use online or for download. Online journal articles, presentations, reports, blogs, and forums are also available through the website. Available education and training materials include tutorials, primers, guides, and online learning modules. The site enables users to find and access standards, real-world examples, and websites of other resources about geospatial data management. Quick links to lists of resources are available for data managers, system developers, and researchers. New resources are featured regularly to highlight current developments in practice and research. A user-centered approach was taken to design and develop the site iteratively, based on a survey of the expectations and needs of community members who have an interest in the management and preservation of geospatial data. Formative and summative evaluation activities have informed design, content, and feature enhancements to enable users to use the website efficiently and effectively. Continuing management and evaluation of the website keeps the content and the infrastructure current with evolving research, practices, and technology. The design, development, evaluation, and use of the website are described along with selected resources and activities that support education and professional development for the management, preservation, and stewardship of geospatial data.

Management of older adults with hip fractures in India: a mixed methods study of current practice, barriers and facilitators, with recommendations to improve care pathways.

PubMed

Rath, Santosh; Yadav, Lalit; Tewari, Abha; Chantler, Tracey; Woodward, Mark; Kotwal, Prakash; Jain, Anil; Dey, Aparajit; Garg, Bhavuk; Malhotra, Rajesh; Goel, Ashish; Farooque, Kamran; Sharma, Vijay; Webster, Premila; Norton, Robyn

2017-12-01

Evidence-based management can reduce deaths and suffering of older adults with hip fractures. This study investigates the evidence-practice gaps in hip fracture care in three major hospitals in Delhi, potential barriers and facilitators to improving care, and consequently, identifies contextually appropriate interventions for implementing best practice for management of older adults with hip fractures in India. Hip fracture in older adults is a significant public health issue in India. The current study sought to document current practices, identify barriers and facilitators to adopting best practice guidelines and recommend improvements in the management of older adults with hip fractures in Delhi, India. This mixed methods observational study collected data from healthcare providers, patients, carers and medical records from three major public tertiary care hospitals in Delhi, India. All patients aged ≥50 years with an X-ray confirmed hip fracture that were admitted to these hospitals over a 10-week period were recruited. Patients' data were collected at admission, discharge and 30 days post-injury. Eleven key informant interviews and four focus group discussions were conducted with healthcare providers. Descriptive data for key quantitative variables were computed. The qualitative data were analysed and interpreted using a behaviour change wheel framework. A total of 136 patients, 74 (54%) men and 62 women, with hip fracture were identified in the three participating hospitals during the recruitment period and only 85 (63%) were admitted for treatment with a mean age of 66.5 years (SD 11.9). Of these, 30% received surgery within 48 h of hospital admission, 95% received surgery within 39 days of hospital admission and two (3%) had died by 30 days of injury. According to the healthcare providers, inadequate resources and overcrowding prevent adequate caring of the hip fracture patients. They unanimously felt the need for protocol-based management of hip fracture in India. The development and implementation of national guidelines and standardized protocols of care for older people with hip fractures in India has the potential to improve both care and patient-related outcomes.

Defining High-Quality Palliative Care in Oncology Practice: An American Society of Clinical Oncology/American Academy of Hospice and Palliative Medicine Guidance Statement.

PubMed

Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K

2016-09-01

Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.

Cognitive Learning Theory Takes a Backseat: Consequences of a Management Development Program for Work Practice

ERIC Educational Resources Information Center

Moesby-Jensen, Cecilie K.

2008-01-01

This paper describes the consequences of a cognitive management development program for middle managers in a public organization. The objective was to teach transformational leadership and teamwork but it occasioned a very limited improved articulation of transformational leadership and teamwork and only a modest change in the managers' actions in…

Maintain workplace civility by sharing the vow of personal responsibility.

PubMed

Chism, Marlene

2012-01-01

Office gossip, power struggles, employee burnout, and short fuses are becoming more the rule than the exception in running a medical practice. The difficult conversation avoided today can turn into the lawsuit 15 years later. Managers often find it hard to confront high performers and authority figures in the workplace. In order to deal with disruptive behavior and incivility before it ruins the medical practice, practice managers should institute the four steps outlined in this article plus the Vow of Personal Responsibility to improve clarity, teamwork, and personal performance.

Managing caries: the need to close the gap between the evidence base and current practice.

PubMed

Schwendicke, F; Doméjean, S; Ricketts, D; Peters, M

2015-11-13

Underpinned by a changing knowledge of the aetiology of caries and its sequelae, and assisted by established and advancing dental materials, there is growing evidence supporting less invasive management of dental caries based on the principles of minimal intervention dentistry. This narrative review assesses both the evidence and the adoption of less invasive caries management strategies and describes ways in which the gap between evidence and practice might be overcome. While there is increasing data supporting less invasive management of carious lesions, these are not standard in most dental practices worldwide. Usually, clinical studies focused on efficacy as outcome, and did not take into consideration the views and priorities of other stakeholders, such as primary care dentists, educators, patients and those financing services. Involving these stakeholders into study design and demonstrating the broader advantages of new management strategies might improve translation of research into practice. In theory, clinical dentists can rely on a growing evidence in cariology regarding less invasive management options. In practice, further factors seem to impede adoption of these strategies. Future research should address these factors by involving major stakeholders and investigating their prioritised outcomes to narrow or close the evidence gap.

Application of a theoretical model to evaluate COPD disease management.

PubMed

Lemmens, Karin M M; Nieboer, Anna P; Rutten-Van Mölken, Maureen P M H; van Schayck, Constant P; Asin, Javier D; Dirven, Jos A M; Huijsman, Robbert

2010-03-26

Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care.

Application of a theoretical model to evaluate COPD disease management

PubMed Central

2010-01-01

Background Disease management programmes are heterogeneous in nature and often lack a theoretical basis. An evaluation model has been developed in which theoretically driven inquiries link disease management interventions to outcomes. The aim of this study is to methodically evaluate the impact of a disease management programme for patients with chronic obstructive pulmonary disease (COPD) on process, intermediate and final outcomes of care in a general practice setting. Methods A quasi-experimental research was performed with 12-months follow-up of 189 COPD patients in primary care in the Netherlands. The programme included patient education, protocolised assessment and treatment of COPD, structural follow-up and coordination by practice nurses at 3, 6 and 12 months. Data on intermediate outcomes (knowledge, psychosocial mediators, self-efficacy and behaviour) and final outcomes (dyspnoea, quality of life, measured by the CRQ and CCQ, and patient experiences) were obtained from questionnaires and electronic registries. Results Implementation of the programme was associated with significant improvements in dyspnoea (p < 0.001) and patient experiences (p < 0.001). No significant improvement was found in mean quality of life scores. Improvements were found in several intermediate outcomes, including investment beliefs (p < 0.05), disease-specific knowledge (p < 0.01; p < 0.001) and medication compliance (p < 0.01). Overall, process improvement was established. The model showed associations between significantly improved intermediate outcomes and improvements in quality of life and dyspnoea. Conclusions The application of a theory-driven model enhances the design and evaluation of disease management programmes aimed at improving health outcomes. This study supports the notion that a theoretical approach strengthens the evaluation designs of complex interventions. Moreover, it provides prudent evidence that the implementation of COPD disease management programmes can positively influence outcomes of care. PMID:20346135

Understanding medical practice team roles.

PubMed

Hills, Laura

2015-01-01

Do you believe that the roles your employees play on your medical practice team are identical to their job titles or job descriptions? Do you believe that team roles are determined by personality type? This article suggests that a more effective way to build and manage your medical practice team is to define team roles through employee behaviors. It provides 10 rules of behavioral team roles that can help practice managers to select and build high-performing teams, build more productive team relationships, improve the employee recruitment process, build greater team trust and understanding; and increase their own effectiveness. This article describes in detail Belbin's highly regarded and widely used team role theory and summarizes four additional behavioral team role theories and systems. It offers lessons learned when applying team role theory to practice. Finally, this article offers an easy-to-implement method for assessing current team roles. It provides a simple four-question checklist that will help practice managers balance an imbalanced medical practice team.

Correlates of domestic waste management and related health outcomes in Sunyani, Ghana: a protocol towards enhancing policy.

PubMed

Addo, Henry O; Dun-Dery, Elvis J; Afoakwa, Eugenia; Elizabeth, Addai; Ellen, Amposah; Rebecca, Mwinfaug

2017-07-03

Domestic waste generation has contributed significantly to hampering national waste management efforts. It poses serious threat to national development and requires proper treatment and management within and outside households. The problem of improper waste management has always been a challenge in Ghana, compelling several national surveys to report on the practice of waste management. However, little is known about how much waste is generated and managed within households and there is a serious dearth of information for national policy and planning. This paper seeks to document the handling and practice of waste management, including collection, storage, transportation and disposal along with the types and amount of waste generated by Households and their related health outcome. The study was a descriptive cross-sectional study and used a multi-stage sampling technique to sample 700 households. The study was planned and implemented from January to May 2015. It involved the use of structured questionnaires in the data collection over the period. Factors such as demographic characteristics, amount of waste generated, types of waste bins used within households, waste recycling, cost of disposing waste, and distance to dumpsite were all assessed. The paper shows that each surveyed household generated 0.002 t of waste per day, of which 29% are both organic and inorganic. Though more than half of the respondents (53.6%) had positive attitude towards waste management, only 29.1% practiced waste management. The study reveals that there is no proper management of domestic waste except in few households that segregate waste. The study identified several elements as determinants of waste management practice. Female respondents were less likely to practice waste management (AOR 0.45; 95% Cl 0.29, 0.79), household size also determined respondents practice (AOR 0.26; Cl 0.09, 0.77). Practice of recycling (AOR 0.03; Cl 0.02, 0.08), distance to dumpsite (AOR 0.45; Cl 0.20, 0.99), were all significant predictors of waste management practice. Cholera which is a hygiene related disease was three times more likely to determine households' waste management practice (AOR 3.22; Cl 1.33, 7.84). Considering the low waste management practice among households, there is the need for improved policy and enhanced education on proper waste management practice among households.

Editor's Choice-The role of the emergency department in the management of acute heart failure: An international perspective on education and research.

PubMed

Pang, Peter S; Collins, Sean P; Miró, Òscar; Bueno, Hector; Diercks, Deborah B; Di Somma, Salvatore; Gray, Alasdair; Harjola, Veli-Pekka; Hollander, Judd E; Lambrinou, Ekaterini; Levy, Phillip D; Papa, AnnMarie; Möckel, Martin

2017-08-01

Emergency departments are a major entry point for the initial management of acute heart failure (AHF) patients throughout the world. The initial diagnosis, management and disposition - the decision to admit or discharge - of AHF patients in the emergency department has significant downstream implications. Misdiagnosis, under or overtreatment, or inappropriate admission may place patients at increased risk for adverse events, and add costs to the healthcare system. Despite the critical importance of initial management, data are sparse regarding the impact of early AHF treatment delivered in the emergency department compared to inpatient or chronic heart failure management. Unfortunately, outcomes remain poor, with nearly a third of patients dying or re-hospitalised within 3 months post-discharge. In the absence of robust research evidence, consensus is an important source of guidance for AHF care. Thus, we convened an international group of practising emergency physicians, cardiologists and advanced practice nurses with the following goals to improve outcomes for AHF patients who present to the emergency department or other acute care setting through: (a) a better understanding of the pathophysiology, presentation and management of the initial phase of AHF care; (b) improving initial management by addressing knowledge gaps between best practices and current practice through education and research; and (c) to establish a framework for future emergency department-based international education and research.

Reducing nitrogen export from the corn belt to the Gulf of Mexico: agricultural strategies for remediating hypoxia

USGS Publications Warehouse

McLellan, Eileen; Robertson, Dale M.; Schilling, Keith; Tomer, Mark; Kostel, Jill; Smith, Douglas G.; King, Kevin

2015-01-01

SPAtially Referenced Regression on Watershed models developed for the Upper Midwest were used to help evaluate the nitrogen-load reductions likely to be achieved by a variety of agricultural conservation practices in the Upper Mississippi-Ohio River Basin (UMORB) and to compare these reductions to the 45% nitrogen-load reduction proposed to remediate hypoxia in the Gulf of Mexico (GoM). Our results indicate that nitrogen-management practices (improved fertilizer management and cover crops) fall short of achieving this goal, even if adopted on all cropland in the region. The goal of a 45% decrease in loads to the GoM can only be achieved through the coupling of nitrogen-management practices with innovative nitrogen-removal practices such as tile-drainage treatment wetlands, drainage–ditch enhancements, stream-channel restoration, and floodplain reconnection. Combining nitrogen-management practices with nitrogen-removal practices can dramatically reduce nutrient export from agricultural landscapes while minimizing impacts to agricultural production. With this approach, it may be possible to meet the 45% nutrient reduction goal while converting less than 1% of cropland in the UMORB to nitrogen-removal practices. Conservationists, policy makers, and agricultural producers seeking a workable strategy to reduce nitrogen export from the Corn Belt will need to consider a combination of nitrogen-management practices at the field scale and diverse nitrogen-removal practices at the landscape scale.

Soft governance, restratification and the 2004 general medical services contract: the case of UK primary care organisations and general practice teams.

PubMed

Grant, Suzanne; Ring, Adele; Gabbay, Mark; Guthrie, Bruce; McLean, Gary; Mair, Frances S; Watt, Graham; Heaney, David; O'Donnell, Catherine

2015-01-01

In the UK National Health Service, primary care organisation (PCO) managers have traditionally relied on the soft leadership of general practitioners based on professional self-regulation rather than direct managerial control. The 2004 general medical services contract (nGMS) represented a significant break from this arrangement by introducing new performance management mechanisms for PCO managers to measure and improve general practice work. This article examines the impact of nGMS on the governance of UK general practice by PCO managers through a qualitative analysis of data from an empirical study in four UK PCOs and eight general practices, drawing on Hood's four-part governance framework. Two hybrids emerged: (i) PCO managers emphasised a hybrid of oversight, competition (comptrol) and peer-based mutuality by granting increased support, guidance and autonomy to compliant practices; and (ii) practices emphasised a broad acceptance of increased PCO oversight of clinical work that incorporated a restratified elite of general practice clinical peers at both PCO and practice levels. Given the increased international focus on the quality, safety and efficiency in primary care, a key issue for PCOs and practices will be to achieve an effective, contextually appropriate balance between the counterposing governance mechanisms of peer-led mutuality and externally led comptrol. © 2015 The Authors. Sociology of Health & Illness © 2015 Foundation for the Sociology of Health & Illness/John Wiley & Sons Ltd.

Practical Suicide-Risk Management for the Busy Primary Care Physician

PubMed Central

McDowell, Anna K.; Lineberry, Timothy W.; Bostwick, J. Michael

2011-01-01

Suicide is a public health problem and a leading cause of death. The number of people thinking seriously about suicide, making plans, and attempting suicide is surprisingly high. In total, primary care clinicians write more prescriptions for antidepressants than mental health clinicians and see patients more often in the month before their death by suicide. Treatment of depression by primary care physicians is improving, but opportunities remain in addressing suicide-related treatment variables. Collaborative care models for treating depression have the potential both to improve depression outcomes and decrease suicide risk. Alcohol use disorders and anxiety symptoms are important comorbid conditions to identify and treat. Management of suicide risk includes understanding the difference between risk factors and warning signs, developing a suicide risk assessment, and practically managing suicidal crises. PMID:21709131

The Indiana Chronic Disease Management Program

PubMed Central

Rosenman, Marc B; Holmes, Ann M; Ackermann, Ronald T; Murray, Michael D; Doebbeling, Caroline Carney; Katz, Barry; Li, Jingjin; Zillich, Alan; Prescott, Victoria M; Downs, Stephen M; Inui, Thomas S

2006-01-01

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation. PMID:16529571

The Indiana Chronic Disease Management Program.

PubMed

Rosenman, Marc B; Holmes, Ann M; Ackermann, Ronald T; Murray, Michael D; Doebbeling, Caroline Carney; Katz, Barry; Li, Jingjin; Zillich, Alan; Prescott, Victoria M; Downs, Stephen M; Inui, Thomas S

2006-01-01

The Indiana Chronic Disease Management Program (ICDMP) is intended to improve the quality and cost-effectiveness of care for Medicaid members with congestive heart failure (chronic heart failure), diabetes, asthma, and other conditions. The ICDMP is being assembled by Indiana Medicaid primarily from state and local resources and has seven components: (1) identification of eligible participants to create regional registries, (2) risk stratification of eligible participants, (3) nurse care management for high-risk participants, (4) telephonic intervention for all participants, (5) an Internet-based information system, (6) quality improvement collaboratives for primary care practices, and (7) program evaluation. The evaluation involves a randomized controlled trial in two inner-city group practices, as well as a statewide observational design. This article describes the ICDMP, highlights challenges, and discusses approaches to its evaluation.

Quality Improvement in Gastroenterology Clinical Practice

PubMed Central

KHERAJ, RAKHI; TEWANI, SUMEET K.; KETWAROO, GYANPRAKASH; LEFFLER, DANIEL A.

2017-01-01

An emphasis on quality improvement (QI) is vital to the cost-effective provision of evidence-based health care. QI projects in gastroenterology have typically focused on endoscopy to minimize or eliminate procedure-related complications or errors. However, a significant component of gastroenterology care is based on the management of chronic disease. Patients with chronic diseases are seen in many different outpatient practices in the community and academia. In an attempt to ensure that every patient receives high-quality care, major gastrointestinal societies have published guidelines on the management of common gastrointestinal complaints. However, adherence to these guidelines varies. We discuss common outpatient gastrointestinal illnesses with established guidelines for management that could benefit from active QI projects; these would ensure a consistently high standard of care for every patient. PMID:22902758

So You Want to Be Trustworthy: A Repository's Guide to Taking Reasonable Steps Towards Achieving ISO 16363

NASA Astrophysics Data System (ADS)

Stall, S.

2016-12-01

To be trustworthy is to be reliable, dependable, honest, principled, ethical, incorruptible, and more. A trustworthy person demonstrates these qualities over time and under all circumstances. A trustworthy repository demonstrates these qualities through the team that manages the repository and its responsible organization. The requirements of a Trusted Digital Repository (TDR) in ISO 16363 can be tough to reach and tough to maintain. Challenges include: limited funds, limited resources and/or skills, and an unclear path to successfully achieve the requirements. The ISO standard defines each requirement separately, but a successful certification recognizes that there are many cross-dependencies among the requirements. Understanding these dependencies leads to a more efficient path towards success. At AGU we recognize that reaching the goal of the TDR ISO standard, or any set of data management objectives defined by an organization, has a better chance at success if the organization clearly knows their current capability, the improvements that are needed, and the best way to make (and maintain) those changes. AGU has partnered with the CMMI® Institute to adapt their Data Management Maturity (DMM)SM model within the Earth and space sciences. Using the DMM, AGU developed a new Data Management Assessment Program aimed at helping data repositories, large and small, domain-specific to general, assess and improve data management practices to meet their goals - including becoming a Trustworthy Digital Repository. The requirements to achieve the TDR ISO standard are aligned to the data management best practices defined in the Data Management Maturity (DMM)SM model. Using the DMM as a process improvement tool in conjunction with the Data Management Assessment method, a team seeking the objective of the TDR ISO standard receives a clear road map to achieving their goal as an outcome of the assessment. Publishers and agencies are beginning to recommend or even require that repositories demonstrate that they are practicing best practices or meeting certain standards. Data preserved in a data facility that is working on achieving a TDR standard will have the level of care desired by the publishing community as well as the science community. Better Data Management results in Better Science.

Data Envelopment Analysis (DEA) Model in Operation Management

NASA Astrophysics Data System (ADS)

Malik, Meilisa; Efendi, Syahril; Zarlis, Muhammad

2018-01-01

Quality management is an effective system in operation management to develops, maintains, and improves quality from groups of companies that allow marketing, production, and service at the most economycal level as well as ensuring customer satisfication. Many companies are practicing quality management to improve their bussiness performance. One of performance measurement is through measurement of efficiency. One of the tools can be used to assess efficiency of companies performance is Data Envelopment Analysis (DEA). The aim of this paper is using Data Envelopment Analysis (DEA) model to assess efficiency of quality management. In this paper will be explained CCR, BCC, and SBM models to assess efficiency of quality management.

Trends in sustainable landfilling in Malaysia, a developing country.

PubMed

Fauziah, S H; Agamuthu, P

2012-07-01

In Malaysia, landfills are being filled up rapidly due to the current daily generation of approximately 30,000 tonnes of municipal solid waste. This situation creates the crucial need for improved landfilling practices, as sustainable landfilling technology is yet to be achieved here. The objective of this paper is to identify and evaluate the development and trends in landfilling practices in Malaysia. In 1970, the disposal sites in Malaysia were small and prevailing waste disposal practices was mere open-dumping. This network of relatively small dumps, typically located close to population centres, was considered acceptable for a relatively low population of 10 million in Malaysia. In the 1980s, a national programme was developed to manage municipal and industrial wastes more systematically and to reduce adverse environmental impacts. The early 1990s saw the privatization of waste management in many parts of Malaysia, and the establishment of the first sanitary landfills for MSW and an engineered landfill (called 'secure landfill' in Malaysia) for hazardous waste. A public uproar in 2007 due to contamination of a drinking water source from improper landfilling practices led to some significant changes in the government's policy regarding the country's waste management strategy. Parliament passed the Solid Waste and Public Cleansing Management (SWPCM) Act 2007 in August 2007. Even though the Act is yet to be implemented, the government has taken big steps to improve waste management system further. The future of the waste management in Malaysia seems somewhat brighter with a clear waste management policy in place. There is now a foundation upon which to build a sound and sustainble waste management and disposal system in Malaysia.

Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects.

PubMed

Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

2017-09-27

To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades-while not inexpensive-contributed to greater system efficiency and modest savings. © Mwencha et al.

Upgrading Supply Chain Management Systems to Improve Availability of Medicines in Tanzania: Evaluation of Performance and Cost Effects

PubMed Central

Mwencha, Marasi; Rosen, James E; Spisak, Cary; Watson, Noel; Kisoka, Noela; Mberesero, Happiness

2017-01-01

ABSTRACT Background: To address challenges in public health supply chain performance, Tanzania invested in a national logistics management unit (LMU) and a national electronic logistics management information system (eLMIS). This evaluation examined the impact of those 2 key management upgrades approximately 1 year after they were introduced. Methods: We used a nonexperimental pre-post study design to compare the previous system with the upgraded management system. We collected baseline data from August to November 2013. We conducted round 1 of post-implementation data collection during April and May 2015, about 1 year after implementation of the upgrades. We evaluated key indicators of data use and reporting; supply chain management practices such as storage and supervision; supply chain performance including stock-out and expiry rates; and supply chain cost and savings. We analyzed the data using a range of techniques including statistical testing of baseline and round-1 results, and cost, cost-effectiveness, and return on investment analysis. Results: The upgrades were associated with improvements in data use, accessibility, visibility, and transparency; planning, control, and monitoring; support for quantification; stock-out rates; stock-out duration; commodity expiry; and forecast error. The upgraded system was more costly, but it was also more efficient, particularly when adjusting for the performance improvements. The upgrades also generated substantial savings that defrayed some, but not all, of the investment costs. Conclusion: Upgrades to Tanzania's supply chain management systems created multiple and complex pathways to impact. One year after implementation, the LMU and eLMIS brought about performance improvements through better data use and through improvements in some, but not all, management practices. Furthermore, the upgrades—while not inexpensive—contributed to greater system efficiency and modest savings. PMID:28877933

Modifying physician behavior to improve cost-efficiency in safety-net ambulatory settings.

PubMed

Borkowski, Nancy; Gumus, Gulcin; Deckard, Gloria J

2013-01-01

Change interventions in one form or another are viewed as important tools to reduce variation in medical services, reduce costs, and improve quality of care. With the current focus on efficient resource use, the successful design and implementation of change strategies are of utmost importance for health care managers. We present a case study in which macro and micro level change strategies were used to modify primary care physicians' practice patterns of prescribing diagnostic services in a safety-net's ambulatory clinics. The findings suggest that health care managers using evidence-based strategies can create a practice environment that reduces barriers and facilitates change.

School Leaders' Engagement with the Concept of Evidence-Based Practice as a Management Tool for School Improvement

ERIC Educational Resources Information Center

Sheard, Mary K.; Sharples, Jonathan

2016-01-01

Strategies that encourage direct linkage and exchange between researchers and practitioners are more likely to support changes in educational practice informed by research evidence. Nevertheless, significant challenges remain in linking effectiveness education research to real-world practice: addressing the knowing-doing gap. The paper describes…

25 CFR 166.314 - Can a permittee apply a conservation practice on permitted Indian land?

Code of Federal Regulations, 2010 CFR

2010-04-01

... 25 Indians 1 2010-04-01 2010-04-01 false Can a permittee apply a conservation practice on permitted Indian land? 166.314 Section 166.314 Indians BUREAU OF INDIAN AFFAIRS, DEPARTMENT OF THE INTERIOR LAND AND WATER GRAZING PERMITS Land and Operations Management Conservation Practices and Improvements...

What can family medicine practices do to facilitate knowledge management?

PubMed

Orzano, A John; Ohman-Strickland, Pamela A; Patel, Meghal

2008-01-01

Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics. To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM. We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role). Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes of these effects were not substantially changed even when practice members perceived their practice environment as more chaotic. Steps to facilitate KM should be considered when evaluating more intensive and costly organizational solutions for enhancing family medicine practice performance.