Science.gov

Sample records for improving operator quality

  1. (abstract) Mission Operations and Control Assurance: Flight Operations Quality Improvements

    NASA Technical Reports Server (NTRS)

    Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Witkowski, Mona M.

    1993-01-01

    Mission Operations and Command Assurance (MO&CA), a recent addition to flight operations teams at JPL. provides a system level function to instill quality in mission operations. MO&CA's primary goal at JPL is to help improve the operational reliability for projects during flight. MO&CA tasks include early detection and correction of process design and procedural deficiencies within projects. Early detection and correction are essential during development of operational procedures and training of operational teams. MO&CA's effort focuses directly on reducing the probability of radiating incorrect commands to a spacecraft. Over the last seven years at JPL, MO&CA has become a valuable asset to JPL flight projects. JPL flight projects have benefited significantly from MO&CA's efforts to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit directly from previous and ongoing experience. Since MO&CA, like Total Quality Management (TQM), focuses on continuous improvement of processes and elimination of rework, we recommend that this effort be continued on NASA flight projects.

  2. Mission operations and command assurance: Flight operations quality improvements

    NASA Technical Reports Server (NTRS)

    Welz, Linda L.; Bruno, Kristin J.; Kazz, Sheri L.; Potts, Sherrill S.; Witkowski, Mona M.

    1994-01-01

    Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous solving among flight teams and provides continuous process improvement to reduce risk in mission operations by addressing human factors. The MO&CA task has evolved from participating as a member of the spacecraft team, to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

  3. Operational data assimilation for improving hydrologic, hydrodynamic, and water quality forecasting using open tools

    NASA Astrophysics Data System (ADS)

    Weerts, Albrecht; Kockx, Arno; Sumihar, Julius; Verlaan, Martin; Hummel, Stef; Kramer, Werner; de Klaermaker, Simone

    2014-05-01

    Data assimilation holds considerable potential for improving water quantity (hydrologic/ hydraulic) and water quality predictions. However, advances in hydrologic DA research have not been adequately or timely implemented in operational forecast systems to improve the skill of forecasts for better informed real-world decision making. In contrast to most operational weather (related) forecast centers operational hydrologic forecast centers often are unable to support & maintain or lack the required computing support to implement such intensive DA calculations. Moreover, it remains difficult to achieve coupling of models, data, DA techniques and exploitation of high performance computing solutions in the operational forecasting process. Several potential components of a future solution have been or are being developed, one of those being the open source project OpenDA (www.openda.org). The objective of this poster is to highlight the development of OpenDA for operational forecasting and its integration with Delft-FEWS that is being used by more than 40 operational forecast centres around the world. Several applications of OpenDA using open source (and available) model codes from various fields will be highlighted.

  4. NASA Symposium on Productivity and Quality: Strategies for Improving Operations in Government and Industry

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The purpose of the Symposium is to increase the awareness of productivity and quality issues in the United States, and to foster national initiatives through government and industry executive leadership. The Symposium will provide a forum for discussion of white-collar productivity issues by experienced executives from successful organizations and an opportunity to share information learned through Productivity initiatives in govemment, industry and academic organizations. It will focus on white-collar organizational issues that are common to large companies and technology oriented organizations. The Symposium program will include strategies for improving operations in government and industry and will be responsive to the management issues viewed necessary to increase our nation's productivity growth rate.

  5. Introducing Change (Science into the Operating Room): Quality Improvement versus Experimentation

    PubMed Central

    Poullis, Mike

    2009-01-01

    Abstract: Introducing change is sometimes vital on an individual, departmental, and institutional level to improve the quality of care of patients undergoing cardiopulmonary bypass. This review discussed the following areas: cost of poor quality, variation, knowledge, Deming’s red bead experiments and his conclusions, how do you try to improve, measurement, statistics, and quality improvement verses research. Successes and failures with regard to the introduction of change, and strategies to introduce change without creating conflict are discussed with reference to the hospital in which the author works. PMID:20092081

  6. Quality and productivity drive innovation and improvement at United Technologies Aerospace Operations, Inc.

    NASA Technical Reports Server (NTRS)

    Jamar, L. G.

    1986-01-01

    Quality and innovation are the hallmarks of the national space program. In programs that preceded the Shuttle Program the emphasis was on meeting the risks and technical challenges of space with safety, quality, reliability, and success. At United Technologies Aerospace Operations, Inc. (UTAO), the battle has developed along four primary fronts. These fronts include programs to motivate and reward people, development and construction of optimized processes and facilities, implementation of specifically tailored management systems, and the application of appropriate measurement and control systems. Each of these initiatives is described. However, to put this quality and productivity program in perspective, UTAO and its role in the Shuttle Program are described first.

  7. FOCUS: the Society of Cardiovascular Anesthesiologists' initiative to improve quality and safety in the cardiovascular operating room.

    PubMed

    Barbeito, Atilio; Lau, William Travis; Weitzel, Nathaen; Abernathy, James H; Wahr, Joyce; Mark, Jonathan B

    2014-10-01

    The Society of Cardiovascular Anesthesiologists (SCA) introduced the FOCUS initiative (Flawless Operative Cardiovascular Unified Systems) in 2005 in response to the need for a rigorous scientific approach to improve quality and safety in the cardiovascular operating room (CVOR). The goal of the project, which is supported by the SCA Foundation, is to identify hazards and develop evidence-based protocols to improve cardiac surgery safety. A hazard is anything that has the potential to cause a preventable adverse event. Specifically, the strategic plan of FOCUS includes 3 goals: (1) identifying hazards in the CVOR, (2) prioritizing hazards and developing risk-reduction interventions, and (3) disseminating these interventions. Collectively, the FOCUS initiative, through the work of several groups composed of members from different disciplines such as clinical medicine, human factors engineering, industrial psychology, and organizational sociology, has identified and documented significant hazards occurring daily in our CVORs. Some examples of frequent occurrences that contribute to reduce the safety and quality of care provided to cardiac surgery patients include deficiencies in teamwork, poor OR design, incompatible technologies, and failure to adhere to best practices. Several projects are currently under way that are aimed at better understanding these hazards and developing interventions to mitigate them. The SCA, through the FOCUS initiative, has begun this journey of science-driven improvement in quality and safety. There is a long and arduous road ahead, but one we need to continue to travel. PMID:25232690

  8. Reducing the carbon footprint of the operating theatre: a multicentre quality improvement report.

    PubMed

    Southorn, T; Norrish, A R; Gardner, K; Baxandall, R

    2013-06-01

    Currently, there are very few provisions for recycling in theatres. We measured the weight of clinical waste for several orthopaedic operations. This waste was then examined and sorted into domestic waste and clinical waste. With staff education it is possible to reduce the amount of clinical waste generated by the operating theatre by roughly 50%. A greater awareness of disposal options leads to a reduction in waste disposed of by incineration.

  9. Utilizing Operational and Improved Remote Sensing Measurements to Assess Air Quality Monitoring Model Forecasts

    NASA Astrophysics Data System (ADS)

    Gan, Chuen-Meei

    Air quality model forecasts from Weather Research and Forecast (WRF) and Community Multiscale Air Quality (CMAQ) are often used to support air quality applications such as regulatory issues and scientific inquiries on atmospheric science processes. In urban environments, these models become more complex due to the inherent complexity of the land surface coupling and the enhanced pollutants emissions. This makes it very difficult to diagnose the model, if the surface parameter forecasts such as PM2.5 (particulate matter with aerodynamic diameter less than 2.5 microm) are not accurate. For this reason, getting accurate boundary layer dynamic forecasts is as essential as quantifying realistic pollutants emissions. In this thesis, we explore the usefulness of vertical sounding measurements on assessing meteorological and air quality forecast models. In particular, we focus on assessing the WRF model (12km x 12km) coupled with the CMAQ model for the urban New York City (NYC) area using multiple vertical profiling and column integrated remote sensing measurements. This assessment is helpful in probing the root causes for WRF-CMAQ overestimates of surface PM2.5 occurring both predawn and post-sunset in the NYC area during the summer. In particular, we find that the significant underestimates in the WRF PBL height forecast is a key factor in explaining this anomaly. On the other hand, the model predictions of the PBL height during daytime when convective heating dominates were found to be highly correlated to lidar derived PBL height with minimal bias. Additional topics covered in this thesis include mathematical method using direct Mie scattering approach to convert aerosol microphysical properties from CMAQ into optical parameters making direct comparisons with lidar and multispectral radiometers feasible. Finally, we explore some tentative ideas on combining visible (VIS) and mid-infrared (MIR) sensors to better separate aerosols into fine and coarse modes.

  10. Quality improvement as an investment.

    PubMed

    Weeks, William B

    2002-01-01

    Health care organizations are experiencing increasing internal and external pressures to improve the quality of care that they provide. However, there is not a framework that can be used to help understand the value of quality improvement projects and to prioritize competing projects. By understanding the current processes, costs and outcomes of care, enumerating the costs and benefits of change, anticipating the timing of the costs and benefits, and performing a financial analysis, quality improvement efforts can be evaluated as investments. Only by understanding and adapting to the financial environments in which health care organizations operate can continuous quality improvement in health care succeed. PMID:12512466

  11. Mesh Quality Improvement Toolkit

    2002-11-15

    MESQUITE is a linkable software library to be used by simulation and mesh generation tools to improve the quality of meshes. Mesh quality is improved by node movement and/or local topological modifications. Various aspects of mesh quality such as smoothness, element shape, size, and orientation are controlled by choosing the appropriate mesh qualtiy metric, and objective function tempate, and a numerical optimization solver to optimize the quality of meshes, MESQUITE uses the TSTT mesh interfacemore » specification to provide an interoperable toolkit that can be used by applications which adopt the standard. A flexible code design makes it easy for meshing researchers to add additional mesh quality metrics, templates, and solvers to develop new quality improvement algorithms by making use of the MESQUITE infrastructure.« less

  12. Assessment of an aerosol treatment to improve air quality in a swine concentrated animal feeding operation (CAFO).

    PubMed

    Rule, Ana M; Chapin, Amy R; McCarthy, Sheila A; Gibson, Kristen E; Schwab, Kellogg J; Buckley, Timothy J

    2005-12-15

    Poor air quality within swine concentrated animal feeding operations (CAFOs) poses a threat to workers, the surrounding community, and farm production. Accordingly, the current study was conducted to evaluate a technology for reducing air pollution including particulate matter (PM), viable bacteria, and ammonia within such a facility. The technology consists of an acid-oil-alcohol aerosol applied daily. Its effectiveness was evaluated by comparing air quality from before to after treatment and between treated and untreated sides of a barn separated by an impervious partition. On the untreated side, air quality was typical for a swine CAFO, with mean PM2.5 of 0.28 mg/m3 and PM(TOT) of 1.5 mg/m3. The treatment yielded a reduction in PM concentration of 75-90% from before to after treatment. Effectiveness increased with time, application, and particle size (40% reduction for 1 microm and 90% for >10 microm). Airborne bacteria levels (total bacteria, Enterobacteriaceae, and gram-positive cocci) decreased one logarithmic unit after treatment. In contrast, treatment had no effect on ammonia concentrations. These findings demonstrate the effectiveness of an intervention in yielding exposure and emission reductions. PMID:16475347

  13. Improving quality at Parkview.

    PubMed

    Ivey, B J

    1992-01-01

    Parkview Episcopal Medical Center in Pueblo, CO, has been implementing a continuous quality improvement (CQI)-driven organization since April 1988. Under the leadership of Michael Pugh, the medical center's president and CEO, Parkview has made great progress in this effort. However, there is much more to be accomplished in the years to come.

  14. Addressing the sociotechnical drivers of quality improvement: a case study of post-operative DVT prophylaxis computerised decision support

    PubMed Central

    Yang, Jianji; McConnachie, Judy; Brenk, Thomas; Winterbottom, Lisa

    2011-01-01

    Background Quality improvement (QI) initiatives characterised by iterative cycles of quantitative data analysis do not readily explain the organisational determinants of change. However, the integration of sociotechnical theory can inform more effective strategies. Our specific aims were to (1) describe a computerised decision support intervention intended to improve adherence with deep venous thrombosis (DVT) prophylaxis recommendations; and (2) show how sociotechnical theory expressed in ‘Fit between Individuals, Task and Technology’ framework (FITT) can identify and clarify the facilitators and barriers to QI work. Methods A multidisciplinary team developed and implemented electronic menus with DVT prophylaxis recommendations. Stakeholders were interviewed and human factors were analysed to optimise integration. Menu exposure, order placement and clinical performance were measured. Vista tool extraction and chart review were used. Performance compliance pre-implementation was 77%. Results There were 80–110 eligible cases per month. Initial menu use rate was 20%. After barriers were classified and addressed using the FITT framework, use improved 50% to 90%. Tasks, users and technology issues in the FITT model and their interfaces were identified and addressed. Workflow styles, concerns about validity of guidelines, cycle times and perceived ambiguity of risk were issues identified. Conclusions DVT prophylaxis in a surgical setting is fraught with socio-political agendas, cognitive dissonance and misaligned expectations. These must be sought and articulated if organisations are to respond to internal resistance to change. This case study demonstrates that QI teams using information technology must understand the clinical context, even in mature electronic health record environments, in order to implement sustainable systems. PMID:21209144

  15. Assessment of the quality and toxicity of the discharges of a wastewater treatment plant and alternatives to improve its operation.

    PubMed

    Robles-Vargas, Daniel; Montoya-Castillo, Sandra Margarita; Avelar-González, Francisco Javier; Jauregui-Rincón, Juan; Rodríguez-Valadez, Francisco Javier; Rico-Martínez, Roberto

    2012-01-01

    Wastewater discharges into freshwater bodies represent a serious ecological problem worldwide. In underdeveloped and developing countries wastewater treatment plants (WTP) only count with basic treatment, leading to the pollution of important aquatic reservoirs causing critical situations. In the present work, a one year evaluation of toxicity and main physical and chemical parameters of one of the major WTP of the state of Aguascalientes was conducted fortnightly, and to assess treatment alternatives for this WTP we tested: a) three white rot fungi (WRF), b) a photo-electrochemical process, c) ion-exchangers resins and activated carbon. The 3 WRF exhibited high COD removal from influents (72 - 95 %) but only Phanerochaete chrysosporium reached significant toxicity removals (70 and 55 %, for an influent and an effluent, respectively). Treatments with electrochemical advanced oxidation processes resulted with the highest toxicity and COD removals (96 % for both parameters) in comparison to biological and physicochemical treatments. Adsorption with activated carbon, zeolite and chelex ion-exchange resins removed 60 - 90 % of COD and 60 - 99 % toxicity. These results could be used to improve operation of the Industrial Park WTP and to plan future modifications to the plant. PMID:22375542

  16. Good Data Can Be Better Data - How Data Management Maturity Can Help Repositories Improve Operations, Data Quality, And Usability, Helping Researchers

    NASA Astrophysics Data System (ADS)

    Stall, S.

    2015-12-01

    Much earth and space science data and metadata are managed and supported by an infrastructure of repositories, ranging from large agency or instrument facilities, to institutions, to smaller repositories including labs. Scientists face many challenges in this ecosystem both on storing their data and in accessing data from others for new research. Critical for all uses is ensuring the credibility and integrity of the data and conveying that and provenance information now and in the future. Accurate information is essential for future researchers to find (or discover) the data, evaluate the data for use (content, temporal, geolocation, precision) and finally select (or discard) that data as meeting a "fit-for-purpose" criteria. We also need to optimize the effort it takes in describing the data for these determinations, which means making it efficient for the researchers who collect the data. At AGU we are developing a program aimed at helping repositories, and thereby researchers, improve data quality and data usability toward these goals. AGU has partnered with the CMMI Institute to develop their Data Management Maturity (DMM) framework within the Earth and space sciences. The CMMI DMM framework guides best practices in a range of data operations, and the application of the DMM, through an assessment, reveals how repositories and institutions can best optimize efforts to improve operations and functionality throughout the data lifecycle and elevate best practices across a variety of data management operations. Supporting processes like data operations, data governance, and data architecture are included. An assessment involves identifying accomplishment, and weaknesses compared to leading practices for data management. Broad application of the DMM can help improve quality in data and operations, and consistency across the community that will facilitate interoperability, discovery, preservation, and reuse. Good data can be better data. Consistency results in

  17. Collaborative quality improvement in surgery.

    PubMed

    Waljee, Jennifer F; Birkmeyer, Nancy J O

    2014-08-01

    Collaborative quality improvement has demonstrated success in improving quality and reducing health care costs in several state-based examples. Professional societies and payers are keen on identifying the most effective strategies to improve the safety and efficiency of surgical care. This review highlights the development and features of collaborative quality improvement programs, their advantages and examples of successful collaborations for several surgical conditions, and their potential application for surgeons caring for patients with upper extremity trauma and disability.

  18. White-collar productivity and quality issues; Proceedings of the Symposium on Productivity and Quality: Strategies for Improving Operations in Government and Industry, Washington, DC, September 25, 26, 1984

    NASA Technical Reports Server (NTRS)

    Gerard, M. (Editor); Edwards, P. W. (Editor)

    1985-01-01

    Techniques for improving the productivity of white-collar workers while maintaining high product quality are examined in reviews and reports. The emphasis is on the application of strategies developed in the private sector to government-agency and aerospace-industry operations. Topics discussed include international competition, organizational attitudes and orientation, management practices, education and training, renewing large organizations, encouraging innovation, national initiatives, employee involvement, management involvement, and applications of new technology.

  19. Improving productivity, efficiency, product quality and environmental sustainability of aquaculture operations through systemic integration of information and knowledge

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Experts on selective breeding, physiology, genomics and bioinformatics will present and discuss state of the art information and relevant examples from fish and other animal systems. Identify strategies that will foster continuous improvements in experimental design and data gathering, analysis, be...

  20. Enhancing water quality in hydropower system operations

    NASA Astrophysics Data System (ADS)

    Hayes, Donald F.; Labadie, John W.; Sanders, Thomas G.; Brown, Jackson K.

    1998-03-01

    The quality of impounded waters often degrades over time because of thermal stratification, sediment oxygen demands, and accumulation of pollutants. Consequently, reservoir releases impact water quality in tailwaters, channels, and other downstream water bodies. Low dissolved oxygen (DO) concentrations in the Cumberland River below Old Hickory dam result from stratification of upstream reservoirs and seasonally low release rates. Operational changes in upstream hydropower reservoirs may be one method to increase DO levels without substantially impacting existing project purposes. A water quality model of the upper Cumberland basin is integrated into an optimal control algorithm to evaluate water quality improvement opportunities through operational modifications. The integrated water quantity/quality model maximizes hydropower revenues, subject to various flow and headwater operational restrictions for satisfying multiple project purposes, as well as maintenance of water quality targets. Optimal daily reservoir release policies are determined for the summer drawdown period which increase DO concentrations under stratification conditions with minimal impact on hydropower production and other project purposes. Appendixes A-D available with entire article on microfiche. Order by mail from AGU, 2000 Florida Ave., N.W., Washington, DC 20009 or by phone at 800-966-2481; $2.50. Document W97-003. Payment must accompany order.

  1. Quality function deployment in launch operations

    NASA Astrophysics Data System (ADS)

    Portanova, P. L.; Tomei, E. J., Jr.

    1990-11-01

    The goal of the Advanced Launch System (ALS) is a more efficient launch capability that provides a highly reliable and operable system at substantially lower cost than current launch systems. Total Quality Management (TQM) principles are being emphasized throughout the ALS program. A continuous improvement philosophy is directed toward satisfying users' and customer's requirements in terms of quality, performance, schedule, and cost. Quality Function Deployment (QFD) is interpreted as the voice of the customer (or user), and it is an important planning tool in translating these requirements throughout the whole process of design, development, manufacture, and operations. This report explores the application of QFD methodology to launch operations, including the modification and addition of events (operations planning) in the engineering development cycle, and presents an informal status of study results to date. QFD is a technique for systematically analyzing the customer's (Space Command) perceptions of what constitutes a highly reliable and operable system and functionally breaking down those attributes to identify the critical characteristics that determine an efficient launch system capability. In applying the principle of QFD, a series of matrices or charts are developed with emphasis on the one commonly known as the House of Quality (because of its roof-like format), which identifies and translates the most critical information.

  2. Mission operations and command assurance: Instilling quality into flight operations

    NASA Technical Reports Server (NTRS)

    Welz, Linda L.; Witkowski, Mona M.; Bruno, Kristin J.; Potts, Sherrill S.

    1993-01-01

    Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous process improvement to reduce the probability of radiating incorrect commands to a spacecraft. The MO&CA task has evolved from participating as a member of the spacecraft team to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

  3. Mission operations and command assurance: Instilling quality into flight operations

    NASA Astrophysics Data System (ADS)

    Welz, Linda L.; Witkowski, Mona M.; Bruno, Kristin J.; Potts, Sherrill S.

    1993-03-01

    Mission Operations and Command Assurance (MO&CA) is a Total Quality Management (TQM) task on JPL projects to instill quality in flight mission operations. From a system engineering view, MO&CA facilitates communication and problem-solving among flight teams and provides continuous process improvement to reduce the probability of radiating incorrect commands to a spacecraft. The MO&CA task has evolved from participating as a member of the spacecraft team to an independent team reporting directly to flight project management and providing system level assurance. JPL flight projects have benefited significantly from MO&CA's effort to contain risk and prevent rather than rework errors. MO&CA's ability to provide direct transfer of knowledge allows new projects to benefit from previous and ongoing flight experience.

  4. Shared Decision Making in Neonatal Quality Improvement.

    PubMed

    Warren, Jamie B; Wiggins, Nikki

    2016-01-01

    Since the Institute of Medicine published Crossing the Quality Chasm in 2001, healthcare systems have become more focused on improving the quality of healthcare delivery. At Oregon Health & Science University and Doernbecher Children's Hospital, we recognize the need to take an interprofessional, team-based approach to improving the care we provide to our current and future patients. We describe here an ongoing quality improvement project in the Doernbecher Neonatal Intensive Care Unit (NICU), with specific attention to the factors we believe have contributed to the implementation and early success of the project. These factors include the history of quality improvement work in our NICU and in the field of neonatology, the "dyad leadership" structure under which we operate in our NICU, and our developing understanding of the concept of "team intelligence." These elements have led to the formation of a team that can practice shared decision making and work as one to realize a shared goal. PMID:27465457

  5. Evaluation of quality improvement programmes

    PubMed Central

    Ovretveit, J; Gustafson, D

    2002-01-01

    

 In response to increasing concerns about quality, many countries are carrying out large scale programmes which include national quality strategies, hospital programmes, and quality accreditation, assessment and review processes. Increasing amounts of resources are being devoted to these interventions, but do they ensure or improve quality of care? There is little research evidence as to their effectiveness or the conditions for maximum effectiveness. Reasons for the lack of evaluation research include the methodological challenges of measuring outcomes and attributing causality to these complex, changing, long term social interventions to organisations or health systems, which themselves are complex and changing. However, methods are available which can be used to evaluate these programmes and which can provide decision makers with research based guidance on how to plan and implement them. This paper describes the research challenges, the methods which can be used, and gives examples and guidance for future research. It emphasises the important contribution which such research can make to improving the effectiveness of these programmes and to developing the science of quality improvement. PMID:12486994

  6. Culture shock: Improving software quality

    SciTech Connect

    de Jong, K.; Trauth, S.L.

    1988-01-01

    The concept of software quality can represent a significant shock to an individual who has been developing software for many years and who believes he or she has been doing a high quality job. The very idea that software includes lines of code and associated documentation is foreign and difficult to grasp, at best. Implementation of a software quality program hinges on the concept that software is a product whose quality needs improving. When this idea is introduced into a technical community that is largely ''self-taught'' and has been producing ''good'' software for some time, a fundamental understanding of the concepts associated with software is often weak. Software developers can react as if to say, ''What are you talking about. What do you mean I'm not doing a good job. I haven't gotten any complaints about my code yetexclamation'' Coupling such surprise and resentment with the shock that software really is a product and software quality concepts do exist, can fuel the volatility of these emotions. In this paper, we demonstrate that the concept of software quality can indeed pose a culture shock to developers. We also show that a ''typical'' quality assurance approach, that of imposing a standard and providing inspectors and auditors to assure its adherence, contributes to this shock and detracts from the very goal the approach should achieve. We offer an alternative, adopted through experience, to implement a software quality program: cooperative assistance. We show how cooperation, education, consultation and friendly assistance can overcome this culture shock. 3 refs.

  7. Nuclear quality assurance operating philosophy: A quality-oriented approach

    SciTech Connect

    Corcoran, W.R. ); Geiger, J.E. ); Heibel, R.E. ); Cotton, J.B. ); Sabol, A.R. )

    1992-01-01

    Quality assurance programs have been part of the nuclear utility management process since the publication of the draft of 10CFR50 Appendix B in the late 1960s. The unwritten operational philosophy of nuclear quality assurance organizations focused on compliance with federal regulations. Adverse experiences, including operational events and extended shutdowns, prompted the gradual adoption of isolated practices extending beyond compliance orientation. These practices have an orientation that accommodates a definition of quality, a perspective of the role of nuclear quality assurance organizations in the overall concept of defense-in-depth, a definition of the segments of the nuclear quality assurance mission, and recent advances in the understanding of self-assessment. Observation of these practices at various nuclear utilities resulted in a syntheses of practices and approaches into a coherent quality-oriented nuclear quality assurance operating philosophy that is not totally adopted at any one utility.

  8. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 40 Protection of Environment 16 2013-07-01 2013-07-01 false Quality improvement plan (QIP... PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements. (a... actions, as appropriate: (i) Improved preventive maintenance practices. (ii) Process operation...

  9. Analyses to improve operational flexibility

    SciTech Connect

    Trikouros, N.G.

    1986-01-01

    Operational flexibility is greatly enhanced if the technical bases for plant limits and design margins are fully understood, and the analyses necessary to evaluate the effect of plant modifications or changes in operating modes on these parameters can be performed as required. If a condition should arise that might jeopardize a plant limit or reduce operational flexibility, it would be necessary to understand the basis for the limit or the specific condition limiting operational flexibility and be capable of performing a reanalysis to either demonstrate that the limit will not be violated or to change the limit. This paper provides examples of GPU Nuclear efforts in this regard. Examples of Oyster Creek and Three Mile Island operating experiences are discussed.

  10. Pediatric CT quality management and improvement program.

    PubMed

    Larson, David B; Molvin, Lior Z; Wang, Jia; Chan, Frandics P; Newman, Beverley; Fleischmann, Dominik

    2014-10-01

    Modern CT is a powerful yet increasingly complex technology that continues to rapidly evolve; optimal clinical implementation as well as appropriate quality management and improvement in CT are challenging but attainable. This article outlines the organizational structure on which a CT quality management and improvement program can be built, followed by a discussion of common as well as pediatric-specific challenges. Organizational elements of a CT quality management and improvement program include the formulation of clear objectives; definition of the roles and responsibilities of key personnel; implementation of a technologist training, coaching and feedback program; and use of an efficient and accurate monitoring system. Key personnel and roles include a radiologist as the CT director, a qualified CT medical physicist, as well as technologists with specific responsibilities and adequate time dedicated to operation management, CT protocol management and CT technologist education. Common challenges in managing a clinical CT operation are related to the complexity of newly introduced technology, of training and communication and of performance monitoring. Challenges specific to pediatric patients include the importance of including patient size in protocol and dose considerations, a lower tolerance for error in these patients, and a smaller sample size from which to learn and improve.

  11. Factors Associated With Sleep Quality Among Operating Engineers

    PubMed Central

    Choi, Seung Hee; Terrell, Jeffrey E.; Pohl, Joanne M.; Redman, Richard W.

    2016-01-01

    Blue collar workers generally report high job stress and are exposed to loud noises at work and engage in many of the health behavioral factors, all of which have been associated with poor sleep quality. However, sleep quality of blue collar workers has not been studied extensively, and no studies have focused Operating Engineers (heavy equipment operators) among whom daytime fatigue would place them at high risk for accidents. Therefore, the purpose of this study was to determine variables associated with sleep quality among Operating Engineers. This was a cross-sectional survey design with a dependent variable of sleep quality and independent variables of personal and related health behavioral factors. A convenience sample of 498 Operating Engineers was recruited from approximately 16,000 Operating Engineers from entire State of Michigan in 2008. Linear regression was used to determine personal and related health behavior factors associated with sleep quality. Multivariate analyses showed that personal factors related to poor sleep quality were younger age, female sex, higher pain, more medical comorbidities and depressive symptoms and behavioral factors related to poor sleep quality were nicotine dependence. While sleep scores were similar to population norms, approximately 34% (n=143) showed interest in health services for sleep problems. While many personal factors are not changeable, interventions to improve sleep hygiene as well as interventions to treat pain, depression and smoking may improve sleep quality resulting in less absenteeism, fatal work accidents, use of sick leave, work disability, medical comorbidities, as well as subsequent mortality. PMID:23393021

  12. Handling Qualities Implications for Crewed Spacecraft Operations

    NASA Technical Reports Server (NTRS)

    Bailey, Randall E.; Jackson, E. Bruce; Arthur, J. J.

    2012-01-01

    Abstract Handling qualities embody those qualities or characteristics of an aircraft that govern the ease and precision with which a pilot is able to perform the tasks required in support of an aircraft role. These same qualities are as critical, if not more so, in the operation of spacecraft. A research, development, test, and evaluation process was put into effect to identify, understand, and interpret the engineering and human factors principles which govern the pilot-vehicle dynamic system as they pertain to space exploration missions and tasks. Toward this objective, piloted simulations were conducted at the NASA Langley Research Center and Ames Research Center for earth-orbit proximity operations and docking and lunar landing. These works provide broad guidelines for the design of spacecraft to exhibit excellent handling characteristics. In particular, this work demonstrates how handling qualities include much more than just stability and control characteristics of a spacecraft or aircraft. Handling qualities are affected by all aspects of the pilot-vehicle dynamic system, including the motion, visual and aural cues of the vehicle response as the pilot performs the required operation or task. A holistic approach to spacecraft design, including the use of manual control, automatic control, and pilot intervention/supervision is described. The handling qualities implications of design decisions are demonstrated using these pilot-in-the-loop evaluations of docking operations and lunar landings.

  13. Improving data quality in neuronal population recordings.

    PubMed

    Harris, Kenneth D; Quiroga, Rodrigo Quian; Freeman, Jeremy; Smith, Spencer L

    2016-08-26

    Understanding how the brain operates requires understanding how large sets of neurons function together. Modern recording technology makes it possible to simultaneously record the activity of hundreds of neurons, and technological developments will soon allow recording of thousands or tens of thousands. As with all experimental techniques, these methods are subject to confounds that complicate the interpretation of such recordings, and could lead to erroneous scientific conclusions. Here we discuss methods for assessing and improving the quality of data from these techniques and outline likely future directions in this field. PMID:27571195

  14. Improvement in aircraft performance reduces operating costs

    SciTech Connect

    Not Available

    1982-04-01

    The escalation of jet transport fuel prices has altered traditional economic formulas for commercial airplane operators. This economic change has provided the impetus to develop improvements for existing production run transports such as the Boeing 727, 737, and 747 airplanes. Improvements have been made in drag reduction, propulsion system, weight reduction, and operation.

  15. The role of the Quality Improvement Organization.

    PubMed

    McArdle, Jill

    2013-01-01

    Quality Improvement Organizations (QIOs) are an unbiased source of quality improvement support and expertise for health care professionals and institutions across the nation. The Carolinas Center for Medical Excellence, the QIO in North Carolina and South Carolina, is supporting the advancement of the National Quality Strategy. PMID:23802481

  16. Surface Operations Systems Improve Airport Efficiency

    NASA Technical Reports Server (NTRS)

    2009-01-01

    With Small Business Innovation Research (SBIR) contracts from Ames Research Center, Mosaic ATM of Leesburg, Virginia created software to analyze surface operations at airports. Surface surveillance systems, which report locations every second for thousands of air and ground vehicles, generate massive amounts of data, making gathering and analyzing this information difficult. Mosaic?s Surface Operations Data Analysis and Adaptation (SODAA) tool is an off-line support tool that can analyze how well the airport surface operation is working and can help redesign procedures to improve operations. SODAA helps researchers pinpoint trends and correlations in vast amounts of recorded airport operations data.

  17. African Primary Care Research: Quality improvement cycles

    PubMed Central

    Mash, Bob

    2014-01-01

    Abstract Improving the quality of clinical care and translating evidence into clinical practice is commonly a focus of primary care research. This article is part of a series on primary care research and outlines an approach to performing a quality improvement cycle as part of a research assignment at a Masters level. The article aims to help researchers design their quality improvement cycle and write their research project proposal. PMID:26245438

  18. How to Begin a Quality Improvement Project.

    PubMed

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. PMID:27016497

  19. How to Begin a Quality Improvement Project.

    PubMed

    Silver, Samuel A; Harel, Ziv; McQuillan, Rory; Weizman, Adam V; Thomas, Alison; Chertow, Glenn M; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T

    2016-05-01

    Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects.

  20. Improving the management of operational information for safer and more efficient spacecraft operations

    NASA Astrophysics Data System (ADS)

    Lecouat, F.; de Saint Vincent, A.; Brenot, J. M.; Darroy, J. M.; Gaullier, F.; Pham, P.; Pessah, P.

    Spacecraft control centers are getting more and more sophisticated over time. A lot of advanced software is installed to improve operations safety and efficiency. The data bases required by the control center software tools together with the technical documentation used by operators, is called the Operational Information in this paper. The effectiveness of operations not only depends on the functions of the control center but also on the quality and completeness of the Operational Information. It is thus necessary to develop new methods and tools so that the information generated during spacecraft development is adapted to new operations requirements. In the same time these tools can also improve the spacecraft development process itself by facilitating information assets and validation. This is illustrated by Matra Marconi Space (MMS) experience on recent spacecraft development projects where OPSWARE tools are used both for operations preparation and operations execution.

  1. Quality and quality improvement in forensic mental health evaluations.

    PubMed

    Wettstein, Robert M

    2005-01-01

    Despite the growing attention to quality and quality improvement in health care in the United States, forensic psychiatry has yet to incorporate relevant developments and information and make quality an important item on the agenda. This article reviews the empirical research regarding the perceived quality of forensic evaluations, which has primarily examined criminal rather than civil forensic evaluations. Beyond the available research, many important policy and empirical questions must be addressed, including the definition of a quality forensic evaluation, the process used to access quality, the indicators and measures used, the methods that provide incentives for performing quality evaluations, the role of forensic psychiatry training programs, and the role of the American Academy of Psychiatry and the Law (AAPL) or other professional organizations in the quality improvement enterprise.

  2. [Quality assurance and quality improvement. Personal experiences and intentions].

    PubMed

    Roche, B G; Sommer, C

    1995-01-01

    In may 1994 we were selected by the surgical Swiss association to make a study about quality in USA. During our travel we visited 3 types of institutions: Hospitals, National Institute of standard and Technology, Industry, Johnson & Johnson. We appreciate to compare 2 types of quality programs: Quality Assurance (QA) and Continuous Quality Improvement (CQI). In traditional healthcare circles, QA is the process established to meet external regulatory requirements and to assure that patient care is consistent with established standards. In a modern quality terms, QA outside of healthcare means designing a product or service, as well as controlling its production, so well that quality is inevitable. The ideas of W. Edward Deming is that there is never improvement just by inspection. He developed a theory based on 14 principles. A productive work is accomplished through processes. Understanding the variability of processes is a key to improve quality. Quality management sees each person in an organisation as part of one or more processes. The job of every worker is to receive the work of others, add value to that work, and supply it to the next person in the process. This is called the triple role the workers as customer, processor, and supplier. The main source of quality defects is problems in the process. The old assumption is that quality fails when people do the right thing wrong; the new assumption is that, more often, quality failures arise when people do the wrong think right. Exhortation, incentives and discipline of workers are unlikely to improve quality. If quality is failing when people do their jobs as designed, then exhorting them to do better is managerial nonsense. Modern quality theory is customer focused. Customers are identified internally and externally. The modern approach to quality is thoroughly grounded in scientific and statistical thinking. Like in medicine, the symptom is a defect in quality. The therapist of process must perform diagnostic

  3. Continuous Quality Improvement: A Roadmap for Rural School Improvement.

    ERIC Educational Resources Information Center

    Kilmer, Lloyd C.

    A case study documented a continuous quality improvement approach to school improvement in a rural Nebraska high school over a 2-year period. Data gathered from surveys, portfolios, pilot results, and test scores indicated that the changes during the 2-year period were not dramatic, but significant and consistent with the Total Quality literature.…

  4. Water quality improvement plan for Greater Vancouver

    SciTech Connect

    Foellmi, S.N. . Environmental Div.); Neden, D.G. ); Dawson, R.N. )

    1993-10-01

    The Greater Vancouver Regional District commissioned an 18-month planning and predesign study to define the components in a comprehensive water and predesign study to define the components in a comprehensive water quality improvement plan for its 2,500-ML/d (660-mgd) system. The study included three primary tasks: (1) predesign of disinfection and corrosion control facilities, (2) a 12-month pilot testing program using parallel pilot plants at the Seymour and Capilano water supply reservoirs, and (3) planning for future filtration plants. The results of the study identified chlorine, ammonia, sulfur dioxide, soda ash, and carbon dioxide in a two-stage treatment approach as the recommended disinfection and corrosion control scheme for the low-pH, low-alkalinity water supplies. The pilot-plant studies confirmed that direct filtration using deep-bed monomedium filters operating at a loading rate of 22.5 m/h provided excellent treatment performance and productivity over a wide range of raw-water quality. Ozonation was studied extensively and found not to be beneficial in the overall treatment performance. The phased improvement plan for the disinfection, corrosion control, and filtration facilities has an estimated capital cost of about Can$459 million.

  5. Rethinking Quality and Improvement in Higher Education

    ERIC Educational Resources Information Center

    Houston, Don

    2008-01-01

    Purpose: The purpose of this paper is to critically review dominant conceptions of and approaches to quality in higher education. It suggests an alternative approach with potential to shift the focus of quality activities from accountability and control to improvement. Design/methodology/approach: The applicability and limits of quality concepts…

  6. Operating multireservoir hydropower systems for downstream water quality

    SciTech Connect

    Hayes, D.F.

    1990-01-01

    Hydropower reservoir operations often impact tailwater quality and water quality in the stream or river below the impoundment for many miles. Determining optimal operating strategies for a system of hydropower reservoirs involves solving a highly dimensional nonlinear, nonconvex optimization problem. This research adds the additional complexities of downstream water quality considerations within the optimization formulation to determine operating strategies for a system of hydropower reservoirs operating in series (tandem) or parallel. The formulation was used to determine operating strategies for six reservoirs of the upper Cumberland river basin in Tennessee and Kentucky. Significant dissolved oxygen (DO) violations occur just upstream of Nashville, Tennessee below Old Hickory dam during the months of August and September. Daily reservoir releases were determined for the period of June through September which would produce the maximum hydropower revenue while meeting downstream water quality objectives. Optimal releases for three operational strategies were compared to historical operations for the years 1985, 1986, and 1988. These strategies included: spilling as necessary to meet water quality criteria, near normal operation (minimal spills), and drawdown of reservoirs as necessary to meet criteria without spills. Optimization results showed an 8% to 15% hydropower loss may be necessary to meet water quality criteria through spills and a 2% to 9% improvement in DO below Old Hickory may be possible without significant spills. Results also showed that substantial increases in initial headwater elevations would be necessary to meet daily DO criteria and avoid spills. The optimal control theory algorithm used to solve the problem proved to be an efficient and robust solver of this large optimization problem.

  7. Essentialism: Common Sense Quality Improvement.

    ERIC Educational Resources Information Center

    Wallin, Desna L.; Ryan, John R.

    Essentialism is a trimmed down, action-oriented, user-friendly approach to Total Quality Management (TQM) in education. This book explores the concept of essentialism to describe strategies for implementing TQM in community colleges. Chapter 1 examines the history of the TQM movement and reviews experiences of community college practitioners…

  8. Lichen recolonization following air quality improvement

    SciTech Connect

    Showman, R.E.

    1981-01-01

    Air quality improvement near a coal-fired power plant led to recolonization of Parmelia caperata (L.) Ach. in a pollution-induced void area. Recolonization was first observed about four years after pollution abatement. Least-affected sites were slowest to recover. After eight years of improved air quality, the distribution of P. caperata has returned to near normal. Lichen biomonitoring is useful not only to detect the effects of poor air quality but to document air quality improvements as well. 5 references, 4 figures.

  9. Practical Approaches to Quality Improvement for Radiologists.

    PubMed

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals.

  10. Practical Approaches to Quality Improvement for Radiologists.

    PubMed

    Kelly, Aine Marie; Cronin, Paul

    2015-10-01

    Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. PMID:26466176

  11. 40 CFR 63.175 - Quality improvement program for valves.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 9 2011-07-01 2011-07-01 false Quality improvement program for valves... improvement program for valves. (a) In Phase III, an owner or operator may elect to comply with one of the... leaking valves, calculated as a rolling average of 2 consecutive quarters, as specified in § 63.168(e)...

  12. Narrative methods in quality improvement research

    PubMed Central

    Greenhalgh, T; Russell, J; Swinglehurst, D

    2005-01-01

    

 This paper reviews and critiques the different approaches to the use of narrative in quality improvement research. The defining characteristics of narrative are chronology (unfolding over time); emplotment (the literary juxtaposing of actions and events in an implicitly causal sequence); trouble (that is, harm or the risk of harm); and embeddedness (the personal story nests within a particular social, historical and organisational context). Stories are about purposeful action unfolding in the face of trouble and, as such, have much to offer quality improvement researchers. But the quality improvement report (a story about efforts to implement change), which is common, must be distinguished carefully from narrative based quality improvement research (focused systematic enquiry that uses narrative methods to generate new knowledge), which is currently none. We distinguish four approaches to the use of narrative in quality improvement research—narrative interview; naturalistic story gathering; organisational case study; and collective sense-making—and offer a rationale, describe how data can be collected and analysed, and discuss the strengths and limitations of each using examples from the quality improvement literature. Narrative research raises epistemological questions about the nature of narrative truth (characterised by sense-making and emotional impact rather than scientific objectivity), which has implications for how rigour should be defined (and how it might be achieved) in this type of research. We offer some provisional guidance for distinguishing high quality narrative research in a quality improvement setting from other forms of narrative account such as report, anecdote, and journalism. PMID:16326792

  13. Quality Improvement in Inflammatory Bowel Disease

    PubMed Central

    Siegel, Corey A.

    2013-01-01

    Chronic illnesses such as inflammatory bowel disease (IBD) present a unique opportunity to define and improve the quality of care. Processes of care can be complex, and outcomes of care may vary across different healthcare delivery settings. Patients with IBD are managed over long periods of time and often by the same physician within a single care delivery system. Both patients with Crohn’s disease and ulcerative colitis have variable courses of disease progression that require changes in therapy over time. These factors necessitate multiple areas of potential assessment and improvement of processes and outcomes of care. A current initiative is the development of quality measures. The American Gastroenterological Association has developed accountability measures for the Physician Quality Reporting System, and the Crohn’s and Colitis Foundation of America has developed a set of top 10 recommended processes and outcomes of measurement for high-quality care of patients with IBD. In addition, the pediatric ImproveCareNow collaborative network has collected improvement data from dozens of pediatric centers over the past 5 years and has demonstrated improvement in overall disease activity in their cohort through iterative quality improvement processes. Future directions for quality indicators for adults with IBD will involve implementation of quality-measure reporting, both for purposes of reimbursement as well as improvement of care. These strategies will need to be closely monitored to evaluate the effect of improvement programs on outcomes. PMID:23943663

  14. Operating the plant, quality assurance, and the job of the operating staff, Volume Twelve

    SciTech Connect

    Not Available

    1986-01-01

    Subject matter includes operating the plant (the role of the operator, the control room, plant technical specifications, plant operating procedures, initial startup program, BWR/PWR plant startup, BWR/PWR steady state power operation, BWR/PWR transient operation, emergency operation), quality assurance (what is quality, what is quality control, quality assurance includes quality control, government regulation and quality assurance, administrative controls for nuclear power plants, the necessity of reviews and audits, practical quality assurance), and the job of the operating staff (the plant operating staff, plant safety, first aid and resuscitation, general plant hazards, personnel protective equipment, handling chemicals, handling compressed gas, equipment repair and maintenance, communicating with others.

  15. Quality and quality improvement in occupational health nursing.

    PubMed

    Widtfeldt, A K

    1992-07-01

    Donabedian first defined quality as the result of assessing the structures, processes, and outcomes of health care. The emphasis on quality assurance is changing to quality improvement. The definition of quality in health care has expanded to include the expectations and opinion of patients, their representative, and society. As the cost of health care continues to rise at twice the rate of inflation, business wants to know how health care dollars are spent. Occupational health nurses, to add value to the businesses in which they work, must be a part of the trend in measuring the quality of the products and services of their health services. PMID:1616507

  16. Can Technology Improve the Quality of Colonoscopy?

    PubMed

    Thirumurthi, Selvi; Ross, William A; Raju, Gottumukkala S

    2016-07-01

    In order for screening colonoscopy to be an effective tool in reducing colon cancer incidence, exams must be performed in a high-quality manner. Quality metrics have been presented by gastroenterology societies and now include higher adenoma detection rate targets than in the past. In many cases, the quality of colonoscopy can often be improved with simple low-cost interventions such as improved procedure technique, implementing split-dose bowel prep, and monitoring individuals' performances. Emerging technology has expanded our field of view and image quality during colonoscopy. We will critically review several technological advances in the context of quality metrics and discuss if technology can really improve the quality of colonoscopy.

  17. A Count for Quality: Child Care Center Directors on Rating and Improvement Systems

    ERIC Educational Resources Information Center

    Schulman, Karen; Matthews, Hannah; Blank, Helen; Ewen, Danielle

    2012-01-01

    Quality Rating and Improvement Systems (QRIS)--a strategy to improve families' access to high-quality child care--assess the quality of child care programs, offer incentives and assistance to programs to improve their ratings, and give information to parents about the quality of child care. These systems are operating in a growing number of…

  18. Improving Service Management in Campus IT Operations

    ERIC Educational Resources Information Center

    Wan, Stewart H. C.; Chan, Yuk-Hee

    2008-01-01

    Purpose: This paper aims at presenting the benefits from implementing IT service management (ITSM) in an organization for managing campus-wide IT operations. In order to improve the fault correlation from business perspectives, we proposed a framework to automate network and system alerts with respect to its business service impact for proactive…

  19. Hazmat review reduces risk and improves operations

    SciTech Connect

    Hartley, P.W.; Trecha, S.J.; Patterson, P.

    1996-07-01

    Through its hazardous materials (hazmat) review initiative, Wisconsin Power and Light Co. (WP and L) repositioned itself for better plant operations while reducing the overall risks and costs associated with hazmats. The utility focused on two primary hazmat improvement objectives: (1) ensure plant hazmat operations are meeting regulatory requirements, optimizing the use, storage, and disposal of hazmats; (2) reduce the overall risk and investment associated with hazmat substances on the plant properties. ``Hazardous materials management is often overlooked as an integral component of the overall purchasing and materials management process``, emphasized Jill Doucette, WP and L Strategic Sourcing Initiative manager. ``Improved performance in this area can significantly reduce personnel and company risks, improve customer service and save dollars.``

  20. Do English NHS Microbiology laboratories offer adequate services for the diagnosis of UTI in children? Healthcare Quality Improvement Partnership (HQIP) Audit of Standard Operational Procedures.

    PubMed

    McNulty, Cliodna A M; Verlander, Neville Q; Moore, Philippa C L; Larcombe, James; Dudley, Jan; Banerjee, Jaydip; Jadresic, Lyda

    2015-09-01

    The National Institute of Care Excellence (NICE) 2007 guidance CG54, on urinary tract infection (UTI) in children, states that clinicians should use urgent microscopy and culture as the preferred method for diagnosing UTI in the hospital setting for severe illness in children under 3 years old and from the GP setting in children under 3 years old with intermediate risk of severe illness. NICE also recommends that all 'infants and children with atypical UTI (including non-Escherichia coli infections) should have renal imaging after a first infection'. We surveyed all microbiology laboratories in England with Clinical Pathology Accreditation to determine standard operating procedures (SOPs) for urgent microscopy, culture and reporting of children's urine and to ascertain whether the SOPs facilitate compliance with NICE guidance. We undertook a computer search in six microbiology laboratories in south-west England to determine urine submissions and urine reports in children under 3 years. Seventy-three per cent of laboratories (110/150) participated. Enterobacteriaceae that were not E. coli were reported only as coliforms (rather than non-E. coli coliforms) by 61% (67/110) of laboratories. Eighty-eight per cent of laboratories (97/110) provided urgent microscopy for hospital and 54% for general practice (GP) paediatric urines; 61% of laboratories (confidence interval 52-70%) cultured 1 μl volume of urine, which equates to one colony if the bacterial load is 106 c.f.u. l(-1). Only 22% (24/110) of laboratories reported non-E. coli coliforms and provided urgent microscopy for both hospital and GP childhood urines; only three laboratories also cultured a 5 μl volume of urine. Only one of six laboratories in our submission audit had a significant increase in urine submissions and urines reported from children less than 3 years old between the predicted pre-2007 level in the absence of guidance and the 2008 level following publication of the NICE guidance. Less than a

  1. Linking Planning, Quality Improvement, and Institutional Research

    ERIC Educational Resources Information Center

    Seymour, Daniel; Kelley, John M.; Jasinski, John

    2004-01-01

    External and internal forces are driving institutions not only to create departments and positions that specialize in planning, quality improvement, and institutional research but also to link them within a systems context.

  2. Neonatal networks: clinical research and quality improvement.

    PubMed

    Profit, Jochen; Soll, Roger F

    2015-12-01

    Worldwide, neonatal networks have been formed to address both the research and quality improvement agenda of neonatal-perinatal medicine. Neonatal research networks have led the way in conducting many of the most important clinical trials of the last 25 years, including studies of cooling for hypoxic-ischemic encephalopathy, delivery room management with less invasive support, and oxygen saturation targeting. As we move into the future, increasing numbers of these networks are tackling quality improvement initiatives as a priority of their collaboration. Neonatal quality improvement networks have been in the forefront of the quality movement in medicine and, in the 21st century, have contributed to many of the reported improvements in care. In the coming years, building and maintaining this community of care is critical to the success of neonatal-perinatal medicine.

  3. How Can We Improve Teacher Quality?

    ERIC Educational Resources Information Center

    Wilson, Suzanne M.

    2011-01-01

    Research on teacher quality is not definitive. But, we know that developing high-quality teachers requires a multipronged approach: We need to recruit promising teachers. We need to retain and reward effective early career teachers. We need mechanisms to dismiss those who don't improve. We need to focus teacher preparation on the foundations of…

  4. How to Sustain Change and Support Continuous Quality Improvement.

    PubMed

    Silver, Samuel A; McQuillan, Rory; Harel, Ziv; Weizman, Adam V; Thomas, Alison; Nesrallah, Gihad; Bell, Chaim M; Chan, Christopher T; Chertow, Glenn M

    2016-05-01

    To achieve sustainable change, quality improvement initiatives must become the new way of working rather than something added on to routine clinical care. However, most organizational change is not maintained. In this next article in this Moving Points in Nephrology feature on quality improvement, we provide health care professionals with strategies to sustain and support quality improvement. Threats to sustainability may be identified both at the beginning of a project and when it is ready for implementation. The National Health Service Sustainability Model is reviewed as one example to help identify issues that affect long-term success of quality improvement projects. Tools to help sustain improvement include process control boards, performance boards, standard work, and improvement huddles. Process control and performance boards are methods to communicate improvement results to staff and leadership. Standard work is a written or visual outline of current best practices for a task and provides a framework to ensure that changes that have improved patient care are consistently and reliably applied to every patient encounter. Improvement huddles are short, regular meetings among staff to anticipate problems, review performance, and support a culture of improvement. Many of these tools rely on principles of visual management, which are systems transparent and simple so that every staff member can rapidly distinguish normal from abnormal working conditions. Even when quality improvement methods are properly applied, the success of a project still depends on contextual factors. Context refers to aspects of the local setting in which the project operates. Context affects resources, leadership support, data infrastructure, team motivation, and team performance. For these reasons, the same project may thrive in a supportive context and fail in a different context. To demonstrate the practical applications of these quality improvement principles, these principles are

  5. Improving Teaching Quality and the Learning Organisation

    ERIC Educational Resources Information Center

    Collie, Sarah L.; Taylor, Alton L.

    2004-01-01

    This study applied a learning organisation framework to understand academic departments' efforts to improve teaching quality. The theoretical framework was generated from literature on learning organisations, organisations devoted to continuous improvement through continuous learning. Research questions addressed relationships among departments'…

  6. Forming tool improves quality of tubing flares

    NASA Technical Reports Server (NTRS)

    1966-01-01

    Punch and die set improves the quality of tubing flares for use with standard flared-tube fittings in high-pressure systems. It forges a dimensionally accurate flare in the tubing and forces more tubing material into the high-stress areas to improve the strength and tightness of the tubing connection.

  7. Operational Water Quality Management: Problem Context and Evaluation of a Model for River Quality

    NASA Astrophysics Data System (ADS)

    Beck, M. B.; Finney, B. A.

    1987-11-01

    In river basins where water is used intensively and by many activities and facilities, the essential questions of water quality management are changing from being issues of planning alone to being problems of operational decision making. In the past 10 years in the United Kingdom, for example, the technology, economics, legislation, and institutional structure of management have all changed substantially. Together these changes have overturned the traditional assumptions made about the nature of managing river water quality. This paper discusses the foundations for a case study in operational water quality management. The basis of the case study is a dynamic model for stream discharge and quality covering a 54-km stretch of the Bedford Ouse River in England. The model describes interactions among biochemical oxygen demand, dissolved oxygen, ammonium N, nitrate N, and chlorophyll a concentrations at various points along the river; preliminary identification results are presented using daily time series data for the whole of 1974. The behavior of the river, which relates the effects of a major upstream discharger to a downstream abstractor, is dominated by the dynamics of algal population growth and mortality. In addition to the presentation of these results the paper sets out the technical, economic, and policy questions central to the practical feasibility and potential of operational water quality management. This includes questions in quantifying the stochastic, dynamic aspects of river basin management, the development of improved operating strategies, and the development of operational decision support systems.

  8. Quality Improvement Efforts in Pediatric Oral Health.

    PubMed

    Ng, Man Wai

    2016-04-01

    Quality improvement (QI) and measurement are increasingly used in health care to improve patient care and outcomes. Despite current barriers in oral health measurement, there are nascent QI and measurement efforts emerging. This paper describes the role that QI and measurement can play in improving oral health care delivery in clinical practice by presenting a QI initiative that aimed to test and implement a chronic disease management approach to address early childhood caries. PMID:27265978

  9. Quality assurance: Importance of systems and standard operating procedures.

    PubMed

    Manghani, Kishu

    2011-01-01

    It is mandatory for sponsors of clinical trials and contract research organizations alike to establish, manage and monitor their quality control and quality assurance systems and their integral standard operating procedures and other quality documents to provide high-quality products and services to fully satisfy customer needs and expectations. Quality control and quality assurance systems together constitute the key quality systems. Quality control and quality assurance are parts of quality management. Quality control is focused on fulfilling quality requirements, whereas quality assurance is focused on providing confidence that quality requirements are fulfilled. The quality systems must be commensurate with the Company business objectives and business model. Top management commitment and its active involvement are critical in order to ensure at all times the adequacy, suitability, effectiveness and efficiency of the quality systems. Effective and efficient quality systems can promote timely registration of drugs by eliminating waste and the need for rework with overall financial and social benefits to the Company. PMID:21584180

  10. MODIS Instrument Operation and Calibration Improvements

    NASA Technical Reports Server (NTRS)

    Xiong, X.; Angal, A.; Madhavan, S.; Link, D.; Geng, X.; Wenny, B.; Wu, A.; Chen, H.; Salomonson, V.

    2014-01-01

    Terra and Aqua MODIS have successfully operated for over 14 and 12 years since their respective launches in 1999 and 2002. The MODIS on-orbit calibration is performed using a set of on-board calibrators, which include a solar diffuser for calibrating the reflective solar bands (RSB) and a blackbody for the thermal emissive bands (TEB). On-orbit changes in the sensor responses as well as key performance parameters are monitored using the measurements of these on-board calibrators. This paper provides an overview of MODIS on-orbit operation and calibration activities, and instrument long-term performance. It presents a brief summary of the calibration enhancements made in the latest MODIS data collection 6 (C6). Future improvements in the MODIS calibration and their potential applications to the S-NPP VIIRS are also discussed.

  11. Quality circles: Organizational adaptations, improvements and results

    NASA Technical Reports Server (NTRS)

    Tortorich, R.

    1985-01-01

    The effective application in industry and government of quality circles work was demonstrated. The results achieved in quality and productivity improvements and cost savings are impressive. The circle process should be institutionalized within industry and government. The stages of circle program growth, innovations that help achieve circle process institutionalization, and the result achieved at Martin Marietta's Michoud Division and within the National Aeronautics and Space Administration (NASA) are addressed.

  12. Improved high operating temperature MCT MWIR modules

    NASA Astrophysics Data System (ADS)

    Lutz, H.; Breiter, R.; Figgemeier, H.; Schallenberg, T.; Schirmacher, W.; Wollrab, R.

    2014-06-01

    High operating temperature (HOT) IR-detectors are a key factor to size, weight and power (SWaP) reduced IR-systems. Such systems are essential to provide infantrymen with low-weight handheld systems with increased battery lifetimes or most compact clip-on weapon sights in combination with high electro-optical performance offered by cooled IR-technology. AIM's MCT standard n-on-p technology with vacancy doping has been optimized over many years resulting in MWIR-detectors with excellent electro-optical performance up to operating temperatures of ~120K. In the last years the effort has been intensified to improve this standard technology by introducing extrinsic doping with Gold as an acceptor. As a consequence the dark current could considerably be suppressed and allows for operation at ~140K with good e/o performance. More detailed investigations showed that limitation for HOT > 140K is explained by consequences from rising dark current rather than from defective pixel level. Recently, several crucial parameters were identified showing great promise for further optimization of HOT-performance. Among those, p-type concentration could successfully be reduced from the mid 1016 / cm3 to the lower 1015/ cm3 range. Since AIM is one of the leading manufacturers of split linear cryocoolers, an increase in operating temperature will directly lead to IR-modules with improved SWaP characteristics by making use of the miniature members of its SX cooler family with single piston and balancer technology. The paper will present recent progress in the development of HOT MWIR-detector arrays at AIM and show electro-optical performance data in comparison to focal plane arrays produced in the standard technology.

  13. Improving the quality of mass produced maps

    USGS Publications Warehouse

    Simley, J.

    2001-01-01

    Quality is critical in cartography because key decisions are often made based on the information the map communicates. The mass production of digital cartographic information to support geographic information science has now added a new dimension to the problem of cartographic quality, as problems once limited to small volumes can now proliferate in mass production programs. These problems can also affect the economics of map production by diverting a sizeable portion of production cost to pay for rework on maps with poor quality. Such problems are common to general industry-in response, the quality engineering profession has developed a number of successful methods to overcome these problems. Two important methods are the reduction of error through statistical analysis and addressing the quality environment in which people work. Once initial and obvious quality problems have been solved, outside influences periodically appear that cause adverse variations in quality and consequently increase production costs. Such errors can be difficult to detect before the customer is affected. However, a number of statistical techniques can be employed to detect variation so that the problem is eliminated before significant damage is caused. Additionally, the environment in which the workforce operates must be conductive to quality. Managers have a powerful responsibility to create this environment. Two sets of guidelines, known as Deming's Fourteen Points and ISO-9000, provide models for this environment.

  14. Engaging with quality improvement in anticoagulation management.

    PubMed

    Barnes, Geoffrey D; Kline-Rogers, Eva

    2015-04-01

    Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process.

  15. Engaging with quality improvement in anticoagulation management

    PubMed Central

    Barnes, Geoffrey D.; Kline-Rogers, Eva

    2016-01-01

    Anticoagulants are highly effective at preventing thrombosis across a variety of clinical indications. However, their use can also lead to devastating effects, including major bleeding and death. Anticoagulation providers strive to balance the benefits of anticoagulant therapy with the risks of major bleeding. A measure of quality care can be used to assess the strengths and potential weaknesses in any system of coordinated care delivery. Quality measures in anticoagulation include patient-centered outcomes (e.g. major bleeding, time in the therapeutic range) and provider- or process-focused outcomes (e.g. compliance with guideline recommendations and response times to out-of-range laboratory values). Engaging in quality improvement activities allows anticoagulation providers to assess their own performance and identify areas for targeted interventions. This review summarizes the justification for engaging in quality improvement for anticoagulation management and describes a number of example programs. Interventions benefiting the management of both warfarin and the direct oral anticoagulants are included. The review also details potential quality measures and resources for any anticoagulation provider looking to begin a quality improvement process. PMID:25772116

  16. [Transgenic technology and soybean quality improvement].

    PubMed

    Cheng, Hao; Jin, Hang-Xia; Gai, Jun-Yi; Yu, De-Yue

    2011-05-01

    Soybean is an important source of edible oil, protein and protein diet. The breeding process of high quality soybean can be accelerated via employment of transgenic technology, by which the key genes for soybean quality traits could be directly manipulated. Thus, various soybean varieties could be bred to fulfill different needs for specific consumers. Here, we reviewed the contribution of transgenic technology to improvement of soybean qualities in recent years. We also introduce some newly developed safe transgenic technologies and hope this information could relieve some concerns on the GM food.

  17. Innovative drilling improves THUMS islands operations

    SciTech Connect

    Moore, S.D.

    1983-08-01

    During the last 2 years, THUMS Long Beach Co. has made tremendous improvements in drilling and production efficiencies. The company implemented several innovative ideas which have reduced drilling time by as much as 25%, as well as increased well productivity. THUMS' engineering and drilling staffs should be credited with willingness to explore and to try state-of-the-art technology to improve ongoing operations. The company as one of the first to use computer optimization for well bore planning, measurement-while-drilling (MWD) tools for monitoring directional drilling parameters, and more recently for using the combination of polycrystalline diamond compact (PDC) underreamers and high-torque, low-speed mud motors to underream selected intervals.

  18. Impacts of organizational context on quality improvement.

    PubMed

    Glasgow, Justin M; Yano, Elizabeth M; Kaboli, Peter J

    2013-01-01

    Variation in how hospitals perform on similar quality improvement (QI) efforts argues for a need to understand how different organizational characteristics affect QI performance. The objective of this study was to use data-mining methods to evaluate relationships between measures of organizational characteristics and hospital QI performance. Organizational characteristics were extracted from 2 surveys and analyzed in 3 separate decision-tree models. The decision trees did not find any predictive associations in this sample of 100 hospitals participating in a national QI collaborative. Further model review identified that measures of QI Experience were associated with an ability to make improvements, whereas measures of Staffing and Culture were associated with an ability to sustain improvements. A key area for future research is to understand the challenges faced as QI teams transition from improving care to sustaining quality and to ascertain what organizational characteristics can best overcome those challenges.

  19. Quality Improvements in Curricula for Global Studies

    ERIC Educational Resources Information Center

    Bader, Lena; Bereuther, Tabea; Deutsch, Elisabeth; Edlinger, Julia; Fureder, Silvia; Kaspar, Emanuel; Kottstorfer, Marlene; Mautner, Claudia; Rossegger, Christine; Samonig, Alina; Samonig, Stefan; Schuster, Christoph; Witz, Gerhard; Zotter, Victoria; Ahamer, Gilbert

    2013-01-01

    Purpose: Based on an in-depth comparison of 20 multicultural university curricula, this article aims to provide practical and implementable suggestions about how to improve such curricula in order to ensure highest and globally compatible academic quality. The recently founded developmental Master's curriculum "Global Studies" (GS) at the…

  20. Continuous Quality Improvement Tools for Effective Teaching.

    ERIC Educational Resources Information Center

    Cornesky, Robert A.

    This manual presents 15 Continuous Quality Improvement (CQI) tools and techniques necessary for effective teaching. By using the tools and techniques of CQI, teachers will be able to help themselves and their students to focus on the classroom processes. This will permit the teacher and students to plan, organize, implement, and make decisions…

  1. Research and Training for Quality Improvement.

    ERIC Educational Resources Information Center

    Box, George

    Quality improvement in the workplace via scientific techniques of research and training is discussed. Topics addressed include time factors, salient problems and assignable causes, informed observation, experimental design, study location, and training. Requirements for change in the workplace include: change in management attitudes and structure…

  2. AQIP and Accreditation: Improving Quality and Performance

    ERIC Educational Resources Information Center

    Spangehl, Stephen D.

    2012-01-01

    For the past 12 years, the Academic Quality Improvement Program (AQIP) has offered an innovative means for colleges and universities to maintain regional accreditation with the Higher Learning Commission (HLC), the only regional U.S. accrediting commission currently providing alternative pathways for maintaining accreditation. Although all HLC…

  3. Fostering Quality Improvement in EHDI Programs

    ERIC Educational Resources Information Center

    Bradham, Tamala S.; Hoffman, Jeff; Houston, K. Todd; Guignard, Gayla Hutsell

    2011-01-01

    State coordinators of early hearing detection and intervention (EHDI) programs completed a strengths, weaknesses, opportunities, and threats, or SWOT, analysis that consisted of 12 evaluative areas of EHDI programs. For the quality improvement area, a total of 218 items were listed by 47 EHDI coordinators, and themes were identified in each…

  4. Improving the Quality of Think-Alouds

    ERIC Educational Resources Information Center

    Ness, Molly; Kenny, MaryBeth

    2016-01-01

    An essential element in teaching children to effectively comprehend text is the use of teacher-led think alouds. This article presents a three-step model to improve the quality and quantity of think alouds in K-6 classrooms. The article follows elementary teachers who planned, implemented, transcribed, and reflected upon think aloud lessons to…

  5. Operational Environmental Monitoring Program Quality Assurance Project Plan

    SciTech Connect

    Perkins, C.J.

    1994-08-01

    This Quality Assurance Project Plan addresses the quality assurance requirements for the activities associated with the preoperational and operational environmental monitoring performed by Westinghouse Hanford Company as it implements the Operational Environmental Monitoring program. This plan applies to all sampling and monitoring activities performed by Westinghouse Hanford Company in implementing the Operational Environmental Monitoring program at the Hanford Site.

  6. Progress at Fresh Kills improving water quality

    SciTech Connect

    Londres, E.J.

    1991-06-01

    This paper reports that in December 1987, the federal district court in Nevada issued a consent order forcing New York City (NYC) to improve its handling of solid waste and reduce the discharge of solid waste into the surrounding waterway. Implementation of the consent order by NYC resulted in many improvements in the transport of solid waste from the Marine Transfer Station (MTS) to Fresh Kills Landfill. The end result was a marked reduction in solid waste discharge and an improvement in water quality along the New Jersey shore areas.

  7. 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. PMID:26430867

  8. Quality in quality improvement research - a new benchmark

    PubMed Central

    2011-01-01

    Expanded abstract Citation Scales DC, Dainty K, Hales B, Pinto R, Fowler RA, Adhikari NK, Zwarenstein M: A multifaceted intervention for quality improvement in a network of intensive care units: a cluster randomized trial. JAMA 2011, 305:363-72. Context Evidence-based practices improve intensive care unit (ICU) outcomes, but eligible patients may not receive them. Community hospitals treat most critically ill patients but may have few resources to devote to quality improvement. Objective To determine the effectiveness of a multicenter quality improvement program to increase delivery of 6 evidence-based ICU practices. Design, setting, and participants Pragmatic, cluster-randomized trial among 15 community hospital ICUs in Ontario, Canada. A total of 9269 admissions occurred during the trial (November 2005 to October 2006) and 7141 admissions during a decay-monitoring period (December 2006 to August 2007). Intervention The authors implemented a videoconference-based forum including audit and feedback, expert-led educational sessions, and dissemination of algorithms to sequentially improve delivery of 6 practices. The ICUs were randomized into 2 groups. Each group received this intervention, targeting a new practice every 4 months, while acting as control for the other group, in which a different practice was targeted in the same period. Main outcomes The primary outcome was the summary ratio of odds ratios (ORs) for improvement in adoption (determined by daily data collection) of all 6 practices during the trial in intervention vs control ICUs. Results Overall, adoption of the targeted practices was greater in intervention ICUs than in controls (summary ratio of ORs, 2.79; 95% confidence interval [CI], 1.00-7.74). Improved delivery in intervention ICUs was greatest for semi recumbent positioning to prevent ventilator-associated pneumonia (90.0% of patient-days in last month vs. 50.0% in first month; OR, 6.35; 95% CI, 1.85-21.79) and precautions to prevent catheter

  9. Wind turbine generator with improved operating subassemblies

    DOEpatents

    Cheney, Jr., Marvin C.

    1985-01-01

    A wind turbine includes a yaw spring return assembly to return the nacelle from a position to which it has been rotated by yawing forces, thus preventing excessive twisting of the power cables and control cables. It also includes negative coning restrainers to limit the bending of the flexible arms of the rotor towards the tower, and stop means on the rotor shaft to orient the blades in a vertical position during periods when the unit is upwind when the wind commences. A pendulum pitch control mechanism is improved by orienting the pivot axis for the pendulum arm at an angle to the longitudinal axis of its support arm, and excessive creep is of the synthetic resin flexible beam support for the blades is prevented by a restraining cable which limits the extent of pivoting of the pendulum during normal operation but which will permit further pivoting under abnormal conditions to cause the rotor to stall.

  10. Identified mortality risk factors associated with presentation, initial hospitalisation, and interstage period for the Norwood operation in a multi-centre registry: a report from the National Pediatric Cardiology-Quality Improvement Collaborative

    PubMed Central

    Cross, Russell R.; Harahsheh, Ashraf S.; McCarter, Robert; Martin, Gerard R.

    2015-01-01

    Introduction Despite improvements in care following Stage 1 palliation, interstage mortality remains substantial. The National Pediatric Cardiology-Quality Improvement Collaborative captures clinical process and outcome data on infants discharged into the interstage period after Stage 1. We sought to identify risk factors for interstage mortality using these data. Materials and methods Patients who reached Stage 2 palliation or died in the interstage were included. The analysis was considered exploratory and hypothesis generating. Kaplan–Meier survival analysis was used to screen for univariate predictors, and Cox multiple regression modelling was used to identify potential independent risk factors. Results Data on 247 patients who met the criteria between June, 2008 and June, 2011 were collected from 33 surgical centres. There were 23 interstage mortalities (9%). The identified independent risk factors of interstage mortality with associated relative risk were: hypoplastic left heart syndrome with aortic stenosis and mitral atresia (relative risk = 13), anti-seizure medications at discharge (relative risk = 12.5), earlier gestational age (relative risk = 11.1), nasogastric or nasojejunal feeding (relative risk = 5.5), unscheduled readmissions (relative risk = 5.3), hypoplastic left heart syndrome with aortic atresia and mitral stenosis (relative risk = 5.2), fewer clinic visits with primary cardiologist identified (relative risk = 3.1), and fewer post-operative vasoactive medications (relative risk = 2.2). Conclusion Interstage mortality remains substantial, and there are multiple potential risk factors. Future efforts should focus on further exploration of each risk factor, with potential integration of the factors into surveillance schemes and clinical practice strategies. PMID:23388401

  11. Why and how a functional information system improves computerized operations

    SciTech Connect

    Pirus, D.

    2006-07-01

    At the beginning of the eighties, designing a computerized control room was similar to exploring a terra incognita. Some major projects were carried out (N4 project, Kashiwasaki for example) in order to provide initial experience feedback. Today design guidelines and standards exist to help designers and now all projects (for new control rooms or for renovating existing ones) are designed to use computerized operations. Experience feedback on existing projects clearly shows that the computerization of operations significantly improves the overall quality and efficiency of operations. Nevertheless, the computerization of operations introduces new specific problems, the most important being the 'key hole effect' and the lack of global vision. These problems can be directly attributed to the media currently used (the screens) where space is scarce, and to the philosophy used when designing the information system (fundamentally, based on a reproduction of existing piping diagrams with little or no summary information). Yesterday, the challenge was to computerize the control room, today, it is to computerize operations and reduce or eliminate these existing problems. One promising method is to design the HSI using a functional methodology. This paper describes the operators' operational needs and how and why a functional information system can help address those needs. Finally, the paper presents a few proposals on how to design a functional information system. (authors)

  12. Continuous quality improvement: improving hemodialysis catheter patency using urokinase.

    PubMed

    Northsea, C

    1996-12-01

    Opportunities for improvements in patient outcomes through applied continuous quality improvement (CQI) programs are endless and exciting. Improving vascular access outcomes has been a long-standing clinical problem for hemodialysis patients and the nephrology team. During the past few years there has been a dramatic increase in the use of dialysis catheters as permanent accesses for hemodialysis patients. All hemodialysis with dialysis catheters are at risk for catheter occlusion. An innovative, 2-year CQI program was developed, implemented, and designed to improve dialysis catheter patency rates with the use of urokinase. The CQI program resulted in a number of clinical outcomes that were beneficial to the patients and dialysis staff, and were cost-effective to the program.

  13. In Brief: Improving Mississippi River water quality

    NASA Astrophysics Data System (ADS)

    Showstack, Randy

    2007-10-01

    If water quality in the Mississippi River and the northern Gulf of Mexico is to improve, the U.S. Environmental Protection Agency (EPA) needs to take a stronger leadership role in implementing the federal Clean Water Act, according to a 16 October report from the U.S. National Research Council. The report notes that EPA has failed to use its authority to coordinate and oversee activities along the river. In addition, river states need to be more proactive and cooperative in efforts to monitor and improve water quality, and the river should be monitored and evaluated as a single system, the report indicates. Currently, the 10 states along the river conduct separate and widely varying water quality monitoring programs. ``The limited attention being given to monitoring and managing the Mississippi's water quality does not match the river's significant economic, ecological, and cultural importance,'' said committee chair David A. Dzombak, director of the Steinbrenner Institute for Environmental Education and Research at Carnegie Mellon University, Pittsburgh, Pa. The report notes that while measures taken under the Clean Water Act have successfully reduced much point source pollution, nutrient and sediment loads from nonpoint sources continue to be significant problems. For more information, visit the Web site: http://books.nap.edu/catalog.php?record_id=12051.

  14. Productivity improvement and quality enhancement at NASA

    NASA Technical Reports Server (NTRS)

    Braunstein, D. R.

    1985-01-01

    NASA's Productivity Improvement and Quality Enhancement (PIQE) effort has as its objectives the encouragement of greater employee participation in management decision-making and the identification of impediments as well as opportunities for high productivity. Attempts are also made to try out novel management practices, and to evolve productivity trend analysis techniques. Every effort is made to note, reward, and diffuse successfully instituted PIQE approaches throughout the NASA-contractor organization.

  15. NanTroSEIZE Stage 1 operational review: Operational limits and data quality

    NASA Astrophysics Data System (ADS)

    Kuramoto, S.; Kyaw Thu, M.; Masago, H.; Curewitz, D.; Gaillot, P.; Sanada, Y.; Science Party, E.

    2008-12-01

    Nankai Trough Seismogenic Zone Experiment (NanTroSEIZE) Stage 1 is first step in the ambitious, coordinated multistage, multi-expedition project from the Integrated Ocean Drilling Program (IODP). Through out the 138 days of continuous operations in three expeditions, two major challenges caused various problems and delays. The Kuroshio current presented at all sites and more often at 3 knot or greater velocity, and the difficult borehole conditions in this tectonically active faulting environment obviously caused substantial loss of operational time, failure of equipments and loss of toolstring. Several other technical problems, ranging from dynamic positioning system, remotely operated vehicle (ROV) to wait-on-weather, made additional delays as well. During the course of these expeditions, Chikyu was able to test and refine operational techniques and structures, and able to pioneer the use of new tools and equipments not only in the lab area but also at the rig floor coring and logging operations. Those include first-ever and rarely-used logging-while-drilling (LWD) tools in the scientific drilling history, new coring systems and techniques, extensive use of X-ray Computed Tomography (XCT) on whole core sections and several others. Expedition 314 collected 4274 m of LWD logs and conducted 2285.5 m of Measurement-While-Drilling (MWD) logs from pilot holes. Expedition 315 recovered 808 m of core from 1287 m penetration, and Expedition 316 recovered 1340 m of core out of 2103 m penetration. With intention of improving CDEX's expedition planning and science services in the future, major review work is in progress focusing on operational, technological and science services. Review on the non-productive time records found to be 23.5% for overall stage 1, which gradually decreases from 33.7% at the beginning (Exp. 314) to 24.9% during the Exp. 315 and then 11.0% in the Exp. 316. Review on the coring operations and functioning of coring tools in focus of core quality

  16. Burnishing of rotatory parts to improve surface quality

    NASA Astrophysics Data System (ADS)

    Celaya, A.; López de Lacalle, L. N.; Albizuri, J.; Alberdi, R.

    2009-11-01

    In this paper, the use of rolling burnishing process to improve the final quality of railway and automotive workpieces is studied. The results are focused on the improvement of the manufacturing processes of rotary workpieces used in railway and automotion industry, attending to generic target of achieving `maximum surface quality with minimal process time'. Burnishing is a finishing operation in which plastic deformation of surface irregularities occurs by applying pressure through a very hard element, a roller or a ceramic ball. This process gives additional advantages to the workpiece such as good surface roughness, increased hardness and high compressive residual stresses. The effect of the initial turning conditions on the final burnishing operation has also been studied. The results show that feeds used in the initial rough turning have little influence in the surface finish of the burnished workpieces. So, the process times of the combined turning and burnishing processes can be reduced, optimizing the shaft's machining process.

  17. How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program

    PubMed Central

    Cho, Yu Kyung

    2016-01-01

    In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary. PMID:27484810

  18. How to Improve the Quality of Screening Endoscopy in Korea: National Endoscopy Quality Improvement Program.

    PubMed

    Cho, Yu Kyung

    2016-07-01

    In Korea, gastric cancer screening, either esophagogastroduodenoscopy or upper gastrointestinal series (UGIS), is performed biennially for adults aged 40 years or older. Screening endoscopy has been shown to be associated with localized cancer detection and better than UGIS. However, the diagnostic sensitivity of detecting cancer is not satisfactory. The National Endoscopy Quality Improvement (QI) program was initiated in 2009 to enhance the quality of medical institutions and improve the effectiveness of the National Cancer Screening Program (NCSP). The Korean Society of Gastrointestinal Endoscopy developed quality standards through a broad systematic review of other endoscopic quality guidelines and discussions with experts. The standards comprise five domains: qualifications of endoscopists, endoscopic unit facilities and equipment, endoscopic procedure, endoscopy outcomes, and endoscopic reprocessing. After 5 years of the QI program, feedback surveys showed that the perception of QI and endoscopic practice improved substantially in all domains of quality, but the quality standards need to be revised. How to avoid missing cancer in endoscopic procedures in daily practice was reviewed, which can be applied to the mass screening endoscopy. To improve the quality and effectiveness of NCSP, key performance indicators, acceptable quality standards, regular audit, and appropriate reimbursement are necessary. PMID:27484810

  19. Increased Mercury Bioaccumulation Follows Water Quality Improvement

    SciTech Connect

    Bogle, M.A.; Peterson, M.J.; Smith, J.G.; Southworth, G.R.

    1999-09-15

    Changes in physical and chemical characteristics of aquatic habitats made to reduce or eliminate ecological risks can sometimes have unforeseen consequences. Environmental management activities on the U.S. Dept. of Energy reservation in Oak Ridge, Tennessee,have succeeded in improving water quality in streams impacted by discharges fi-om industrial facilities and waste disposal sites. The diversity and abundance of pollution-sensitive components of the benthic macroinvertebrate communities of three streams improved after new waste treatment systems or remedial actions reduced inputs of various toxic chemicals. Two of the streams were known to be mercury-contaminated from historical spills and waste disposal practices. Waterborne mercury concentrations in the third were typical of uncontaminated systems. In each case, concentrations of mercury in fish, or the apparent biological availability of mercury increased over the period during which ecological metrics indicated improved water quality. In the system where waterborne mercury concentrations were at background levels, increased mercury bioaccumulation was probably a result of reduced aqueous selenium concentrations; however, the mechanisms for increased mercury accumulation in the other two streams remain under investigation. In each of the three systems, reduced inputs of metals and inorganic anions was followed by improvements in the health of aquatic invertebrate communities. However, this reduction in risk to aquatic invertebrates was accompanied by increased risk to humans and piscivorous wildlife related to increased mercury concentrations in fish.

  20. Improving quality at many levels. Profamilia's experience in Colombia.

    PubMed

    Trias, M; Plata, M I

    1994-01-01

    Profamilia, the Colombian family planning association and the country's largest family planning provider, began diversifying its services in 1982 to offer prenatal care services as well as general medical consultations. The organization has since attempted to integrate quality assurance at all levels of operation. Specifically, Profamilia is aiming to provide care which is of sustainably high quality to satisfy present clients and attract new ones without overtaxing available organization resources, thereby prompting the eventual financial collapse of the programs and the failure to increase coverage especially among the middle and lower classes of the country. Drawing from the credo of modern corporate enterprise, "the client is always right," Profamilia listens and responds to clients' needs with the goal of making their satisfaction the ultimate objective. Moreover, organization staff receive regular training to motivate their receptiveness to client needs, while the pursuit of quality exists as a major goal at the managerial level. Profamilia regards quality maintenance and improvement as indispensable in program sustainability.

  1. Improving the Blanco Telescope's delivered image quality

    NASA Astrophysics Data System (ADS)

    Abbott, Timothy M. C.; Montane, Andrés; Tighe, Roberto; Walker, Alistair R.; Gregory, Brooke; Smith, R. Christopher; Cisternas, Alfonso

    2010-07-01

    The V. M. Blanco 4-m telescope at Cerro Tololo Inter-American Observatory is undergoing a number of improvements in preparation for the delivery of the Dark Energy Camera. The program includes upgrades having potential to deliver gains in image quality and stability. To this end, we have renovated the support structure of the primary mirror, incorporating innovations to improve both the radial support performance and the registration of the mirror and telescope top end. The resulting opto-mechanical condition of the telescope is described. We also describe some improvements to the environmental control. Upgrades to the telescope control system and measurements of the dome environment are described in separate papers in this conference.

  2. Operational excellence (six sigma) philosophy: Application to software quality assurance

    SciTech Connect

    Lackner, M.

    1997-11-01

    This report contains viewgraphs on operational excellence philosophy of six sigma applied to software quality assurance. This report outlines the following: goal of six sigma; six sigma tools; manufacturing vs administrative processes; Software quality assurance document inspections; map software quality assurance requirements document; failure mode effects analysis for requirements document; measuring the right response variables; and questions.

  3. Improving Air Quality Forecasts with AURA Observations

    NASA Technical Reports Server (NTRS)

    Newchurch, M. J.; Biazer, A.; Khan, M.; Koshak, W. J.; Nair, U.; Fuller, K.; Wang, L.; Parker, Y.; Williams, R.; Liu, X.

    2008-01-01

    Past studies have identified model initial and boundary conditions as sources of reducible errors in air-quality simulations. In particular, improving the initial condition improves the accuracy of short-term forecasts as it allows for the impact of local emissions to be realized by the model and improving boundary conditions improves long range transport through the model domain, especially in recirculating anticyclones. During the August 2006 period, we use AURA/OMI ozone measurements along with MODIS and CALIPSO aerosol observations to improve the initial and boundary conditions of ozone and Particulate Matter. Assessment of the model by comparison of the control run and satellite assimilation run to the IONS06 network of ozonesonde observations, which comprise the densest ozone sounding campaign ever conducted in North America, to AURA/TES ozone profile measurements, and to the EPA ground network of ozone and PM measurements will show significant improvement in the CMAQ calculations that use AURA initial and boundary conditions. Further analyses of lightning occurrences from ground and satellite observations and AURA/OMI NO2 column abundances will identify the lightning NOx signal evident in OMI measurements and suggest pathways for incorporating the lightning and NO2 data into the CMAQ simulations.

  4. Health care quality improvement publication trends.

    PubMed

    Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

    2014-01-01

    To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991.

  5. Revitalizing Space Operations through Total Quality Management

    NASA Technical Reports Server (NTRS)

    Baylis, William T.

    1995-01-01

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

  6. Quality improvement in basic histotechnology: the lean approach.

    PubMed

    Clark, David

    2016-01-01

    Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems. PMID:26306714

  7. Commentary: quality improvement projects: how do we protect patients' rights?

    PubMed

    Diamond, Louis H; Kliger, Alan S; Goldman, Richard S; Palevsky, Paul M

    2004-01-01

    A recent ruling by the Office of Human Research Protection (OHRP) has renewed an ongoing debate over whether Institutional Review Boards (IRBs) should have oversight not only over clinical research but also over quality improvement projects (QIPs). The authors discussed the similarities and differences among clinical practice, QIPs, and clinical research, pointing out issues to consider when identifying the most appropriate method for QIP oversight and accountability. They note that potential solutions must address ethical issues (eg, patient safety, privacy, and self-determination) and weigh the effect of the underlying QIP goal (administrative versus clinical improvement) on an individual patient and patient populations. They conclude that because QIPs are an extension of clinical practice and have elements of clinical research, it too should have an oversight system. Institutional or regional quality improvement boards, operating parallel to current IRBs, are suggested as 1 means of ensuring that QIP participants are offered the same protections as those who take part in clinical research.

  8. Quality improvement in basic histotechnology: the lean approach.

    PubMed

    Clark, David

    2016-01-01

    Lean is a comprehensive system of management based on the Toyota production system (TPS), encompassing all the activities of an organization. It focuses management activity on creating value for the end-user by continuously improving operational effectiveness and removing waste. Lean management creates a culture of continuous quality improvement with a strong emphasis on developing the problem-solving capability of staff using the scientific method (Deming's Plan, Do, Check, Act cycle). Lean management systems have been adopted by a number of histopathology departments throughout the world to simultaneously improve quality (reducing errors and shortening turnround times) and lower costs (by increasing efficiency). This article describes the key concepts that make up a lean management system, and how these concepts have been adapted from manufacturing industry and applied to histopathology using a case study of lean implementation and evidence from the literature. It discusses the benefits, limitations, and pitfalls encountered when implementing lean management systems.

  9. The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

    PubMed

    Nicholas, D D; Heiby, J R; Hatzell, T A

    1991-01-01

    Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems. PMID:1782383

  10. The Quality Assurance Project: introducing quality improvement to primary health care in less developed countries.

    PubMed

    Nicholas, D D; Heiby, J R; Hatzell, T A

    1991-01-01

    Persistently excessive morbidity and mortality rates in less developed countries (LDCs) served by primary health care systems suggest that the quality of services is inadequate. The PRICOR project, sponsored by the United States Agency for International Development, has designed and implemented methods for quality assessment and problem solving in LDC health systems. After developing comprehensive lists of essential activities and tasks, similar to practice parameters, for seven child survival interventions, PRICOR supported comprehensive quality assessment studies in twelve LDC countries. The studies, yielding over 6000 observations of health worker-client encounters, indicated highly prevalent, serious program deficiencies in areas including diagnosis, treatment, patient education and supervision. To facilitate corrective action, PRICOR assisted managers in conducting operations research to resolve priority problems revealed by the assessments. The recently initiated Quality Assurance Project is building on PRICOR techniques in designing and implementing sustainable continuous quality improvement programs for LDC health systems.

  11. Project Hanford management contract quality improvement project management plan

    SciTech Connect

    ADAMS, D.E.

    1999-03-25

    On July 13, 1998, the U.S. Department of Energy, Richland Operations Office (DOE-RL) Manager transmitted a letter to Fluor Daniel Hanford, Inc. (FDH) describing several DOE-RL identified failed opportunities for FDH to improve the Quality Assurance (QA) Program and its implementation. In addition, DOE-RL identified specific Quality Program performance deficiencies. FDH was requested to establish a periodic reporting mechanism for the corrective action program. In a July 17, 1998 response to DOE-RL, FDH agreed with the DOE concerns and committed to perform a comprehensive review of the Project Hanford Management Contract (PHMC) QA Program during July and August, 1998. As a result, the Project Hanford Management Contract Quality Improvement Plan (QIP) (FDH-3508) was issued on October 21, 1998. The plan identified corrective actions based upon the results of an in-depth Quality Program Assessment. Immediately following the scheduled October 22, 1998, DOE Office of Enforcement and Investigation (EH-10) Enforcement Conference, FDH initiated efforts to effectively implement the QIP corrective actions. A Quality Improvement Project (QI Project) leadership team was assembled to prepare a Project Management Plan for this project. The management plan was specifically designed to engage a core team and the support of representatives from FDH and the major subcontractors (MSCs) to implement the QIP initiatives; identify, correct, and provide feedback as to the root cause for deficiency; and close out the corrective actions. The QI Project will manage and communicate progress of the process.

  12. Ensemble Streamflow Forecast Improvements in NYC's Operations Support Tool

    NASA Astrophysics Data System (ADS)

    Wang, L.; Weiss, W. J.; Porter, J.; Schaake, J. C.; Day, G. N.; Sheer, D. P.

    2013-12-01

    end of high flow periods. These improvements allowed DEP to more effectively manage water quality control and spill mitigation operations immediately after storm events. Later on, post-processed hydrologic forecasts from the National Weather Service (NWS) including the Advanced Hydrologic Prediction Service (AHPS) and the Hydrologic Ensemble Forecast Service (HEFS) were implemented into OST. These forecasts further increased the predictive skill over the initial statistical models as current basin conditions (e.g. soil moisture, snowpack) and meteorological forecasts (with HEFS) are now explicitly represented. With the post-processed HEFS forecasts, DEP may now truly quantify impacts associated with wet weather events on the horizon, rather than relying on statistical representations of current hydrologic trends. This presentation will highlight the benefits of the improved forecasts using examples from actual system operations.

  13. Biospecimen Reporting for Improved Study Quality

    SciTech Connect

    Moore, Ph.D., Helen M.; Kelly, Ph.D., Andrea B.; Jewell, Ph.D., Scott D.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas P.; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth A.; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Seijo, M.S., Edward; Somiari, Ph.D., Stella; Chir., B; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Vaught, Ph.D., Jim; Watson,M.B., Peter

    2010-12-27

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  14. Biospecimen Reporting for Improved Study Quality (BRISQ)

    SciTech Connect

    National Cancer Institute; Jewell, Ph.D., Scott D.; Seijo, M.S., Edward; Kelly, Ph.D., Andrea; Somiari, Ph.D., Stella; B.Chir., M.B.; McShane, Ph.D., Lisa M.; Clark, M.D., Douglas; Greenspan, M.D., Renata; Hayes, M.D., Daniel F.; Hainaut, Ph.D., M.S., Pierre; Kim, Paula; Mansfield, Ph.D., Elizabeth; Potapova, Ph.D., Olga; Riegman, Ph.D., Peter; Rubinstein, Ph.D., Yaffa; Weier, Ph.D., Heinz-Ulrich; Zhu, Ph.D., Claire; Moore, Ph.D., Helen M.; Vaught, Ph.D., Jim; Watson, Peter

    2010-09-02

    Human biospecimens are subjected to collection, processing, and storage that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research that uses human tissues, it is crucial that information on the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications on biospecimen-related research and to help reassure patient contributors and the advocacy community that their contributions are valued and respected.

  15. Biospecimen Reporting for Improved Study Quality (BRISQ)

    SciTech Connect

    Moore, Ph.D., Helen M.; Kelly Ph.D., Andrea; Jewell Ph.D., Scott D.; McShane Ph.D., Lisa M.; Clark M.D., Douglas P.; Greenspan M.D., Renata; Hayes M.D., Daniel F.; Hainaut Ph.D.,, Pierre; Kim, Paula; Mansfield Ph.D., Elizabeth; Potapova Ph.D., Olga; Riegman Ph.D., Peter; Rubinstein Ph.D., Yaffa; Seijo M.S., Edward; Somiari Ph.D., Stella; Watson M.B., Peter; Weier Ph.D., Heinz-Ulrich; Zhu Ph.D., Claire; Vaught Ph.D., Jim

    2011-04-26

    Human biospecimens are subject to a number of different collection, processing, and storage factors that can significantly alter their molecular composition and consistency. These biospecimen preanalytical factors, in turn, influence experimental outcomes and the ability to reproduce scientific results. Currently, the extent and type of information specific to the biospecimen preanalytical conditions reported in scientific publications and regulatory submissions varies widely. To improve the quality of research utilizing human tissues it is critical that information regarding the handling of biospecimens be reported in a thorough, accurate, and standardized manner. The Biospecimen Reporting for Improved Study Quality (BRISQ) recommendations outlined herein are intended to apply to any study in which human biospecimens are used. The purpose of reporting these details is to supply others, from researchers to regulators, with more consistent and standardized information to better evaluate, interpret, compare, and reproduce the experimental results. The BRISQ guidelines are proposed as an important and timely resource tool to strengthen communication and publications around biospecimen-related research and help reassure patient contributors and the advocacy community that the contributions are valued and respected.

  16. Methodology of quality improvement projects for the Texas Medicare population.

    PubMed

    Pendergrass, P W; Abel, R L; Bing, M; Vaughn, R; McCauley, C

    1998-07-01

    The Texas Medical Foundation, the quality improvement organization for the state of Texas, develops local quality improvement projects for the Medicare population. These projects are developed as part of the Health Care Quality Improvement Program undertaken by the Health Care Financing Administration. The goal of a local quality improvement project is to collaborate with providers to identify and reduce the incidence of unintentional variations in the delivery of care that negatively impact outcomes. Two factors are critical to the success of a quality improvement project. First, as opposed to peer review that is based on implicit criteria, quality improvement must be based on explicit criteria. These criteria represent key steps in the delivery of care that have been shown to improve outcomes for a specific disease. Second, quality improvement must be performed in partnership with the health care community. As such, the health care community must play an integral role in the design and evaluation of a quality improvement project and in the design and implementation of the resulting quality improvement plan. Specifically, this article provides a historical perspective for the transition from peer review to quality improvement. It discusses key steps used in developing and implementing local quality improvement projects including topic selection, quality indicator development, collaborator recruitment, and measurement of performance/improvement. Two Texas Medical Foundation projects are described to highlight the current methodology and to illustrate the impact of quality improvement projects.

  17. Evolution of quality management: integration of quality assurance functions into operations, or "quality is everyone's responsibility".

    PubMed

    Foss, Mary L; Breanndan Moore, S

    2003-09-01

    The management of quality in the Division of Transfusion Medicine at our institution has undergone a lengthy, sometimes painful but always progressive evolution over nearly four decades. Initially, it consisted of one laboratory technologist who was assigned the task of performing certain basic QC checks on a predetermined list of laboratory, collection, and processing steps. This technologist reported directly to the medical director. The tasks gradually grew in volume and complexity so that a four-person quality unit was established, administratively quite separate from the operations and accountable only to the Medical Director. The next stage in the evolutionary process was more revolutionary in scope because it involved a comprehensive cultural shift toward the concept of "quality is everyone's responsibility." The evolutionary process in our institution to date and the planning and organization involved in the direction and management of the evolution itself are described.

  18. Light baryon spectrum using improved interpolating operators

    SciTech Connect

    S. Basak, R. G. Edwards, G. T. Fleming, J. Juge, A. Lichtl, C. Morningstar D. G. Richards, I. Sato, S. J. Wallace

    2006-06-26

    Energies for excited light baryons are computed in quenched QCD with a pion mass of 490 MeV. Operators used in the simulations include local operators and the simplest nonlocal operators that have nontrivial orbital structures. All operators are designed with the use of Clebsch-Gordan coefficients of the octahedral group so that they transform irreducibly under the group rotations. Matrices of correlation functions are computed for each irreducible representation, and then the variational method is applied to separate mass eigenstates. We obtained 17 states for isospin 1/2 and 11 states for isospin 3/2 in various spin-parity channels including J{sup P}=5/2{sup {+-}}. The pattern of the lowest-lying energies from each irrep is discussed. We use anisotropic lattices of volume 24{sup 3} x 64 with temporal lattice spacing a{sub t}{sup -1}=6.05 GeV with renormalized anisotropy xi=3.0.

  19. How can we recognize continuous quality improvement?

    PubMed Central

    Rubenstein, Lisa; Khodyakov, Dmitry; Hempel, Susanne; Danz, Margie; Salem-Schatz, Susanne; Foy, Robbie; O'Neill, Sean; Dalal, Siddhartha; Shekelle, Paul

    2014-01-01

    Objective Continuous quality improvement (CQI) methods are foundational approaches to improving healthcare delivery. Publications using the term CQI, however, are methodologically heterogeneous, and labels other than CQI are used to signify relevant approaches. Standards for identifying the use of CQI based on its key methodological features could enable more effective learning across quality improvement (QI) efforts. The objective was to identify essential methodological features for recognizing CQI. Design Previous work with a 12-member international expert panel identified reliably abstracted CQI methodological features. We tested which features met rigorous a priori standards as essential features of CQI using a three-phase online modified-Delphi process. Setting Primarily United States and Canada. Participants 119 QI experts randomly assigned into four on-line panels. Intervention(s) Participants rated CQI features and discussed their answers using online, anonymous and asynchronous discussion boards. We analyzed ratings quantitatively and discussion threads qualitatively. Main outcome measure(s) Panel consensus on definitional CQI features. Results Seventy-nine (66%) panelists completed the process. Thirty-three completers self-identified as QI researchers, 18 as QI practitioners and 28 as both equally. The features ‘systematic data guided activities,’ ‘designing with local conditions in mind’ and ‘iterative development and testing’ met a priori standards as essential CQI features. Qualitative analyses showed cross-cutting themes focused on differences between QI and CQI. Conclusions We found consensus among a broad group of CQI researchers and practitioners on three features as essential for identifying QI work more specifically as ‘CQI.’ All three features are needed as a minimum standard for recognizing CQI methods. PMID:24311732

  20. Quality improvement in neurology: dementia management quality measures.

    PubMed

    Odenheimer, Germaine; Borson, Soo; Sanders, Amy E; Swain-Eng, Rebecca J; Kyomen, Helen H; Tierney, Samantha; Gitlin, Laura; Forciea, Mary Ann; Absher, John; Shega, Joseph; Johnson, Jerry

    2014-03-01

    Professional and advocacy organizations have long urged that dementia should be recognized and properly diagnosed. With the passage of the National Alzheimer's Project Act in 2011, an Advisory Council for Alzheimer's Research, Care, and Services was convened to advise the Department of Health and Human Services. In May 2012, the Council produced the first National Plan to address Alzheimer's disease, and prominent in its recommendations is a call for quality measures suitable for evaluating and tracking dementia care in clinical settings. Although other efforts have been made to set dementia care quality standards, such as those pioneered by RAND in its series Assessing Care of Vulnerable Elders (ACOVE), practitioners, healthcare systems, and insurers have not widely embraced implementation. This executive summary (full manuscript available at www.neurology.org) reports on a new measurement set for dementia management developed by an interdisciplinary Dementia Measures Work Group (DWG) representing the major national organizations and advocacy organizations concerned with the care of individuals with dementia. The American Academy of Neurology (AAN), the American Geriatrics Society, the American Medical Directors Association, the American Psychiatric Association, and the American Medical Association-convened Physician Consortium for Performance Improvement led this effort. The ACOVE measures and the measurement set described here apply to individuals whose dementia has already been identified and properly diagnosed. Although similar in concept to ACOVE, the DWG measurement set differs in several important ways; it includes all stages of dementia in a single measure set, calls for the use of functional staging in planning care, prompts the use of validated instruments in patient and caregiver assessment and intervention, highlights the relevance of using palliative care concepts to guide care before the advanced stages of illness, and provides evidence-based support

  1. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    PubMed

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

  2. Quality improvement education to improve performance on ulcerative colitis quality measures and care processes aligned with National Quality Strategy priorities.

    PubMed

    Greene, Laurence; Moreo, Kathleen

    2015-01-01

    Studies on inflammatory bowel disease (IBD) have reported suboptimal approaches to patient care. In the United States, the findings have motivated leading gastroenterology organizations to call for initiatives that support clinicians in aligning their practices with quality measures for IBD and priorities of the National Quality Strategy (NQS). We designed and implemented a quality improvement (QI) education program on ulcerative colitis in which patient charts were audited for 30 gastroenterologists before (n = 300 charts) and after (n = 290 charts) they participated in QI-focused educational activities. Charts were audited for nine measures, selected for their alignment with four NQS priorities: making care safer, ensuring patient engagement, promoting communication, and promoting effective treatment practices. Four of the measures, including guideline-directed vaccinations and assessments of disease type and activity, were part of the CMS Physician Quality Reporting System (PQRS). The other five measures involved counseling patients on various topics in ulcerative colitis management, documentation of side effects, assessment of adherence status, and simplification of dosing. The gastroenterologists also completed baseline and post-education surveys designed to assess qualitative outcomes. One of the educational interventions was a private audit feedback session conducted for each gastroenterologist. The sessions were designed to support participants in identifying measures reflecting suboptimal care quality and developing action plans for improvement. In continuous improvement cycles, follow-up interventions included QI tools and educational monographs. Across the nine chart variables, post-education improvements ranged from 0% to 48%, with a mean improvement of 15.9%. Survey findings revealed improvements in self-reported understanding of quality measures and intentions to apply them to practice, and lower rates of perceived significant barriers to high-quality

  3. Quality improvement teaching at medical school: a student perspective

    PubMed Central

    Nair, Pooja; Barai, Ishani; Prasad, Sunila; Gadhvi, Karishma

    2016-01-01

    Guidelines in the UK require all doctors to actively take part in quality improvement. To ease future doctors into the process, formal quality improvement teaching can be delivered during medical school. PMID:27051330

  4. Early Palliative Care Improves Patients' Quality of Life

    MedlinePlus

    ... fullstory_160885.html Early Palliative Care Improves Patients' Quality of Life Also increases chances of having end-of-life ... incurable cancer helps patients cope and improves their quality of life, a new study shows. It also leads to ...

  5. Operating Systems. Curriculum Improvement Project. Region II.

    ERIC Educational Resources Information Center

    Wagstaff, Charlene

    This course curriculum is intended for community college instructors and administrators to use in implementing an operating systems course. A student's course syllabus provides this information: credit hours, catalog description, prerequisites, required texts, instructional process, objectives, student evaluation, and class schedule. A student…

  6. 42 CFR 441.474 - Quality assurance and improvement plan.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... order to learn of critical incidents or events that affect participants, correct shortcomings, and pursue opportunities for system improvement. (b) The quality assurance and improvement plan shall...

  7. Continuous quality improvement in contract research organizations--managing improvement processes.

    PubMed

    Sollecito, W A; Kaluzny, A D

    2000-01-01

    The challenge of quality improvement extends beyond traditional service delivery organizations. This article, the second in a two-part series (see QMHC 7:3, Spring 1999, 7-21 for the first part) focuses on training and empowerment, leadership and statistical process control, and the contribution of these factors to the success of CROs in the pharmaceutical and biotechnology industry. The importance of each is presented along with specific illustrations from operating CROs.

  8. Foliage Plants for Improving Indoor Air Quality

    NASA Technical Reports Server (NTRS)

    Wolverton, B. C.

    1988-01-01

    NASA's research with foliage houseplants during the past 10 years has produced a new concept in indoor air quality improvement. This new and exciting technology is quite simple. Both plant leaves and roots are utilized in removing trace levels of toxic vapors from inside tightly sealed buildings. Low levels of chemicals such as carbon monoxide and formaldehyde can be removed from indoor environments by plant leaves alone, while higher concentrations of numerous toxic chemicals can be removed by filtering indoor air through the plant roots surrounded by activated carbon. The activated carbon absorbs large quantities of the toxic chemicals and retains them until the plant roots and associated microorganisms degrade and assimilate these chemicals.

  9. Quality improvement in health care: how to do it.

    PubMed

    Walsh, Kieran; Helm, Rufus; Aboshady, Omar A

    2016-09-01

    This article outlines the steps to success in quality improvement and explains how quality improvement can help you, your patients and your institution. Although many tactics can be used to drive quality improvement, some tactics deliver results that are short term and unsustainable and that fail to embed a culture of quality improvement within organizations. Consensus is emerging that a bottom-up approach may be better - where the intrinsic motivations of clinical staff are harnessed to drive quality improvement. This is an ideal opportunity for clinical staff at all levels to join in. The steps involved in quality improvement include choosing a topic, choosing tools to measure the problem, using plan, do, study, act cycles to drive improvement, and then writing up and sharing the project. Quality improvement projects can achieve multiple outcomes including improved patient experience and saved costs. PMID:27640657

  10. Coaching for Quality Improvement: Lessons Learned from Quality Rating and Improvement Systems (QRIS). Research Brief

    ERIC Educational Resources Information Center

    Tout, Kathryn; Isner, Tabitha; Zaslow, Martha

    2011-01-01

    Coaching and other on-site, individualized professional development strategies (consultation, mentoring, and technical assistance) are promising approaches to support the application of new teaching practices and overall quality improvement among practitioners in early care and education settings. This Research Brief summarizes a recent report…

  11. Criteria for the Evaluation of Quality Improvement Programs and the Use of Quality Improvement Data

    ERIC Educational Resources Information Center

    American Psychologist, 2009

    2009-01-01

    This document provides a set of criteria to be used by psychologists in evaluating quality improvement programs (QIPs) that have been promulgated by health care organizations, government agencies, professional associations, or other entities. These criteria also address the privacy and confidentiality issues evoked by the intended use of patient…

  12. Improvements needed in EPA's Inspector General operations

    SciTech Connect

    Bowsher, C.A.

    1983-10-21

    At the request of the Subcommittee on Natural Resources, Agriculture Research and Environment and the Subcommittee on Civil Service, House of Representatives, GAO reviewed the operations of the Office of Inspector General, Environmental Protection Agency, under the leadership of former Inspector General Matthew Novick. GAO found that although most investigations appear to have been handled properly, in some cases all relevant matters were not followed up and consistently addressed. GAO also noted the need to use investigative resources more effectively and to provide more balanced audit coverage. Acting Inspector General Charles Dempsey recognized and made a concerted effort to correct many problems during his tenure. GAO recommends further actions to strengthen inspector general operations at EPA.

  13. Improving Robotic Operator Performance Using Augmented Reality

    NASA Technical Reports Server (NTRS)

    Maida, James C.; Bowen, Charles K.; Pace, John W.

    2007-01-01

    The Special Purpose Dexterous Manipulator (SPDM) is a two-armed robot that functions as an extension to the end effector of the Space Station Robotics Manipulator System (SSRMS), currently in use on the International Space Station (ISS). Crew training for the SPDM is accomplished using a robotic hardware simulator, which performs most of SPDM functions under normal static Earth gravitational forces. Both the simulator and SPDM are controlled from a standard robotic workstation using a laptop for the user interface and three monitors for camera views. Most operations anticipated for the SPDM involve the manipulation, insertion, and removal of any of several types of Orbital Replaceable Unit (ORU), modules which control various ISS functions. Alignment tolerances for insertion of the ORU into its receptacle are 0.25 inch and 0.5 degree from nominal values. The pre-insertion alignment task must be performed within these tolerances by using available video camera views of the intrinsic features of the ORU and receptacle, without special registration markings. Since optimum camera views may not be available, and dynamic orbital lighting conditions may limit periods of viewing, a successful ORU insertion operation may require an extended period of time. This study explored the feasibility of using augmented reality (AR) to assist SPDM operations. Geometric graphical symbols were overlaid on one of the workstation monitors to afford cues to assist the operator in attaining adequate pre-insertion ORU alignment. Twelve skilled subjects performed eight ORU insertion tasks using the simulator with and without the AR symbols in a repeated measures experimental design. Results indicated that using the AR symbols reduced pre-insertion alignment error for all subjects and reduced the time to complete pre-insertion alignment for most subjects.

  14. National quality improvement policies and strategies in European healthcare systems

    PubMed Central

    Spencer, E; Walshe, K

    2009-01-01

    Objective: This survey provides an overview of the development of policies and strategies for quality improvement in European healthcare systems, by mapping quality improvement policies and strategies, progress in their implementation, and early indications of their impact. Study design: A survey of quality improvement policies and strategies in healthcare systems of the European Union was conducted in 2005 for the first phase of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project. Participants: The survey, completed by 68 key experts in quality improvement from 24 European Union member states, represents their views and accounts of quality improvement policies and strategies in their healthcare systems. Principal findings: There are substantial international and intra-national variations in the development of healthcare quality improvement. Legal requirements for quality improvement strategies are an important driver of progress, along with the activities of national governments and professional associations and societies. Patient and service user organisations appear to have less influence on quality improvement. Wide variation in voluntary and mandatory coverage of quality improvement policies and strategies across sectors can potentially lead to varying levels of progress in implementation. Many healthcare organisations lack basic infrastructure for quality improvement. Conclusions: Some convergence can be observed in policies on quality improvement in healthcare. Nevertheless, the growth of patient mobility across borders, along with the implications of free market provisions for the organisation and funding of healthcare systems in European Union member states, require policies for cooperation and learning transfer. PMID:19188457

  15. Priorities of Higher Education Quality Improvement: Student and Teacher Attitude

    ERIC Educational Resources Information Center

    Savickiene, Izabela

    2006-01-01

    Higher education quality improvement is a constant and continuous university activity and its implementation should be given a priority. This article analyses the most important tasks set at three Lithuanian universities seeking to improve higher education quality: the improvement of higher education quality assurance system, teacher professional…

  16. An approach to hospital quality improvement.

    PubMed

    Lurie, Jon D; Merrens, Edward J; Lee, Joshua; Splaine, Mark E

    2002-07-01

    This study demonstrates many of the important features and challenges of improving hospital care. The unique confluence of software technology advances and increasingly complex clinical needs have made possible a redesign of the process by which discharge documentation is generated and disseminated. Using knowledge of the patients' experience of hospital care, a multidisciplinary team identified communication at the time of discharge as a key interaction point in the system of care. With this need in mind, the team identified an aim of improving the accuracy and timeliness of discharge data and their dissemination. The project leveraged existing information technology to help satisfy the general aims of recording only useful information only once and reducing wait times for information [14]. The ability to manage structured medication data and translate this information and specialized care instructions into patient-directed language facilitated the creation of a document that would ensure that patients knew what was expected of them after discharge. Implementation of a discharge form requires understanding all of the constituencies within a medical center. It was therefore necessary to put together a team that included representation from all the groups who interact with this discharge information. The authors proceeded with a small-scale test of change during which they identified training and education needs that would be useful as the new process expands to other areas of the hospital. The case illustrates how in one project a team needs to address all of the challenges to improving hospital quality. The discharge form clearly required understanding the patient's perspective. The approach taken by the team to change the discharge form also showed detailed understanding of the process of discharging a patient from the hospital. Many microsystems are involved in this process and the change that was implemented took into account the needs of each of those

  17. The impact of flying qualities on helicopter operational agility

    NASA Technical Reports Server (NTRS)

    Padfield, Gareth D.; Lappos, Nick; Hodgkinson, John

    1993-01-01

    Flying qualities standards are formally set to ensure safe flight and therefore reflect minimum, rather than optimum, requirements. Agility is a flying quality but relates to operations at high, if not maximum, performance. While the quality metrics and test procedures for flying, as covered for example in ADS33C, may provide an adequate structure to encompass agility, they do not currently address flight at high performance. This is also true in the fixed-wing world and a current concern in both communities is the absence of substantiated agility criteria and possible conflicts between flying qualities and high performance. AGARD is sponsoring a working group (WG19) title 'Operational Agility' that deals with these and a range of related issues. This paper is condensed from contributions by the three authors to WG19, relating to flying qualities. Novel perspectives on the subject are presented including the agility factor, that quantifies performance margins in flying qualities terms; a new parameter, based on maneuver acceleration is introduced as a potential candidate for defining upper limits to flying qualities. Finally, a probabilistic analysis of pilot handling qualities ratings is presented that suggests a powerful relationship between inherent airframe flying qualities and operational agility.

  18. Making the case to improve quality and reduce costs in pediatric health care.

    PubMed

    Sachdeva, Ramesh C; Jain, Shabnam

    2009-08-01

    This article makes a case for the urgent need to improve health care quality and reduce costs. It provides an overview of the importance of the quality movement and the definition of quality, including the concept of clinical and operational quality. Some national drivers for quality improvement as well as drivers of escalating health care costs are discussed, along with the urgency of reducing health care costs. The link between quality and cost is reviewed using the concept of value in health care, which combines quality and cost in the same equation. The article ends with a discussion of future directions of the quality movement, including emerging concepts, such as risk-adjustment, shared responsibility for quality, measuring quality at the individual provider level, and evolving legal implications of the quality movement, as well as the concept of a shared savings model. PMID:19660624

  19. Development of improved technology for decommissioning operations

    SciTech Connect

    Allen, R.P.

    1982-07-01

    This paper describes the technology development activities conducted at Pacific Northwest Laboratory under US Department of Energy sponsorship to help ensure the availability of safe, cost-effective and environmentally sound decommissioning technology for radioactively contaminated facilities. These improved decommissioning technologies include techniques for the removal of contaminated concrete surfaces and coatings, adaptation of electropolishing and vibratory finishing decontamination techniques for field decommissioning applications, development of sensitive field instrumentation and methods for the monitoring of large surface areas, techniques for the field sectioning of contaminated components, improved contamination-stabilizing coatings and application methods, and development of a small solidification system for the field solidification of liquid waste. The results of cost/benefit studies for some of these technologies are also reported.

  20. Paying for quality: providers' incentives for quality improvement.

    PubMed

    Rosenthal, Meredith B; Fernandopulle, Rushika; Song, HyunSook Ryu; Landon, Bruce

    2004-01-01

    Paying health care providers to meet quality goals is an idea with widespread appeal, given the common perception that quality of care in the United States remains unacceptably low despite a decade of benchmarking and public reporting. There has been little critical analysis of the design of the current generation of quality incentive programs. In this paper we examine public reports of paying for quality over the past five years and assess each of the identified programs in terms of key design features, including the market share of payers, the structure of the reward system, the amount of revenue at stake, and the targeted domains of health care quality.

  1. Improved Operating Performance of Mining Machine Picks

    NASA Astrophysics Data System (ADS)

    Prokopenko, S.; Li, A.; Kurzina, I.; Sushko, A.

    2016-08-01

    The reasons of low performance of mining machine picks are stated herein. In order to improve the wear resistance and the cutting ability of picks a new design of a cutting carbide tip insert to be fixed on a removable and rotating pick head is developed. Owing to the new design, the tool ensures a twofold increase in the cutting force maintained longer, a twofold reduction in the specific power consumption of the breaking process, and extended service life of picks and the possibility of their multiple use.

  2. Improved Pulsed Laser Operation with Engineered Nanomaterials.

    PubMed

    Latterman, Ryan E; Birrell, Steven; Sullivan, Philip A; Walker, Robert A

    2016-08-01

    The power efficiency of a diode-pumped solid state laser was improved by encasing the Nd:YAG lasing medium with gold nanorod-doped epoxy. Gold nanorods were synthesized with a specific aspect ratio tuned to absorb at the Nd:YAG lasing wavelength of 1064 nm. The surfactant-stabilized nanorods in aqueous solution were then treated with a sequential, two-step functionalization in order to improve nanorod solubility in organic solvents. This process required treating the gold nanorods with a thiol-containing polyethylene glycol (PEG) polymer followed by replacing the PEG-SH polymer with a multidentate thiol containing block copolymer synthesized using RAFT synthesis. With a multidentate polymer, the nanorods were soluble in traditional epoxies that could be used to coat the outside of Nd:YAG rods. By absorbing excess lateral 1064 nm emission, the gold nanorod coating attenuates amplified spontaneous emission (ASE), a parasitic, incoherent process that limits power produced by Q-switch laser designs. Laser power increased by nearly 2-fold with addition of the 1064 nm absorbing gold nanorod coating. Gold nanorod epoxy coatings stand out as attractive materials for attenuating ASE by avoiding the fabrication difficulties of samarium oxide ceramics and the photostability limitations of organic dyes.

  3. Improvements in sparse matrix operations of NASTRAN

    NASA Technical Reports Server (NTRS)

    Harano, S.

    1980-01-01

    A "nontransmit" packing routine was added to NASTRAN to allow matrix data to be refered to directly from the input/output buffer. Use of the packing routine permits various routines for matrix handling to perform a direct reference to the input/output buffer if data addresses have once been received. The packing routine offers a buffer by buffer backspace feature for efficient backspacing in sequential access. Unlike a conventional backspacing that needs twice back record for a single read of one record (one column), this feature omits overlapping of READ operation and back record. It eliminates the necessity of writing, in decomposition of a symmetric matrix, of a portion of the matrix to its upper triangular matrix from the last to the first columns of the symmetric matrix, thus saving time for generating the upper triangular matrix. Only a lower triangular matrix must be written onto the secondary storage device, bringing 10 to 30% reduction in use of the disk space of the storage device.

  4. Team Learning for Healthcare Quality Improvement.

    PubMed

    Manukyan, Narine; Eppstein, Margaret J; Horbar, Jeffrey D

    2013-08-28

    In organized healthcare quality improvement collaboratives (QICs), teams of practitioners from different hospitals exchange information on clinical practices with the aim of improving health outcomes at their own institutions. However, what works in one hospital may not work in others with different local contexts because of nonlinear interactions among various demographics, treatments, and practices. In previous studies of collaborations where the goal is a collective problem solving, teams of diverse individuals have been shown to outperform teams of similar individuals. However, when the purpose of collaboration is knowledge diffusion in complex environments, it is not clear whether team diversity will help or hinder effective learning. In this paper, we first use an agent-based model of QICs to show that teams comprising similar individuals outperform those with more diverse individuals under nearly all conditions, and that this advantage increases with the complexity of the landscape and level of noise in assessing performance. Examination of data from a network of real hospitals provides encouraging evidence of a high degree of similarity in clinical practices, especially within teams of hospitals engaging in QIC teams. However, our model also suggests that groups of similar hospitals could benefit from larger teams and more open sharing of details on clinical outcomes than is currently the norm. To facilitate this, we propose a secure virtual collaboration system that would allow hospitals to efficiently identify potentially better practices in use at other institutions similar to theirs without any institutions having to sacrifice the privacy of their own data. Our results may also have implications for other types of data-driven diffusive learning such as in personalized medicine and evolutionary search in noisy, complex combinatorial optimization problems.

  5. Applying total quality management techniques to improve software development.

    PubMed

    Mezher, T; Assem Abdul Malak, M; el-Medawar, H

    1998-01-01

    Total Quality Management (TQM) is a new management philosophy and a set of guiding principles that represent the basis of a continuously improving organization. This paper sheds light on the application of TQM concepts for software development. A fieldwork study was conducted on a Lebanese software development firm and its customers to determine the major problems affecting the organization's operation and to assess the level of adoption of TQM concepts. Detailed questionnaires were prepared and handed out to the firm's managers, programmers, and customers. The results of the study indicate many deficiencies in applying TQM concepts, especially in the areas of planning, defining customer requirements, teamwork, relationship with suppliers, and adopting standards and performance measures. One of the major consequences of these deficiencies is considerably increased programming errors and delays in delivery. Recommendations on achieving quality are discussed.

  6. Timing control improves seabed survey data quality

    SciTech Connect

    Green, R.

    1996-04-01

    Seateam has completed development of and field-proven the Dolphin data acquisition and timing system for high-density surveys offshore. The Dolphin project was initiated to improve quality control of survey sensor data and ensure time synchronization, thus leading to faster turnaround of seabed terrain information. Data received from survey sensors is asynchronous, so the system must provide for data correlation. This includes establishment of data latency, i.e., the time difference between data creation and timing of the message at first-byte arrival at the recording system. Until recently, asynchronous data from multiple sensors was collected by a single computer, regardless of whether it had additional intelligent or non-intelligent serial cards. This computer was fully responsible for time stamping all incoming data, plus associated storage and distribution. Though this initially sufficed and is still applicable to low-density data, increasingly larger data volumes required an associated boost in the capability to time stamp data prior to eventual correction.

  7. Improving Water Quality With Conservation Buffers

    NASA Astrophysics Data System (ADS)

    Lowrance, R.; Dabney, S.; Schultz, R.

    2003-12-01

    Conservation buffer technologies are new approaches that need wider application. In-field buffer practices work best when used in combination with other buffer types and other conservation practices. Vegetative barriers may be used in combination with edge-of-field buffers to protect and improve their function and longevity by dispersing runoff and encouraging sediment deposition upslope of the buffer. It's important to understand how buffers can be managed to help reduce nutrient transport potential for high loading of nutrients from manure land application sites, A restored riparian wetland buffer retained or removed at least 59 percent of the nitrogen and 66 percent of the phosphorus that entered from an adjacent manure land application site. The Bear Creek National Restoration Demonstration Watershed project in Iowa has been the site of riparian forest buffers and filter strips creation; constructed wetlands to capture tile flow; stream-bank bioengineering; in-stream structures; and controlling livestock grazing. We need field studies that test various widths of buffers of different plant community compositions for their efficacy in trapping surface runoff, reducing nonpoint source pollutants in subsurface waters, and enhancing the aquatic ecosystem. Research is needed to evaluate the impact of different riparian grazing strategies on channel morphology, water quality, and the fate of livestock-associated pathogens and antibiotics. Integrating riparian buffers and other conservation buffers into these models is a key objective in future model development.

  8. Optical parametric osicllators with improved beam quality

    DOEpatents

    Smith, Arlee V.; Alford, William J.

    2003-11-11

    An optical parametric oscillator (OPO) having an optical pump, which generates a pump beam at a pump frequency greater than a desired signal frequency, a nonlinear optical medium oriented so that a signal wave at the desired signal frequency and a corresponding idler wave are produced when the pump beam (wave) propagates through the nonlinear optical medium, resulting in beam walk off of the signal and idler waves, and an optical cavity which directs the signal wave to repeatedly pass through the nonlinear optical medium, said optical cavity comprising an equivalently even number of non-planar mirrors that produce image rotation on each pass through the nonlinear optical medium. Utilizing beam walk off where the signal wave and said idler wave have nonparallel Poynting vectors in the nonlinear medium and image rotation, a correlation zone of distance equal to approximately .rho.L.sub.crystal is created which, through multiple passes through the nonlinear medium, improves the beam quality of the OPO output.

  9. "Ethics? But it's only quality improvement!".

    PubMed

    Flaming, Don; Barrett-Smith, Linda; Brown, Norma; Corcoran, Judy

    2009-01-01

    Many people assume that quality improvement (QI) projects pose no ethical issues in relation to participants or their rights. However, members of the Alberta Research Ethics Community Consensus Initiative (ARECCI) submit that all projects that generate knowledge, including QI projects, can create risks to participants that need to be identified, assessed and addressed in the context of the kind of project. The possibility of risk raises the question of ethical conduct in QI projects. Ethical considerations, such as the rights to respect and privacy, protection from harm and voluntary consent, may apply to QI projects, even if the participants are not regarded as research subjects. In this article, we use a case example to illustrate potential ethical issues raised by a QI project, and argue for an ethics review approach that is distinct from that used with research projects. We propose six considerations with guidelines to help assess (and ultimately minimize and mitigate) the risk for participants in QI projects and assist in the appropriate ethical management of these projects.

  10. Practice improvement requires more than guidelines and quality measures.

    PubMed

    Sigsbee, Bruce; Bever, Christopher T; Jones, Lyell K

    2016-01-12

    Increasing emphasis on improving health care quality has led to a variety of programs that require neurologists to be familiar with the concept of systematic quality improvement. While they vary in extent, these quality improvement programs and their attendant costs now have implications for physician payment and certification. In response to these factors, the American Academy of Neurology is establishing a clinical quality data registry. This article reviews evidence demonstrating the ability of quality improvement initiatives to improve care, the role of clinical quality data registries in the identification and mitigation of gaps in care, and the principles to be considered in development of registry-based quality improvement programs. It addresses the key question: Is the effort worthwhile?

  11. Improving the Quality of Training: Coach and Player Responsibilities.

    ERIC Educational Resources Information Center

    Voight, Mike

    2002-01-01

    Discusses the importance of linking player and coach responsibilities to improve the quality of individual and team training, discussing four major factors that encapsulate the most important areas that athletes and coaches should address: adopting quality attitudes, utilizing quality preparation prior to training, incorporating quality execution…

  12. Informatics: essential infrastructure for quality assessment and improvement in nursing.

    PubMed Central

    Henry, S B

    1995-01-01

    In recent decades there have been major advances in the creation and implementation of information technologies and in the development of measures of health care quality. The premise of this article is that informatics provides essential infrastructure for quality assessment and improvement in nursing. In this context, the term quality assessment and improvement comprises both short-term processes such as continuous quality improvement (CQI) and long-term outcomes management. This premise is supported by 1) presentation of a historical perspective on quality assessment and improvement; 2) delineation of the types of data required for quality assessment and improvement; and 3) description of the current and potential uses of information technology in the acquisition, storage, transformation, and presentation of quality data, information, and knowledge. PMID:7614118

  13. Improving Quality Higher Education in Nigeria: The Roles of Stakeholders

    ERIC Educational Resources Information Center

    Asiyai, Romina Ifeoma

    2015-01-01

    This paper discusses the roles of stakeholders in improving quality of university education in Nigeria. Internal and external stakeholders are identified and the various roles they could play in improving the quality of university education are discussed. The paper contends that continuous and holistic improvement in university education system…

  14. Improving the Quality of Teaching in Australia

    ERIC Educational Resources Information Center

    Dinham, Stephen

    2011-01-01

    Australia needs to more effectively attract, train, support, retain, recognize, and reward quality teachers throughout their careers. After a slow start and decades of debate, the pieces of the quality teaching puzzle are now coming together. Increased federal government intervention and financial support, along with state and territorial support…

  15. Improving the Quality of Telephone Reference Service.

    ERIC Educational Resources Information Center

    Quinn, Brian

    1995-01-01

    Discusses telephone reference services in libraries. Topics include characteristics of quality phone reference; policies and guidelines for quality service; a survey of pertinent literature evaluating telephone reference; training; and technology for telephone reference, including cellular and cordless phones, electronic resources, and automated…

  16. EPA Pushing Improved Air Quality in Schools.

    ERIC Educational Resources Information Center

    Sack, Joetta L.

    2002-01-01

    Discusses how, in response to the growing problem of poor air quality in schools, the Environmental Protection Agency (EPA) has set new voluntary air-quality guidelines for schools. Addresses common air-related irritants; successful efforts at Guerrero Elementary School in Mesa, Arizona; preventive maintenance; and a sample of the EPA's…

  17. Operational air quality forecast guidance for the United States

    NASA Astrophysics Data System (ADS)

    Stajner, Ivanka; Lee, Pius; Tong, Daniel; Pan, Li; McQueen, Jeff; Huang, Jinaping; Djalalova, Irina; Wilczak, James; Huang, Ho-Chun; Wang, Jun; Stein, Ariel; Upadhayay, Sikchya

    2016-04-01

    NOAA provides operational air quality predictions for ozone and wildfire smoke over the United States (U.S.) and predictions of airborne dust over the contiguous 48 states at http://airquality.weather.gov. These predictions are produced using U.S. Environmental Protection Agency (EPA) Community Model for Air Quality (CMAQ) and NOAA's HYSPLIT model (Stein et al., 2015) with meteorological inputs from the North American Mesoscale Forecast System (NAM). The current efforts focus on improving test predictions of fine particulate matter (PM2.5) from CMAQ. Emission inputs for ozone and PM2.5 predictions include inventory information from the U.S. EPA and recently added contributions of particulate matter from intermittent wildfires and windblown dust that rely on near real-time information. Current testing includes refinement of the vertical grid structure in CMAQ and inclusion of contributions of dust transport from global sources into the U.S. domain using the NEMS Global Aerosol Capability (NGAC). The addition of wildfire smoke and dust contributions in CMAQ reduced model underestimation of PM2.5 in summertime. Wintertime overestimation of PM2.5 was reduced by suppressing emissions of soil particles when the terrain is covered by snow or ice. Nevertheless, seasonal biases and biases in the diurnal cycle of PM2.5 are still substantial. Therefore, a new bias correction procedure based on an analog ensemble approach was introduced (Djalalova et al., 2015). It virtually eliminates biases in monthly means or in the diurnal cycle, but it also reduces day-to-day variability in PM2.5 predictions. Refinements to the bias correction procedure are being developed. Upgrades for the representation of wildfire smoke emissions within the domain and from global sources are in testing. Another area of active development includes approaches to scale emission inventories for nitrogen oxides in order to reproduce recent changes observed by the AirNow surface monitoring network and by

  18. Handling Qualities Influences on Civil Tiltrotor Terminal Operating Procedure Development

    NASA Technical Reports Server (NTRS)

    Decker, William A.; Simmons, Rickey C.; Tucker, George E.; Aiken, Edwin W. (Technical Monitor)

    1994-01-01

    The potential for tiltrotor aircraft as civil transports has been well recognized. Realization of that potential requires development of operating procedures tailored to take advantage of the tiltrotor's capabilities, including thrust vectoring independent of body pitch attitude and good low-speed control. While the tiltrotor shares flight characteristics with both fixed wing airplanes and helicopters, it must convert between those flight modes, typically within the context of precise terminal operations. A series of piloted simulation experiments has been conducted on the NASA Ames Research Center Vertical Motion Simulator (VMS) to investigate the influence of tiltrotor cockpit design features on developing certification and operating criteria for civil tiltrotor transports. Handling qualities evaluations have shaped cockpit design guidelines and operating procedure development for a civil tiltrotor. In particular, four topics demonstrate the interplay of handling qualities and operations profile in the development of terminal operating procedures and cockpit or control equipment for a civil tiltrotor: conversion (airplane to helicopter mode), final approach path angle, operating profile speeds and speed changes (particularly under instrument conditions), and one engine inoperative operational considerations.

  19. Guidelines for appraisal and publication of PDSA quality improvement.

    PubMed

    Speroff, Theodore; James, Brent C; Nelson, Eugene C; Headrick, Linda A; Brommels, Mats

    2004-01-01

    Plan-do-study-act (PDSA) quality improvement is the application of the scientific method to implement and test the effects of change ideas on the performance of the health care system. Users of quality improvement could benefit with markers to gauge the "best" science. Four core questions can determine the value of a quality improvement study: Is the quality improvement study pertinent and relevant? Are the results valid? Are appropriate criteria used to interpret the results? Will the study help you with your practice or organization of care? A set of guidelines is provided to help answer these questions. Similar guidelines exist for randomized clinical trials and clinical-epidemiologic observational studies. Analogous to these existing research guidelines, the PDSA quality improvement guidelines will provide researchers and reviewers with succinct standards of methodological rigor to assist in critical appraisal of quality improvement protocols and publications.

  20. An introduction to quality improvement in paediatrics and child health.

    PubMed

    Lemer, C; Cheung, C R L H; Klaber, R E

    2013-10-01

    Quality improvement is a focus on changing the way in which patient care is delivered. Central to this is developing a more rounded, patient-focused approach to the design and delivery of care. Here, in the first of a series, we introduce the concepts of quality improvement, explain why quality improvement should matter to paediatricians and give some pointers as to where and how paediatricians can learn and do more.

  1. Auditing and assessing air quality in concentrated feeding operations

    Technology Transfer Automated Retrieval System (TEKTRAN)

    The potential adverse effects of concentrated animal feeding operations (CAFO) on the environment are a growing concern. The air quality issues of most concerns to CAFO vary, but generally include ammonia, hydrogen sulfide, particulate matter (PM), volatile organic compounds (VOC), green house gase...

  2. Orion Handling Qualities During ISS Proximity Operations and Docking

    NASA Technical Reports Server (NTRS)

    Stephens, John-Paul; Vos, Gordon A.; Bilimoria, Karl D.; Mueller, Eric R.; Brazzel, Jack; Spehar, Pete

    2011-01-01

    NASA's Orion spacecraft is designed to autonomously rendezvous and dock with many vehicles including the International Space Station. However, the crew is able to assume manual control of the vehicle s attitude and flight path. In these instances, Orion must meet handling qualities requirements established by NASA. Two handling qualities assessments were conducted at the Johnson Space Center to evaluate preliminary designs of the vehicle using a six degree of freedom, high-fidelity guidance, navigation, and control simulation. The first assessed Orion s handling qualities during the last 20 ft before docking, and included both steady and oscillatory motions of the docking target. The second focused on manual acquisition of the docking axis during the proximity operations phase and subsequent station-keeping. Cooper-Harper handling qualities ratings, workload ratings and comments were provided by 10 evaluation pilots for the docking study and 5 evaluation pilots for the proximity operations study. For the docking task, both cases received 90% Level 1 (satisfactory) handling qualities ratings, exceeding NASA s requirement. All ratings for the ProxOps task were Level 1. These evaluations indicate that Orion is on course to meet NASA's handling quality requirements for ProxOps and docking.

  3. How Quality Improvement Practice Evidence Can Advance the Knowledge Base.

    PubMed

    OʼRourke, Hannah M; Fraser, Kimberly D

    2016-01-01

    Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base. PMID:27584696

  4. Improving Hospital Quality and Patient Safety an Examination of Organizational Culture and Information Systems

    ERIC Educational Resources Information Center

    Gardner, John Wallace

    2012-01-01

    This dissertation examines the effects of safety culture, including operational climate and practices, as well as the adoption and use of information systems for delivering high quality healthcare and improved patient experience. Chapter 2 studies the influence of both general and outcome-specific hospital climate and quality practices on process…

  5. [Quality improvement in acute pain management in Germany].

    PubMed

    Meißner, Winfried

    2016-01-01

    In Germany, different quality management approaches in postoperative pain management have been established. In this context, quality is distinguished into structure quality (e.g. personnel and equipment resources), process quality (e. g. standardized treatment schemes) and outcome quality (e.g. pain intensity, side effects, satisfaction). While guidelines and recommendations help to set up evidence based structures and processes and offer support for decision making, benchmark projects offer insights in real life conditions. By use of feedback and benchmarking tools, they can be used for outcome-oriented quality improvement. Certification projects assess compliance with or achievement of defined quality criteria on the basis of predefined structure, process, and outcome parameter.

  6. Improved Adjoint-Operator Learning For A Neural Network

    NASA Technical Reports Server (NTRS)

    Toomarian, Nikzad; Barhen, Jacob

    1995-01-01

    Improved method of adjoint-operator learning reduces amount of computation and associated computational memory needed to make electronic neural network learn temporally varying pattern (e.g., to recognize moving object in image) in real time. Method extension of method described in "Adjoint-Operator Learning for a Neural Network" (NPO-18352).

  7. Improving Quality in Education: Dynamic Approaches to School Improvement

    ERIC Educational Resources Information Center

    Creemers, Bert P. M.; Kyriakides, Leonidas

    2011-01-01

    This book explores an approach to school improvement that merges the traditions of educational effectiveness research and school improvement efforts. It displays how the dynamic model, which is theoretical and empirically validated, can be used in both traditions. Each chapter integrates evidence from international and national studies, showing…

  8. Update on the Improving Teacher Quality Program. Report 09-05

    ERIC Educational Resources Information Center

    Humphrey, Karen

    2009-01-01

    The Improving Teacher Quality (ITQ) State Grants Program is currently operating professional development grants for California teachers at 40 sites statewide. This is as large a cadre of projects as the California Postsecondary Education Commission has operated since the ITQ Program began with the passage of the No Child Left Behind Act of 2001.…

  9. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... each of those plans, an ongoing quality improvement program that meets applicable requirements of this section for the service it furnishes to its MA enrollees. As part of its ongoing quality...

  10. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... each of those plans, an ongoing quality improvement program that meets applicable requirements of this section for the service it furnishes to its MA enrollees. As part of its ongoing quality...

  11. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., quality of life indicators, depression scales, or chronic disease outcomes). (iii) Staff implementation of... each of those plans, an ongoing quality improvement program that meets applicable requirements of this section for the service it furnishes to its MA enrollees. As part of its ongoing quality...

  12. Technological developments and approaches to improving service quality.

    PubMed

    Blumberg, M R

    1999-01-01

    In summary, major paradigm shifts in the health care industry are altering the way technology is maintained and supported. Service organizations are now responsible for maintaining a broader base of technology within the health care delivery network and must to this on an extremely rapid, efficient, and productive basis. A number of new technologies are coming on-line, which can allow a health care technology service organization to experience significant improvements in profitability, efficiency, and productivity. To realize maximum benefit from these technologies, service organizations may find themselves re-engineering their service processes. The author believes that this is a requirement for many service organizations, regardless of whether new technology is implemented. The traditional approaches to service delivery are ineffective in managing the new structural realities and service requirements of today's health care environment. New strategies and tactics are required for ensuring that these requirements are met. These approaches will no doubt improve the overall quality, productivity, and efficiency of service and are based on best practices utilized by leading OEMs and ISOs in the medical electronics and other high technology service industry such as information technology and telecommunications, where the service organization is responsible for supporting a broad array of the technology over a large geography with a densely populated installed base, not unlike the typical health care delivery service environment. Once operational improvements are made, a service organization can take advantage of the productivity and efficiency gains brought on by new technology. Organizations interested in doing so are urged to thoroughly research the current state-of-the-art and best practices, because there are numerous systems currently available off-the-shelf. The author believes that new technology will be a basic requirement for competing in the health care

  13. Quality Rating and Improvement Systems: A Strategic Movement for Defining Quality

    ERIC Educational Resources Information Center

    Neugebauer, Roger

    2009-01-01

    One of the most important trends in the early childhood field is the emergence of quality rating systems (QRS), or quality rating and improvement systems (QRIS), which are designed to assess, improve, and communicate the level of quality of early and school-age care programs. QRS came onto the scene in 1998 when Oklahoma enacted its "Reaching for…

  14. Quality assurance and yield improvement in photomask fabrication

    NASA Astrophysics Data System (ADS)

    Yamauchi, Takashi

    2000-07-01

    Photomask used in aspect of semiconductor is called on 'No.0 process in wafer' or 'Key-parts', so that we are required to make it with Hi-reliability and Hi-quality level. On the other hand, its problem that cost of Photomask Fabrication jumps because machine price, inspection tool, and inspection steps in leading-edge are increasing. For decreasing what we call 'cost of quality assurance', its policy is significant that quality management in photomask production line is equal quality assurance in photomask, in addition improvement process capability. This report clears the requirement of customer, specification, and the problem, introduces quality assurance and yield improvement in photomask fabrication.

  15. Does Automated Feedback Improve Writing Quality?

    ERIC Educational Resources Information Center

    Wilson, Joshua; Olinghouse, Natalie G.; Andrada, Gilbert N.

    2014-01-01

    The current study examines data from students in grades 4-8 who participated in a statewide computer-based benchmark writing assessment that featured automated essay scoring and automated feedback. We examined whether the use of automated feedback was associated with gains in writing quality across revisions to an essay, and with transfer effects…

  16. The Benefits of Improving Indoor Environmental Quality

    ERIC Educational Resources Information Center

    Lamping, Jerry

    2012-01-01

    As school funding levels nationwide continue to plummet amid public demands for increased student performance, an expanding body of research in the field of indoor environmental quality (IEQ) is providing greater statistical validity about the relationship between environmental conditions in school facilities and student achievement. Since the…

  17. Improving Regional Air Quality with Wind Energy

    SciTech Connect

    Not Available

    2005-05-01

    This model documentation is designed to assist State and local governments in pursuing wind energy purchases as a control measure under regional air quality plans. It is intended to support efforts to draft State Implementation Plans (SIPs), including wind energy purchases, to ensure compliance with the standard for ground-level ozone established under the Clean Air Act.

  18. Sleep Quality Improvement During Cognitive Behavioral Therapy for Anxiety Disorders.

    PubMed

    Ramsawh, Holly J; Bomyea, Jessica; Stein, Murray B; Cissell, Shadha H; Lang, Ariel J

    2016-01-01

    Despite the ubiquity of sleep complaints among individuals with anxiety disorders, few prior studies have examined whether sleep quality improves during anxiety treatment. The current study examined pre- to posttreatment sleep quality improvement during cognitive behavioral therapy (CBT) for panic disorder (PD; n = 26) or generalized anxiety disorder (GAD; n = 24). Among sleep quality indices, only global sleep quality and sleep latency improved significantly (but modestly) during CBT. Sleep quality improvement was greater for treatment responders, but did not vary by diagnosis. Additionally, poor baseline sleep quality was independently associated with worse anxiety treatment outcome, as measured by higher intolerance of uncertainty. Additional intervention targeting sleep prior to or during CBT for anxiety may be beneficial for poor sleepers.

  19. How do we improve quality in primary dental care?

    PubMed

    Campbell, S; Tickle, M

    2013-09-01

    Quality improvement differs from quality assurance (which is retrospective in nature) in that it attempts to use a quality assessment cycle and focuses on the organisation or system of production as a whole. In this paper, the third in a series of three published in this Journal, we discuss the concept and evidence base of quality improvement, the main approaches that have been used in other healthcare settings and the importance of a multi-faceted strategy to address this issue. These topics are then related to the context of primary dental care and the way dentistry currently addresses quality improvement. Finally, we set out an agenda and provide recommendations for a system-based quality improvement strategy for primary dental care and identify the likely barriers and facilitators for this approach.

  20. The Role of Staff in Quality Improvement in Early Childhood

    ERIC Educational Resources Information Center

    Sims, Margaret; Waniganayake, Manjula

    2015-01-01

    There is international recognition of the importance of high quality services for young children with a consensus that three pillars contribute to quality improvement: adult: child ratios, staff qualifications and group size. In Australia over the past 5 years, early childhood policy has attempted to drive improvements in early childhood service…

  1. Small Steps, Big Reward: Quality Improvement through Pilot Groups.

    ERIC Educational Resources Information Center

    Bindl, Jim; Schuler, Jim

    1988-01-01

    Because of a need for quality improvement, Wisconsin Power and Light trained two six-person pilot groups in statistical process control, had them apply that knowledge to actual problems, and showed management the dollars-and-cents savings that come from quality improvement. (JOW)

  2. Ethical issues surrounding quality improvement activities: a review.

    PubMed

    Wise, Lowell C

    2007-06-01

    During the past 15 years, issues regarding the ethical conduct of quality improvement activities have emerged. Recently, many have called for regulation of quality improvement studies using institutional review boards. The author reviews the history of the human rights argument within the context of a relevant, newly released study by the Hastings Center and concludes with practical application of the study's findings.

  3. 42 CFR 423.162 - Quality improvement organization activities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 3 2011-10-01 2011-10-01 false Quality improvement organization activities. 423.162 Section 423.162 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement Requirements §...

  4. 42 CFR 423.162 - Quality improvement organization activities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Quality improvement organization activities. 423.162 Section 423.162 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM VOLUNTARY MEDICARE PRESCRIPTION DRUG BENEFIT Cost Control and Quality Improvement Requirements §...

  5. Does the EUA Institutional Evaluation Programme Contribute to Quality Improvement?

    ERIC Educational Resources Information Center

    Tavares, Diana Amado; Rosa, Maria Joao; Amaral, Alberto

    2010-01-01

    Purpose: This paper aims to reflect on the relevance of the Institutional Evaluation Programme (IEP) of the European University Association (EUA) to universities' quality improvement. It aims to analyse IEP follow-up reports to determine whether the programme contributes to the development of a quality improvement culture.…

  6. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 40 Protection of Environment 16 2014-07-01 2014-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements....

  7. International Accreditations as Drivers of Business School Quality Improvement

    ERIC Educational Resources Information Center

    Bryant, Michael

    2013-01-01

    Business schools are under pressure to implement continuous improvement and quality assurance processes to remain competitive in a globalized higher education market. Drivers for quality improvement include external, environmental pressures, regulatory bodies such as governments, and, increasingly, voluntary accreditation agencies such as AACSB…

  8. "Virtual" health care organizations and the challenges of improving quality.

    PubMed

    Page, Stephen

    2003-01-01

    This article examines the challenges of improving health care quality continuously within and across "virtual" provider organizations such as independent practice associations and physician-hospital organizations. It draws on recent research and theory about interorganizational networks in other fields to develop recommendations for securing physicians' commitment to quality improvement strategies in today's health care environment.

  9. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements....

  10. 40 CFR 64.8 - Quality improvement plan (QIP) requirements.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 40 Protection of Environment 15 2011-07-01 2011-07-01 false Quality improvement plan (QIP) requirements. 64.8 Section 64.8 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) COMPLIANCE ASSURANCE MONITORING § 64.8 Quality improvement plan (QIP) requirements....

  11. Quality Improvement Strategies and Best Practices in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Casey, Michelle M.; Moscovice, Ira

    2004-01-01

    Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. This article…

  12. Operational Quality Control of SAR Data under the IDEAS Contract

    NASA Astrophysics Data System (ADS)

    Griffiths, Emma; Haria, Kajal; Meadowws, Peter; Miranda, Nuno

    2010-12-01

    Operational Quality Control (QC) of ERS-1/2 Synthetic Aperture Radar (SAR), Envisat's Advanced Synthetic Aperture Radar (ASAR) and the Phased-Array L-band SAR (PALSAR) on board JAXA's Advanced Land Observing Satellite (ALOS) is currently carried out under the Image Data quality Evaluation and Analysis Service (IDEAS). This paper introduces the concept of IDEAS as it applies to SAR QC including the daily and long-term analysis and shows the interaces to related services, including ESA's user-facing Earth Observation (EO) Help Desk

  13. Improving the Quality and Scope of EIA Data

    EIA Publications

    2011-01-01

    Section 805(a) of the Energy Independence and Security Act of 2007 (EISA), Public Law 110-1401 requires the U.S. Energy Information Administration (EIA) to establish a five-year plan to enhance the quality and scope of its data collection necessary to ensure that the scope, accuracy, and timeliness of the information needed for efficient functioning of energy markets and related financial operations. This report is in response to section 805(b) of EISA which calls on EIA to submit to Congress the plan established under subsection (a), including a description of any improvements needed to enhance the ability of the Administrator to collect and process energy information in a manner consistent with the needs of energy markets.

  14. Valuation of improved air quality in Utah County, USA

    NASA Astrophysics Data System (ADS)

    Pope, C. Arden; Miner, F. Dean

    1988-05-01

    A contingent valuation approach was used to estimate maximum willingness-to-pay for improved air quality in Utah County. Respondents demonstrated a high rate of concern over poor air quality and averaged a willingness-to-pay of 37 per month per household. Noniterative openended questions were used successfully. No information bias was observed but benchmark values did influence bids. Willingness-to-pay for improved air quality was large for both sexes and across all income groups, ages, and occupations.

  15. Early Experience with a Hepatobiliary and Pancreatic Quality Improvement Program.

    PubMed

    O'Reilly, Derek; Edmiston, Rachel; Bijoor, Pooja; Deshpande, Rahul; de'Liguori Carino, Nicola; Ammori, Basil; Sherlock, David J

    2014-01-01

    This project aims to assess the impact of the introduction of a hepatobiliary and pancreatic (HPB) Quality Improvement Program (QIP) on postoperative complications following liver, biliary and pancreatic surgery. A prospective analysis of postoperative complications over a six month period was performed. Complications were analysed and graded according to internationally agreed definitions. Justification was sought and errors identified. Weekly meetings were performed to review each complication enabling an action plan to be created to prevent future recurrence. Rates were compared with previously audited and published results, using the chi-square test. A total of 326 procedures were performed over the six months including 30 pancreatectomies, 45 liver resections and 251 other procedures. 37 patients developed complications (11.3%) with 47 complications in total including two deaths. Using the ISGPS grading, eight complications were identified; two grade A, four grade B and two grade C. There were three grade A ISGLS complications and one grade B. 30 complications were justified as unavoidable, 16 as avoidable and one as indeterminate. Action plans included continued monitoring (n=41), formulation of new policy (n=3), individual counselling (n=4), educational offering (n=4). When compared with 2010 complication rates, 114 complications occurred in 233 liver operations during the baseline period, compared with 17 complications in 45 liver operations during the QIP period, OR=0.63 (95% CI: 0.33 to 1.22), p=0.17 and 86 complications occurred in 99 pancreatic resections during the baseline period, compared with 20 complications in 30 pancreatic resections during the QIP period OR=0.30 (95% CI: 0.12 to 0.79), p=0.01 The HPB QIP is a rigorous approach to grade every complication and death. A statistically significant reduction in pancreas related complications has already been obtained. Further work is required to determine the persistence and magnitude of this quality

  16. Improving quality in paediatric respiratory disease management.

    PubMed

    Harrop, Michele; Amegavie, Laweh

    2003-11-01

    Throughout the development, implementation and dissemination of the Paediatric Respiratory Newsletter, effective channels of communication between healthcare professionals have been established, highlighting the importance of collaboration. Promoting education, training, audit and research, the newsletter has nurtured both professional and practice development. The work begun during this project, and the outcomes it has achieved, have been developed into an ethos that recognises effective clinical practice and organisational development as central to the delivery of a quality service. This work informs and is informed by strategic developments, in particular, research and development, clinical audit, quality, practice development and clinical risk, all of which are observed to be the key elements of clinical governance. On a personal level, the project has provided me with an opportunity to consolidate information, forge links with the multidisciplinary team and establish a framework for the development of paediatric respiratory services. We hope it will continue to respond to, and be influenced by, changing health and social care demands.

  17. [New operating rooms: problems related with ventilation and air quality].

    PubMed

    Sabbadini, M; Verga, M; Boglioni, R; Zotti, A

    2002-01-01

    Realizing the project of the new operating theatres, We bring out the importance of creating bright environments, rational and wide ways, a good indoor air quality, thermal comfort and occupational hygiene. Therefore for the first time We've installed an automatic system for permanent monitoring of gases, vapours and particles, associated with the study of ventilation, to evaluate the real condition of the mantenance and of staff behaviour.

  18. Rotorcraft flying qualities improvement using advanced control

    NASA Technical Reports Server (NTRS)

    Walker, D.; Postlethwaite, I.; Howitt, J.; Foster, N.

    1993-01-01

    We report on recent experience gained when a multivariable helicopter flight control law was tested on the Large Motion Simulator (LMS) at DRA Bedford. This was part of a study into the application of multivariable control theory to the design of full-authority flight control systems for high-performance helicopters. In this paper, we present some of the results that were obtained during the piloted simulation trial and from subsequent off-line simulation and analysis. The performance provided by the control law led to level 1 handling quality ratings for almost all of the mission task elements assessed, both during the real-time and off-line analysis.

  19. Approaches to improve quality of care in inflammatory bowel diseases.

    PubMed

    Shah, Rajesh; Hou, Jason K

    2014-07-28

    Studies across medical disciplines have shown gaps in the care recommended in evidence based guidelines and the care actually delivered. Quality improvement projects using systematic audit and feedback interventions such as quality measures, will become increasingly important tools to address these gaps in care. These gaps are also apparent in the care of patients with inflammatory bowel disease. Multiple organizations, including the American Gastroenterology Association and the Crohn's and Colitis Foundation of America, have developed programs designed to implement quality measures to improve the care of inflammatory bowel disease (IBD) patients. Early results show promise of improving quality, but numerous barriers remain. Gastroenterologists need to be aware of these processes to provide the highest care possible to patients with IBD. We review the existing literature on approaches to quality improvement and their potential application and barriers when applied to IBD care. PMID:25071321

  20. Use of Electronic Documentation for Quality Improvement in Hospice

    PubMed Central

    Cagle, John G.; Rokoske, Franziska S.; Durham, Danielle; Schenck, Anna P.; Spence, Carol; Hanson, Laura C.

    2015-01-01

    Little evidence exists on the use of electronic documentation in hospice and its relationship to quality improvement practices. The purposes of this study were to: (1) estimate the prevalence of electronic documentation use in hospice; (2) identify organizational characteristics associated with use of electronic documentation; and (3) determine whether quality measurement practices differed based on documentation format (electronic vs. nonelectronic). Surveys concerning the use of electronic documentation for quality improvement practices and the monitoring of quality-related care and outcomes were collected from 653 hospices. Users of electronic documentation were able to monitor a wider range of quality-related data than users of nonelectronic documentation. Quality components such as advanced care planning, cultural needs, experience during care of the actively dying, and the number/types of care being delivered were more likely to be documented by users of electronic documentation. Use of electronic documentation may help hospices to monitor quality and compliance. PMID:22267819

  1. Improving College Effectiveness: Raising Quality and Achievement.

    ERIC Educational Resources Information Center

    Somekh, Bridget; Convery, Andy; Delaney, Jean; Fisher, Roy; Gray, John; Gunn, Stan; Henworth, Andrew; Powell, Loraine

    1999-01-01

    Work undertaken to improve the effectiveness of the United Kingdom's schools and further education (FE) sectors was identified and assessed in a study entailing four data collection methods: literature review; questionnaire administered to all FE college principals in England and Wales; expert seminar and face-to-face interviews with high-level…

  2. Quality improvement in Vignoles through clonal selection

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Our goal is to select an improved, loose-clustered clone of Vignoles that will contribute to an integrated approach to disease control. Clonal selection has historically proven useful in reducing cluster compactness through a variety of mechanisms, including decreased berry size, lengthening of the ...

  3. It Pays to Improve School Quality

    ERIC Educational Resources Information Center

    Hanushek, Eric A.; Ruhose, Jens; Woessmann, Ludger

    2016-01-01

    Congress passed the Every Student Succeeds Act, supplanting No Child Left Behind and placing responsibility for public school improvement squarely upon each of the 50 states. With the federal government's role in school accountability sharply diminished, it now falls to state and local governments to take decisive action. Even though most…

  4. NASA's Productivity Improvement and Quality Enhancement Initiatives

    NASA Technical Reports Server (NTRS)

    1984-01-01

    The National Aeronautics and Space Administration celebrated its 25th Anniversary in 1983 at the Air and Space Museum in Washington, DC, with President Reagan in attendance. We look back on the accomplishments of these twenty-five years with pride in our missions and our people. NASA captured the world's imagination during the days of the Apollo mission. So much so, that we now talk about the Apollo era. In the l970s, we moved into the Space Transportation business and in the 199Os, we look forward to having a manned Space Station. Each succeeding mission has presented its own challenge in terms of technology and resources. This is especially true today, when we are being asked to do more with less. To ensure that NASA continues to be a productive and quality conscious agency, one of our highest Agency goals is leadership in the development and application of practices which contribute to high productivity and quality. greatest competitive strength, and this country has a solid scientific and engineering foundation. Traditionally we have spent more money on research and development than Japan and Europe combined, and we are the source of most of this century significant innovations. We should build on this solid base and use it more effectively.

  5. Improving communication between phlebotomists and doctors: a quality improvement project.

    PubMed

    Saunsbury, Emma; Howarth, Gabrielle

    2016-01-01

    Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the "Phlebotomy Box," a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic, sustainable

  6. Improving communication between phlebotomists and doctors: a quality improvement project

    PubMed Central

    Saunsbury, Emma; Howarth, Gabrielle

    2016-01-01

    Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the “Phlebotomy Box,” a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic

  7. Improving communication between phlebotomists and doctors: a quality improvement project

    PubMed Central

    Saunsbury, Emma; Howarth, Gabrielle

    2016-01-01

    Blood tests are a seemingly basic investigation, but are often a vital part of directing patient management. Despite the importance of this everyday process, we indentified the potential for improvement of the current phlebotomy service in our hospital, as both junior doctors and phlebotomists reported a lack of communication and standardised practice across the wards. Resulting delays in obtaining blood test results can impact detrimentally on patient safety and management. We designed a survey which highlighted inefficient handovers and discrepancies between wards as driving factors behind this. We therefore aimed to improve communication between phlebotomists and doctors, as well as the overall organisation of the service. This took the form of the “Phlebotomy Box,” a box file system offering a set location for blood stickers to be situated. The box concept was optimised on a series of medical and surgical wards, incorporating multidisciplinary feedback from relevant teams. We measured how many untaken bloods were handed over to medical staff continuously, both pre- and post implementation of the phlebotomy box. Our baseline ward demonstrated poor handover rates of untaken bloods, ranging from 0% to 40%. This increased to a consistent 100% following introduction of the Phlebotomy Box and ongoing staff education. Once optimised, the box was trialled on a further two medical wards and one surgical ward, achieving 100% handover from an initial 0% to 67%. Quantitative improvement was also reflected qualitatively in widespread staff surveys, with overwhelmingly positive support and acceptance. In summary, the Phlebotomy Box innovation has led to 100% of untaken bloods being effectively handed over. We have demonstrated a significant improvement in communication and efficiency within the phlebotomy service, with tangible benefits to patient care, as minimising time lags can prevent delays in clinical decisions. The phlebotomy box represents a simplistic

  8. Cover crops can improve potato tuber yield and quality

    Technology Transfer Automated Retrieval System (TEKTRAN)

    There is the need to develop sustainable systems with higher yields and crop quality. We conducted studies with cover crops grown under limited irrigation (< 200 mm) to assess the effects of certain types of cover crops on tuber yield and quality. On a commercial farm operation prior to the 2006 and...

  9. The Armstrong Institute: An Academic Institute for Patient Safety and Quality Improvement, Research, Training, and Practice.

    PubMed

    Pronovost, Peter J; Holzmueller, Christine G; Molello, Nancy E; Paine, Lori; Winner, Laura; Marsteller, Jill A; Berenholtz, Sean M; Aboumatar, Hanan J; Demski, Renee; Armstrong, C Michael

    2015-10-01

    Academic medical centers (AMCs) could advance the science of health care delivery, improve patient safety and quality improvement, and enhance value, but many centers have fragmented efforts with little accountability. Johns Hopkins Medicine, the AMC under which the Johns Hopkins University School of Medicine and the Johns Hopkins Health System are organized, experienced similar challenges, with operational patient safety and quality leadership separate from safety and quality-related research efforts. To unite efforts and establish accountability, the Armstrong Institute for Patient Safety and Quality was created in 2011.The authors describe the development, purpose, governance, function, and challenges of the institute to help other AMCs replicate it and accelerate safety and quality improvement. The purpose is to partner with patients, their loved ones, and all interested parties to end preventable harm, continuously improve patient outcomes and experience, and eliminate waste in health care. A governance structure was created, with care mapped into seven categories, to oversee the quality and safety of all patients treated at a Johns Hopkins Medicine entity. The governance has a Patient Safety and Quality Board Committee that sets strategic goals, and the institute communicates these goals throughout the health system and supports personnel in meeting these goals. The institute is organized into 13 functional councils reflecting their behaviors and purpose. The institute works daily to build the capacity of clinicians trained in safety and quality through established programs, advance improvement science, and implement and evaluate interventions to improve the quality of care and safety of patients.

  10. Rendezvous, proximity operations and capture quality function deployment report

    NASA Technical Reports Server (NTRS)

    Lamkin, Stephen L. (Editor)

    1991-01-01

    Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

  11. Rendezvous, proximity operations and capture quality function deployment report

    NASA Astrophysics Data System (ADS)

    Lamkin, Stephen L.

    1991-12-01

    Rendezvous, Proximity Operations, and Capture (RPOC) is a missions operations area which is extremely important to present and future space initiatives and must be well planned and coordinated. To support this, a study team was formed to identify a specific plan of action using the Quality Function Deployment (QFD) process. This team was composed of members from a wide spectrum of engineering and operations organizations which are involved in the RPOC technology area. The key to this study's success is an understanding of the needs of potential programmatic customers and the technology base available for system implementation. To this end, the study team conducted interviews with a variety of near term and future programmatic customers and technology development sponsors. The QFD activity led to a thorough understanding of the needs of these customers in the RPOC area, as well as the relative importance of these needs.

  12. Improving Prediction of Surgery Duration using Operational and Temporal Factors

    PubMed Central

    Kayis, Enis; Wang, Haiyan; Patel, Meghna; Gonzalez, Tere; Jain, Shelen; Ramamurthi, RJ; Santos, Cipriano; Singhal, Sharad; Suermondt, Jaap; Sylvester, Karl

    2012-01-01

    Inherent uncertainties in surgery durations impact many critical metrics about the performance of an operating room (OR) environment. OR schedules that are robust to natural variability in surgery durations require surgery duration estimates that are unbiased, with high accuracy, and with few cases with large absolute errors. Earlier studies have shown that factors such as patient severity, personnel, and procedure type greatly affect the accuracy of such estimations. In this paper we investigate whether operational and temporal factors can be used to improve these estimates further. We present an adjustment method based on a combination of these operational and temporal factors. We validate our method with two years of detailed operational data from an electronic medical record. We conclude that while improving estimates of surgery durations is possible, the inherent variability in such estimates remains high, necessitating caution in their use when optimizing OR schedules. PMID:23304316

  13. Approaching the Practice Quality Improvement Project in Interventional Radiology.

    PubMed

    Reis, Stephen P; White, Benjamin; Sutphin, Patrick D; Pillai, Anil K; Kalva, Sanjeeva P; Toomay, Seth M

    2015-12-01

    An important component of maintenance of certification and quality improvement in radiology is the practice quality improvement (PQI) project. In this article, the authors describe several methodologies for initiating and completing PQI projects. Furthermore, the authors illustrate several tools that are vital in compiling, analyzing, and presenting data in an easily understandable and reproducible manner. Last, they describe two PQI projects performed in an interventional radiology division that have successfully improved the quality of care for patients. Using the DMAIC (define, measure, analyze, improve, control) quality improvement framework, interventional radiology throughput has been increased, to lessen mediport wait times from 43 to 8 days, and mediport infection rates have decreased from more than 2% to less than 0.4%. PMID:26337461

  14. Improving collected rainwater quality in rural communities.

    PubMed

    Garrido, S; Aviles, M; Ramirez, A; Gonzalez, A; Montellano, L; Gonzalez, B; de la Paz, J; Ramirez, R M

    2011-01-01

    The country of Mexico is facing serious problems with water quality and supply for human use and consumption in rural communities, mainly due to topographic and isolation. In Mexico the average annual precipitation is 1,500 cubic kilometers of water, if 3% of that amount were used, 13 million Mexicans could be supplied with drinking water that they currently do not have access. Considering the limited infrastructure and management in rural communities, which do not receive services from the centralized systems of large cities, a modified pilot multi-stage filtration (MMSF) system was designed, developed, and evaluated for treating collected rainwater in three rural communities, Ajuchitlan and Villa Nicolas Zapata (Morelos State) and Xacxamayo (Puebla State). The efficiencies obtained in the treatment system were: colour and turbidity >93%. It is worth mentioning that the water obtained for human use and consumption complies with the Mexican Standard NOM-127-SSA1-1994.

  15. Dedicated operating room for emergency surgery improves access and efficiency

    PubMed Central

    Heng, Marilyn; Wright, James G.

    2013-01-01

    Background Scheduling emergency cases among elective surgeries often results in prolonged waits for emergency surgery and delays or cancellation of elective cases. We evaluated the benefits of a dedicated operating room (OR) for emergency procedures available to all surgical services at a large children’s hospital. Methods We compared a 6-month period (January 2009 to June 2009) preimplementation with a 6-month period (January 2010 to June 2010) postimplementation of a dedicated OR. We evaluated OR use, wait times, percentage of cases done within and outside of access targets, off-hours surgery, cancellations, overruns and length of stay. Results Preimplementation, 1069 of the 5500 surgeries performed were emergency cases. Postimplementation, 1084 of the 5358 surgeries performed were emergency cases. Overall use of the dedicated OR was 53% (standard deviation 25%) postimplementation. Excluding outliers, the average wait time for priority 3 emergency patients decreased from 11 hours 8 minutes to 10 hours 5 minutes (p = 0.004). An increased proportion of priority 3 patients, from 52% to 58%, received surgery within 12 hours (p = 0.020). There was a 9% decrease in the proportion of priority 3 cases completed during the evening and night (p < 0.001). The elective surgical schedule benefited from the dedicated OR, with a significant decrease in cancellations (1.5% v. 0.7%, p < 0.001) and an accumulated decrease of 5211 minutes in overrun minutes in elective rooms. The average hospital stay after emergency surgery decreased from 16.0 days to 14.7 days (p = 0.12) following implementation of the dedicated OR. Conclusion A dedicated OR for emergency cases improved quality of care by decreasing cancellations and overruns in elective rooms and increasing the proportion of priority 3 patients who accessed care within the targeted time. PMID:23706847

  16. Improving Qubit Quality Factors Through Exotic Materials

    NASA Astrophysics Data System (ADS)

    Norman, Victoria

    In the time since the first qubits were successfully fabricated, the coherence times of superconducting Josephson junction qubits have improved by several orders of magnitude. Yet as the quantum information and computation field moves forward, these coherence times still need further improvement. We are now finding that in some superconducting systems, non-thermal equilibrium quasiparticles are becoming the limiting factor in qubit lifetimes. For SIS superconducting qubits, the T1 and T2* values may be improved by the use of materials with higher superconducting band gap, EG, for which low values may allow for quasiparticles to break up cooper pairs more easily, leading to a shorter lifetime. At this time, Al-Al2Ox3-Al transmons are very well characterized and understood and will therefore serve as an appropriate baseline with which to compare the more exotic junction materials. Using tantalum and niobium, which have Eg values of 3 times and 10 times that of aluminum respectively, we expect the T1 and T2* values to increase significantly for the Al-Al2Ox3-Nb, Al-Al2Ox3-Ta, and Ta-Ta2Ox5-Nb qubits.

  17. Quality of Instruction Improved by Evaluation and Consultation of Instructors

    ERIC Educational Resources Information Center

    Rindermann, Heiner; Kohler, Jurgen; Meisenberg, Gerhard

    2007-01-01

    One aim of student evaluation of instruction is the improvement of teaching quality, but there is little evidence that student assessment of instruction alone improves teaching. This study tried to improve the effects of evaluation by combining evaluation with individual counselling in an institutional development approach. Evaluation was…

  18. Evidence-Based Practice and Quality Improvement in Nursing Education.

    PubMed

    Balakas, Karen; Smith, Joan R

    2016-01-01

    For more than a decade, nursing education has experienced several significant changes in response to challenges faced by healthcare organizations. Accrediting organizations have called for improved quality and safety in care, and the Institute of Medicine has identified evidence-based practice and quality improvement as 2 core competencies to include in the curricula for all healthcare professionals. However, the application of these competencies reaches far beyond the classroom setting. For nurses to possess the knowledge, skills, and attitudes to apply evidence-based practice and quality improvement to the real-world setting, academic-clinical institution partnerships are vital. PMID:27465447

  19. Improving the Quality of Voluntary Medical Male Circumcision through Use of the Continuous Quality Improvement Approach: A Pilot in 30 PEPFAR-Supported Sites in Uganda

    PubMed Central

    Opio, Alex; Calnan, Jacqueline; Njeuhmeli, Emmanuel

    2015-01-01

    Background Uganda adopted voluntary medical male circumcision (VMMC) (also called Safe Male Circumcision in Uganda), as part of its HIV prevention strategy in 2010. Since then, the Ministry of Health (MOH) has implemented VMMC mostly with support from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) through its partners. In 2012, two PEPFAR-led external quality assessments evaluated compliance of service delivery sites with minimum quality standards. Quality gaps were identified, including lack of standardized forms or registers, lack of documentation of client consent, poor preparedness for emergencies and use of untrained service providers. In response, PEPFAR, through a USAID-supported technical assistance project, provided support in quality improvement to the MOH and implementing partners to improve quality and safety in VMMC services and build capacity of MOH staff to continuously improve VMMC service quality. Methods and Findings Sites were supported to identify barriers in achieving national standards, identify possible solutions to overcome the barriers and carry out improvement plans to test these changes, while collecting performance data to objectively measure whether they had bridged gaps. A 53-indicator quality assessment tool was used by teams as a management tool to measure progress; teams also measured client-level indicators through self-assessment of client records. At baseline (February-March 2013), less than 20 percent of sites scored in the “good” range (>80%) for supplies and equipment, patient counseling and surgical procedure; by November 2013, the proportion of sites scoring “good” rose to 67 percent, 93 percent and 90 percent, respectively. Significant improvement was noted in post-operative follow-up at 48 hours, sexually transmitted infection assessment, informed consent and use of local anesthesia but not rate of adverse events. Conclusion Public sector providers can be engaged to address the quality of

  20. Pulmonary rehabilitation improves sleep quality in chronic lung disease.

    PubMed

    Soler, Xavier; Diaz-Piedra, Carolina; Ries, Andrew L

    2013-04-01

    Sleep-related disorders are common in patients with chronic obstructive pulmonary disease (COPD) and, possibily, other lung disorders. Exercise has been shown to improve sleep disturbances. In patients with COPD, pulmonary rehabilitation (PR) produces important health benefits with improvement in symptoms, exercise tolerance, and quality of life. However, the effect of PR on sleep quality remains unknown. The aim of this observational study was to evaluate sleep quality in patients with chronic lung disease and the role of PR as a non-pharmacologic treatment to improve sleep. Sixty-four patients with chronic lung disease enrolled in an 8-week comprehensive PR program, and completed the study (48% male; obstructive [72%], restrictive [20%], mixed [8%]; 44% on supplemental oxygen). Baseline spirometry [mean (SD)]: FEV1% pred = 48.9 (17.4), FVC% pred = 72.5 (18.1), and FEV1/FVC% = 53.1 (18.9). Exercise tolerance and questionnaires related to symptoms, health-related quality of life (HRQL), and sleep quality using the Pittsburgh Sleep Quality Index (PSQI) were obtained before and after PR. 58% reported poor sleep quality (PSQI > 5) at baseline. Sleep quality improved by 19% (p = 0.017) after PR, along with significant improvements in dyspnea, exercise tolerance, self-efficacy, and HRQL. Sleep quality in patients with chronic lung disease was poor. In addition to expected improvements in symptoms, exercise tolerance, and HRQL after PR, the subgroup of patients with COPD had a significant improvement in sleep quality. These findings suggest that PR may be an effective, non-pharmacologic treatment option for sleep problems in patients with COPD. PMID:23514215

  1. Operational tips for improving intrusion detection system performance

    SciTech Connect

    Adams, D.G.

    1996-09-01

    The installation of a new intrusion detection system (IDS) is, of course, expected to improve site security. However, depending upon the way the system is used, it can, over time, actually degrade security. Proper use, control, and maintenance of the IDS is critical if site security is to be maintained. This paper discusses several operational issues that should be addressed in order to use an IDS effectively. Several anecdotes from the author`s experience are given to illustrate proper and improper use of an IDS. Improper operational use of an IDS can render it ineffective. Applying these tips can help keep the IDS operating at peak performance.

  2. Operational tips for improving intrusion detection system performance

    SciTech Connect

    Adams, D.G.

    1996-12-31

    The installation of a new intrusion detection system (IDS) is, of course, expected to improve site security. However, depending upon the way the system is used, it can, over time, actually degrade security. Proper use, control, and maintenance of the IDS is critical if site security is to be maintained. This paper discusses several operational issues that should be addressed in order to use an IDS effectively. Several anecdotes from the author`s experience are given to illustrate proper and improper use of an IDS. Improper operational use of an IDS can render it ineffective. Applying these tips can help keep the IDS operating at peak performance.

  3. Head-aimed vision system improves tele-operated mobility

    NASA Astrophysics Data System (ADS)

    Massey, Kent

    2004-12-01

    A head-aimed vision system greatly improves the situational awareness and decision speed for tele-operations of mobile robots. With head-aimed vision, the tele-operator wears a head-mounted display and a small three axis head-position measuring device. Wherever the operator looks, the remote sensing system "looks". When the system is properly designed, the operator's occipital lobes are "fooled" into believing that the operator is actually on the remote robot. The result is at least a doubling of: situational awareness, threat identification speed, and target tracking ability. Proper system design must take into account: precisely matching fields of view; optical gain; and latency below 100 milliseconds. When properly designed, a head-aimed system does not cause nausea, even with prolonged use.

  4. Improved actions, redundant operators and scaling in lattice SU(3)

    NASA Astrophysics Data System (ADS)

    Patel, Apoorva; Gupta, Rajan

    1987-01-01

    Schwinger-Dyson equations are used to systematically calculate redundant operators in lattice QCD and their role in perturbatively improved actions is analyzed. The criteria for improved actions in Monte Carlo simulations are discussed and their usefulness also. In particular the renormalized trajectory is estimated for the b = sqrt(3) renormalization group transformation in a four-parameter space and its scaling behavior is studied for future use in spectrum calculations. J. Robert Oppenheimer Fellow.

  5. Geometrically tuned wettability of dynamic micromechanical sensors for an improved in-liquid operation

    NASA Astrophysics Data System (ADS)

    Peiker, P.; Oesterschulze, E.

    2015-09-01

    Partial wetting is a vital tool to improve the quality factor of dynamic micromechanical sensors operated in liquids owing to the reduced viscous damping. This technique employs meniscus formation which so far could only be stabilized for a hydrophobic sensory surface excluding biosensing applications. Here, we report on the geometrically tuned wettability of particular hybrid bridge resonators (HBR) with an integrated overhang structure. This allows low-loss operation irrespective of the sensory surface material. The impact of the overhang structure on wetting is explained in a simplified model. Experimental evidence is adduced operating the HBR coated with hydrophilic thin films in water. With an in-liquid quality factor Q of 91 and a small mass m ≈ 5 ng of the HBR, the m/Q-ratio, which is proportional to the limit of detection for mass sensing, was significantly improved in comparison to immersed resonators presented so far.

  6. Quality Implementation in Health Physics Unit, Cosenza Hospital. Accreditation Program as Quality Improvement instrument.

    PubMed

    Loizzo, M; Siciliano, R

    2016-01-01

    Achieving high levels of quality in healthcare, which could be measurable, is increasingly important at present and is dictated by the radical changes of the welfare system imposed today by the well known economic constraints. However, even in the ongoing legislation, the practices concerning the verification and review of the quality of health care has had a major impact in the galaxy of Health. On the one hand, the citizen is developing an awareness of the possibilities of choice (Empowerment) between a plurality of providers of healthcare services, on the other hand providers themselves are obliged, within the logic of a global market, to retrain their offers to respond satisfactorily to the needs of citizens. The purpose of this study was to demonstrate how the adoption of Operational Procedures, following the granting of a certificate of accreditation to the Unit of Medical Physics, has changed the approach to the work on the part of health workers, in the direction of a dynamic quality improvement. PMID:27479767

  7. Process safety improvement--quality and target zero.

    PubMed

    Van Scyoc, Karl

    2008-11-15

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

  8. Process safety improvement--quality and target zero.

    PubMed

    Van Scyoc, Karl

    2008-11-15

    Process safety practitioners have adopted quality management principles in design of process safety management systems with positive effect, yet achieving safety objectives sometimes remain a distant target. Companies regularly apply tools and methods which have roots in quality and productivity improvement. The "plan, do, check, act" improvement loop, statistical analysis of incidents (non-conformities), and performance trending popularized by Dr. Deming are now commonly used in the context of process safety. Significant advancements in HSE performance are reported after applying methods viewed as fundamental for quality management. In pursuit of continual process safety improvement, the paper examines various quality improvement methods, and explores how methods intended for product quality can be additionally applied to continual improvement of process safety. Methods such as Kaizen, Poke yoke, and TRIZ, while long established for quality improvement, are quite unfamiliar in the process safety arena. These methods are discussed for application in improving both process safety leadership and field work team performance. Practical ways to advance process safety, based on the methods, are given. PMID:18374483

  9. Improving patient flow in pre-operative assessment

    PubMed Central

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  10. Improving patient flow in pre-operative assessment.

    PubMed

    Stark, Cameron; Gent, Anne; Kirkland, Linda

    2015-01-01

    Annual patient attendances at a pre-operative assessment department increased by 24.8% from 5659 in 2009, to 7062 in 2012. The unit was staffed by administrative staff, nurses, and health care assistants (HCA). Medical review was accessed via on call medical staff, or notes were sent to anaesthetists for further review. With rising demand, patient waits increased. The average lead time for a patient (time from entering the department to leaving) was 79 minutes. 9.3% of patients attended within two weeks of their scheduled surgery date. 10% of patients were asked to return on a later day, as there was not sufficient capacity to undertake their assessment. There were nine routes of referral in to the department. Patients moved between different clinic rooms and the waiting area several times. Work patterns were uneven, as many attendances were from out-patient clinics which meant peak attendance times were linked to clinic times. There were substantial differences in the approaches of different nurses, making the HCA role difficult. Patients reported dissatisfaction with waits. Using a Lean quality improvement process with rapid PDSA cycles, the service changed to one in which patients were placed in a room, and remained there for the duration of their assessment. Standard work was developed for HCWs and nurses. Rooms were standardised using 5S processes, and set up improved to reduce time spent looking for supplies. A co-ordinator role was introduced using existing staff to monitor flow and to organise the required medical assessments and ECGs. Timing of booked appointments were altered to take account of clinic times. Routes in to the department were reduced from nine to one. Ten months after the work began, the average lead time had reduced to 59 minutes. The proportion of people attending within two weeks of their surgery decreased from 9.3% to 5.3%. Referrals for an anaesthetic opinion decreased from 30% to 20%, and in the month reviewed no one had to return to

  11. Quality improvement study at Mission House Clinic.

    PubMed

    Spiller, Kelsey; Khan, Natasha

    2014-08-01

    Mission House Clinic is a We-Care clinic that provides medical care to low income, homeless, and uninsured individuals. The Prescription Assistance Program (PAP) was created to bridge the gap between pharmaceutical companies that provide free medication and the patients at Mission House Clinic. UNF Nursing students have been involved with the PAP program since 2006. Previously, the PAP has focused on patients with respiratory diseases, hypertension, and diabetes. More recently, the population has shifted towards patients with mental health needs. The purpose of this project was to enhance the effectiveness of the PAP at Mission House Clinic and to improve upon the methods used to identify the prescription needs of the clinic population. PMID:25072218

  12. Quality improvement study at Mission House Clinic.

    PubMed

    Spiller, Kelsey; Khan, Natasha

    2014-08-01

    Mission House Clinic is a We-Care clinic that provides medical care to low income, homeless, and uninsured individuals. The Prescription Assistance Program (PAP) was created to bridge the gap between pharmaceutical companies that provide free medication and the patients at Mission House Clinic. UNF Nursing students have been involved with the PAP program since 2006. Previously, the PAP has focused on patients with respiratory diseases, hypertension, and diabetes. More recently, the population has shifted towards patients with mental health needs. The purpose of this project was to enhance the effectiveness of the PAP at Mission House Clinic and to improve upon the methods used to identify the prescription needs of the clinic population.

  13. Improving Quality of Voice Conversion Systems

    NASA Astrophysics Data System (ADS)

    Farhid, M.; Tinati, M. A.

    New improvement scheme for voice conversion are proposed in this paper. We take Human factor cepstral coefficients (HFCC), a modification of MFCC that uses the known relationship between center frequency and critical bandwidth from human psychoacoustics to decouple filter bandwidth from filter spacing, as the basic feature. We propose U/V (Unvoiced/Voiced) decision rule such that two sets of codebooks are used to capture the difference between unvoiced and voiced segments of the source speaker. Moreover, we apply three schemes to refine the synthesized voice, including pitch refinement, energy equalization, and frame concatenation. The acceptable performance of the voice conversion system can be verified through ABX listening test and MOS grad.

  14. Improve strategic supplier performance using DMAIC to develop a Quality Improvement Plan

    NASA Astrophysics Data System (ADS)

    Jardim, Kevin P.

    Supplier performance that meets the requirements of the customer has long plagued quality professionals. Despite the vast efforts by organizations to improve supplier performance, little has been done to standardize the plan to improve performance. This project presents a guideline and problem-solving strategy using a Define, Measure, Analyze, Improve, and Control (DMAIC) structured tool that will assist in the management and improvement of supplier performance. An analysis of benchmarked Quality Improvement Plans indicated that this topic needs more focus on how to accomplish improved supplier performance. This project is part of a growing body of supplier continuous improvement efforts. With the input of Zodiac Aerospace quality professionals this project's results provide a solution to Quality Improvement Plans and show objective evidence of its benefits. This project contributes to the future research on similar topics.

  15. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    PubMed

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

  16. Quality Improvement in Critical Care: Selection and Development of Quality Indicators

    PubMed Central

    Martin, Claudio M.; Project, The Quality Improvement in Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts. PMID:27493476

  17. Quality Improvement in Critical Care: Selection and Development of Quality Indicators.

    PubMed

    Chrusch, Carla A; Martin, Claudio M; Project, The Quality Improvement In Critical Care

    2016-01-01

    Background. Caring for critically ill patients is complex and resource intensive. An approach to monitor and compare the function of different intensive care units (ICUs) is needed to optimize outcomes for patients and the health system as a whole. Objective. To develop and implement quality indicators for comparing ICU characteristics and performance within and between ICUs and regions over time. Methods. Canadian jurisdictions with established ICU clinical databases were invited to participate in an iterative series of face-to-face meetings, teleconferences, and web conferences. Eighteen adult intensive care units across 14 hospitals and 5 provinces participated in the process. Results. Six domains of ICU function were identified: safe, timely, efficient, effective, patient/family satisfaction, and staff work life. Detailed operational definitions were developed for 22 quality indicators. The feasibility was demonstrated with the collection of 3.5 years of data. Statistical process control charts and graphs of composite measures were used for data display and comparisons. Medical and nursing leaders as well as administrators found the system to be an improvement over prior methods. Conclusions. Our process resulted in the selection and development of 22 indicators representing 6 domains of ICU function. We have demonstrated the feasibility of such a reporting system. This type of reporting system will demonstrate variation between units and jurisdictions to help identify and prioritize improvement efforts.

  18. Examining Pre-School Classroom Quality in a Statewide Quality Rating and Improvement System

    ERIC Educational Resources Information Center

    Jeon, Lieny; Buettner, Cynthia K.; Hur, Eunhye

    2014-01-01

    Background: Research has documented the importance of high-quality early childhood experiences in preparing children for school. Quality rating and improvement systems (QRIS) have recently emerged in many states as a way to build quality of child care and to promote better child outcomes. Objective: The goal of this study was to determine if…

  19. Improvement of Flow Quality in NAL Chofu Mach 10 Nozzle

    NASA Technical Reports Server (NTRS)

    Lacey, John; Inoue, Yasutoshi; Higashida, Akio; Inoue, Manabu; Ishizaka, Kouichi; Korte, John J.

    2002-01-01

    As a result of CFD analysis and remachining of the nozzle, the flow quality of the Mach 10 Hypersonic Wind Tunnel at NAL Chofu, Japan was improved. The subsequent test results validated the CFD analytical predictions by NASA and MHL.

  20. Smart City Planning Can Cut Deadly Diseases, Improve Air Quality

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_161133.html Smart City Planning Can Cut Deadly Diseases, Improve Air Quality Study ... three quarters of this population living in cities, city planning must be part of a comprehensive solution to ...

  1. The business case for health-care quality improvement.

    PubMed

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance. PMID:23429226

  2. The business case for health-care quality improvement.

    PubMed

    Swensen, Stephen J; Dilling, James A; Mc Carty, Patrick M; Bolton, Jeffrey W; Harper, Charles M

    2013-03-01

    The business case for health-care quality improvement is presented. We contend that investment in process improvement is aligned with patients' interests, the organization's reputation, and the engagement of their workforce. Four groups benefit directly from quality improvement: patients, providers, insurers, and employers. There is ample opportunity, even in today's predominantly pay-for-volume (that is, evolving toward value-based purchasing) insurance system, for providers to deliver care that is in the best interest of the patient while improving their financial performance.

  3. Quality Rating and Improvement Systems and Children's Cognitive Development

    ERIC Educational Resources Information Center

    Jeon, Lieny; Buettner, Cynthia K.

    2015-01-01

    Background: Providing enriched learning environments is important to stimulating children's development in early childhood. Early child-care policymakers in many states in the US have adopted Quality Rating and Improvement Systems (QRIS) as a way to verify quality of child care and to support children's school readiness. Objective: The purpose of…

  4. Using Deming To Improve Quality in Colleges and Universities.

    ERIC Educational Resources Information Center

    Cornesky, Robert A.; And Others

    Of all the people known for stressing quality in industry, W. Edwards Deming is the pioneer. He stresses statistical process control (SPC) and a 14-point process for managers to improve quality and productivity. His approach is humanistic and treats people as intelligent human beings who want to do a good job. Twelve administrators in a university…

  5. Total Quality Improvement Guide for Institutions of Higher Education.

    ERIC Educational Resources Information Center

    Cornesky, Robert A.; McCool, Samuel A.

    This book describes the steps and tools of Total Quality Management (TQM) and their use in the academic units of colleges and universities for Total Quality Improvement (TQI), illustrated by a case study from the School of Arts & Sciences at a state university. Section 1 explains how to: (1) identify problems contributing to non-value-added work;…

  6. Improving Indoor Air Quality in St. Cloud Schools.

    ERIC Educational Resources Information Center

    Forer, Mike; Haus, El

    2000-01-01

    Describes how the St. Cloud Area School District (Minnesota), using Tools for Schools provided by the U.S. Environmental Protection Agency, managed the improvement of their school building indoor air quality (IAQ). The district goals of the IAQ Management Committee and the policy elements used to maintain high classroom air quality are…

  7. Effects of Quality Improvement System for Child Care Centers

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

    2011-01-01

    Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

  8. Adopting Deming's quality improvement ideas: a case study.

    PubMed

    Koska, M T

    1990-07-01

    Much has been written about quality guru W. Edward Deming's quality improvement ideas. But how can his concepts be applied to a health care setting? Michael Pugh, CEO of Parkview Episcopal Medical Center, Pueblo, CO, and key members of his staff talked with Hospitals about what happened when they applied Deming's ideas at their hospital.

  9. Quality Improvement in Nursing Homes: Identifying Depressed Residents is Critical to Improving Quality of Life.

    PubMed

    Crogan, Neval L; Evans, Bronwynne C

    2008-05-01

    The prevalence of depression in nursing home residents is three to five times higher than in older adults from the community.1 Depression is thought to be related to the gloomy institutionalized environment and an assortment of losses, including those associated with function, independence, social roles, friends and relatives, and past leisure activities.2 Despite the public's increased awareness of depression, it remains underrecognized and undertreated by professionals who care for older residents in nursing homes.3 It seems intuitive that depression must be recognized before it can be treated, yet our national long-term care system continues to utilize an unreliable scale from the Minimum Data Set as its foundation for assessment. Warnings of the scale's inadequacy have been sounded repeatedly almost since its conception4,5 and its potential role in lack of recognition and treatment of depression by nursing home staff, nurse practitioners, and physicians is a troubling one.The purpose of this article is to (1) report the prevalence of depression in a sub-sample of residents from a National Institutes of Health study whose depression was not detected by the MDS and, consequently, was previously untreated, (2) compare their nutritional and functional status with residents whose depressive states were previously detected by the MDS and treated, and (3) recommend quality improvement strategies for identification and treatment of depression in nursing home residents.

  10. Maintenance & Operations Solutions: Meeting the Challenge of Improving School Facilities.

    ERIC Educational Resources Information Center

    Association of School Business Officials International, Reston, VA.

    This paper examines the impact current maintenance and operations (M&O) practices have on U.S. school performance and offers possible opportunities for improvement through the judicious use of technology and methodology. The paper also presents a regional comparative analysis of M&O costs across the country. A list of equipment and their service…

  11. Operation Breakthrough for Continuous Self-Systems Improvement.

    ERIC Educational Resources Information Center

    Given, Barbara K.

    1994-01-01

    Operation Breakthrough, in which graduate student interns teach life skills to adolescents with learning disabilities, provided an impetus for identifying a profile of learning and work habits necessary for production of an agile workforce. Agile learning for self-systems improvement calls for self-empowered learning, collaborative learning,…

  12. Measuring and Costing Quality in Education: Using Quality and Productivity Methods To Improve Schools.

    ERIC Educational Resources Information Center

    Spanbauer, Stanley J.

    The Measurement and Costing Model (MCM) described in this book was developed and tested at Fox Valley Technical College (FVTC), Wisconsin, to enhance the college's quality improvement process and to serve as a guide to other institutions interested in improving their quality. The book presents a description of the model and outlines seven steps…

  13. Operational air quality forecasting system for Spain: CALIOPE

    NASA Astrophysics Data System (ADS)

    Baldasano, J. M.; Piot, M.; Jorba, O.; Goncalves, M.; Pay, M.; Pirez, C.; Lopez, E.; Gasso, S.; Martin, F.; García-Vivanco, M.; Palomino, I.; Querol, X.; Pandolfi, M.; Dieguez, J. J.; Padilla, L.

    2009-12-01

    The European Commission (EC) and the United States Environmental Protection Agency (US-EPA) have shown great concerns to understand the transport and dynamics of pollutants in the atmosphere. According to the European directives (1996/62/EC, 2002/3/EC, 2008/50/EC), air quality modeling, if accurately applied, is a useful tool to understand the dynamics of air pollutants, to analyze and forecast the air quality, and to develop programs reducing emissions and alert the population when health-related issues occur. The CALIOPE project, funded by the Spanish Ministry of the Environment, has the main objective to establish an air quality forecasting system for Spain. A partnership of four research institutions composes the CALIOPE project: the Barcelona Supercomputing Center (BSC), the center of investigation CIEMAT, the Earth Sciences Institute ‘Jaume Almera’ (IJA-CSIC) and the CEAM Foundation. CALIOPE will become the official Spanish air quality operational system. This contribution focuses on the recent developments and implementation of the integrated modelling system for the Iberian Peninsula (IP) and Canary Islands (CI) with a high spatial and temporal resolution (4x4 sq. km for IP and 2x2 sq. km for CI, 1 hour), namely WRF-ARW/HERMES04/CMAQ/BSC-DREAM. The HERMES04 emission model has been specifically developed as a high-resolution (1x1 sq. km, 1 hour) emission model for Spain. It includes biogenic and anthropogenic emissions such as on-road and paved-road resuspension production, power plant generation, ship and plane traffic, airports and ports activities, industrial and agricultural sectors as well as domestic and commercial emissions. The qualitative and quantitative evaluation of the model was performed for a reference year (2004) using data from ground-based measurement networks. The products of the CALIOPE system will provide 24h and 48h forecasts for O3, NO2, SO2, CO, PM10 and PM2.5 at surface level. An operational evaluation system has been developed

  14. Expression Marker-Based Strategy to Improve Beef Quality.

    PubMed

    Cassar-Malek, Isabelle; Picard, Brigitte

    2016-01-01

    For beef cattle research, a main objective is to control concomitantly the development of muscles and the qualities of beef cuts. Beef quality is a complex phenotype that is only detectable after slaughter and is highly variable. The beef industry is in need of tools to estimate beef quality of live cattle or online in abattoirs, with specific attention towards sensory attributes (tenderness, juiciness, flavour, and colour). Identification of relevant genetic and genomic markers is ongoing, especially for tenderness--a top priority quality attribute. In this paper, we describe the steps of an expression marker-based strategy to improve beef sensory quality, from the discovery of biomarkers that identify consistent beef and the biological functions governing beef tenderness to the integration of the knowledge into detection tests for desirable animals. These tools should soon be available for the management of sensory quality in the beef production chain for meeting market's demands and assuring good quality standards. PMID:27066527

  15. Expression Marker-Based Strategy to Improve Beef Quality

    PubMed Central

    Cassar-Malek, Isabelle; Picard, Brigitte

    2016-01-01

    For beef cattle research, a main objective is to control concomitantly the development of muscles and the qualities of beef cuts. Beef quality is a complex phenotype that is only detectable after slaughter and is highly variable. The beef industry is in need of tools to estimate beef quality of live cattle or online in abattoirs, with specific attention towards sensory attributes (tenderness, juiciness, flavour, and colour). Identification of relevant genetic and genomic markers is ongoing, especially for tenderness—a top priority quality attribute. In this paper, we describe the steps of an expression marker-based strategy to improve beef sensory quality, from the discovery of biomarkers that identify consistent beef and the biological functions governing beef tenderness to the integration of the knowledge into detection tests for desirable animals. These tools should soon be available for the management of sensory quality in the beef production chain for meeting market's demands and assuring good quality standards. PMID:27066527

  16. Integrating New Technology Solutions to Improve Plant Operations

    SciTech Connect

    HEAVIN, ERIC

    2004-06-29

    Continuing advancements in software and hardware technology are providing facilities the opportunity for improvements in the areas of safety, regulatory compliance, administrative control, data collection, and reporting. Implementing these changes to improve plant operating efficiency can also create many challenges which include but are not limited to: justifying cost, planning for scalability, implementing applications across varied platforms, integrating multitudes of proprietary vendor applications, and creating a common vision for diverse process improvement projects. The Defense Programs (DP) facility at the Savannah River Site meets these challenges on a daily basis. Like many other plants, DP, has room for improvement when it comes to effective and clear communication, data entry, data storage, and system integration. Specific examples of areas targeted for improvement include: shift turnover meetings using system status data one to two hours old, lockouts and alarm inhibits performed on points on the Distributed Control System (DCS) and tracked in a paper logbook, disconnected systems preventing preemptive correction of regulatory compliance issues, and countless examples of additional task and data duplication on independent systems. Investment of time, money, and careful planning addressing these issues are already providing returns in the form of increased efficiency, improved plant tracking and reduced cost of implementing the next process improvement. Specific examples of improving plant operations through thoroughly planned Rapid Application Development of new applications are discussed. Integration of dissimilar and independent data sources (NovaTech D/3 DCS, SQL Server, Access, Filemaker Pro, etc.) is also explored. The tangible benefits of the implementation of the different programs to solve the operational problems previously described are analyzed in an in-depth and comparative manner.

  17. Operating theatre quality and prevention of surgical site infections.

    PubMed

    Spagnolo, A M; Ottria, G; Amicizia, D; Perdelli, F; Cristina, M L

    2013-09-01

    Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres. PMID:24783890

  18. Operating theatre quality and prevention of surgical site infections.

    PubMed

    Spagnolo, A M; Ottria, G; Amicizia, D; Perdelli, F; Cristina, M L

    2013-09-01

    Surgical site infections (SSI) account for 14% to 17% of all hospital-acquired infections and 38% of nosocomial infections in surgical patients. SSI remain a substantial cause of morbidity and death, possibly because of the larger numbers of elderly surgical patients or those with a variety of chronic and immunocompromising conditions, and emergence of antibiotic-resistant microorganisms. Factors causing surgical site infection are multifarious. Several studies have identified the main patient-related (endogenous risk factors) and procedure-related (external risk factors) factors that influence the risk of SSI. The rate of surgical wound infections is strongly influenced by operating theatre quality, too. A safe and salubrious operating theatre is an environment in which all sources of pollution and any micro-environmental alterations are kept strictly under control. This can be achieved only through careful planning, maintenance and periodic checks, as well as proper ongoing training for staff Many international scientific societies have produced guidelines regarding the environmental features of operating theatres (positive pressure, exchanges of filtered air per hour, air-conditioning systems with HEPA filters, etc.) and issued recommendations on healthcare-associated infection, including SSI, concerning surveillance methods, intervention to actively prevent SSI and approaches to monitoring the implementation of such strategies. Therefore, the prevention of SSI requires a multidisciplinary approach and the commitment of all concerned, including that of those who are responsible for the design, layout and functioning of operating theatres.

  19. [Quality assurance and quality improvement in medical practice. Part 3: Clinical audit in medical practice].

    PubMed

    Godény, Sándor

    2012-02-01

    The first two articles in the series were about the definition of quality in healthcare, the quality approach, the importance of quality assurance, the advantages of quality management systems and the basic concepts and necessity of evidence based medicine. In the third article the importance and basic steps of clinical audit are summarised. Clinical audit is an integral part of quality assurance and quality improvement in healthcare, that is the responsibility of any practitioner involved in medical practice. Clinical audit principally measures the clinical practice against clinical guidelines, protocols and other professional standards, and sometimes induces changes to ensure that all patients receive care according to principles of the best practice. The clinical audit can be defined also as a quality improvement process that seeks to identify areas for service improvement, develop and carry out plans and actions to improve medical activity and then by re-audit to ensure that these changes have an effect. Therefore, its aims are both to stimulate quality improvement interventions and to assess their impact in order to develop clinical effectiveness. At the end of the article key points of quality assurance and improvement in medical practice are summarised.

  20. A Comprehensive Method for GNSS Data Quality Determination to Improve Ionospheric Data Analysis

    PubMed Central

    Kim, Minchan; Seo, Jiwon; Lee, Jiyun

    2014-01-01

    Global Navigation Satellite Systems (GNSS) are now recognized as cost-effective tools for ionospheric studies by providing the global coverage through worldwide networks of GNSS stations. While GNSS networks continue to expand to improve the observability of the ionosphere, the amount of poor quality GNSS observation data is also increasing and the use of poor-quality GNSS data degrades the accuracy of ionospheric measurements. This paper develops a comprehensive method to determine the quality of GNSS observations for the purpose of ionospheric studies. The algorithms are designed especially to compute key GNSS data quality parameters which affect the quality of ionospheric product. The quality of data collected from the Continuously Operating Reference Stations (CORS) network in the conterminous United States (CONUS) is analyzed. The resulting quality varies widely, depending on each station and the data quality of individual stations persists for an extended time period. When compared to conventional methods, the quality parameters obtained from the proposed method have a stronger correlation with the quality of ionospheric data. The results suggest that a set of data quality parameters when used in combination can effectively select stations with high-quality GNSS data and improve the performance of ionospheric data analysis. PMID:25196005

  1. A comprehensive method for GNSS data quality determination to improve ionospheric data analysis.

    PubMed

    Kim, Minchan; Seo, Jiwon; Lee, Jiyun

    2014-01-01

    Global Navigation Satellite Systems (GNSS) are now recognized as cost-effective tools for ionospheric studies by providing the global coverage through worldwide networks of GNSS stations. While GNSS networks continue to expand to improve the observability of the ionosphere, the amount of poor quality GNSS observation data is also increasing and the use of poor-quality GNSS data degrades the accuracy of ionospheric measurements. This paper develops a comprehensive method to determine the quality of GNSS observations for the purpose of ionospheric studies. The algorithms are designed especially to compute key GNSS data quality parameters which affect the quality of ionospheric product. The quality of data collected from the Continuously Operating Reference Stations (CORS) network in the conterminous United States (CONUS) is analyzed. The resulting quality varies widely, depending on each station and the data quality of individual stations persists for an extended time period. When compared to conventional methods, the quality parameters obtained from the proposed method have a stronger correlation with the quality of ionospheric data. The results suggest that a set of data quality parameters when used in combination can effectively select stations with high-quality GNSS data and improve the performance of ionospheric data analysis. PMID:25196005

  2. A comprehensive method for GNSS data quality determination to improve ionospheric data analysis.

    PubMed

    Kim, Minchan; Seo, Jiwon; Lee, Jiyun

    2014-08-14

    Global Navigation Satellite Systems (GNSS) are now recognized as cost-effective tools for ionospheric studies by providing the global coverage through worldwide networks of GNSS stations. While GNSS networks continue to expand to improve the observability of the ionosphere, the amount of poor quality GNSS observation data is also increasing and the use of poor-quality GNSS data degrades the accuracy of ionospheric measurements. This paper develops a comprehensive method to determine the quality of GNSS observations for the purpose of ionospheric studies. The algorithms are designed especially to compute key GNSS data quality parameters which affect the quality of ionospheric product. The quality of data collected from the Continuously Operating Reference Stations (CORS) network in the conterminous United States (CONUS) is analyzed. The resulting quality varies widely, depending on each station and the data quality of individual stations persists for an extended time period. When compared to conventional methods, the quality parameters obtained from the proposed method have a stronger correlation with the quality of ionospheric data. The results suggest that a set of data quality parameters when used in combination can effectively select stations with high-quality GNSS data and improve the performance of ionospheric data analysis.

  3. Survey of methods for improving operator acceptance of computerized aids

    SciTech Connect

    Frey, P. R.; Kisner, R. A.

    1982-04-01

    The success of current attempts to improve the operational performance and safety of nuclear power plants by installing computerized operational aids in the control rooms is dependent, in part, on the operator's attitude toward the aid. Utility experience with process computer systems indicates that problems may already exist with operator acceptance of computerized aids. The growth of the role that computers have in nuclear power plants makes user acceptance of computer technology an important issue for the nuclear industry. The purpose of this report is to draw from the literature factors related to user acceptance of computerized equipment that may also be applicable to the acceptance of computerized aids used in the nuclear power plant control room.

  4. USING SEQUENCING TO IMPROVE OPERATIONAL EFFICIENCY AND RELIABILITY

    SciTech Connect

    D OTTAVIO,T.; NIEDZIELA, J.

    2007-10-15

    Operation of an accelerator requires the efficient and reproducible execution of many different types of procedures. Some procedures, like beam acceleration, magnet quench recovery, and species switching can be quite complex. To improve accelerator reliability and efficiency, automated execution of procedures is required. Creation of a single robust sequencing application permits the streamlining of this process and offers many benefits in sequence creation, editing, and control. In this paper, we present key features of a sequencer application commissioned at the Collider-Accelerator Department of Brookhaven National Laboratory during the 2007 run. Included is a categorization of the different types of sequences in use, a discussion of the features considered desirable in a good sequencer, and a description of the tools created to aid in sequence construction and diagnosis. Finally, highlights from our operational experience are presented, with emphasis on Operations control of the sequencer, and the alignment of sequence construction with existing operational paradigms.

  5. Can Quality Improvement System Improve Childcare Site Performance in School Readiness?

    ERIC Educational Resources Information Center

    Ma, Xin; Shen, Jianping; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Watson, Grace

    2013-01-01

    The authors evaluated the effectiveness of the Quality Improvement System (QIS) developed and implemented by Children's Services Council of Palm Beach County (Florida) as a voluntary initiative to improve the quality of childcare and education. They adopted a growth model approach to investigate whether childcare sites that participated in…

  6. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality.

  7. Galantamine improves sleep quality in patients with dementia.

    PubMed

    Naharci, Mehmet Ilkin; Ozturk, Ahmet; Yasar, Halit; Cintosun, Umit; Kocak, Necmettin; Bozoglu, Ergun; Tasci, Ilker; Doruk, Huseyin

    2015-12-01

    The purpose of the study was to evaluate the influences of cholinesterase inhibitors on sleep pattern and sleep disturbance. A total of 87 mild to moderate stage dementia patients who were not on cholinesterase enzyme inhibitor and memantine treatment were included in the study. The dementia patients were treated with donepezil, galantamine or rivastigmine, depending on the preference of the clinician. Fifty-five dementia patients (63.2 %) completed the study. Twenty-three elderly subjects, who had normal cognitive functions, were included in the study as the control group. The Pittsburgh Sleep Quality Index was used for evaluating the sleep quality at the beginning and at the final assessment. The improvement in sleep quality was better with regard to changes in Pittsburgh Sleep Quality Index scores with galantamine treatment compared to the donepezil and the control groups. A significant decrease in Pittsburgh Sleep Quality Index scores was detected in the galantamine group after treatment. Although statistically not significant, rivastigmine decreased and donepezil increased the Pittsburgh Sleep Quality Index scores after treatment. Dementia patients who had a poor sleep quality (n: 36), the rate of improvement in sleep disturbance was 81.8 % in the galantamine group, 75 % in the rivastigmine, and 50 % in the donepezil group. Galantamine may be the first choice of cholinesterase inhibitor in mild to moderate dementia patients in terms of improving sleep quality. PMID:25777522

  8. Quality assurance and performance improvement in intraoperative neurophysiologic monitoring programs.

    PubMed

    Tamkus, Arvydas A; Rice, Kent S; McCaffrey, Michael T

    2013-03-01

    Quality assurance (QA) as it relates to intraoperative neurophysiological monitoring (IONM) can be defined as the systematic monitoring, evaluation, and modification of the IONM service to insure that desired standards of quality are being met. In practice, that definition is usually extended to include the concept that the quality of the IONM service will be improved wherever possible and, although there are some differences in the two terms, in this article the term QA will be understood to include quality improvement (QI) processes as well. The measurement and documentation of quality is becoming increasingly important to healthcare providers. This trend is being driven by pressures from accrediting agencies, payers, and patients. The essential elements of a QA program are described. A real-life example of QA techniques and management relevant to IONM providers is presented and discussed.

  9. System change: quality assessment and improvement for Medicaid managed care.

    PubMed

    Smith, W R; Cotter, J J; Rossiter, L F

    1996-01-01

    Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (QA/I) for Medicaid, adapting the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration (HCFA). The article concludes that redesigns should emphasize Continuous Quality Improvement (CQI) by all providers and of multi-faceted, population-based data.

  10. Internal quality audit and quality standards as a method of quality improvement at the Department of Ophthalmology, University Hospital.

    PubMed

    Nasić, Mirjana; Pokupec, Rajko; Katusić, Damir; Miklić, Pavle; Suić, Ivan; Galić, Slobodan

    2005-01-01

    Quality assessment of clinical health care with the programme of quality standard is a method of health management, through which better efficiency and safety of health outcomes can be achieved. In the period from 2002 to 2004, a pilot program of quality has been carried out on the Department of Ophthalmology, University Hospital Center in Zagreb. Seven internal audit teams of hospital commission and teams of hospital departments were evaluating introducing practice for quality standards every three months. In the period of two years improvement in all standards of quality has been noticed (expressed in percent of progress towards the ideal result of 100%): personnel 20%, patient rights 15%, medical equipment 40%, quality of emergency service 60%, implementation of clinical guidelines and criteria for elective admission 55%, quality of risk prevention 70%, quality of medical records 60%. The two-years-improvement dynamics of about 46%, first year 24%.

  11. Measurement of Quality to Improve Care in Sleep Medicine

    PubMed Central

    Morgenthaler, Timothy I.; Aronsky, Amy J.; Carden, Kelly A.; Chervin, Ronald D.; Thomas, Sherene M.; Watson, Nathaniel F.

    2015-01-01

    The Board of Directors of the American Academy of Sleep Medicine (AASM) commissioned a Task Force to develop quality measures as part of its strategic plan to promote high quality patient-centered care. Among many potential dimensions of quality, the AASM requested Workgroups to develop outcome and process measures to aid in evaluating the quality of care of five common sleep disorders: restless legs syndrome, insomnia, narcolepsy, obstructive sleep apnea in adults, and obstructive sleep apnea in children. This paper describes the rationale, background, general methods development, and considerations in implementation for these sleep disorder quality measures. The Workgroup papers are published in this issue under the following titles: Quality Measures for the Care of Adult Patients with Restless Legs Syndrome, Quality Measures for the Care of Patients with Insomnia, Quality Measures for the Care of Patients with Narcolepsy, Quality Measures for the Care of Adult Patients with Obstructive Sleep Apnea, and Quality Measures for the Care of Pediatric Patients with Obstructive Sleep Apnea. Citation: Morgenthaler TI, Aronsky AJ, Carden KA, Chervin RD, Thomas SM, Watson NF. Measurement of quality to improve care in sleep medicine. J Clin Sleep Med 2015;11(3):279–291. PMID:25700883

  12. High-pressure jet cutters improve capping operations

    SciTech Connect

    Abel, L.W.; Campbell, P.J.; Bowden, J.R. Sr.

    1995-05-08

    Advances in abrasive cutting technology have improved the methods for removing damaged equipment and preparing wellheads for capping. This technology, much of which was refined during well control operations in Kuwait in 1991, can improve the safety and efficiency of capping jobs by cutting wellheads or casing quickly and cleanly. The majority of well control jobs involve one of three types of capping operations: capping to a flange, capping by installing a wellhead, or capping to a casing stub. Capping operations are often the first major step in regaining control of the well during blowout intervention. Proper planning of a capping operation must take into account the mass flow rate, combustible nature of the flow, well bore geometry, and operations in the post-capping phase of the project. The paper discusses capping vehicles, tree removal, jet cutters, capping to a flange, capping to a stub, swallowing the stub, spin-on technique, capping on fire, stinging, offshore blowouts, firefighting, pollution control, intervention equipment, and rig removal.

  13. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    PubMed

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide. PMID:24600783

  14. Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.

    PubMed

    Szablowski, Katarzyna M

    2014-01-01

    VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide.

  15. Applying GRA and QFD to Improve Library Service Quality

    ERIC Educational Resources Information Center

    Chen, Yen-Ting; Chou, Tsung-Yu

    2011-01-01

    This paper applied Grey Relational Analysis (GRA) to Quality Function Deployment (QFD) to identify service improvement techniques for an academic library. First, reader needs and their importance, and satisfaction degrees were examined via questionnaires. Second, the service improvement techniques for satisfying the reader needs were developed by…

  16. Workbook for Taguchi Methods for Product Quality Improvement.

    ERIC Educational Resources Information Center

    Zarghami, Ali; Benbow, Don

    Taguchi methods are methods of product quality improvement that analyze major contributions and how they can be controlled to reduce variability of poor performance. In this approach, knowledge is used to shorten testing. Taguchi methods are concerned with process improvement rather than with process measurement. This manual is designed to be used…

  17. Lean management systems: creating a culture of continuous quality improvement.

    PubMed

    Clark, David M; Silvester, Kate; Knowles, Simon

    2013-08-01

    This is the first in a series of articles describing the application of Lean management systems to Laboratory Medicine. Lean is the term used to describe a principle-based continuous quality improvement (CQI) management system based on the Toyota production system (TPS) that has been evolving for over 70 years. Its origins go back much further and are heavily influenced by the work of W Edwards Deming and the scientific method that forms the basis of most quality management systems. Lean has two fundamental elements--a systematic approach to process improvement by removing waste in order to maximise value for the end-user of the service and a commitment to respect, challenge and develop the people who work within the service to create a culture of continuous improvement. Lean principles have been applied to a growing number of Healthcare systems throughout the world to improve the quality and cost-effectiveness of services for patients and a number of laboratories from all the pathology disciplines have used Lean to shorten turnaround times, improve quality (reduce errors) and improve productivity. Increasingly, models used to plan and implement large scale change in healthcare systems, including the National Health Service (NHS) change model, have evidence-based improvement methodologies (such as Lean CQI) as a core component. Consequently, a working knowledge of improvement methodology will be a core skill for Pathologists involved in leadership and management.

  18. Using AMLO to Improve the Quality of Teacher Education Outcomes

    ERIC Educational Resources Information Center

    Al-Shammari, Zaid

    2012-01-01

    This study aims to find ways to improve learning outcomes in teacher education courses by using an Analysis Model for Learning Outcomes (AMLO). It addresses the improvement of the quality of teacher education by analyzing learning outcomes and implementing curriculum modifications related to specific learning objectives and their effects on…

  19. Using Operational Analysis to Improve Access to Pulmonary Function Testing.

    PubMed

    Ip, Ada; Asamoah-Barnieh, Raymond; Bischak, Diane P; Davidson, Warren J; Flemons, W Ward; Pendharkar, Sachin R

    2016-01-01

    Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment. PMID:27445545

  20. Using Operational Analysis to Improve Access to Pulmonary Function Testing.

    PubMed

    Ip, Ada; Asamoah-Barnieh, Raymond; Bischak, Diane P; Davidson, Warren J; Flemons, W Ward; Pendharkar, Sachin R

    2016-01-01

    Background. Timely pulmonary function testing is crucial to improving diagnosis and treatment of pulmonary diseases. Perceptions of poor access at an academic pulmonary function laboratory prompted analysis of system demand and capacity to identify factors contributing to poor access. Methods. Surveys and interviews identified stakeholder perspectives on operational processes and access challenges. Retrospective data on testing demand and resource capacity was analyzed to understand utilization of testing resources. Results. Qualitative analysis demonstrated that stakeholder groups had discrepant views on access and capacity in the laboratory. Mean daily resource utilization was 0.64 (SD 0.15), with monthly average utilization consistently less than 0.75. Reserved testing slots for subspecialty clinics were poorly utilized, leaving many testing slots unfilled. When subspecialty demand exceeded number of reserved slots, there was sufficient capacity in the pulmonary function schedule to accommodate added demand. Findings were shared with stakeholders and influenced scheduling process improvements. Conclusion. This study highlights the importance of operational data to identify causes of poor access, guide system decision-making, and determine effects of improvement initiatives in a variety of healthcare settings. Importantly, simple operational analysis can help to improve efficiency of health systems with little or no added financial investment.

  1. Improving Outcomes for ESRD Patients: Shifting the Quality Paradigm

    PubMed Central

    2014-01-01

    Summary The availability of life-saving dialysis therapy has been one of the great successes of medicine in the past four decades. Over this time period, despite treatment of hundreds of thousands of patients, the overall quality of life for patients with ESRD has not substantially improved. A narrow focus by clinicians and regulators on basic indicators of care, like dialysis adequacy and anemia, has consumed time and resources but not resulted in significantly improved survival; also, frequent hospitalizations and dissatisfaction with the care experience continue to be seen. A new quality paradigm is needed to help guide clinicians, providers, and regulators to ensure that patients’ lives are improved by the technically complex and costly therapy that they are receiving. This paradigm can be envisioned as a quality pyramid: the foundation is the basic indicators (outstanding performance on these indicators is necessary but not sufficient to drive the primary outcomes). Overall, these basics are being well managed currently, but there remains an excessive focus on them, largely because of publically reported data and regulatory requirements. With a strong foundation, it is now time to focus on the more complex intermediate clinical outcomes—fluid management, infection control, diabetes management, medication management, and end-of-life care among others. Successfully addressing these intermediate outcomes will drive improvements in the primary outcomes, better survival, fewer hospitalizations, better patient experience with the treatment, and ultimately, improved quality of life. By articulating this view of quality in the ESRD program (pushing up the quality pyramid), the discussion about quality is reframed, and also, clinicians can better target their facilities in the direction of regulatory oversight and requirements about quality. Clinicians owe it to their patients, as the ESRD program celebrates its 40th anniversary, to rekindle the aspirations of the

  2. Improved Wide Operating Temperature Range of Li-Ion Cells

    NASA Technical Reports Server (NTRS)

    Smart, Marshall C.; Bugga, Ratnakumar V.

    2013-01-01

    Future NASA missions aimed at exploring the Moon, Mars, and the outer planets require rechargeable batteries that can operate over a wide temperature range (-60 to +60 C) to satisfy the requirements of various applications including landers, rovers, penetrators, CEV, CLV, etc. This work addresses the need for robust rechargeable batteries that can operate well over a wide temperature range. The Department of Energy (DoE) has identified a number of technical barriers associated with the development of Liion rechargeable batteries for PHEVs. For this reason, DoE has interest in the development of advanced electrolytes that will improve performance over a wide range of temperatures, and lead to long life characteristics (5,000 cycles over a 10-year life span). There is also interest in improving the high-voltage stability of these candidate electrolyte systems to enable the operation of up to 5 V with high specific energy cathode materials. Currently, the state-of-the-art lithium-ion system has been demonstrated to operate over a wide range of temperatures (-40 to +40 C); however, the rate capability at the lower temperatures is very poor. In addition, the low-temperature performance typically deteriorates rapidly upon being exposed to high temperatures. A number of electrolyte formulations were developed that incorporate the use of electrolyte additives to improve the high-temperature resilience, low-temperature power capability, and life characteristics of methyl propionate (MP)-based electrolyte solutions. These electrolyte additives include mono-fluoroethylene carbonate (FEC), lithium oxalate, vinylene carbonate (VC), and lithium bis(oxalate borate) (LiBOB), which have previously been shown to result in improved high-temperature resilience of all carbonate-based electrolytes. These MP-based electrolytes with additives have been shown to have improved performance in experiments with MCMB-LiNiCoAlO2 cells.

  3. Combining clinical microsystems and an experiential quality improvement curriculum to improve residency education in internal medicine.

    PubMed

    Tess, Anjala V; Yang, Julius J; Smith, C Christopher; Fawcett, Caitlin M; Bates, Carol K; Reynolds, Eileen E

    2009-03-01

    Beth Israel Deaconess Medical Center's internal medicine residency program was admitted to the new Education Innovation Project accreditation pathway of the Accreditation Council of Graduate Medical Education to begin in July 2006. The authors restructured the inpatient medical service to create clinical microsystems in which residents practice throughout residency. Program leadership then mandated an active curriculum in quality improvement based in those microsystems. To provide the experience to every graduating resident, a core faculty in patient safety was trained in the basics of quality improvement. The authors hypothesized that such changes would increase the number of residents participating in quality improvement projects, improve house officer engagement in quality improvement work, enhance the culture of safety the residents perceive in their training environment, improve work flow on the general medicine ward rotations, and improve the overall educational experience for the residents on ward rotations.The authors describe the first 18 months of the intervention (July 2006 to January 2008). The authors assessed attitudes and the educational experience with surveys and evaluation forms. After the intervention, the authors documented residents' participation in projects that overlapped with hospital priorities. More residents reported roles in designing and implementing quality improvement changes. Residents also noted greater satisfaction with the quality of care they deliver. Fewer residents agreed or strongly agreed that the new admitting system interfered with communication. Ongoing residency program assessment showed an improved perception of workload, and educational ratings of rotations improved. The changes required few resources and can be transported to other settings. PMID:19240439

  4. Improving intensive care unit quality using collaborative networks.

    PubMed

    Watson, Sam R; Scales, Damon C

    2013-01-01

    Collaborative networks of intensive care units can help promote a quality-improvement agenda across an entire system or region. Proposed advantages include targeting a greater number of patients, sharing of resources, and common measurement systems for audit and feedback or benchmarking. This review focuses on elements that are essential for the success and sustainability of these collaborative networks, using as examples networks in Michigan and Ontario. More research is needed to understand the mechanisms through which collaborative networks lead to improved care delivery and to demonstrate their cost-effectiveness in comparison with other approaches to system-level quality improvement.

  5. Lessons learned from performance feedback by a quality improvement organization.

    PubMed

    Van Hoof, Thomas J; Pearson, David A; Giannotti, Tierney E; Tate, Janet P; Elwell, Anne; Barr, Judith K; Meehan, Thomas P

    2006-01-01

    Performance feedback is a common quality improvement (QI) intervention strategy in the outpatient setting. This article describes the use by one quality improvement organization (QIO) of performance feedback to primary-care physicians with claims-based measures relating to diabetes, adult vaccinations, and mammography screening. Feedback from the physicians identified themes relating to data accuracy, methodology of the feedback reports, reasons for low performance rates, and suggestions on how the QIO could improve its intervention strategy. The article highlights the value of collecting and analyzing formative data on the process and offers specific recommendations to other QI professionals contemplating the use of claims data for performance feedback.

  6. Partners advancing clinical excellence: building professional councils for quality improvement at six community hospitals.

    PubMed

    Sakowski, Julie Ann; Hooper, Lynda; Holton, Thomas; Brody, Abraham A

    2012-01-01

    Engaging bedside clinicians, especially nurses, is essential for the success of sustainable process improvement programs and thus for improving the quality of health care. Studies have shown that properly implemented professional councils can be effective in engaging and empowering bedside clinicians to create lasting and meaningful improvements. This case study describes a 5-year program to implement and operate staff-led councils to lead evidence-based practice (EBP) quality improvement initiatives at 6 community hospitals. The outcomes presented in this case study demonstrate that staff-led councils have the potential to improve patient safety and quality of care as evidenced by observed reductions in ventilator-associated pneumonias, central line-associated bloodstream infections, and mortality from acute myocardial infarction and severe sepsis.

  7. Health insurers' financial performance and quality improvement expenditures in the Affordable Care Act's second year.

    PubMed

    McCue, Michael J; Hall, Mark

    2015-02-01

    The Affordable Care Act requires health insurers to rebate any amounts less than 80%-85% of their premiums that they fail to spend on medical claims or quality improvement. This study uses the new comprehensive reporting under this law to examine changes in insurers' financial performance and differences in their quality improvement expenditures. In the ACA's second year (2012), insurers' median medical loss ratios continued to increase and their median administrative cost ratios dropped, producing moderate operating margins in the group markets but a small operating loss in the individual market, at the median. For-profit insurers showed larger changes, in general, than did nonprofits. For quality improvement, insurers reported spending a significantly greater amount per member in their government plans than they did on their self-insured members, with spending on commercial insurance being in between these two extremes. The magnitude and source of these differences varied by corporate ownership. PMID:25524866

  8. Ten tips for incorporating scientific quality improvement into everyday work.

    PubMed

    Goldmann, Don

    2011-04-01

    Healthcare personnel often find it challenging to incorporate disciplined quality improvement into their daily work. Planning, managing and completing improvement projects with sufficient rigour to generate credible evidence and potentially publishable knowledge are even more difficult. Nonetheless, careful set-up and agile leveraging of existing resources and expertise can lead to surprisingly robust results. Project designs that integrate data collection with the work itself are especially helpful. Although the general perception is that top-flight journals are loath to publish the results of quality improvement work, accumulating experience suggests that this hurdle can be overcome. The Standards for Quality Improvement Reporting Excellence guidelines provide a promising framework for crafting publications that can meet the exacting standards of peer-reviewed journals. PMID:21450777

  9. Ten tips for incorporating scientific quality improvement into everyday work.

    PubMed

    Goldmann, Don

    2011-04-01

    Healthcare personnel often find it challenging to incorporate disciplined quality improvement into their daily work. Planning, managing and completing improvement projects with sufficient rigour to generate credible evidence and potentially publishable knowledge are even more difficult. Nonetheless, careful set-up and agile leveraging of existing resources and expertise can lead to surprisingly robust results. Project designs that integrate data collection with the work itself are especially helpful. Although the general perception is that top-flight journals are loath to publish the results of quality improvement work, accumulating experience suggests that this hurdle can be overcome. The Standards for Quality Improvement Reporting Excellence guidelines provide a promising framework for crafting publications that can meet the exacting standards of peer-reviewed journals.

  10. High-quality remote interactive imaging in the operating theatre

    NASA Astrophysics Data System (ADS)

    Grimstead, Ian J.; Avis, Nick J.; Evans, Peter L.; Bocca, Alan

    2009-02-01

    We present a high-quality display system that enables the remote access within an operating theatre of high-end medical imaging and surgical planning software. Currently, surgeons often use printouts from such software for reference during surgery; our system enables surgeons to access and review patient data in a sterile environment, viewing real-time renderings of MRI & CT data as required. Once calibrated, our system displays shades of grey in Operating Room lighting conditions (removing any gamma correction artefacts). Our system does not require any expensive display hardware, is unobtrusive to the remote workstation and works with any application without requiring additional software licenses. To extend the native 256 levels of grey supported by a standard LCD monitor, we have used the concept of "PseudoGrey" where slightly off-white shades of grey are used to extend the intensity range from 256 to 1,785 shades of grey. Remote access is facilitated by a customized version of UltraVNC, which corrects remote shades of grey for display in the Operating Room. The system is successfully deployed at Morriston Hospital, Swansea, UK, and is in daily use during Maxillofacial surgery. More formal user trials and quantitative assessments are being planned for the future.

  11. Quality improvement 101 for surgeons: Navigating the alphabet soup.

    PubMed

    Santore, Matthew T; Islam, Saleem

    2015-12-01

    It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. PMID:26653158

  12. Improving Healthcare Quality in the United States: A New Approach.

    PubMed

    Nix, Kathryn A; O'Shea, John S

    2015-06-01

    Improving the quality of health care has been a focus of health reformers during the last 2 decades, yet meaningful and sustainable quality improvement has remained elusive in many ways. Although a number of individual institutions have made great strides toward more effective and efficient care, progress has not gone far enough on a national scale. Barriers to quality of care lie in fundamental, systemwide factors that impede large-scale change. Notable among these is the third-party financing arrangement that dominates the healthcare system. Long-term goals for healthcare reform should address this barrier to higher quality of care. A new model for healthcare financing that includes patient awareness of the cost of care will encourage better quality and reduced spending by engaging patients in the pursuit of value, aligning incentives for insurers to reduce costs with patients' desire to receive excellent care, and holding providers accountable for the quality and cost of the care they provide. Several new programs implemented under the Patient Protection and Affordable Care Act aim to catalyze improvement in the quality of care, but the law takes the wrong approach, directing incentives at providers only and maintaining a system that excludes patients from the search for high-value care.

  13. Continuous quality improvement in the ambulatory endoscopy center.

    PubMed

    Johanson, John F

    2002-04-01

    What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

  14. Continuous quality improvement in the ambulatory endoscopy center.

    PubMed

    Johanson, John F

    2002-04-01

    What does quality assessment have to do with the practicing gastroenterologist? Why should one spend the time and effort to incorporate CQI activities into an already busy practice? First and foremost, quality improvement should directly benefit the patient by ensuring that they receive the highest quality of care possible. For example, comparing endoscopic use or outcomes, such as procedure success or complications, with national standards or other endoscopists in the same community may identify physicians who could benefit from additional training. Similar analyses may likewise identify outstanding physicians who might serve as resources for other physicians. Surveys of patient satisfaction may reveal deficiencies, which might be unknown to a physician who is otherwise technically excellent; deficiencies that would never have been uncovered by traditional measures of quality. Second, applying the techniques of CQI to study one's own practice can provide a competitive edge when vying for managed care or corporate contracts. In this regard, CQI can be used to document physician or practice performance through tracking of endoscopic use, procedure success and complication rates, and patient satisfaction. Finally, the rising concern among various patient advocacy groups has led to an increased emphasis on quality improvement, and in most cases it is a required activity as part of the accreditation process. Steps to quality improvement There is more to quality improvement than simply selecting and implementing a performance improvement plan. A number of steps have been suggested to achieve fundamental improvement in the quality of medical care [3]. The first is to use outcomes management for improvement rather than for judgment. One of the major criticisms of QA is that it will be used to judge physicians providing care. It is feared that CQI will be used to identify poor performers who will then be punished. This strategy leads to fear and inhibits an honest pursuit

  15. Operative treatment improves patient function in recalcitrant medial epicondylitis.

    PubMed

    Shahid, M; Wu, F; Deshmukh, S C

    2013-10-01

    The purpose of this retrospective study was to assess the outcome of open surgery for patients with recalcitrant medial epicondylitis following failed conservative management. The clinical results are presented for 15 patients (17 elbows) who were reviewed at a mean follow-up of 66 months. Operative treatment improved patient function significantly with a mean increase in grip strength of 10kg and a mean decrease (improvement) in DASH (Disabilities of the Arm, Shoulder and Hand) score of 25.7. All but one patient experienced little or no residual elbow discomfort and had excellent Mayo elbow performance scores postoperatively. Eleven of the twelve patients who were previously in employment were able to return to work within eight weeks of surgery. This study demonstrates that operative treatment for recalcitrant medial epicondylitis is effective in restoring patient function and strength.

  16. Benchmarking: a method for continuous quality improvement in health.

    PubMed

    Ettorchi-Tardy, Amina; Levif, Marie; Michel, Philippe

    2012-05-01

    Benchmarking, a management approach for implementing best practices at best cost, is a recent concept in the healthcare system. The objectives of this paper are to better understand the concept and its evolution in the healthcare sector, to propose an operational definition, and to describe some French and international experiences of benchmarking in the healthcare sector. To this end, we reviewed the literature on this approach's emergence in the industrial sector, its evolution, its fields of application and examples of how it has been used in the healthcare sector. Benchmarking is often thought to consist simply of comparing indicators and is not perceived in its entirety, that is, as a tool based on voluntary and active collaboration among several organizations to create a spirit of competition and to apply best practices. The key feature of benchmarking is its integration within a comprehensive and participatory policy of continuous quality improvement (CQI). Conditions for successful benchmarking focus essentially on careful preparation of the process, monitoring of the relevant indicators, staff involvement and inter-organizational visits. Compared to methods previously implemented in France (CQI and collaborative projects), benchmarking has specific features that set it apart as a healthcare innovation. This is especially true for healthcare or medical-social organizations, as the principle of inter-organizational visiting is not part of their culture. Thus, this approach will need to be assessed for feasibility and acceptability before it is more widely promoted.

  17. Quality improvement methodologies increase autologous blood product administration.

    PubMed

    Hodge, Ashley B; Preston, Thomas J; Fitch, Jill A; Harrison, Sheilah K; Hersey, Diane K; Nicol, Kathleen K; Naguib, Aymen N; McConnell, Patrick I; Galantowicz, Mark

    2014-03-01

    Whole blood from the heart-lung (bypass) machine may be processed through a cell salvaging device (i.e., cell saver [CS]) and subsequently administered to the patient during cardiac surgery. It was determined at our institution that CS volume was being discarded. A multidisciplinary team consisting of anesthesiologists, perfusionists, intensive care physicians, quality improvement (QI) professionals, and bedside nurses met to determine the challenges surrounding autologous blood delivery in its entirety. A review of cardiac surgery patients' charts (n = 21) was conducted for analysis of CS waste. After identification of practices that were leading to CS waste, interventions were designed and implemented. Fishbone diagram, key driver diagram, Plan-Do-Study-Act (PDSA) cycles, and data collection forms were used throughout this QI process to track and guide progress regarding CS waste. Of patients under 6 kg (n = 5), 80% had wasted CS blood before interventions, whereas those patients larger than 36 kg (n = 8) had 25% wasted CS before interventions. Seventy-five percent of patients under 6 kg who had wasted CS blood received packed red blood cell transfusions in the cardiothoracic intensive care unit within 24 hours of their operation. After data collection and didactic education sessions (PDSA Cycle I), CS blood volume waste was reduced to 5% in all patients. Identification and analysis of the root cause followed by implementation of education, training, and management of change (PDSA Cycle II) resulted in successful use of 100% of all CS blood volume. PMID:24783313

  18. Quality improvement methodologies increase autologous blood product administration.

    PubMed

    Hodge, Ashley B; Preston, Thomas J; Fitch, Jill A; Harrison, Sheilah K; Hersey, Diane K; Nicol, Kathleen K; Naguib, Aymen N; McConnell, Patrick I; Galantowicz, Mark

    2014-03-01

    Whole blood from the heart-lung (bypass) machine may be processed through a cell salvaging device (i.e., cell saver [CS]) and subsequently administered to the patient during cardiac surgery. It was determined at our institution that CS volume was being discarded. A multidisciplinary team consisting of anesthesiologists, perfusionists, intensive care physicians, quality improvement (QI) professionals, and bedside nurses met to determine the challenges surrounding autologous blood delivery in its entirety. A review of cardiac surgery patients' charts (n = 21) was conducted for analysis of CS waste. After identification of practices that were leading to CS waste, interventions were designed and implemented. Fishbone diagram, key driver diagram, Plan-Do-Study-Act (PDSA) cycles, and data collection forms were used throughout this QI process to track and guide progress regarding CS waste. Of patients under 6 kg (n = 5), 80% had wasted CS blood before interventions, whereas those patients larger than 36 kg (n = 8) had 25% wasted CS before interventions. Seventy-five percent of patients under 6 kg who had wasted CS blood received packed red blood cell transfusions in the cardiothoracic intensive care unit within 24 hours of their operation. After data collection and didactic education sessions (PDSA Cycle I), CS blood volume waste was reduced to 5% in all patients. Identification and analysis of the root cause followed by implementation of education, training, and management of change (PDSA Cycle II) resulted in successful use of 100% of all CS blood volume.

  19. Quality Improvement Methodologies Increase Autologous Blood Product Administration

    PubMed Central

    Hodge, Ashley B.; Preston, Thomas J.; Fitch, Jill A.; Harrison, Sheilah K.; Hersey, Diane K.; Nicol, Kathleen K.; Naguib, Aymen N.; McConnell, Patrick I.; Galantowicz, Mark

    2014-01-01

    Abstract: Whole blood from the heart–lung (bypass) machine may be processed through a cell salvaging device (i.e., cell saver [CS]) and subsequently administered to the patient during cardiac surgery. It was determined at our institution that CS volume was being discarded. A multidisciplinary team consisting of anesthesiologists, perfusionists, intensive care physicians, quality improvement (QI) professionals, and bedside nurses met to determine the challenges surrounding autologous blood delivery in its entirety. A review of cardiac surgery patients’ charts (n = 21) was conducted for analysis of CS waste. After identification of practices that were leading to CS waste, interventions were designed and implemented. Fishbone diagram, key driver diagram, Plan–Do–Study–Act (PDSA) cycles, and data collection forms were used throughout this QI process to track and guide progress regarding CS waste. Of patients under 6 kg (n = 5), 80% had wasted CS blood before interventions, whereas those patients larger than 36 kg (n = 8) had 25% wasted CS before interventions. Seventy-five percent of patients under 6 kg who had wasted CS blood received packed red blood cell transfusions in the cardiothoracic intensive care unit within 24 hours of their operation. After data collection and didactic education sessions (PDSA Cycle I), CS blood volume waste was reduced to 5% in all patients. Identification and analysis of the root cause followed by implementation of education, training, and management of change (PDSA Cycle II) resulted in successful use of 100% of all CS blood volume. PMID:24783313

  20. Theory and implementation of summarization: Improving sensor interpretation for spacecraft operations

    NASA Astrophysics Data System (ADS)

    Swartwout, Michael Alden

    New paradigms in space missions require radical changes in spacecraft operations. In the past, operations were insulated from competitive pressures of cost, quality and time by system infrastructures, technological limitations and historical precedent. However, modern demands now require that operations meet competitive performance goals. One target for improvement is the telemetry downlink, where significant resources are invested to acquire thousands of measurements for human interpretation. This cost-intensive method is used because conventional operations are not based on formal methodologies but on experiential reasoning and incrementally adapted procedures. Therefore, to improve the telemetry downlink it is first necessary to invent a rational framework for discussing operations. This research explores operations as a feedback control problem, develops the conceptual basis for the use of spacecraft telemetry, and presents a method to improve performance. The method is called summarization, a process to make vehicle data more useful to operators. Summarization enables rational trades for telemetry downlink by defining and quantitatively ranking these elements: all operational decisions, the knowledge needed to inform each decision, and all possible sensor mappings to acquire that knowledge. Summarization methods were implemented for the Sapphire microsatellite; conceptual health management and system models were developed and a degree-of-observability metric was defined. An automated tool was created to generate summarization methods from these models. Methods generated using a Sapphire model were compared against the conventional operations plan. Summarization was shown to identify the key decisions and isolate the most appropriate sensors. Secondly, a form of summarization called beacon monitoring was experimentally verified. Beacon monitoring automates the anomaly detection and notification tasks and migrates these responsibilities to the space segment. A

  1. Humana looks to ISO registration to address quality improvement and customer satisfaction.

    PubMed

    2003-01-01

    Seeking new ways to improve standardization of clinical operations and customer focus, Louisville, KY-based Humana, Inc. announced in November that it has become the first healthcare company to be registered in the U.S. under ISO 9001:2000, a quality management standard published by the International Organization for Standardization (ISO).

  2. HCFA's health care quality improvement program: the medical informatics challenge.

    PubMed Central

    Grant, J B; Hayes, R P; Pates, R D; Elward, K S; Ballard, D J

    1996-01-01

    The peer-review organizations (PROs) were created by Congress in 1984 to monitor the cost and quality of care received by Medicare beneficiaries. In order to do this, the Health Care Financing Administration (HCFA) contracted with the PROs through a series of contracts referred to as "Scopes of Work." Under the Fourth Scope of Work, the HCFA initiated the Health Care Quality Improvement Program (HCQIP) in 1990, as an application of the principles of continuous quality improvement. Since then, the PROs have participated with health care providers in cooperative projects to improve the quality of primarily inpatient care provided to Medicare beneficiaries. Through HCFA-supplied administrative data and clinical data abstracted from patient records, the PROs have been able to identify opportunities for improvements in patient care. In May 1995, the HCFA proposed a new Fifth Scope of Work, which will shift the focus of HCQIP from inpatient care projects to projects in outpatient and managed care settings. This article describes the HCQIP process, the types of data used by the PROs to conduct cooperative projects with health care providers, and the informatics challenges in improving the quality of care received by Medicare beneficiaries. PMID:8750387

  3. 42 CFR 475.103 - Requirements for performing quality improvement initiatives.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 4 2014-10-01 2014-10-01 false Requirements for performing quality improvement... HEALTH AND HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS QUALITY IMPROVEMENT ORGANIZATIONS Quality Improvement Organizations § 475.103 Requirements for performing quality improvement...

  4. Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model

    PubMed Central

    Kim, Kyungjoo; Kim, Minyoung

    2010-01-01

    The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view

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

    PubMed Central

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

    1995-01-01

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

  6. Interventions to improve water quality for preventing diarrhoea

    PubMed Central

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  7. State Public Health Laboratory System Quality Improvement Activities

    PubMed Central

    Vagnone, Paula Snippes

    2013-01-01

    The Association of Public Health Laboratories (APHL) and the APHL Laboratory Systems and Standards Committee manage the Laboratory System Improvement Program (L-SIP). One component of L-SIP is an assessment that allows the members and stakeholders of a laboratory system to have an open and honest discussion about the laboratory system's strengths and weaknesses. From these facilitated discussions, gaps and opportunities for improvement are identified. In some cases, ideas for how to best address these gaps emerge, and workgroups are formed. Depending on resources, both monetary and personnel, laboratory staff will then prioritize the next component of L-SIP: which quality improvement activities to undertake. This article describes a sample of quality improvement activities initiated by several public health laboratories after they conducted L-SIP assessments. These projects can result in more robust linkages between system entities, which can translate into improvements in the way the system addresses the needs of stakeholders. PMID:23997301

  8. Operational Performance Improvements to BRIght Target Explorer Constellation

    NASA Astrophysics Data System (ADS)

    Choi, Seung Yun

    The BRIght Target Explorer (BRITE)-Constellation is composed of six nano-satellites funded by Austria, Canada, and Poland, and each of them is equipped with an optical telescope that observes stars with visual magnitude +3.5 or brighter. BRITE-Constellation has provided numerous images of bright stars from Low Earth Orbit, which will eventually lead to investigation of origin of the Universe. This thesis presents the contribution of the author to BRITE mission, especially in BRITE Operations. The author performed antenna steering experiments on UniBRITE and BRITE-Toronto, to improve data downlink. To improve scientific data collection from BRITE satellites, the author computed available observation time for multiple targets every orbit, which resulted in collection of twice the amount of scientific data. Also, the author increased the available observation time for each target from 32 minutes to 48 minutes by improving the performance of the star tracker on-board BRITE-Toronto.

  9. Improving Mississippi water quality: CAFO regulations and nutrient TMDLs

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Confined Animal Feeding Operations (CAFOs) are regulated to reduce nutrient discharges to local waters, although nutrient water quality standards do not yet exist. At first, it may seem that there is some discontinuity between requiring CAFOs to limit nutrient discharges without knowing what levels...

  10. Improving Quality of Emergency Care Through Integration of Mental Health.

    PubMed

    Okafor, Martha; Wrenn, Glenda; Ede, Victor; Wilson, Nana; Custer, William; Risby, Emile; Claeys, Michael; Shelp, Frank E; Atallah, Hany; Mattox, Gail; Satcher, David

    2016-04-01

    The goal of this study was to better integrate emergency medical and psychiatric care at a large urban public hospital, identify impact on quality improvement metrics, and reduce healthcare cost. A psychiatric fast track service was implemented as a quality improvement initiative. Data on disposition from the emergency department from January 2011 to May 2012 for patients impacted by the pilot were analyzed. 4329 patients from January 2011 to August 2011 (pre-intervention) were compared with 4867 patients from September 2011 to May 2012 (intervention). There was a trend of decline on overall quality metrics of time to triage and time from disposition to discharge. The trend analysis of the psychiatric length of stay and use of restraints showed significant reductions. Integrated emergency care models are evidence-based approach to ensuring that patients with mental health needs receive proper and efficient treatment. Results suggest that this may also improve overall emergency department's throughput.

  11. Assessing local resources and culture before instituting quality improvement projects.

    PubMed

    Hawkins, C Matthew

    2014-12-01

    The planning phases of quality improvement projects are commonly overlooked. Disorganized planning and implementation can escalate chaos, intensify resistance to change, and increase the likelihood of failure. Two important steps in the planning phase are (1) assessing local resources available to aid in the quality improvement project and (2) evaluating the culture in which the desired change is to be implemented. Assessing local resources includes identifying and engaging key stakeholders and evaluating if appropriate expertise is available for the scope of the project. This process also involves engaging informaticists and gathering available IT tools to plan and automate (to the extent possible) the data-gathering, analysis, and feedback steps. Culture in a department is influenced by the ability and willingness to manage resistance to change, build consensus, span boundaries between stakeholders, and become a learning organization. Allotting appropriate time to perform these preparatory steps will increase the odds of successfully performing a quality improvement project and implementing change. PMID:25467724

  12. A new quality assessment and improvement system for print media

    NASA Astrophysics Data System (ADS)

    Liu, Mohan; Konya, Iuliu; Nandzik, Jan; Flores-Herr, Nicolas; Eickeler, Stefan; Ndjiki-Nya, Patrick

    2012-12-01

    Print media collections of considerable size are held by cultural heritage organizations and will soon be subject to digitization activities. However, technical content quality management in digitization workflows strongly relies on human monitoring. This heavy human intervention is cost intensive and time consuming, which makes automization mandatory. In this article, a new automatic quality assessment and improvement system is proposed. The digitized source image and color reference target are extracted from the raw digitized images by an automatic segmentation process. The target is evaluated by a reference-based algorithm. No-reference quality metrics are applied to the source image. Experimental results are provided to illustrate the performance of the proposed system. We show that it features a good performance in the extraction as well as in the quality assessment step compared to the state-of-the-art. The impact of efficient and dedicated quality assessors on the optimization step is extensively documented.

  13. An agenda for quality improvement in forensic mental health consultation.

    PubMed

    Barnum, R

    1993-01-01

    Recent developments in quality assurance in health care have embraced the total quality management approach to industrial quality control. Setting a goal of "continuous quality improvement" for medical care, this approach features special attention to the process and systems of care provision. Applying this approach to the specialty of forensic mental health consultation yields a variety of potential ways of improving care, by articulating common problems in the consultation process that might respond to the total quality management approach. These problems include the setting of appropriate goals for forensic evaluation, and selecting cases for attention on the basis of those goals; determining appropriate standards for thoroughness and validity in the use of evaluation techniques; and establishing clear expectations regarding the provision of mental health services beyond the consultation process itself. Creating interdisciplinary teams at various levels of administration of trial courts and mental health agencies can provide contexts for reviewing cases, with the aim of discovering problems in these areas, educating professionals across boundaries about sources of problems, and developing clearer and more consistent standards of practice to reduce problems and improve quality of service.

  14. [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.

  15. Rapid core measure improvement through a "business case for quality".

    PubMed

    Perlin, Jonathan B; Horner, Stephen J; Englebright, Jane D; Bracken, Richard M

    2014-01-01

    Incentives to improve performance are emerging as revenue or financial penalties are linked to the measured quality of service provided. The HCA "Getting to Green" program was designed to rapidly increase core measure performance scores. Program components included (1) the "business case for quality"-increased awareness of how quality drives financial performance; (2) continuous communication of clinical and financial performance data; and (3) evidence-based clinical protocols, incentives, and tools for process improvement. Improvement was measured by comparing systemwide rates of adherence to national quality measures for heart failure (HF), acute myocardial infarction (AMI), pneumonia (PN), and surgical care (SCIP) to rates from all facilities reporting to the Centers for Medicare and Medicaid Services (CMS). As of the second quarter of 2011, 70% of HCA total measure set composite scores were at or above the 90th percentile of CMS scores. A test of differences in regression coefficients between the CMS national average and the HCA average revealed significant differences for AMI (p = .001), HF (p = .012), PN (p < .001), and SCIP (p = .015). This program demonstrated that presentation of the financial implications of quality, transparency in performance data, and clearly defined goals could cultivate the desire to use improvement tools and resources to raise performance.

  16. Advances in genomics for the improvement of quality in coffee.

    PubMed

    Tran, Hue Tm; Lee, L Slade; Furtado, Agnelo; Smyth, Heather; Henry, Robert J

    2016-08-01

    Coffee is an important crop that provides a livelihood to millions of people living in developing countries. Production of genotypes with improved coffee quality attributes is a primary target of coffee genetic improvement programmes. Advances in genomics are providing new tools for analysis of coffee quality at the molecular level. The recent report of a genomic sequence for robusta coffee, Coffea canephora, is a major development. However, a reference genome sequence for the genetically more complex arabica coffee (C. arabica) will also be required to fully define the molecular determinants controlling quality in coffee produced from this high quality coffee species. Genes responsible for control of the levels of the major biochemical components in the coffee bean that are known to be important in determining coffee quality can now be identified by association analysis. However, the narrow genetic base of arabica coffee suggests that genomics analysis of the wild relatives of coffee (Coffea spp.) may be required to find the phenotypic diversity required for effective association genetic analysis. The genomic resources available for the study of coffee quality are described and the potential for the application of next generation sequencing and association genetic analysis to advance coffee quality research are explored. © 2016 Society of Chemical Industry. PMID:26919810

  17. Evaluation of coal quality impacts on power plant operation

    SciTech Connect

    Doherty, M.B.

    1996-12-31

    The purpose of this presentation is to have the opportunity to discuss the relationships between coal quality and steam generation. American Electric Power (AEP) is the nations largest burner of coal, consuming approximately 55 million annual tons for its own use and that of companies for which it has management responsibilities. The System has a wide variety of steam generators representing many different steam conditions and boiler configurations. In addition, the company annually mines over 7.5 million tons of coal from its own reserves and operates a highly integrated coal transportation network of river barges, rail cars and terminal transfer facilities. AEP`s approach to evaluating fuels is to first match the fuel being considered to the needs of the steam generator. This includes meeting the environmental control requirements of the unit. Our objective is to supply the fuel to a unit that will enable the unit to operate at the lowest bus bar price. This concept acknowledges that the lowest price of coal per ton may not be synonymous with the lowest cost of production per net KWH.

  18. How grounded theory can improve nursing care quality.

    PubMed

    Nathaniel, Alvita K; Andrews, Tom

    2007-01-01

    This article presents an overview of the grounded theory research method and demonstrates how nurses can employ specific grounded theories to improve patient care quality. Because grounded theory is derived from real-world experience, it is a particularly appropriate method for nursing research. An overview of the method and language of grounded theory provides a background for nurses as they read grounded theories and apply newly acquired understandings to predictable processes and patterns of behavior. This article presents 2 exemplar grounded theories with suggestions as to how nurses can apply these and other grounded theories to improve the provision of quality nursing care.

  19. Improving Quality and Efficiency of Postpartum Hospital Education

    PubMed Central

    Buchko, Barbara L.; Gutshall, Connie H.; Jordan, Elizabeth T.

    2012-01-01

    The purpose of this study was to investigate the implementation of an evidence-based, streamlined, education process (comprehensive education booklet, individualized education plan, and integration of education into the clinical pathway) and nurse education to improve the quality and efficiency of postpartum education during hospitalization. A one-group pretest–posttest design was used to measure the quality of discharge teaching for new mothers and efficiency of the education process for registered nurses before and after implementation of an intervention. Results indicated that a comprehensive educational booklet and enhanced documentation can improve efficiency in the patient education process for nurses. PMID:23997552

  20. Operational water quality forecasting with EnKF data assimilation in the Yeongsan river basin, Korea

    NASA Astrophysics Data System (ADS)

    Shin, Changmin; Kim, Kyunghyun; Min, Joong-Hyuk; Na, Eunhye; Park, Suyoung; Song, Hyunoh

    2016-04-01

    National institute of environmental research(NIER) have been operating the water quality forecasting to prevent water quality deterioration for the major rivers in South Korea through WQFS-NIER(Water Quality Forecasting System) which developed based on Delft-FEWS system by the international joint research with NIER and Deltares from 2011 to 2013 The coupled the Hydrologic Simulation Program Fortran(HSPF) and the Environmental Fluid Dynamic Code(EFDC) models are being used to quantitatively predict the water quality. HSPF watershed model are used to generate the flows and water quality loads of the major tributaries which are used as the boundary conditions for EFDC model. The uncertainties in water quality forecasting are contributed by various factors such as input uncertainty, model structure uncertainty, parametric uncertainty, initial conditions uncertainty, of which to reduce uncertainty on the initial conditions is relatively effective in improving accuracy of short term water quality forecast. To reduce initial conditions uncertainties, ensemble Kalman filter(EnKF) data assimilation(DA) techniques are applied to the EFDC models. DA is to condition the model state on the observations to get a better estimate of state. Model error is assumed to come from uncertainties of the boundary conditions of EFDC model. The case study for Yeongsan river demonstrate that EnKF is successful in bringing the algae concentrations closer to the observations.

  1. How the ESRD quality incentive program could potentially improve quality of life for patients on dialysis.

    PubMed

    Moss, Alvin H; Davison, Sara N

    2015-05-01

    For over 20 years, the quality of medical care of the Medicare ESRD Program has been a concern. The Centers for Medicare and Medicaid Services have implemented the ESRD Quality Incentive Program, which uses the principles of value-based purchasing; dialysis providers are paid for performance on predefined quality measures, with a goal of improving patient outcomes and the quality of patient care. The ESRD Quality Incentive Program measures have been criticized, because they are largely disease oriented and use easy-to-obtain laboratory-based indicators, such as Kt/V and hemoglobin, that do not reflect outcomes that are most important to patients and have had a minimal effect on survival or quality of life. A key goal of improving quality of care is to enhance quality of life, a patient-important quality measure that matters more to many patients than even survival. None of the ESRD Quality Incentive Program measures assess patient-reported quality of life. As outlined in the National Quality Strategy, the Centers for Medicare and Medicaid Services are holding providers accountable in six priority domains, in which quality measures have been and are being developed for value-based purchasing. Three measures-patient experience and engagement, clinical care, and care coordination-are particularly relevant to quality care in the ESRD Program; the 2014 ESRD Quality Incentive Program includes six measures, none of which provide data from a patient-centered perspective. Value-based purchasing is a well intentioned step to improve care of patients on dialysis. However, the Centers for Medicare and Medicaid Services need to implement significant change in what is measured for the ESRD Quality Incentive Program to be patient centered and aligned with patients' values, preferences, and needs. This paper provides examples of potential quality measures for patient experience and engagement, clinical care, and care coordination, which if implemented, would be much more likely to

  2. Improving care in patients with acute coronary syndromes: the Erlanger quality improvement initiative.

    PubMed

    Fesmire, Francis M

    2004-09-01

    Quality improvement (QI) in emergency department (ED) patients with acute coronary syndromes (ACS) is a complex and dynamic phenomenon. ED physicians are faced with the challenge of multitasking a variety of patient complaints. This chaotic environment frequently hampers the ED physician's ability to properly evaluate and treat chest pain patients. Just as an airplane pilot would never take off without performing the comprehensive preflight operational checklist, the ED physician should have a standardized protocol for the evaluation and treatment of chest pain patients. In this report, we describe Erlanger Medical Center's 10-year QI initiative in developing a successful chest pain protocol for the rapid evaluation and treatment of patients with suspected ACS. Our initiative resulted from a collaborative effort among emergency physicians, cardiologists, nuclear radiologists, nursing staff, and administration. The systematic step-wise approach we utilized at our institution consisted of identification of the problem, development of standardized protocols, hospital-based QI initiatives, and continuation of QI efforts through national initiatives. Through this "building of bridges" among physicians, nursing, and administration, we hope that other institutions will modify our protocols to assist them in the development of their own successful QI program for improving the evaluation, treatment, and disposition of patients with suspected ACS.

  3. Improving the quality factor of cantilevers in viscous fluids by the adaptation of their interface

    NASA Astrophysics Data System (ADS)

    Linden, J.; Oesterschulze, E.

    2012-03-01

    The adaptation of the fluid-microresonator interface enables the operation of cantilevers with high quality factor in viscous fluids. Partial wetting was proposed to implement the adapted interface by meniscus formation. An excellent quality factor of 79 was achieved in water applying the concept of partial wetting to thin film silicon nitride cantilevers. Compared to the quality factor calculated from Sader's theory of the hydrodynamic damping of fully immersed cantilevers, this is an improvement by more than one decade. As a first application the partially wetted cantilevers were employed as mass sensors in water revealing a sensitivity of 2.77 fg/Hz.

  4. Enhancement of pressurizer safety valve operability by seating design improvement

    SciTech Connect

    Moisidis, N.T.; Ratiu, M.D.

    1994-12-31

    Operating conditions specific to Pressurizer Safety Valves (PSVs) have led to numerous problems and have caused industry and NRC concerns regarding the adequacy of spring loaded self-actuated safety valves for Reactor Coolant System (RCS) overpressure protection. Specific concerns are: setpoint drift, spurious actuations and leakage. Based on testing and valve construction analysis of a Crosby model 6M6 PSV, it was established that the primary contributor to the valve problems is a susceptibility to weak seating. To eliminate spring instability, a new spring washer was designed, which guides the spring and precludes its rotation from the reference installed position. Results of tests performed on a prototype PSV equipped with the modified upper spring washer has shown significant improvements in valve operability and a consistent setpoint reproducibility to less than {+-}1% of the PSV setpoint (testing of baseline, unmodified valve, resulted in a setpoint drift of {+-}2%). Enhanced valve operability will result in a significant decrease in operating and maintenance costs associated with valve maintenance and testing. In addition, the enhanced setpoint reproducibility will allow the development of a nitrogen to steam correlation for future in-house PSV testing which will result in further reductions in costs associated with valve testing.

  5. Enhancement of pressurizer safety valve operability by seating design improvement

    SciTech Connect

    Moisidis, N.T.; Ratiu, M.D.

    1995-08-01

    Operating conditions specific to pressurizer safety valves (PSVs) have led to numerous problems and have caused industry and NRC concerns regarding the adequacy of spring-loaded self-actuated safety valves for reactor coolant system (RCS) overpressure protection. Specific concerns are: setpoint drift, spurious actuations, and pressure protection. Specific concerns are: setpoint drift, spurious actuations, and leakage. Based on testing and valve construction analysis of a Crosby model 6M6 PSV (Moisidis and Ratiu, 1992), it was established that the primary contributor to the valve problems is a susceptibility to weak seating. To eliminate spring instability, a new spring washer was designed, which guides the spring and precludes its rotation from the reference installed position. Results of tests performed on a prototype PSV equipped with the modified upper spring washer has shown significant improvements in valve operability and a consistent setpoint reproducibility to less than {+-}1% of the PSV setpoint (testing of baseline, unmodified valve, resulted in a setpoint drift of {+-} 2%). Enhanced valve operability will result in a significant decrease in operating and maintenance costs associated with valve maintenance and testing. In addition, the enhanced setpoint reproducibility will allow the development of a nitrogen to steam correlation for future in-house PSV testing which will result in further reductions in costs associated with valve testing.

  6. Improved Fermi operator expansion methods for fast electronic structure calculations

    NASA Astrophysics Data System (ADS)

    Liang, WanZhen; Saravanan, Chandra; Shao, Yihan; Baer, Roi; Bell, Alexis T.; Head-Gordon, Martin

    2003-08-01

    Linear scaling algorithms based on Fermi operator expansions (FOE) have been considered significantly slower than other alternative approaches in evaluating the density matrix in Kohn-Sham density functional theory, despite their attractive simplicity. In this work, two new improvements to the FOE method are introduced. First, novel fast summation methods are employed to evaluate a matrix polynomial or Chebyshev matrix polynomial with matrix multiplications totalling roughly twice the square root of the degree of the polynomial. Second, six different representations of the Fermi operators are compared to assess the smallest possible degree of polynomial expansion for a given target precision. The optimal choice appears to be the complementary error function. Together, these advances make the FOE method competitive with the best existing alternatives.

  7. Telephone - delivered quality of life after 365 male stress urinary incontinence (SUI) operations

    PubMed Central

    Bretterbauer, Katharina Maria; Huber, Erik Randall; Remzi, Mesut; Huebner, Wilhelm

    2016-01-01

    ABSTRACT Objectives: To assess patient satisfaction and quality of life and factors that may be related to these outcomes. Materials and Methods: Between 2000 and 2008 a retrospective chart review and telephone survey of all surgeries for male SUI was performed. Average age at times of operation was 69.4 ± 7.4 (median 69). As part of the survey 270 of 365 patients were available (response rate: 74%). The average follow up time (from operation to telephone survey) was 34.8 ± 22.8 months (median 32). Results: Pad use per day improved significantly after operation from 6.23±5.3 to 1.61±2.92 pads/day (p=0.001). 74.7% (n=198) declared to be continent with one safety pad and 87.7% (n=236) confirmed the postoperative improvement of incontinence. 189 (70.5%) patients were “very satisfied” and “satisfied”. In 81% (n=218) the expectation in operation could be met, therefore 84.3% (n=226) would undergo it again and 90.3% (n=243) would recommend it to others. Lower age (rs=0.211), few postoperative pads per day (rs=0.58), high reduction of pads (rs=-0.35) and physical activity level (rs=0.2) correlate significantly with better satisfaction. Conclusions: Eighty-seven pint seven percent (87.7%) of our incontinence operations (n=236) lead to an improvement, which is independent from the number of prior incontinence operations and preoperative pad count. The postoperative quality of life remains constant over the observed follow up time. Certain subgroups of patients (younger age, high physical activity level, large reduction of pads) demonstrated superior satisfaction rates. PMID:27532111

  8. CONSTRUCTED WETLAND TREATMENT SYSTEMS FOR WATER QUALITY IMPROVEMENT

    SciTech Connect

    Nelson, E.

    2010-07-19

    The Savannah River National Laboratory implemented a constructed wetland treatment system (CWTS) in 2000 to treat industrial discharge and stormwater from the Laboratory area. The industrial discharge volume is 3,030 m{sup 3} per day with elevated toxicity and metals (copper, zinc and mercury). The CWTS was identified as the best treatment option based on performance, capital and continuing cost, and schedule. A key factor for this natural system approach was the long-term binding capacity of heavy metals (especially copper, lead, and zinc) in the organic matter and sediments. The design required that the wetland treat the average daily discharge volume and be able to handle 83,280 m{sup 3} of stormwater runoff in a 24 hour period. The design allowed all water flow within the system to be driven entirely by gravity. The CWTS for A-01 outfall is composed of eight one-acre wetland cells connected in pairs and planted with giant bulrush to provide continuous organic matter input to the system. The retention basin was designed to hold stormwater flow and to allow controlled discharge to the wetland. The system became operational in October of 2000 and is the first wetland treatment system permitted by South Carolina DHEC for removal of metals. Because of the exceptional performance of the A-01 CWTS, the same strategy was used to improve water quality of the H-02 outfall that receives discharge and stormwater from the Tritium Area of SRS. The primary contaminants in this outfall were also copper and zinc. The design for this second system required that the wetland treat the average discharge volume of 415 m{sup 3} per day, and be able to handle 9,690 m{sup 3} of stormwater runoff in a 24 hour period. This allowed the building of a system much smaller than the A-01 CWTS. The system became operational in July 2007. Metal removal has been excellent since water flow through the treatment systems began, and performance improved with the maturation of the vegetation during

  9. Benchmarking and audit of breast units improves quality of care.

    PubMed

    van Dam, P A; Verkinderen, L; Hauspy, J; Vermeulen, P; Dirix, L; Huizing, M; Altintas, S; Papadimitriou, K; Peeters, M; Tjalma, W

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on "QIs and breast cancer" and "benchmarking and breast cancer care", and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload.

  10. Benchmarking and audit of breast units improves quality of care.

    PubMed

    van Dam, P A; Verkinderen, L; Hauspy, J; Vermeulen, P; Dirix, L; Huizing, M; Altintas, S; Papadimitriou, K; Peeters, M; Tjalma, W

    2013-01-01

    Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on "QIs and breast cancer" and "benchmarking and breast cancer care", and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload. PMID:24753926

  11. The Mark III IR FEL: Improvements in performance and operation

    SciTech Connect

    Barnett, G.A.; Madey, J.M.J.; Straub, K.D.

    1995-12-31

    The Mark III IR FEL has been upgraded by the installation of a new thermionic microwave gun. The new gun yields a reduced emittance and allows operation at a higher repetition rate and an increased electron macropulse length. The RF system of the Mark III has also been phase-locked to the RF systemof the adjacent storage ring driver for the laboratory`s short-wavelength FEL sources, making possible two-color UV-IR pump probe experiments. In this paper, the design and performance of the new gun are presented and the implications of the improvements investigated.

  12. Observation Leads to Improved Operations in Nuclear Medicine.

    PubMed

    Religioso, Deo G

    2016-01-01

    The concept of observation--going out and seeing what is happening in daily operations---would seem like a normal management activity, but the reality in practice of the philosophy and technique is often underutilized. Once an observation has been determined, the next steps are to test and validate any discoveries on paper. For process change to be implemented, numerical data is needed to back-up observations in order to be heard and taken seriously by the executive team. Boca Raton Regional Hospital saw an opportunity to improve the process for radiopharmaceutical standing orders within its nuclear imaging department. As a result of this observation, the facility realized improved savings and an increase in employee motivation.

  13. Observation Leads to Improved Operations in Nuclear Medicine.

    PubMed

    Religioso, Deo G

    2016-01-01

    The concept of observation--going out and seeing what is happening in daily operations---would seem like a normal management activity, but the reality in practice of the philosophy and technique is often underutilized. Once an observation has been determined, the next steps are to test and validate any discoveries on paper. For process change to be implemented, numerical data is needed to back-up observations in order to be heard and taken seriously by the executive team. Boca Raton Regional Hospital saw an opportunity to improve the process for radiopharmaceutical standing orders within its nuclear imaging department. As a result of this observation, the facility realized improved savings and an increase in employee motivation. PMID:27172652

  14. Measuring and improving quality in university hospitals in Canada: The Collaborative for Excellence in Healthcare Quality.

    PubMed

    Backman, Chantal; Vanderloo, Saskia; Forster, Alan John

    2016-09-01

    Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. PMID:27460940

  15. Quality and performance improvement: what's a program to do?

    PubMed

    McCorry, Frank

    2007-04-01

    A confluence of forces is challenging traditional approaches to issues of quality in substance abuse care. The availability of effective, research-based interventions, the Federal emphasis on performance measurement and outcomes, and national initiatives to improve quality and data infrastructure are driving a transition from a static, compliance-oriented approach to a more dynamic performance improvement model. This new way of achieving and documenting quality will produce better outcomes for consumers and greater confidence in the value of substance abuse services, but first it will require new behaviors from all parties involved in the delivery of substance abuse prevention and treatment services. This article describes some of the shifts already under way and offers advice on how organizations can get ready for the coming changes.

  16. Using Quality Function Deployment To Improve Academic Advising Processes.

    ERIC Educational Resources Information Center

    Barrows, Richard; Murray, Bruce

    1997-01-01

    Quality Function Deployment, a set of concepts and tools used in manufacturing engineering to link consumer needs with product design, can also improve academic advising systems and processes. The technique promotes structured, logical examination of students' advising needs and their relationship to advising system design, processes, methods,…

  17. IMPROVING NATIONAL AIR QUALITY FORECASTS WITH SATELLITE AEROSOL OBSERVATIONS

    EPA Science Inventory

    Air quality forecasts for major US metropolitan areas have been provided to the public through a partnership between the US Environmental Protection Agency and state and local air agencies since 1997. Recent years have witnessed improvement in forecast skill and expansion of fore...

  18. Improving NAVFAC's total quality management of construction drawings with CLIPS

    NASA Technical Reports Server (NTRS)

    Antelman, Albert

    1991-01-01

    A diagnostic expert system to improve the quality of Naval Facilities Engineering Command (NAVFAC) construction drawings and specification is described. C Language Integrated Production System (CLIPS) and computer aided design layering standards are used in an expert system to check and coordinate construction drawings and specifications to eliminate errors and omissions.

  19. Software quality and process improvement in scientific simulation codes

    SciTech Connect

    Ambrosiano, J.; Webster, R.

    1997-11-01

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

  20. 42 CFR 441.474 - Quality assurance and improvement plan.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 4 2011-10-01 2011-10-01 false Quality assurance and improvement plan. 441.474 Section 441.474 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS SERVICES: REQUIREMENTS AND LIMITS APPLICABLE TO SPECIFIC SERVICES Optional Self-Directed...

  1. Approaches for vegetable and fruit quality trait improvement

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Improving food quality traits has become a major goal of fruit and vegetable breeding due to the increasing public awareness of nutraceutical compounds to human nutrition and health. During domestication and breeding of modern varieties, many traits were left behind in the wild and in the primitive ...

  2. 40 CFR 65.116 - Quality improvement program for pumps.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... PROGRAMS (CONTINUED) CONSOLIDATED FEDERAL AIR RULE Equipment Leaks § 65.116 Quality improvement program for... pumps in a process unit (or plant site) or three pumps in a process unit (or plant site) leak, the owner... leak is detected, the repair methods used and the instrument readings after repair. (v) If the...

  3. 40 CFR 65.116 - Quality improvement program for pumps.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... PROGRAMS (CONTINUED) CONSOLIDATED FEDERAL AIR RULE Equipment Leaks § 65.116 Quality improvement program for... pumps in a process unit (or plant site) or three pumps in a process unit (or plant site) leak, the owner... leak is detected, the repair methods used and the instrument readings after repair. (v) If the...

  4. 40 CFR 65.116 - Quality improvement program for pumps.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    .... 65.116 Section 65.116 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) AIR PROGRAMS (CONTINUED) CONSOLIDATED FEDERAL AIR RULE Equipment Leaks § 65.116 Quality improvement program for... with the requirements in § 65.107. (c) Resumption of QIP. If in a subsequent monitoring period,...

  5. 40 CFR 63.175 - Quality improvement program for valves.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... process specific factors. (ii) The analysis shall also be used to identify any superior performing valve... 40 Protection of Environment 9 2010-07-01 2010-07-01 false Quality improvement program for valves. 63.175 Section 63.175 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED)...

  6. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... communication as evidenced by measures from the care coordination domain (for example, call center utilization... 42 Public Health 3 2011-10-01 2011-10-01 false Quality improvement program. 422.152 Section 422.152 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN...

  7. 42 CFR 422.152 - Quality improvement program.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... regional PPO plans and local PPO plans as defined in paragraph (e) of this section) quality improvement... and results of each project to CMS as requested. (e) Requirements for MA regional plans and MA local... by CMS that are of the same type as those described under paragraph (e)(2)(i) of this section....

  8. Improving the quality of asphalt coating with carbon nanomodifiers

    NASA Astrophysics Data System (ADS)

    Larisa, Urkhanova; Nikolay, Shestakov; Aleksandr, Semenov; Natalya, Smirnyagina; Irina, Semenova

    2015-07-01

    This article deals with the possibility of modifying the binder by adding carbon nanomodifier to bitumen to improve the quality of asphalt. Addition of 0.05%-0.5% of nanomodifier significantly changes the properties of bitumen. Asphalt with this astringent has increased strength, heat resistance and shear resistance.

  9. Guiding and Modelling Quality Improvement in Higher Education Institutions

    ERIC Educational Resources Information Center

    Little, Daniel

    2015-01-01

    The article considers the process of creating quality improvement in higher education institutions from the point of view of current organisational theory and social-science modelling techniques. The author considers the higher education institution as a functioning complex of rules, norms and other organisational features and reviews the social…

  10. 40 CFR 65.116 - Quality improvement program for pumps.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (for example, piston, horizontal or vertical centrifugal, gear, bellows); pump manufacturer; seal type... 40 Protection of Environment 15 2010-07-01 2010-07-01 false Quality improvement program for pumps... pumps. (a) Criteria. If, on a 6-month rolling average, at least the greater of either 10 percent of...

  11. Dramatic Improvements in Beach Water Quality Following Gull Removal

    EPA Science Inventory

    Gulls are often cited as important contributors of fecal contamination to surface waters, and some recreational beaches have used gull control measures to improve microbial water quality. In this study, gulls were chased from a Lake Michigan beach using specially trained dogs, a...

  12. Continuous Quality Improvement: Making the Transition to Education.

    ERIC Educational Resources Information Center

    Hubbard, Dean L., Ed.

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

  13. Remote Sensing and Modeling for Improving Operational Aquatic Plant Management

    NASA Technical Reports Server (NTRS)

    Bubenheim, Dave

    2016-01-01

    The California Sacramento-San Joaquin River Delta is the hub for California’s water supply, conveying water from Northern to Southern California agriculture and communities while supporting important ecosystem services, agriculture, and communities in the Delta. Changes in climate, long-term drought, water quality changes, and expansion of invasive aquatic plants threatens ecosystems, impedes ecosystem restoration, and is economically, environmentally, and sociologically detrimental to the San Francisco Bay/California Delta complex. NASA Ames Research Center and the USDA-ARS partnered with the State of California and local governments to develop science-based, adaptive-management strategies for the Sacramento-San Joaquin Delta. The project combines science, operations, and economics related to integrated management scenarios for aquatic weeds to help land and waterway managers make science-informed decisions regarding management and outcomes. The team provides a comprehensive understanding of agricultural and urban land use in the Delta and the major water sheds (San Joaquin/Sacramento) supplying the Delta and interaction with drought and climate impacts on the environment, water quality, and weed growth. The team recommends conservation and modified land-use practices and aids local Delta stakeholders in developing management strategies. New remote sensing tools have been developed to enhance ability to assess conditions, inform decision support tools, and monitor management practices. Science gaps in understanding how native and invasive plants respond to altered environmental conditions are being filled and provide critical biological response parameters for Delta-SWAT simulation modeling. Operational agencies such as the California Department of Boating and Waterways provide testing and act as initial adopter of decision support tools. Methods developed by the project can become routine land and water management tools in complex river delta systems.

  14. A Framework for Improving the Quality of Research in the Biological Sciences

    PubMed Central

    Ellis, Lee M.; Davies, Erika W.; McFall-Ngai, Margaret; Fang, Ferric C.

    2016-01-01

    ABSTRACT The American Academy of Microbiology convened a colloquium to discuss problems in the biological sciences, with emphasis on identifying mechanisms to improve the quality of research. Participants from various disciplines made six recommendations: (i) design rigorous and comprehensive evaluation criteria to recognize and reward high-quality scientific research; (ii) require universal training in good scientific practices, appropriate statistical usage, and responsible research practices for scientists at all levels, with training content regularly updated and presented by qualified scientists; (iii) establish open data at the timing of publication as the standard operating procedure throughout the scientific enterprise; (iv) encourage scientific journals to publish negative data that meet methodologic standards of quality; (v) agree upon common criteria among scientific journals for retraction of published papers, to provide consistency and transparency; and (vi) strengthen research integrity oversight and training. These recommendations constitute an actionable framework that, in combination, could improve the quality of biological research. PMID:27578756

  15. A Framework for Improving the Quality of Research in the Biological Sciences.

    PubMed

    Casadevall, Arturo; Ellis, Lee M; Davies, Erika W; McFall-Ngai, Margaret; Fang, Ferric C

    2016-01-01

    The American Academy of Microbiology convened a colloquium to discuss problems in the biological sciences, with emphasis on identifying mechanisms to improve the quality of research. Participants from various disciplines made six recommendations: (i) design rigorous and comprehensive evaluation criteria to recognize and reward high-quality scientific research; (ii) require universal training in good scientific practices, appropriate statistical usage, and responsible research practices for scientists at all levels, with training content regularly updated and presented by qualified scientists; (iii) establish open data at the timing of publication as the standard operating procedure throughout the scientific enterprise; (iv) encourage scientific journals to publish negative data that meet methodologic standards of quality; (v) agree upon common criteria among scientific journals for retraction of published papers, to provide consistency and transparency; and (vi) strengthen research integrity oversight and training. These recommendations constitute an actionable framework that, in combination, could improve the quality of biological research. PMID:27578756

  16. Improving the quality of patient handover on a surgical ward.

    PubMed

    Bradley, Alison

    2014-01-01

    The European Working Time Directive means safe patient hand over is imperative. It is the responsibility of every doctor and an issue of patient safety and clinical governance [1]. The aims of this project were to improve the quality of patient handover between combined assessment unit (CAU) and surgical ward FY1 doctors. The Royal College of Surgeons England (RCSEng) guidelines on surgical patient handover [1] were used as the standard. Data was collected throughout November 2013. A handover tool was then introduced and attached to the front of patient notes when a patient was transferred from CAU to the surgical ward. The doctor handing over the patient and the ward doctor receiving the handover signed this document. Policy was also changed so that handover should take place once the patient had received senior review on the CAU and was deemed appropriate for transfer to the surgical ward. Data from the handover tool was collated and checked against the list of surgical admission for February 2014. The number of patients handed over improved from 15 % to 45%. The quality of patient handover also improved. 0 patient handovers in November 2013 included all of the information recommended by the RCSEng guidelines. 100% of the patient handovers in February 2014 contained all the recommended information. Introduction of a handover tool and formalisation of timing of patient handover helped to improve quality and number of patients being handed over. Further work needs to be done to improve safe handover of surgical patients, particularly out of hours.

  17. Counseling in Primary Care Improves Depression and Quality of Life

    PubMed Central

    Carta, MG; Petretto, D; Adamo, S; Bhat, KM; Lecca, ME; Mura, G; Carta, V; Angermeyer, M; Moro, MF

    2012-01-01

    Introduction: To measure the effectiveness on Quality of Life of adjunctive cognitive behavioral counseling in the setting of General Practitioners (GPs) along with the treatment as usual (TAU;) for the treatment of depression. Methods: Six month-controlled trial of patients who were referred to randomly assigned GPs (four for experimental group of patients and ten for the control) was done. Experimental sample had 34 patients with DSM-IV diagnosis of Depression (Depressed Episode, Dysthymia, or Adjustment Disorder with Depressed Mood) receiving the TAU supplemented with counseling. Control group had 30 patients with diagnosis of Depression receiving only the TAU. Results: The Beck Depression Inventory (BDI) score improved in both groups. Patients in the experimental group showed greater improvement compared to the control group at T2. The World Health Organization Quality OF Life Questionnaire (WHOQOL) score also improved in the experimental group but not in the control group. The improvement in the experimental group was statistically significant in terms of both BDI and WHOQOL scores. Conclusions: Adding counseling to TAU in general medical practice settings is more effective in controlling the symptoms of depression and improving the quality of life as measured over a period of six months, than TAU alone. These results while encouraging, also calls for a larger study involving a largersample size and a longer period of time. PMID:23173011

  18. Continuous quality improvement: educating towards a culture of clinical governance

    PubMed Central

    Heard, S; Schiller, G; Aitken, M; Fergie, C; Hall, L

    2001-01-01

    The National Health Service in England and Wales has recently adopted a policy aimed at embedding continuous quality improvement (CQI) at all levels and across all services. The key goal is to achieve changes in practice which improve patient outcomes. This paper describes the use of a training course for multiprofessional groups of participants tailored to offer them relevant knowledge, management and team working skills, and approaches to personal and career development. These were intended to assist them in changing their practice for the benefit of patients. The participants rated the course highly in fulfilling its objectives. One cohort followed up for 6 months named changes in practice which related specifically to learning from the course. This paper shows the important contribution of multiprofessional learning to CQI and presents a useful method of evaluating links between learning and performance. Key Words: continuous quality improvement; clinical governance; multiprofessional learning; performance PMID:11700383

  19. Quality improvement for feeding assistance care in nursing homes.

    PubMed

    Simmons, Sandra F

    2007-03-01

    Unintentional weight loss is a common problem among nursing home residents and one that can lead to adverse and costly clinical outcomes. Observational studies have shown that residents often receive inadequate and poor-quality feeding assistance during meals, and residents consume few calories between meals from oral liquid nutritional supplements or other food and fluid items. Improvements in the adequacy and quality of feeding assistance either during or between meals have been shown to improve residents' daily oral food and fluid consumption and promote weight gain. However, these feeding assistance interventions require significantly more time than nursing home staff currently spend on feeding assistance care activities. Alternative staffing models are explored through the recent federal "paid feeding assistant" regulation and an observational tool is described for use in practice to improve feeding assistance care.

  20. Method and apparatus for operating an improved thermocline storage unit

    DOEpatents

    Copeland, Robert J.

    1985-01-01

    A method and apparatus for operating a thermocline storage unit in which an insulated barrier member is provided substantially at the interface region between the hot and cold liquids in the storage tank. The barrier member physically and thermally separates the hot and cold liquids substantially preventing any diffusing or mixing between them and substantially preventing any heat transfer therebetween. The barrier member follows the rise and fall of the interface region between the liquids as the tank is charged and discharged. Two methods of maintaining it in the interface region are disclosed. With the structure and operation of the present invention and in particular the significant reduction in diffusing or mixing between the hot and cold liquids as well as the significant reduction in the thermal heat transfer between them, the performance of the storage tank is improved. More specifically, the stability of the interface region or thermocline is enhanced and the thickness of the thermocline is reduced producing a corresponding increase in the steepness of the temperature gradient across the thermocline and a more efficiently operating thermocline storage unit.

  1. Method and apparatus for operating an improved thermocline storage unit

    DOEpatents

    Copeland, R.J.

    1982-09-30

    A method and apparatus for operating a thermocline storage unit in which an insulated barrier member is provided substantially at the interface region between the hot and cold liquids in the storage tank. The barrier member physically and thermally separates the hot and cold liquids substantially preventing any diffusing or mixing between them and substantially preventing any heat transfer there between. The barrier member follows the rise and fall of the interface region between the liquids as the tank is charged and discharged. Two methods of maintaining it in the interface region are disclosed. With the structure and operation of the present invention and in particular the significant reduction in diffusing or mixing between the hot and cold liquids as well as the significant reduction in the thermal heat transfer between them, the performance of the storage tank is improved. More specifically, the stability of the interface region or thermocline is enhanced and the thickness of the thermocline is reduced producing a corresponding increase in the steepness of the temperature gradient across the thermocline and a more efficiently operating thermocline storage unit.

  2. Improving Reference Service: The Case for Using a Continuous Quality Improvement Method.

    ERIC Educational Resources Information Center

    Aluri, Rao

    1993-01-01

    Discusses the evaluation of library reference service; examines problems with past evaluations, including the lack of long-term planning and a systems perspective; and suggests a method for continuously monitoring and improving reference service using quality improvement tools such as checklists, cause and effect diagrams, Pareto charts, and…

  3. The Physician Quality Improvement Initiative: Engaging Physicians in Quality Improvement, Patient Safety, Accountability and their Provision of High-Quality Patient Care.

    PubMed

    Wentlandt, Kirsten; Degendorfer, Niki; Clarke, Cathy; Panet, Hayley; Worthington, Jim; McLean, Richard F; Chan, Charlie K N

    2016-01-01

    University Health Network has been working to become a high-reliability organization, with a focus on safe, quality patient care. In response, the Medical Affairs Department has implemented several strategic initiatives to drive accountability, quality improvement and engagement with our physician population. One of these initiatives, the Physician Quality Improvement Initiative (PQII) is a physician-led project designed to provide active medical staff, in collaboration with their physician department chiefs, a comprehensive approach to focused and practical quality improvement in their practice. In this document, we outline the project, including its implementation strategy, logic model and outcomes, and provide discussion on how it fits into UHN's global strategy to provide safe, quality patient care. PMID:27009706

  4. Statistical process management: An essential element of quality improvement

    NASA Astrophysics Data System (ADS)

    Buckner, M. R.

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

  5. Improving the Quality of Imaging in the Emergency Department.

    PubMed

    Blackmore, C Craig; Castro, Alexandra

    2015-12-01

    Imaging is critical for the care of emergency department (ED) patients. However, much of the imaging performed for acute care today is overutilization, creating substantial cost without significant benefit. Further, the value of imaging is not easily defined, as imaging only affects outcomes indirectly, through interaction with treatment. Improving the quality, including appropriateness, of emergency imaging requires understanding of how imaging contributes to patient care. The six-tier efficacy hierarchy of Fryback and Thornbury enables understanding of the value of imaging on multiple levels, ranging from technical efficacy to medical decision-making and higher-level patient and societal outcomes. The imaging efficacy hierarchy also allows definition of imaging quality through the Institute of Medicine (IOM)'s quality domains of safety, effectiveness, patient-centeredness, timeliness, efficiency, and equitability and provides a foundation for quality improvement. In this article, the authors elucidate the Fryback and Thornbury framework to define the value of imaging in the ED and to relate emergency imaging to the IOM quality domains.

  6. Statistical process management: An essential element of quality improvement

    SciTech Connect

    Buckner, M.R.

    1992-09-01

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

  7. Statistical process management: An essential element of quality improvement

    SciTech Connect

    Buckner, M.R.

    1992-01-01

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

  8. Standards, Guidance and Practices for Improved Data Quality

    SciTech Connect

    Martin B. Sattison

    2010-06-01

    Since the mid 1980s, the Idaho National Laboratory (INL) has been involved with numerous projects to collect operational reactor data, develop data tools, and trend and analyze that data for the U.S. Nuclear Regulatory Commission (NRC). Because the data are used in subsequent risk analyses, the NRC must have confidence in the quality of the data delivered. The NRC tasked the INL to establish a comprehensive data quality assurance program. A key element of that effort was to establish a set of requirements based on industry and government standards, guidance and good practices. This paper discusses where these were found, the process of extracting the requirements and recommendations from the source materials, and the consolidation of them into a concise set of 22 standards, guidance and practices for technical data quality. While this set was created specifically for the data programs within the NRC’s Office of Research, they have broad application to many high-technology industries.

  9. Bee pollination improves crop quality, shelf life and commercial value.

    PubMed

    Klatt, Björn K; Holzschuh, Andrea; Westphal, Catrin; Clough, Yann; Smit, Inga; Pawelzik, Elke; Tscharntke, Teja

    2014-01-22

    Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination. Bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades. They had increased redness and reduced sugar-acid-ratios and were firmer, thus improving the commercially important shelf life. Longer shelf life reduced fruit loss by at least 11%. This is accounting for 0.32 billion US$ of the 1.44 billion US$ provided by bee pollination to the total value of 2.90 billion US$ made with strawberry selling in the European Union 2009. The fruit quality and yield effects are driven by the pollination-mediated production of hormonal growth regulators, which occur in several pollination-dependent crops. Thus, our comprehensive findings should be transferable to a wide range of crops and demonstrate bee pollination to be a hitherto underestimated but vital and economically important determinant of fruit quality.

  10. Bee pollination improves crop quality, shelf life and commercial value

    PubMed Central

    Klatt, Björn K.; Holzschuh, Andrea; Westphal, Catrin; Clough, Yann; Smit, Inga; Pawelzik, Elke; Tscharntke, Teja

    2014-01-01

    Pollination improves the yield of most crop species and contributes to one-third of global crop production, but comprehensive benefits including crop quality are still unknown. Hence, pollination is underestimated by international policies, which is particularly alarming in times of agricultural intensification and diminishing pollination services. In this study, exclusion experiments with strawberries showed bee pollination to improve fruit quality, quantity and market value compared with wind and self-pollination. Bee-pollinated fruits were heavier, had less malformations and reached higher commercial grades. They had increased redness and reduced sugar–acid–ratios and were firmer, thus improving the commercially important shelf life. Longer shelf life reduced fruit loss by at least 11%. This is accounting for 0.32 billion US$ of the 1.44 billion US$ provided by bee pollination to the total value of 2.90 billion US$ made with strawberry selling in the European Union 2009. The fruit quality and yield effects are driven by the pollination-mediated production of hormonal growth regulators, which occur in several pollination-dependent crops. Thus, our comprehensive findings should be transferable to a wide range of crops and demonstrate bee pollination to be a hitherto underestimated but vital and economically important determinant of fruit quality. PMID:24307669

  11. Accreditation and Continuous Quality Improvement In Athletic Training Education

    PubMed Central

    Peer, Kimberly S.; Rakich, Jonathon S.

    2000-01-01

    Objective: To apply the continuous quality improvement model commonly associated with the business sector to entrylevel athletic training education program accreditation. Data Sources: We applied athletic training educational program accreditation as a tool for ensuring quality in the entrylevel athletic training education programs accredited by the Commission on the Accreditation of Allied Health Education Programs. Literature from the business, education, and athletic training fields is integrated to support this paradigm shift in athletic training education. Data Synthesis: The advent of mandated entry-level athletic training educational program accreditation has forced institutions to evaluate their educational programs. Accreditation will promote continuous quality improvement in athletic training education through mechanisms such as control measures and process improvement. Conclusions/Recommendations: Although accreditation of entry-level athletic training education programs has created some dissonance among athletic training professionals, it will strengthen the profession as a whole. Athletic training educators must capture the synergy generated from this change to ensure quality educational experiences for all our students as we move forward to secure a strong position in the allied health care market. PMID:16558629

  12. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

    PubMed Central

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-01-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement. PMID:26178332

  13. Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes.

    PubMed

    Wandersman, Abraham; Alia, Kassandra Ann; Cook, Brittany; Ramaswamy, Rohit

    2015-10-01

    While the body of evidence-based healthcare interventions grows, the ability of health systems to deliver these interventions effectively and efficiently lags behind. Quality improvement approaches, such as the model for improvement, have demonstrated some success in healthcare but their impact has been lessened by implementation challenges. To help address these challenges, we describe the empowerment evaluation approach that has been developed by programme evaluators and a method for its application (Getting To Outcomes (GTO)). We then describe how GTO can be used to implement healthcare interventions. An illustrative healthcare quality improvement example that compares the model for improvement and the GTO method for reducing hospital admissions through improved diabetes care is described. We conclude with suggestions for integrating GTO and the model for improvement.

  14. Quality and productivity improvement program (PPKP) from alumni perspective

    NASA Astrophysics Data System (ADS)

    Ruza, Nadiah; Mustafa, Zainol

    2013-04-01

    Defining the quality of the university education system is not easy. Institutions of higher education, through curriculum are hoped to provide the knowledge, wisdom and personality of students. It is questionable of how far Quality and Productivity Improvement Program (PPKP) are capable to ensure the courses offered relevant and effective in preparing the students for job market. The effectiveness of a university to undertake responsibilities and the impact given to students even after they graduate can be a measure of education quality at university. So, the quality of education can be enhanced and improved from time to time. In general, this study is aims to determine the effectiveness of PPKP's education system from the perspective of their alumni as well as their satisfaction and the importance level based on how PPKP be able to meet their needs. In overall, summary of open-ended questions from the questionnaire, Importance-Performance analysis and correlation analysis were conducted for this study. Based on result, it appears that there are still some deficiencies that can be improve, particularly in terms of teaching skills and PPKP's relationships with external organizations to enable knowledge be channel effectively. Importance-Performance analysis highlights some topics or courses that should be offered by PPKP based on their importance in industrial practice. Summary of the results of correlation analysis was found that women are more positive and not too demanding compared to men. In addition, it is found that the responsibilities and workload of the older generations, higher income and a high level of experience demands them to use and practice what they have learned during their studies at PPKP. Results of this study are hoped could be used to improve the quality of education system at PPKP.

  15. A decade of improvement: New York State fluid milk quality.

    PubMed

    Martin, N H; Carey, N R; Murphy, S C; Wiedmann, M; Boor, K J

    2012-12-01

    The microbiological and sensory qualities of New York State (NYS) fluid milk products were assessed as part of an ongoing fluid milk quality program. Commercially packaged pasteurized fluid milk samples were collected twice a year over the 10-yr period from 2001 to 2010 from 14 NYS dairy processing facilities and analyzed at the Milk Quality Improvement Program (MQIP) laboratory. Each sample was tested throughout refrigerated storage (6°C) on day initial, 7, 10, and 14 for standard plate count (SPC), coliform count (CC), and sensory quality. Over the 10-yr period, the percentage of samples with bacterial numbers below the Pasteurized Milk Ordinance (PMO) limit of 20,000 cfu/mL at d 14 postprocessing ranged from a low of 21.1% in 2002 to a high of 48.6% in 2010. Percent samples positive for coliforms during that same period ranged from a high of 26.6% in 2002 to a low of 7.5% in 2007. Mean d 14 sensory scores ranged from a low of 6.0 in 2002 to a high of 7.3 in 2007. Samples contaminated with coliforms after pasteurization have significantly higher SPC counts and significantly lower sensory scores on d 14 of shelf-life than those not contaminated with coliforms. Product factors such as fat level were not significantly associated with SPC, CC, or sensory quality of the product, whereas the factor processing plant significantly affected overall product quality. This study demonstrates that overall fluid milk quality in NYS, as determined by microbiological and sensory analyses, has improved over the last decade, and identifies some challenges that remain.

  16. Nightly home hemodialysis: improvement in nutrition and quality of life.

    PubMed

    McPhatter, L L; Lockridge, R S; Albert, J; Anderson, H; Craft, V; Jennings, F M; Spencer, M; Swafford, A; Barger, T; Coffey, L

    1999-10-01

    In September, 1997, we began a Nightly Home Hemodialysis Program modeled after a program in Toronto, Canada. We have assessed nutritional parameters and quality of life indicators before initiation of the program, and at 3, 6, 12, and 18 months. Data suggest that patients have improved overall quality of life as measured by the CHOICE Health Experience Questionnaire. Three-day dietary recalls at 0, 3, 6, 12, and 18 months also show patients are eating healthy and maintaining adequate kilocalorie and protein intakes, as well as maintaining adequate dry weight and protein stores.

  17. Quality: performance improvement, teamwork, information technology and protocols.

    PubMed

    Coleman, Nana E; Pon, Steven

    2013-04-01

    Using the Institute of Medicine framework that outlines the domains of quality, this article considers four key aspects of health care delivery which have the potential to significantly affect the quality of health care within the pediatric intensive care unit. The discussion covers: performance improvement and how existing methods for reporting, review, and analysis of medical error relate to patient care; team composition and workflow; and the impact of information technologies on clinical practice. Also considered is how protocol-driven and standardized practice affects both patients and the fiscal interests of the health care system.

  18. [Improvement of River Water Quality by Aeration: WASP Model Study].

    PubMed

    Zhu, Wen-bo; Wang, Hong-xiu; Liu, Cui; Zhang, Jian; Liang, Shuang

    2015-04-01

    Aeration is one of the main technical methods to remediate polluted rivers, and mathematical models are the main ways to predict and assess the environmental pollution. WASP model was used to study the effect of aeration on improving the water quality of a small river over a time span. The preliminary results showed that the simulation values were consistent with practical monitoring data, which could be useful for the management and control of polluted water. Furthermore, simulations under different aeration conditions suggested that aeration technology could significantly lower the levels of chemical oxygen demand (COD) and ammonia-nitrogen (NH4(+)-N) of river water, thus improving the water quality. With the improvement of dissolved oxygen (DO), the water quality could be further improved. However, the increase in the removal rate of pollutants would slow down. Also, there were remarkable differences among various months throughout the whole year, and aeration from May to September had better results. Considering economic costs and environmental benefits, river aeration with a 4 mg x L(1) DO standard in summer was determined as the best condition.

  19. Using Vision System Technologies to Enable Operational Improvements for Low Visibility Approach and Landing Operations

    NASA Technical Reports Server (NTRS)

    Kramer, Lynda J.; Ellis, Kyle K. E.; Bailey, Randall E.; Williams, Steven P.; Severance, Kurt; Le Vie, Lisa R.; Comstock, James R.

    2014-01-01

    Flight deck-based vision systems, such as Synthetic and Enhanced Vision System (SEVS) technologies, have the potential to provide additional margins of safety for aircrew performance and enable the implementation of operational improvements for low visibility surface, arrival, and departure operations in the terminal environment with equivalent efficiency to visual operations. To achieve this potential, research is required for effective technology development and implementation based upon human factors design and regulatory guidance. This research supports the introduction and use of Synthetic Vision Systems and Enhanced Flight Vision Systems (SVS/EFVS) as advanced cockpit vision technologies in Next Generation Air Transportation System (NextGen) operations. Twelve air transport-rated crews participated in a motion-base simulation experiment to evaluate the use of SVS/EFVS in NextGen low visibility approach and landing operations. Three monochromatic, collimated head-up display (HUD) concepts (conventional HUD, SVS HUD, and EFVS HUD) and two color head-down primary flight display (PFD) concepts (conventional PFD, SVS PFD) were evaluated in a simulated NextGen Chicago O'Hare terminal environment. Additionally, the instrument approach type (no offset, 3 degree offset, 15 degree offset) was experimentally varied to test the efficacy of the HUD concepts for offset approach operations. The data showed that touchdown landing performance were excellent regardless of SEVS concept or type of offset instrument approach being flown. Subjective assessments of mental workload and situation awareness indicated that making offset approaches in low visibility conditions with an EFVS HUD or SVS HUD may be feasible.

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

    PubMed

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

    2008-11-01

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

  1. An Effect of the Co-Operative Network Model for Students' Quality in Thai Primary Schools

    ERIC Educational Resources Information Center

    Khanthaphum, Udomsin; Tesaputa, Kowat; Weangsamoot, Visoot

    2016-01-01

    This research aimed: 1) to study the current and desirable states of the co-operative network in developing the learners' quality in Thai primary schools, 2) to develop a model of the co-operative network in developing the learners' quality, and 3) to examine the results of implementation of the co-operative network model in the primary school.…

  2. Automatisms in EMIR instrument to improve operation, safety and maintenance

    NASA Astrophysics Data System (ADS)

    Fernández Izquierdo, Patricia; Núñez Cagigal, Miguel; Barreto Rodríguez, Roberto; Martínez Rey, Noelia; Santana Tschudi, Samuel; Barreto Cabrera, Maria; Patrón Recio, Jesús; Garzón López, Francisco

    2014-08-01

    EMIR is the NIR imager and multiobject spectrograph being built as a common user instrument for the 10-m class GTC. Big cryogenic instruments demand a reliable design and a specific hardware and software to increase its safety and productivity. EMIR vacuum, cooling and heating systems are monitored and partially controlled by a Programmable Logic Controller (PLC) in industrial format with a touch screen. The PLC aids the instrument operator in the maintenance tasks recovering autonomously vacuum if required or proposing preventive maintenance actions. The PLC and its associated hardware improve EMIR safety having immediate reactions against eventual failure modes in the instrument or in external supplies, including hardware failures during the heating procedure or failure in the PLC itself. EMIR PLC provides detailed information periodically about status and alarms of vacuum and cooling components or external supplies.

  3. Highlights of contractor initiatives in quality enhancement and productivity improvement

    NASA Technical Reports Server (NTRS)

    1986-01-01

    The NASA/Contractor Team efforts are presented as part of NASA's continuing effort to facilitate the sharing of quality and productivity improvement ideas among its contractors. This complilation is not meant to be a comprehensive review of contractor initiative nor does it necessarily express NASA's views. The submissions represent samples from a general survey, and were not edited by NASA. The efforts are examples of quality and productivity programs in private industry, and as such, highlight company efforts in individual areas. Topics range from modernization of equipment, hardware, and technology to management of human resources. Of particular interest are contractor initiatives which deal with measurement and evaluation data pertaining to quality and productivity performance.

  4. Continuous quality improvement. A proposal for Arabian Gulf Medical Associations.

    PubMed

    Al-Shahri, M Z; Kinchin-White, J

    2000-02-01

    Having well-established and active medical associations in the Arabian Gulf countries is a promising event. Ideally, however, it must be assured that these associations are efficiently and effectively functioning in a manner designed to serve the ultimate goal of promoting the standards of the medical profession and thus, the quality of health care in the region. This paper is designed to promote the application of Continuous Quality Improvement principles by the medical associations in the Arabian Gulf. The paper is presented in a general format so as to allow for appropriate modifications according to the specific objectives of different medical associations. The indicators identified in this proposal to assess the quality of structure, process or outcome are not intended as a comprehensive list. Rather, the authors aim at establishing a framework on which various fine-tuned and appropriately tailored systems can be based.

  5. Quality-based financial incentives in health care: can we improve quality by paying for it?

    PubMed

    Conrad, Douglas A; Perry, Lisa

    2009-01-01

    This article asks whether financial incentives can improve the quality of health care. A conceptual framework drawn from microeconomics, agency theory, behavioral economics, and cognitive psychology motivates a set of propositions about incentive effects on clinical quality. These propositions are evaluated through a synthesis of extant peer-reviewed empirical evidence. Comprehensive financial incentives--balancing rewards and penalties; blending structure, process, and outcome measures; emphasizing continuous, absolute performance standards; tailoring the size of incremental rewards to increasing marginal costs of quality improvement; and assuring certainty, frequency, and sustainability of incentive payoffs--offer the prospect of significantly enhancing quality beyond the modest impacts of prevailing pay-for-performance (P4P) programs. Such organizational innovations as the primary care medical home and accountable health care organizations are expected to catalyze more powerful quality incentive models: risk- and quality-adjusted capitation, episode of care payments, and enhanced fee-for-service payments for quality dimensions (e.g., prevention) most amenable to piece-rate delivery. PMID:19296779

  6. Improving diabetic foot screening at a primary care clinic: A quality improvement project

    PubMed Central

    Allen, Michelle L.; Gunst, Colette

    2016-01-01

    Background Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. Aim This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Setting A primary health care clinic in the Western Cape province of South Africa Methods A quality improvement project was conducted. HCWs’ needs were assessed using a questionnaire. This was followed by focus group discussions with the HCWs, which were recorded, transcribed and assessed using a general inductive approach. An intervention was designed based on common themes. Staff members were trained on foot screening and patient information pamphlets and screening tools were made available to all clinic staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 with that in 2014 after initiation of the quality improvement cycle. Results HCWs’ confidence in conducting foot screening using the diabetic foot assessment questionnaire improved markedly after training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first quality improvement cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusion The findings showed a significant improvement in the number of diabetic patients screened. Using strategic planning with appreciative intent based on SOAR, proved to be motivational and can be used in the planning of the next cycle. PMID:27608673

  7. Yarn Quality Prediction Based on Improved BP Neural Network

    NASA Astrophysics Data System (ADS)

    Yang, Jian-Guo; Xiong, Jing-Wei; Xun, Lan

    Aiming at the key quality indexes xbt in spinning processing is caused by many complex and interactions factors. A xbt prediction model is put forward based on the PSO-BP neural network, which adjusts weights of BP neural network using particle swarm optimization (PSO) rather than the traditional gradient descent method, is used to improve the convergence speed of neural network and the ability of getting the global optimal solution. As the object of a large number of field detection data in a spinning workshop, the results show that, compared with the traditional BP algorithm and GA-BP algorithm, the PSO-BP neural network can obvious improve yarn quality prediction model precision and stability.

  8. IMPROVING (SOFTWARE) PATENT QUALITY THROUGH THE ADMINISTRATIVE PROCESS.

    PubMed

    Rai, Arti K

    2013-11-24

    The available evidence indicates that patent quality, particularly in the area of software, needs improvement. This Article argues that even an agency as institutionally constrained as the U.S. Patent and Trademark Office ("PTO") could implement a portfolio of pragmatic, cost-effective quality improvement strategies. The argument in favor of these strategies draws upon not only legal theory and doctrine but also new data from a PTO software examination unit with relatively strict practices. Strategies that resolve around Section 112 of the patent statute could usefully be deployed at the initial examination stage. Other strategies could be deployed within the new post-issuance procedures available to the agency under the America Invents Act. Notably, although the strategies the Article discusses have the virtue of being neutral as to technology, they are likely to have a very significant practical impact in the area of software.

  9. Quality, cost efficiency, the new quality-cost imperative: systemwide improvements can yield financial gains.

    PubMed

    Birk, Susan

    2010-01-01

    The need to focus internally on cost management has largely replaced the revenue growth model of the past two decades and the external pursuit of opportunities for market and service expansion, according to Stephen R Mayfield, DHA, senior vice president of quality and performance improvement for the American Hospital Association. Outside financial pressure from primarily uncontrollable forces--the potential bundling of Medicare reimbursements to hospitals and nonpayments for readmissions and adverse events, to name a few--have compelled healthcare organizations to spend more time looking inward to finetune existing capabilities. As a result, quality improvement is evolving into a strategy for fiscal stability as well as a critical priority in itself.

  10. Using continuous quality improvement to implement evidence-based medicine.

    PubMed

    Quick, Barbara; Nordstrom, Sue; Johnson, Kevin

    2006-01-01

    The importance of implementing evidence-based medicine is being driven by public reporting of outcome data and linking these measures to reimbursement. Most hospitals are faced with many challenges in gaining sponsorship, staffing, creating tools, and reporting of evidence-based outcome measures. This article describes the use of the SSM Health Care (SSMHC) Continuous Quality Improvement model in implementing evidence-based practices at SSM DePaul Health Center, a community hospital member of SSMHC, including successes, opportunities for improvement, and lessons learned. Specifically, the article includes two different processes for data collection and interventions with staff, process requirements for each, and outcome data associated with each model. PMID:17135874

  11. Quantitative study designs used in quality improvement and assessment.

    PubMed

    Ormes, W S; Brim, M B; Coggan, P

    2001-01-01

    This article describes common quantitative design techniques that can be used to collect and analyze quality data. An understanding of the differences between these design techniques can help healthcare quality professionals make the most efficient use of their time, energies, and resources. To evaluate the advantages and disadvantages of these various study designs, it is necessary to assess factors that threaten the degree with which quality professionals may infer a cause-and-effect relationship from the data collected. Processes, the conduits of organizational function, often can be assessed by methods that do not take into account confounding and compromising circumstances that affect the outcomes of their analyses. An assumption that the implementation of process improvements may cause real change is incomplete without a consideration of other factors that might also have caused the same result. It is only through the identification, assessment, and exclusion of these alternative factors that administrators and healthcare quality professionals can assess the degree to which true process improvement or compliance has occurred. This article describes the advantages and disadvantages of common quantitative design techniques and reviews the corresponding threats to the interpretability of data obtained from their use. PMID:11378972

  12. Tracking neonatal nosocomial infection: the continuous quality improvement cycle.

    PubMed

    Gill, A W; Keil, A D; Jones, C; Aydon, L; Biggs, S

    2011-05-01

    Neonatal nosocomial infection (NNI) is a major complication of neonatal care, increasing mortality, morbidity and the costs of healthcare. Management of NNI involves attention to many details of care, creating a culture of change within a neonatal unit and the implementation of a continuous quality improvement cycle. This paper describes the initiation of a quality improvement team (QIT) and the aspects of infection control bundles that have been implemented. The setting was a single large perinatal centre over a seven-year period. Statistical tracking of NNI in exceedingly premature infants was by control charting methodology. A steady and statistically significant decline in NNI rates from 13 to seven episodes per 1000 bed-days (censored to day 35) for infants less than 29 weeks of gestation has been recorded. A multidisciplinary QIT has managed the implementation of measures designed to reduce NNI in the unit. These have included raising awareness of the need for asepsis, improved hand hygiene, increased vigilance in using central lines, monitoring blood culture collection techniques and improving the environment. We believe such measures in conjunction with the positive feedback obtained from charting have been responsible for the steady decline in NNI. This study is one of the first to close the QIT loop and to demonstrate statistical improvement in NNI through the introduction of specific care bundles.

  13. Improving Quality of Seal Leak Test Product using Six Sigma

    NASA Astrophysics Data System (ADS)

    Luthfi Malik, Abdullah; Akbar, Muhammad; Irianto, Dradjad

    2016-02-01

    Seal leak test part is a polyurethane material-based product. Based on past data, defect level of this product was 8%, higher than the target of 5%. Quality improvement effort was done using six sigma method that included phases of define, measure, analyse, improve, and control. In the design phase, a Delphi method was used to identify factors that were critical to quality. In the measure phase, stability and process capability was measured. Fault tree analysis (FTA) and failure mode and effect analysis (FMEA) were used in the next phase to analize the root cause and to determine the priority issues. Improve phase was done by compiling, selecting, and designing alternative repair. Some improvement efforts were identified, i.e. (i) making a checklist for maintenance schedules, (ii) making written reminder form, (iii) modifying the SOP more detail, and (iv) performing a major service to the vacuum machine. To ensure the continuity of improvement efforts, some control activities were executed, i.e. (i) controlling, monitoring, documenting, and setting target frequently, (ii) implementing reward and punishment system, (iii) adding cleaning tool, and (iv) building six sigma organizational structure.

  14. [Financial incentives in improving healthcare quality. SESPAS Report 2012].

    PubMed

    Eirea Eiras, Carlos; Ortún Rubio, Vicente

    2012-03-01

    We address the contribution of financial incentives linked to pay for performance (P4P) to improving the quality of care. The situation of P4P is analyzed internationally and in the distinct health services in Spain. The participation of P4P in wage compensation and the effects of the current economic crisis on these incentives is discussed. We review the results of recent studies to clarify the role of these incentive models and assess possible orientations and new proposals.

  15. Digital TV image quality improvement considering distributions of edge characteristic

    NASA Astrophysics Data System (ADS)

    Hong, Sang-Gi; Kim, Jae-Chul; Park, Jong-Hyun

    2003-12-01

    Sharpness enhancement is widely used technique for improving the perceptual quality of an image by emphasizing its high-frequency component. In this paper, a psychophysical experiment is conducted by the 20 observers with simple linear unsharp masking for sharpness enhancement. The experimental result is extracted using z-score analysis and linear regression. Finally using this result we suggest observer preferable sharpness enhancement method for digital television.

  16. Integrating superconducting qubit systems for improved quantum operations

    NASA Astrophysics Data System (ADS)

    Filipp, Stefan; Sheldon, Sarah; Magesan, Easwar; Bishop, Lev S.; Steffen, Matthias; Chow, Jerry M.; Gambetta, Jay M.

    2015-03-01

    Recent progress in the field of superconducting circuits has led to qubit coherence times exceeding by far typical single and two-qubit gate times. In this regime, in which relaxation (T1) and dephasing (T2) times are above 40 and 50 microseconds, respectively, quantum gates are not limited by intrinsic noise sources. We enter this regime by optimizing the design of coplanar transmon qubits to reduce the influence of surface loss. Furthermore, we have eliminated spurious microwave resonances which we can detect by monitoring the qubit coherence while sweeping the frequency of an external microwave drive applied to the system. To improve T2 times, we minimize dephasing caused by thermal photons in coupled resonator modes by increasing the attenuation of the readout drive lines. To maintain the ability to drive fast gates with strong microwave signals while preserving coherence, we employ weakly capacitively coupled control lines providing independent control of the qubits and allowing for improved two-qubit entangling gate operations. We acknowledge support from ARO under Contract W911NF-14-1-0124.

  17. Improving operational anodising process performance using simulation approach

    NASA Astrophysics Data System (ADS)

    Liong, Choong-Yeun; Ghazali, Syarah Syahidah

    2015-10-01

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

  18. Improving operational anodising process performance using simulation approach

    SciTech Connect

    Liong, Choong-Yeun Ghazali, Syarah Syahidah

    2015-10-22

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

  19. Operation of a tokamak reactor in the radiative improved mode

    NASA Astrophysics Data System (ADS)

    Morozov, D. Kh.; Mavrin, A. A.

    2016-03-01

    The operation of a nuclear fusion reactor has been simulated within a model based on experimental results obtained at the TEXTOR-94 tokamak and other facilities in which quasistationary regimes were achieved with long confinement times, high densities, and absence of the edge-localized mode. The radiative improved mode of confinement studied in detail at the TEXTOR-94 tokamak is the most interesting such regime. One of the most important problems of modern tokamaks is the problem of a very high thermal load on a divertor (or a limiter). This problem is quite easily solved in the radiative improved mode. Since a significant fraction of the thermal energy is reemitted by an impurity, the thermal loading is significantly reduced. As the energy confinement time τ E at high densities in the indicated mode is significantly larger than the time predicted by the scaling of ITERH-98P(y, 2), ignition can be achieved in a facility much smaller than the ITER facility at plasma temperatures below 20 keV. The revealed decrease in the degradation of the confinement time τ E with an increase in the introduced power has been analyzed.

  20. Partnering health disparities research with quality improvement science in pediatrics.

    PubMed

    Lion, K Casey; Raphael, Jean L

    2015-02-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction.

  1. Partnering Health Disparities Research With Quality Improvement Science in Pediatrics

    PubMed Central

    Lion, K. Casey

    2015-01-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. PMID:25560436

  2. Partnering health disparities research with quality improvement science in pediatrics.

    PubMed

    Lion, K Casey; Raphael, Jean L

    2015-02-01

    Disparities in pediatric health care quality are well described in the literature, yet practical approaches to decreasing them remain elusive. Quality improvement (QI) approaches are appealing for addressing disparities because they offer a set of strategies by which to target modifiable aspects of care delivery and a method for tailoring or changing an intervention over time based on data monitoring. However, few examples in the literature exist of QI interventions successfully decreasing disparities, particularly in pediatrics, due to well-described challenges in developing, implementing, and studying QI with vulnerable populations or in underresourced settings. In addition, QI interventions aimed at improving quality overall may not improve disparities, and in some cases, may worsen them if there is greater uptake or effectiveness of the intervention among the population with better outcomes at baseline. In this article, the authors review some of the challenges faced by researchers and frontline clinicians seeking to use QI to address health disparities and propose an agenda for moving the field forward. Specifically, they propose that those designing and implementing disparities-focused QI interventions reconsider comparator groups, use more rigorous evaluation methods, carefully consider the evidence for particular interventions and the context in which they were developed, directly engage the social determinants of health, and leverage community resources to build collaborative networks and engage community members. Ultimately, new partnerships between communities, providers serving vulnerable populations, and QI researchers will be required for QI interventions to achieve their potential related to health care disparity reduction. PMID:25560436

  3. New pulsating casing collar to improve cementing quality

    SciTech Connect

    Chen, P.; He, K.; Wu, J.

    1998-12-31

    This paper presents the design and test results of a new pulsating casing collar which improves cementing quality. The new pulsating casing collar (PCC) is designed according to the Helmholtz oscillator to generate a pulsating jet flow by self-excitation in the cementing process. By placing this new pulsating casing collar at the bottom of casing string, the generated pulsating jet flow transmits vibrating pressure waves up through the annulus and helps remove drilling mud in the annulus. It can therefore improve cementing quality, especially when eccentric annulus exists due to casing eccentricity where the mud is difficult to remove. The new pulsating casing collar consists of a top nozzle, a resonant chamber, and a bottom nozzle. It can be manufactured easily and is easy to use in the field. It has been tested in Jianghan oil-field, P.R. China. The field-test results support the theoretical analysis and laboratory test, and the cementing quality is shown greatly improved by using the new pulsating casing collar.

  4. AN OPERATIONAL EVALUATION OF THE ETA-CMAQ AIR QUALITY FORECAST MODEL

    EPA Science Inventory

    The National Oceanic and Atmospheric Administration (NOAA), in collaboration with the Environmental Protection Agency (EPA), are developing an Air Quality Forecasting Program that will eventually result in an operational Nationwide Air Quality Forecasting System. The initial pha...

  5. Macroergonomic analysis and design for improved safety and quality performance.

    PubMed

    Kleiner, B M

    1999-01-01

    Macroergonomics, which emerged historically after sociotechnical systems theory, quality management, and ergonomics, is presented as the basis for a needed integrative methodology. A macroergonomics methodology was presented in some detail to demonstrate how aspects of microergonomics, total quality management (TQM), and sociotechnical systems (STS) can be triangulated in a common approach. In the context of this methodology, quality and safety were presented as 2 of several important performance criteria. To demonstrate aspects of the methodology, 2 case studies were summarized with safety and quality performance results where available. The first case manipulated both personnel and technical factors to achieve a "safety culture" at a nuclear site. The concept of safety culture is defined in INSAG-4 (International Atomic Energy Agency, 1991). as "that assembly of characteristics and attitudes in organizations and individuals which establishes that, as an overriding priority, nuclear plant safety issues receive the attention warranted by their significance." The second case described a tire manufacturing intervention to improve quality (as defined by Sink and Tuttle, 1989) through joint consideration of technical and social factors. It was suggested that macroergonomics can yield greater performance than can be achieved through ergonomic intervention alone. Whereas case studies help to make the case, more rigorous formative and summative research is needed to refine and validate the proposed methodology respectively.

  6. Detection of High Quality Rainfall Data to Improve Flood Resilience

    NASA Astrophysics Data System (ADS)

    Hoang, T. C.; Tchiguirinskaia, I.; Schertzer, D. J.; Lovejoy, S.

    2012-12-01

    European flood management systems require reliable rainfall statistics, e.g. the Intensity-duration-Frequency curves for shorter and shorter durations and for a larger and larger range of return periods. Preliminary studies showed that the number of floods depends on the quality of available data, e.g. the time resolution quality. These facts suggest that a particular attention should be paid to the rainfall data quality in order to adequately investigate flood risk aiming to achieve flood resilience. The potential consequences of changes in measuring and recording techniques have been somewhat discussed in the literature with respect to a possible introduction of artificial inhomogeneities in time series. In this direction, we developed a first version of a SERQUAL procedure to automatically detect the effective time resolution of highly mixed data. We show that most of the rainfall time series have a lower recording frequency than that is assumed. This question is particularly important for operational hydrology, because an error on the effective recording high frequency introduces biases in the corresponding statistics. It is therefore essential to quantify the quality of the rainfall time series before their use. Due to the fact that the multiple scales and possible scaling behaviour of hydrological data are particularly important for many applications, including flood resilience research, this paper first investigates the sensitivity of the scaling estimates and methods to the deficit of short duration rainfall data, and consequently propose a few simple criteria for a reliable evaluation of the data quality. The SERQUAL procedure enable us to extract high quality sub-series from longer time series that will be much more reliable to calibrate and/or validate short duration quantiles and hydrological models.

  7. Method and apparatus for improving the quality and efficiency of ultrashort-pulse laser machining

    DOEpatents

    Stuart, Brent C.; Nguyen, Hoang T.; Perry, Michael D.

    2001-01-01

    A method and apparatus for improving the quality and efficiency of machining of materials with laser pulse durations shorter than 100 picoseconds by orienting and maintaining the polarization of the laser light such that the electric field vector is perpendicular relative to the edges of the material being processed. Its use is any machining operation requiring remote delivery and/or high precision with minimal collateral dames.

  8. Understanding quality improvement at scale in general practice: a qualitative evaluation of a COPD improvement programme

    PubMed Central

    Marshall, Martin; Mountford, James; Gamet, Kirsten; Gungor, Gulsen; Burke, Conor; Hudson, Robyn; Morris, Steve; Patel, Nishma; Koczan, Phil; Meaker, Rob; Chantler, Cyril; Roberts, Christopher Michael

    2014-01-01

    Background A growing body of knowledge exists to guide efforts to improve the organisation and delivery of health care, most of which is based on work carried out in hospitals. It is uncertain how transferable this knowledge is to primary care. Aim To understand the enablers and constraints to implementing a large-scale quality improvement programme in general practice, designed to improve care for people with chronic obstructive pulmonary disease. Design and setting A qualitative study of 189 general practices in a socioeconomically and ethnically-mixed, urban area in east London, UK. Method Twelve semi-structured interviews were conducted with people leading the programme and 17 in-depth interviews with those participating in it. Participants were local health system leaders, clinicians, and managers. A theoretical framework derived from evidence-based guidance for improvement programmes was used to interpret the findings. A complex improvement intervention took place with social and technical elements including training and mentorship, guidance, analytical tools, and data feedback. Results Practice staff wanted to participate in and learn from well-designed collaborative improvement projects. Nevertheless, there were limitations in the capacities and capabilities of the workforce to undertake systematic improvement, significant problems with access to and the quality of data, and tensions between the narrative-based generalist orientation of many primary care clinicians and the quantitative single-disease orientation that has characterised much of the quality improvement movement to date. Conclusion Improvement guidance derived largely from hospital-based studies is, for the most part, applicable to improvement efforts in primary care settings, although large-scale change in general practice presents some particular challenges. These need to be better understood and addressed if improvement initiatives are to be effective. PMID:25452538

  9. Operational aspects of asynchronous filtering for improved flood forecasting

    NASA Astrophysics Data System (ADS)

    Rakovec, Oldrich; Weerts, Albrecht; Sumihar, Julius; Uijlenhoet, Remko

    2014-05-01

    Hydrological forecasts can be made more reliable and less uncertain by recursively improving initial conditions. A common way of improving the initial conditions is to make use of data assimilation (DA), a feedback mechanism or update methodology which merges model estimates with available real world observations. The traditional implementation of the Ensemble Kalman Filter (EnKF; e.g. Evensen, 2009) is synchronous, commonly named a three dimensional (3-D) assimilation, which means that all assimilated observations correspond to the time of update. Asynchronous DA, also called four dimensional (4-D) assimilation, refers to an updating methodology, in which observations being assimilated into the model originate from times different to the time of update (Evensen, 2009; Sakov 2010). This study investigates how the capabilities of the DA procedure can be improved by applying alternative Kalman-type methods, e.g., the Asynchronous Ensemble Kalman Filter (AEnKF). The AEnKF assimilates observations with smaller computational costs than the original EnKF, which is beneficial for operational purposes. The results of discharge assimilation into a grid-based hydrological model for the Upper Ourthe catchment in Belgian Ardennes show that including past predictions and observations in the AEnKF improves the model forecasts as compared to the traditional EnKF. Additionally we show that elimination of the strongly non-linear relation between the soil moisture storage and assimilated discharge observations from the model update becomes beneficial for an improved operational forecasting, which is evaluated using several validation measures. In the current study we employed the HBV-96 model built within a recently developed open source modelling environment OpenStreams (2013). The advantage of using OpenStreams (2013) is that it enables direct communication with OpenDA (2013), an open source data assimilation toolbox. OpenDA provides a number of algorithms for model calibration

  10. Interdisciplinary teamwork and the power of a quality improvement collaborative in tertiary neonatal intensive care units.

    PubMed

    Grover, Theresa R; Pallotto, Eugenia K; Brozanski, Beverly; Piazza, Anthony J; Chuo, John; Moran, Susan; McClead, Richard; Mingrone, Teresa; Morelli, Lorna; Smith, Joan R

    2015-01-01

    Significant gaps in healthcare quality and outcomes can be reduced via quality improvement collaboratives (QICs), which improve care by leveraging data and experience from multiple organizations.The Children's Hospital Neonatal Consortium Collaborative Initiatives for Quality Improvement team developed an infrastructure for neonatal QICs. We describe the structure and components of an effective multi-institutional neonatal QIC that implemented the "SLUG Bug" project designed to reduce central line-associated bloodstream infections (CLABSIs).The operational infrastructure of SLUG Bug involved 17 tertiary care neonatal intensive care units with a goal to reduce CLABSI in high-risk neonates. Clinical Practice Recommendations were produced, and the Institute of Healthcare Improvement Breakthrough Series provided the framework for the collaborative. Process measures studied the effectiveness of the collaborative structure.CLABSI rates decreased by 20% during a 12-month study period. Compliance bundle reporting exceeded 80%. A QIC score of 2.5 or more ("improvement") was achieved by 94% of centers and a score 4 or more ("significant improvement") was achieved by 35%.Frequent interactive project meetings, well-defined project metrics, continual shared learning opportunities, and individual team coaching were key QIC success components. Through a coordinated approach and committed leadership, QICs can effectively implement change and improve the care of neonates with complex diagnoses and rare diseases. PMID:25919608

  11. Clinical performance feedback and quality improvement opportunities for perioperative physicians.

    PubMed

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The "buy-in" includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  12. Clinical performance feedback and quality improvement opportunities for perioperative physicians

    PubMed Central

    Kaye, Alan David; Okanlawon, Olutoyin J; Urman, Richard D

    2014-01-01

    Clinical performance feedback is an important component of the ongoing development and education of health care practitioners. For physicians, feedback about their clinical practice and outcomes is central to developing both confidence and competence at all stages of their medical careers. Cultural and financial infrastructures need to be in place, and the concept of feedback needs to be readily embraced and encouraged by clinical leadership and other stakeholders. The “buy-in” includes the expectation and view that feedback occurs on a routine basis, and those engaged in the process are both encouraged to participate and held accountable. Feedback must be part of an overarching quality improvement and physician education agenda; it is not meant to be an isolated, fragmented initiative that is typically undermined by lack of resources or systemic barriers to gaining improvement within programs. Effective feedback should be an integral part of clinical practice. Anesthesiologists and other perioperative physicians are identifying specialty-specific indicators that can be used when creating a broader quality improvement agenda. Placing a more immediate formal feedback strategy that focuses on goal-oriented behavior is rapidly becoming a mainstay. Physicians may use their individual feedback reports for reflection and designing personal development plans as lifelong learners and leaders in improving patient care. PMID:24833948

  13. Does arthroscopic subacromial decompression improve quality of life

    PubMed Central

    Whiteman, A; Wilson, J; Paul, E; Roy, B

    2015-01-01

    Introduction There has been a significant rise in the volume of subacromial decompression surgery performed in the UK. This study aimed to determine whether arthroscopic subacromial decompression improves health related quality of life in a cost effective manner. Methods Patients undergoing arthroscopic subacromial decompression surgery for impingement were enrolled between 2012 and 2014. The Oxford shoulder score and the EQ-5D™ instruments were completed prior to and following surgery. A cost–utility analysis was performed. Results Eighty-three patients were eligible for the study with a mean follow-up duration of 15 months (range: 4–27 months). The mean Oxford shoulder score improved by 13 points (95% confidence interval [CI]: 11–15 points). The mean health utility gain extrapolated from the EQ-5D™ questionnaire improved by 0.23 (95% CI: 0.16–0.30), translating to a minimum cost per QALY of £5,683. Conclusions Subacromial decompression leads to significant improvement in function and quality of life in a cost effective manner. This provides justification for its ongoing practice by appropriately trained shoulder surgeons in correctly selected patients. PMID:26263808

  14. Implementing a systems-oriented morbidity and mortality conference in remote rural Nepal for quality improvement

    PubMed Central

    Schwarz, Dan; Schwarz, Ryan; Gauchan, Bikash; Andrews, Jason; Sharma, Ranju; Karelas, Gregory; Rajbhandari, Ruma; Acharya, Bibhav; Mate, Kedar; Bista, Amir; Bista, Megha Giri; Sox, Colin

    2011-01-01

    Problem In hospitals in rural, resource-limited settings, there is an acute need for simple, practical strategies to improve healthcare quality. Setting A district hospital in remote western Nepal. Key measures for improvement To provide a mechanism for systems-level reflection so that staff can identify targets for quality improvement in healthcare delivery. Strategies for change To develop a morbidity and mortality conference (M&M) quality improvement initiative that aims to facilitate structured analysis of patient care and identify barriers to providing quality care, which can subsequently be improved. Design The authors designed an M&M involving clinical and non-clinical staff in conducting root-cause analyses of healthcare delivery at their hospital. Weekly conferences focus on seven domains of causal analysis: operations, supply chain, equipment, personnel, outreach, societal, and structural. Each conference focuses on assessing the care provided, and identifying ways in which services can be improved in the future. Effects of change Staff reception of the M&Ms was positive. In these M&Ms, staff identified problem areas in healthcare delivery and steps for improvement. Subsequently, changes were made in hospital workflow, supply procurement, and on-site training. Lessons learnt While widely practiced throughout the world, M&Ms typically do not involve both clinical and non-clinical staff members and do not take a systems-level approach. The authors' experience suggests that the adapted M&M conference is a simple, feasible tool for quality improvement in resource-limited settings. Senior managerial commitment is crucial to ensure successful implementation of M&Ms, given the challenging logistics of implementing these programmes in resource-limited health facilities. PMID:21949441

  15. Improving the quality of handover in a liaison psychiatry team.

    PubMed

    Brook, Jennifer; Amaro Calcia, Marilia

    2016-01-01

    Handover is a high risk point for errors in clinical care, in many cases leading to adverse events or near misses. The timely transfer of accurate and useful information between professionals is vital to ensure quality and safety, and to ensure the transfer of accountability for care. In this project standards were developed for quality handover between doctors in a liaison psychiatry department. The aim of these were to ensure adequate identification of patients, clear communication of tasks to be completed and relevant risk issues, as well as a guide to the priority of jobs. We measured compliance with these standards for all patients documented in the handover book during three week periods in 2013, 2014 (following delivery of education and guidance on handover to all doctors), and finally in 2015 after implementation of a proforma for handover. Handover documentation prior to the implementation of standards was of poor quality with significant absences of information. Key information to identify patients was frequently absent, for example hospital number was only recorded in 1% of cases. Only 81% of entries included the reason for the patient's referral, and 27% made no mention of the outstanding tasks for completion. Despite guidance and education of all doctors regarding the standards, there was no consistent improvement in compliance. It was particularly concerning that risk issues were only mentioned in 18% of cases, even when assessed immediately after education was given. Following introduction of the proforma compliance increased with overall completeness of handover improving from 40% to 71%. Without guidelines handover between shifts is of a poor quality, and often lacks key information to allow colleagues to identify patients and prioritise need. Education of those performing these handovers did not produce any benefits, either immediately following its delivery or in longer term follow up. The implementation of a template to aid clinicians in

  16. Improving the quality of handover in a liaison psychiatry team

    PubMed Central

    Brook, Jennifer; Amaro Calcia, Marilia

    2016-01-01

    Handover is a high risk point for errors in clinical care, in many cases leading to adverse events or near misses. The timely transfer of accurate and useful information between professionals is vital to ensure quality and safety, and to ensure the transfer of accountability for care. In this project standards were developed for quality handover between doctors in a liaison psychiatry department. The aim of these were to ensure adequate identification of patients, clear communication of tasks to be completed and relevant risk issues, as well as a guide to the priority of jobs. We measured compliance with these standards for all patients documented in the handover book during three week periods in 2013, 2014 (following delivery of education and guidance on handover to all doctors), and finally in 2015 after implementation of a proforma for handover. Handover documentation prior to the implementation of standards was of poor quality with significant absences of information. Key information to identify patients was frequently absent, for example hospital number was only recorded in 1% of cases. Only 81% of entries included the reason for the patient's referral, and 27% made no mention of the outstanding tasks for completion. Despite guidance and education of all doctors regarding the standards, there was no consistent improvement in compliance. It was particularly concerning that risk issues were only mentioned in 18% of cases, even when assessed immediately after education was given. Following introduction of the proforma compliance increased with overall completeness of handover improving from 40% to 71%. Without guidelines handover between shifts is of a poor quality, and often lacks key information to allow colleagues to identify patients and prioritise need. Education of those performing these handovers did not produce any benefits, either immediately following its delivery or in longer term follow up. The implementation of a template to aid clinicians in

  17. Digital processing to improve image quality in real-time neutron radiography

    NASA Astrophysics Data System (ADS)

    Fujine, Shigenori; Yoneda, Kenji; Kanda, Keiji

    1985-01-01

    Real-time neutron radiography (NTV) has been used for practical applications at the Kyoto University Reactor (KUR). At present, however, the direct image from the TV system is still poor in resolution and low in contrast. In this paper several image improvements are demonstrated, such as a frame summing technique, which are effective in increasing image quality in neutron radiography. Image integration before the A/D converter has a beneficial effect on image quality and the high quality image reveals details invisible in direct images, such as: small holes by a reversed image, defects in a neutron converter screen through a high quality image, a moving object in a contoured image, a slight difference between two low-contrast images by a subtraction technique, and so on. For the real-time application a contouring operation and an averaging approach can also be utilized effectively.

  18. [Quality of conventional PAP smears. Quality assessment and motivation for improvement].

    PubMed

    Regitnig, P; Nader, A; Wiener, H

    2012-07-01

    The success of cytology in screening programs for cervical cancer is highly dependent on the smear quality. Interdisciplinary projects which evaluate the smear quality and the results of collection devices could be helpful for an improvement and a successful example for quality improvement is presented here. An average of 83% technically adequate and representative smears was documented for 12 million conventional PAP smears; however only an average of 68% technically adequate and representative smears was found for the group of least successful smear takers of all laboratories. This indicates a potential for improvement. Following an interdisciplinary project on smear quality improvement the average rate of representative smears increased from 69 to 83% and in another project this rate remained stable at 86%. Based on 158,411 conventional smears, representative smears were achieved in 92% using Cervex-Brush®, 86% using Szalay Spatula and 82% Cytobrush methods. The combinations of Cytobrush with the Ayre wooden spatula, cotton wool swab or Szalay Spatula achieved 97%, 94% and 92% representative smears, respectively.

  19. Understanding the "How" of Quality Improvement: Lessons from the Rhode Island Program Quality Intervention

    ERIC Educational Resources Information Center

    Devaney, Elizabeth; Smith, Charles; Wong, Kenneth

    2012-01-01

    Over the past 10 years, afterschool and youth development programming has moved from providing childcare for working parents to being an integral component of the learning day, supporting the academic, social, and emotional development of young people. An important part of that transition has been a growing emphasis on improving program quality.…

  20. Interventions to improve water quality for preventing diarrhoea

    PubMed Central

    Clasen, Thomas F; Alexander, Kelly T; Sinclair, David; Boisson, Sophie; Peletz, Rachel; Chang, Howard H; Majorin, Fiona; Cairncross, Sandy

    2015-01-01

    Background Diarrhoea is a major cause of death and disease, especially among young children in low-income countries. In these settings, many infectious agents associated with diarrhoea are spread through water contaminated with faeces. In remote and low-income settings, source-based water quality improvement includes providing protected groundwater (springs, wells, and bore holes), or harvested rainwater as an alternative to surface sources (rivers and lakes). Point-of-use water quality improvement interventions include boiling, chlorination, flocculation, filtration, or solar disinfection, mainly conducted at home. Objectives To assess the effectiveness of interventions to improve water quality for preventing diarrhoea. Search methods We searched the Cochrane Infectious Diseases Group Specialized Register (11 November 2014), CENTRAL (the Cochrane Library, 7 November 2014), MEDLINE (1966 to 10 November 2014), EMBASE (1974 to 10 November 2014), and LILACS (1982 to 7 November 2014). We also handsearched relevant conference proceedings, contacted researchers and organizations working in the field, and checked references from identified studies through 11 November 2014. Selection criteria Randomized controlled trials (RCTs), quasi-RCTs, and controlled before-and-after studies (CBA) comparing interventions aimed at improving the microbiological quality of drinking water with no intervention in children and adults. Data collection and analysis Two review authors independently assessed trial quality and extracted data. We used meta-analyses to estimate pooled measures of effect, where appropriate, and investigated potential sources of heterogeneity using subgroup analyses. We assessed the quality of evidence using the GRADE approach. Main results Forty-five cluster-RCTs, two quasi-RCTs, and eight CBA studies, including over 84,000 participants, met the inclusion criteria. Most included studies were conducted in low- or middle-income countries (LMICs) (50 studies) with

  1. 21 CFR 111.130 - What quality control operations are required for returned dietary supplements?

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... returned dietary supplements? 111.130 Section 111.130 Food and Drugs FOOD AND DRUG ADMINISTRATION... PRACTICE IN MANUFACTURING, PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Production... are required for returned dietary supplements? Quality control operations for returned...

  2. 21 CFR 111.130 - What quality control operations are required for returned dietary supplements?

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... returned dietary supplements? 111.130 Section 111.130 Food and Drugs FOOD AND DRUG ADMINISTRATION... PRACTICE IN MANUFACTURING, PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Production... are required for returned dietary supplements? Quality control operations for returned...

  3. 21 CFR 111.130 - What quality control operations are required for returned dietary supplements?

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... returned dietary supplements? 111.130 Section 111.130 Food and Drugs FOOD AND DRUG ADMINISTRATION... PRACTICE IN MANUFACTURING, PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Production... are required for returned dietary supplements? Quality control operations for returned...

  4. 21 CFR 111.130 - What quality control operations are required for returned dietary supplements?

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... returned dietary supplements? 111.130 Section 111.130 Food and Drugs FOOD AND DRUG ADMINISTRATION... PRACTICE IN MANUFACTURING, PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Production... are required for returned dietary supplements? Quality control operations for returned...

  5. 21 CFR 111.130 - What quality control operations are required for returned dietary supplements?

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... returned dietary supplements? 111.130 Section 111.130 Food and Drugs FOOD AND DRUG ADMINISTRATION... PRACTICE IN MANUFACTURING, PACKAGING, LABELING, OR HOLDING OPERATIONS FOR DIETARY SUPPLEMENTS Production... are required for returned dietary supplements? Quality control operations for returned...

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

    PubMed Central

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

    2016-01-01

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

  7. Quality Improvement Project to Improve Patient Satisfaction With Pain Management: Using Human-Centered Design.

    PubMed

    Trail-Mahan, Tracy; Heisler, Scott; Katica, Mary

    2016-01-01

    In this quality improvement project, our health system developed a comprehensive, patient-centered approach to improving inpatient pain management and assessed its impact on patient satisfaction across 21 medical centers. Using human-centered design principles, a bundle of 6 individual and team nursing practices was developed. Patient satisfaction with pain management, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems pain composite score, increased from the 25th to just under the 75th national percentile.

  8. Building Perinatal Case Manager Capacity Using Quality Improvement

    PubMed Central

    Fitzgerald, Elaine

    2015-01-01

    ABSTRACT Improving breastfeeding rates among Black women is a potential strategy to address disparities in health outcomes that disproportionately impact Black women and children. This quality improvement (QI) initiative aimed to improve perinatal case manager knowledge and self-efficacy to promote breastfeeding among Black, low-income women who use services through Boston Healthy Start Initiative. QI methodology was used to develop and test a two-part strategy for perinatal case managers to promote and support breastfeeding. A positive change was observed in infant feeding knowledge and case manager self-efficacy to promote breastfeeding. Among the 24 mothers participating in this QI initiative, 100% initiated and continued breastfeeding at 1 week postpartum, and 92% were breastfeeding at 2 weeks postpartum. PMID:26937160

  9. Family physicians improve patient health care quality and outcomes.

    PubMed

    Bowman, Marjorie A; Neale, Anne Victoria

    2013-01-01

    This issue exemplifies family physicians' ability to provide great care and to continuously improve. For example, beyond other specialty care, the care provided by family physicians is associated with improved melanoma diagnosis and outcomes and improved preventive services for those with a history of breast cancer. Electronic health records are providing new avenues to both assess outcomes and influence care. However, to truly reward quality care, simplistic and readily measurable items such as laboratory results or assessment of the provision of preventive services must be adjusted for risk. Health insurance influences classic preventive care services more than personal health behaviors. The care provided at federally qualified health centers throughout the nation is highly appreciated by the people they serve and is not plagued by the types of disparities in other settings.

  10. Dextre: Improving maintenance operations on the International Space Station

    NASA Astrophysics Data System (ADS)

    Coleshill, Elliott; Oshinowo, Layi; Rembala, Richard; Bina, Bardia; Rey, Daniel; Sindelar, Shelley

    2009-05-01

    The Special Purpose Dexterous Manipulator (SPDM), known as "Dextre", is currently slated to launch in February 2008 for deployment on the International Space Station (ISS) as the final component of Canada's Mobile Servicing System (MSS). Dextre's primary role on the Space Station is to perform repair and replacement (R&R) maintenance tasks on robotically compatible hardware such as Orbital Replaceable Units (ORUs), thereby eventually easing the burden on the ISS crew. This burden on the on-orbit crew translates practically into crew time being a limited resource on the ISS, and as such, finding ways to assist the crew in performing their tasks or offloading the crew completely when appropriate is a bonus to the ISS program. This is already accomplished very effectively by commanding as many non-critical robotics tasks as possible, such as powering up and free-space maneuvering of the Space Station Remote Manipulator System (SSRMS), known as "Canadarm2", from the Ground. Thus, beyond its primary role, and based on an increasing clarity regarding the challenges of external maintenance on the ISS, Dextre is being considered for use in a number of ways with the objective of improving ISS operations while reducing and optimizing the use of crew time through the use of ground control for various tasks, pre-positioning hardware, acting as a temporary storage platform to break an Extra Vehicular Activity (EVA) day into manageable timelines, and extending the physical reach and range of the Canadarm2. This paper discusses the planned activities and operations for Dextre an rationale for how these will help optimize the use of crew resources on the ISS.

  11. 76 FR 46814 - Medicare Program; Evaluation Criteria and Standards for Quality Improvement Program Contracts...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-03

    ... Restraints, Nursing Home Systemic Improvement, Adverse Drug Events, Quality Reporting and Improvement... Standards for Quality Improvement Program Contracts (10th Statement of Work) AGENCY: Centers for Medicare... Conditions in Nursing Homes-- Pressure Ulcers and Physical Restraints; Developing a learning and...

  12. Data Mining Methods Applied to Flight Operations Quality Assurance Data: A Comparison to Standard Statistical Methods

    NASA Technical Reports Server (NTRS)

    Stolzer, Alan J.; Halford, Carl

    2007-01-01

    In a previous study, multiple regression techniques were applied to Flight Operations Quality Assurance-derived data to develop parsimonious model(s) for fuel consumption on the Boeing 757 airplane. The present study examined several data mining algorithms, including neural networks, on the fuel consumption problem and compared them to the multiple regression results obtained earlier. Using regression methods, parsimonious models were obtained that explained approximately 85% of the variation in fuel flow. In general data mining methods were more effective in predicting fuel consumption. Classification and Regression Tree methods reported correlation coefficients of .91 to .92, and General Linear Models and Multilayer Perceptron neural networks reported correlation coefficients of about .99. These data mining models show great promise for use in further examining large FOQA databases for operational and safety improvements.

  13. Transportation Safety Excellence in Operations Through Improved Transportation Safety Document

    SciTech Connect

    Dr. Michael A. Lehto; MAL

    2007-05-01

    A recent accomplishment of the Idaho National Laboratory (INL) Materials and Fuels Complex (MFC) Nuclear Safety analysis group was to obtain DOE-ID approval for the inter-facility transfer of greater-than-Hazard-Category-3 quantity radioactive/fissionable waste in Department of Transportation (DOT) Type A drums at MFC. This accomplishment supported excellence in operations through safety analysis by better integrating nuclear safety requirements with waste requirements in the Transportation Safety Document (TSD); reducing container and transport costs; and making facility operations more efficient. The MFC TSD governs and controls the inter-facility transfer of greater-than-Hazard-Category-3 radioactive and/or fissionable materials in non-DOT approved containers. Previously, the TSD did not include the capability to transfer payloads of greater-than-Hazard-Category-3 radioactive and/or fissionable materials using DOT Type A drums. Previous practice was to package the waste materials to less-than-Hazard-Category-3 quantities when loading DOT Type A drums for transfer out of facilities to reduce facility waste accumulations. This practice allowed operations to proceed, but resulted in drums being loaded to less than the Waste Isolation Pilot Plant (WIPP) waste acceptance criteria (WAC) waste limits, which was not cost effective or operations friendly. An improved and revised safety analysis was used to gain DOE-ID approval for adding this container configuration to the MFC TSD safety basis. In the process of obtaining approval of the revised safety basis, safety analysis practices were used effectively to directly support excellence in operations. Several factors contributed to the success of MFC’s effort to obtain approval for the use of DOT Type A drums, including two practices that could help in future safety basis changes at other facilities. 1) The process of incorporating the DOT Type A drums into the TSD at MFC helped to better integrate nuclear safety

  14. Improving urban air quality in China: Beijing case study.

    PubMed

    Hao, Jiming; Wang, Litao

    2005-09-01

    China is undergoing rapid urbanization because of unprecedented economic growth. As a result, many cities suffer from air pollution. Two-thirds of China's cities have not attained the ambient air quality standards applicable to urban residential areas (Grade II). Particulate matter (PM), rather than sulfur dioxide (SO2), is the major pollutant reflecting the shift from coal burning to mixed source pollution. In 2002, 63.2 and 22.4% of the monitored cities have PM and SO2 concentrations exceeding the Grade II standard, respectively. Nitrogen oxides (NOx) concentration kept a relatively stable level near the Grade II standard in the last decade and had an increasing potential in recent years because of the rapid motorization. In general, the air pollutants emission did not increase as quickly as the economic growth and energy consumption, and air quality in Chinese cities has improved to some extent. Beijing, a typical representative of rapidly developing cities, is an example to illustrate the possible options for urban air pollution control. Beijing's case provides hope that the challenges associated with improving air quality can be met during a period of explosive development and motorization.

  15. Improving urban air quality in China: Beijing case study

    SciTech Connect

    Jiming Hao; Litao Wang

    2005-09-01

    China is undergoing rapid urbanization because of unprecedented economic growth. As a result, many cities suffer from air pollution. Two-thirds of China's cities have not attained the ambient air quality standards applicable to urban residential areas (Grade II). Particulate matter (PM), rather than sulfur dioxide (SO{sub 2}), is the major pollutant reflecting the shift from coal burning to mixed source pollution. In 2002, 63.2 and 22.4% of the monitored cities have PM and SO{sub 2} concentrations exceeding the Grade II standard, respectively. Nitrogen oxides (NOx) concentration kept a relatively stable level near the Grade II standard in the last decade and had an increasing potential in recent years because of the rapid motorization. In general, the air pollutants emission did not increase as quickly as the economic growth and energy consumption, and air quality in Chinese cities has improved to some extent. Beijing, a typical representative of rapidly developing cities, is an example to illustrate the possible options for urban air pollution control. Beijing's case provides hope that the challenges associated with improving air quality can be met during a period of explosive development and motorization. 21 refs., 19 figs., 6 tabs.

  16. Overarching goals: a strategy for improving healthcare quality and safety?

    PubMed

    Nanji, Karen C; Ferris, Timothy G; Torchiana, David F; Meyer, Gregg S

    2013-03-01

    The management literature reveals that many successful organisations have strategic plans that include a bold 'stretch-goal' to stimulate progress over a ten-to-thirty-year period. A stretch goal is clear, compelling and easily understood. It serves as a unifying focal point for organisational efforts. The ambitiousness of such goals has been emphasised with the phrase Big Hairy Audacious Goal ('BHAG'). President Kennedy's proclamation in 1961 that 'this Nation should commit itself to achieving the goal, before this decade is out, of landing a man on the moon and returning him safely to earth' provides a famous example. This goal energised the US National Aeronautics and Space Administration, and it captured the attention of the American public and resulted in one of the largest accomplishments of any organisation. The goal set by Sony, a small, cash-strapped electronics company in the 1950s, to change the poor image of Japanese products around the world represents a classic BHAG. Few examples of quality goals that conform to the BHAG definition exist in the healthcare literature. However, the concept may provide a useful framework for organisations seeking to transform the quality of care they deliver. This review examines the merits and cautions of setting overarching quality goals to catalyse quality improvement efforts, and assists healthcare organisations with determining whether to adopt these goals.

  17. Geocoding coronial data: tools and techniques to improve data quality.

    PubMed

    Freestone, Darren; Williamson, Dianne; Wollersheim, Dennis

    2012-01-01

    Clinical, administrative and demographic health information is fundamental to understanding the nature of health and evaluating the effectiveness of efforts to reduce morbidity and mortality of the population. The demographic data item 'location' is an integral part of any injury surveillance tool or injury prevention strategy. The true value of location data can only be realised once these data have been appropriately classified and quality assured. Geocoding as a means of classifying location is increasingly used in various health fields to enable spatial analysis of data. This article reports on research carried out in Australia at the National Coroners Information System (NCIS). Trends in the use of NCIS location-based data by researchers were identified. The research also aimed to establish the factors that impacted on the quality of geocoded data and the extent of this impact. A systematic analysis of the geocoding process identified source documentation, data cleaning, and software settings as key factors impacting on data quality. Understanding and application of these processes can improve data quality and therefore inform the analysis and interpretation of these data by researchers. PMID:23087078

  18. Listserv use enhances quality and safety in multisite quality improvement efforts.

    PubMed

    Neily, Julia; Mills, Peter D; Surott-Kimberly, B C; Weeks, William Brinson

    2004-01-01

    A listserv is an e-mail group to which people subscribe based upon common interests. We used a retrospective study to examine the relationship between listserv use and team success for health care quality improvement efforts. We hypothesized high listserv use would be associated with team success. Eighty-seven Department of Veterans Affairs teams participated in facilitated quality improvement efforts to address three areas: improving safety in high-hazard areas, improving the disability evaluation process, and reducing falls and related injuries. We coded messages sent to the listserv according to sender (faculty or participant), team, and content. We correlated the volume of messages sent per team with team success and with team and facility characteristics. Teams with high listserv contributions were more likely to complete their first test of change, report facility use of nonpunitive methods of investigating medical incidents, and report their information systems were useful. We found a negative correlation between listserv contribution and the number of face-to-face meetings and a physician as an active team member, but we found no relationship between team success and listserv contribution. Team listserv contribution was not associated with team success in multisite quality improvement efforts. Successful teams may be accessing information on the listserv but not sending a message to indicate use.

  19. Improved accounting of emissions from utility energy storage system operation

    SciTech Connect

    Paul Denholm; Tracey Holloway

    2005-12-01

    Several proposed utility-scale energy storage systems in the U.S. will use the spare output capacity of existing electric power systems to create the equivalent of new load-following plants that can rapidly respond to fluctuations in electricity demand and increase the flexibility of baseload generators. New energy storage systems using additional generation from existing plants can directly compete with new traditional sources of load-following and peaking electricity, yet this application of energy storage is not required to meet many of the Clean Air Act standards required of new electricity generators (e.g., coal- or gas-fired power plants). This study evaluates the total emissions that will likely result from the operation of a new energy storage facility when coupled with an average existing U.S. coal-fired power plant and estimates that the emission rates of SO{sub 2} and NOx will be considerably higher than the rate of a new plant meeting Clean Air Act standards, even accounting for the efficiency benefits of energy storage. This study suggests that improved emissions 'accounting' might be necessary to provide accurate environmental comparisons between energy storage and more traditional sources of electricity generation. 35 refs., 5 figs., 2 tabs.

  20. Improved accounting of emissions from utility energy storage system operation.

    PubMed

    Denholm, Paul; Holloway, Tracey

    2005-12-01

    Several proposed utility-scale energy storage systems in the U.S. will use the spare output capacity of existing electric power systems to create the equivalent of new load-following plants that can rapidly respond to fluctuations in electricity demand and increase the flexibility of baseload generators. New energy storage systems using additional generation from existing plants can directly compete with new traditional sources of load-following and peaking electricity, yet this application of energy storage is not required to meet many of the Clean Air Act standards required of new electricity generators (e.g., coal- or gas-fired power plants). This study evaluates the total emissions that will likely result from the operation of a new energy storage facility when coupled with an average existing U.S. coal-fired power plant and estimates that the emission rates of SO2 and NOx will be considerably higher than the rate of a new plant meeting Clean Air Act standards, even accounting for the efficiency benefits of energy storage. This study suggests that improved emissions "accounting" might be necessary to provide accurate environmental comparisons between energy storage and more traditional sources of electricity generation.

  1. Improved models for increasing wind penetration, economics and operating reliability

    NASA Astrophysics Data System (ADS)

    Schlueter, R. A.; Park, G. L.; Sigari, G.; Costi, T.

    1984-04-01

    The need for wind power prediction in order to enable larger wind power penetrations and improve the economics and reliability of power system operation is discussed. Methods for estimating turbulence and prediction of diurnal wind power prediction are reviewed. A method is presented to predict meteorological event induced wind power variation from measurements of wind speed at reference meteorological towers that encircle all wind turbine clusters and from sites within the wind turbine clusters. The methodology uses a recursive least squares model and requires: (1) detection of even propagation direction; and (2) determination of delays between groups of measurements at reference meteorological towers and those measurements at towers in the array. Proper filtering of the data and methods for switching reference sites and delays for the transition from one frontal system to another are also discussed. The performance of the prediction methodology on data sets from both sites was quite good and indicates one or more hour ahead prediction of wind power for meteorological events is feasible.

  2. Macromolecule Crystal Quality Improvement in Microgravity: The Role of Impurities

    NASA Technical Reports Server (NTRS)

    Judge, Russell A.; Snell, Edward H.; Pusey, Marc L.; Sportiello, Michael G.; Todd, Paul; Bellamy, Henry; Borgstahl, Gloria E.; Pokros, Matt; Cassanto, John M.

    2000-01-01

    While macromolecule impurities may affect crystal size and morphology the over-riding question is; "How do macromolecule impurities effect crystal X-ray quality and diffraction resolution?" In the case of chicken egg white lysozyme, crystals can be grown in the presence of a number of impurities without affecting diffraction resolution. One impurity however, the lysozyme dimer, does negatively impact the X-ray crystal properties. Crystal quality improvement as a result of better partitioning of this impurity during crystallization in microgravity has been reported'. In our recent experimental work dimer partitioning was found to be not significantly different between the two environments. Mosaicity analysis of pure crystals showed a reduced mosaicity and increased signal to noise for the microgravity grown crystals. Dimer incorporation however, did greatly reduce the resolution limit in both ground and microgravity grown crystals. These results indicate that impurity effects in microgravity are complex and may rely on the conditions or techniques employed.

  3. Asan Medical Information System for Healthcare Quality Improvement

    PubMed Central

    Ryu, Hyeon Jeong; Kim, Woo Sung; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

    2010-01-01

    Objectives This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Methods Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. Results AMIS consisted of several distinctive systems: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. Conclusions AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed. PMID:21818439

  4. Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.

    PubMed

    Ryan, Rosemary W; Harris, Karen K; Mattox, Lisa; Singh, Olivine; Camp, Melanie; Shirey, Maria R

    2015-01-01

    Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers' Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the "why," create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship. PMID:26049600

  5. Nursing Leader Collaboration to Drive Quality Improvement and Implementation Science.

    PubMed

    Ryan, Rosemary W; Harris, Karen K; Mattox, Lisa; Singh, Olivine; Camp, Melanie; Shirey, Maria R

    2015-01-01

    Nursing leadership opportunities to improve quality and align resources in health care exist. An estimated 18% of United States gross domestic product is spent on health care delivery systems that produce poor outcomes. The purpose of this article was to describe how quality improvement and implementation science initiatives enhance outcomes using nursing leadership strategies that play an integral role in aligning key colleagues to drive the collaborative process. A critical appraisal of the literature was conducted, which supports the importance of evidenced-based practice improvement, collaborative change process, and professional role of nursing leadership. Limited evidence exists related to practice strategies for nursing leaders to implement sustainable change at the unit level for successful alignment of resources. Strategies based on Rogers' Diffusion of Innovation Theory are recommended to address the gap in the literature. The strategies aim to increase meaningful knowledge or the "why," create a tipping point, and implement sustainable change starting with the end in mind. Nurse leaders are a central component for driving alignment and implementing change at the unit level. Uses of the described evidenced-based strategies have implications for nursing practice, education, and scholarship.

  6. Performance indicators: A tool for continuous quality improvement

    PubMed Central

    Bhatnagar, Nidhi M; Soni, Shital; Gajjar, Maitrey; Shah, Mamta; Shah, Sangita; Patel, Vaidehi

    2016-01-01

    Background: Performance monitoring is an important tool which can be used for setting priorities for process improvement. At our centre, we have been monitoring every step in the processes, right from inventory of consumables (both critical and routine) to number of donors reactive for TTI. We conducted a study to measure the impact of monitoring Performance Indicators and how it could be used as a tool for Continuous Quality Improvement (CQI). Materials and Methods: The present study was a retrospective study where the performance indicator (PI) data of blood bank was analyzed for over four years. For certain parameters, benchmarks or thresholds were set that represented warning limits or action limits. The yearly data were collated from monthly data. Shifts or Trends, if any, were identified and Corrective and Preventive Action (CAPA) taken accordingly. At the end, outcomes of the analysis were charted. Results: After the yearly data evaluation, outcomes obtained were used to plan, correct and amend processes and systems in the blood center. It was observed that the workload of the center showed an upward trend. This helped us to plan for the purchase of consumables and management of manpower. The monitoring of usage and discard of blood helped in the efficient management of blood stocks. The need for any new equipment could also be judged by the trends in workload. Conclusion: Performance indicators are indispensible tools which various stakeholders in the Blood Transfusion centres should implement to improve on quality performance. PMID:27011669

  7. Integrating health promotion with quality improvement in a Swedish hospital.

    PubMed

    Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese

    2016-09-01

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals.

  8. Integrating health promotion with quality improvement in a Swedish hospital.

    PubMed

    Astnell, Sandra; von Thiele Schwarz, Ulrica; Hasson, Henna; Augustsson, Hanna; Stenfors-Hayes, Terese

    2016-09-01

    Integration of workplace employee health promotion (HP) and occupational health and safety (OHS) work into organizational quality improvement systems is suggested as a way to strengthen HP and OHS activities in an organization. The aim of this article was to study what consequences integration of HP, OHS and a quality improvement system called kaizen has on the frequency and type of HP and OHS activities. A quasi-experimental study design was used where an integration of the three systems for HP, OHS respectively kaizen, was performed at six intervention units at a Swedish hospital. The remaining six units served as controls. Document analysis of all employees' written improvement suggestions (kaizen notes) during 2013 was conducted. The findings show that the intervention group had more suggestions concerning HP and OHS (n = 114) when compared with the control group (n = 78) and a greater variety of HP and OHS suggestions. In addition, only the intervention group had included HP aspects. In both groups, most kaizen notes with health consideration had a preventive focus rather than rehabilitative. The intervention, i.e. the integration of HP, OHS and kaizen work, had a favourable effect on HP and OHS work when compared with the controls. The results of the study support that this system can work in practice at hospitals. PMID:25983332

  9. Implementing Change in Perfusion Practice: Quality Improvement vs. Experimentation?

    PubMed Central

    Newland, Richard F.; Baker, Robert A.

    2009-01-01

    Abstract: The desire to optimize techniques and interventions that comprise clinical practice will inevitably involve the implementation of change in the process of care. To confirm the intended benefits of instituting clinical change, the process should be undertaken in a scientific manner. Although implementing changes in perfusion practice is limited by the availability of evidence based practice guidelines, we have the opportunity to audit our current practice according to institutional guidelines using quality improvement methods. Current electronic data collection technology is a useful tool available to facilitate the reporting of both clinical and process outcome improvements. The model of clinical effectiveness can be used as a systematic approach to introducing change in clinical practice, which involves reviewing the literature, acquiring appropriate skills and resources, auditing the change, and implementing continuous quality improvement to standardize the process. Finally, reporting the findings allows dissemination of the knowledge that can be generalized. Reporting change strengthens our efforts in clinical effectiveness, highlights the importance of perfusion practice, and increases the influence of the profession. PMID:20092082

  10. Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

    ERIC Educational Resources Information Center

    Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

    2010-01-01

    Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

  11. CPI (clinical practice improvement): improving quality and decreasing cost in managed care.

    PubMed

    Horn, S D

    1995-07-01

    The focus on quality has never been greater. As a result, a new concept, clinical practice improvement (CPI), is emerging. Clinical practice improvement is the application of the scientific method to the day-to-day practice of medicine and can be employed in all health care settings: inpatient or ambulatory, large or small. According to the author, CPI has proved to be effective in reducing costs and improving outcomes because it requires the committed support of clinicians who are involved directly in the process of designing studies, analyzing data, and developing more efficient forms of treatment in their own organizations. PMID:10143825

  12. TBDQ: A Pragmatic Task-Based Method to Data Quality Assessment and Improvement.

    PubMed

    Vaziri, Reza; Mohsenzadeh, Mehran; Habibi, Jafar

    2016-01-01

    Organizations are increasingly accepting data quality (DQ) as a major key to their success. In order to assess and improve DQ, methods have been devised. Many of these methods attempt to raise DQ by directly manipulating low quality data. Such methods operate reactively and are suitable for organizations with highly developed integrated systems. However, there is a lack of a proactive DQ method for businesses with weak IT infrastructure where data quality is largely affected by tasks that are performed by human agents. This study aims to develop and evaluate a new method for structured data, which is simple and practical so that it can easily be applied to real world situations. The new method detects the potentially risky tasks within a process, and adds new improving tasks to counter them. To achieve continuous improvement, an award system is also developed to help with the better selection of the proposed improving tasks. The task-based DQ method (TBDQ) is most appropriate for small and medium organizations, and simplicity in implementation is one of its most prominent features. TBDQ is case studied in an international trade company. The case study shows that TBDQ is effective in selecting optimal activities for DQ improvement in terms of cost and improvement. PMID:27192547

  13. TBDQ: A Pragmatic Task-Based Method to Data Quality Assessment and Improvement

    PubMed Central

    Vaziri, Reza; Mohsenzadeh, Mehran; Habibi, Jafar

    2016-01-01

    Organizations are increasingly accepting data quality (DQ) as a major key to their success. In order to assess and improve DQ, methods have been devised. Many of these methods attempt to raise DQ by directly manipulating low quality data. Such methods operate reactively and are suitable for organizations with highly developed integrated systems. However, there is a lack of a proactive DQ method for businesses with weak IT infrastructure where data quality is largely affected by tasks that are performed by human agents. This study aims to develop and evaluate a new method for structured data, which is simple and practical so that it can easily be applied to real world situations. The new method detects the potentially risky tasks within a process, and adds new improving tasks to counter them. To achieve continuous improvement, an award system is also developed to help with the better selection of the proposed improving tasks. The task-based DQ method (TBDQ) is most appropriate for small and medium organizations, and simplicity in implementation is one of its most prominent features. TBDQ is case studied in an international trade company. The case study shows that TBDQ is effective in selecting optimal activities for DQ improvement in terms of cost and improvement. PMID:27192547

  14. Telemetry packetization for improved mission operations. [instrument packages for Space Shuttle mission operations data management

    NASA Technical Reports Server (NTRS)

    Greene, E. P.

    1976-01-01

    The requirements for mission-operations data management will accelerate sharply when the Space Transportation System (i.e., Space Shuttle) becomes the primary vehicle for research from space. These demands can be satisfied most effectively by providing a higher-level source encoding function within the spaceborne vehicle. An Instrument Telemetry Packet (ITP) concept is described which represents an alternative to the conventional multiplexed telemetry frame approach for acquiring spaceborne instrument data. By providing excellent data-integrity protection at the source and a variable instrument bandwidth capability, this ITP concept represents a significant improvement over present data acquisition procedures. Realignments in the ground telemetry processing functions are described which are intended to take advantage of the ITP concept and to make the data management system more responsive to the scientific investigators.

  15. Does pre-operative physiotherapy improve outcomes from lower limb joint replacement surgery? A systematic review.

    PubMed

    Ackerman, Ilana N; Bennell, Kim L

    2004-01-01

    A systematic review of randomised controlled trials was performed to evaluate the effectiveness of pre-operative physiotherapy programmes on outcome following lower limb joint replacement surgery. A search of relevant key terms was used to find suitable trials, with five papers meeting the inclusion criteria for the review. The methodological quality of the trials was rated using the PEDro scale. Estimates of the size of treatment effects were calculated for each outcome in each trial, with 95% confidence intervals calculated where sufficient data were provided. Of the three trials pertaining to total knee replacement, only very small mean differences were found between control and intervention groups for all of the outcome measures. Where confidence intervals could be calculated, these showed no clinically important differences between the groups. Two papers (one study) pertaining to total hip replacements found significant improvements in WOMAC scores, hip strength and range of movement, walking distance, cadence, and gait velocity for the intervention group, compared to a control group. Estimates of treatment effect sizes for these outcomes were larger than for the total knee replacement studies, with confidence intervals showing potentially clinically important differences between group means. However, as the intervention group also received an additional intensive post-operative physiotherapy program, these results cannot be attributed solely to the pre-operative program. This systematic review shows that pre-operative physiotherapy programmes are not effective in improving outcome after total knee replacement but their effect on outcome from total hip replacement cannot be adequately determined.

  16. Can mental healthcare nurses improve sleep quality for inpatients?

    PubMed

    de Niet, Gerrit; Tiemens, Bea; Hutschemaekers, Giel

    This article describes a pilot study that was carried out to in order to gain an indication as to whether mental healthcare nurses can apply evidence-based interventions for sleep problems effectively in inpatient mental health care. The study had a pre-test/post-test design and a comparison group was used. The study was performed on three psychiatric admission wards, located in three different towns in one province of The Netherlands. The participants were inpatients (18-60 years old) admitted owing to severe mental health problems like psychotic, mood or anxiety disorders. Of the newly admitted patients, 62.8% perceived having a sleep problem. Two brief, evidence-based interventions were introduced on two of the wards: the first with stimulus control (SC) as active component; the second with music-assisted relaxation (MAR). A third ward, with no interventions other than usual care, served as a point of comparison. Sleep quality was monitored using the Richards-Campbell Sleep Questionnaire (RCSQ). The change score means of the treatment groups were compared with the mean score of the comparison group by means of a t-test. Estimates of effect were calculated. The results of this study showed that MAR produced a statistically significant improvement of sleep quality and showed a large effect size. The total RCSQ score did not improve significantly. SC failed to produce statistically significant improvement of sleep quality, nor of the RCSQ total score. This pilot study provided a strong indication that mental health nurses can apply MAR effectively. No such indication was found for stimulus control. PMID:20871513

  17. Use of Pressure Activation in Food Quality Improvement.

    PubMed

    Shigematsu, Toru

    2015-01-01

    Beside intensive studies on inactivation microorganisms by high hydrostatic pressure (HP) for food storage, pressure effects on property of food materials have also been studied based on knowledge in pressure effect on biomolecules. Pressure effects on biological membranes and mass transfer in cellular biological materials and on enzyme activity would give an idea that HP treatment can introduce two types of activations into food materials: improved mass transfer and enzyme activity. Studies focusing on these pressure activations on food materials were then reviewed. Rice flour with an exclusively fine mean particle size and small starch damage was obtained due to improved water absorption properties and/or enzyme activity by HP. HP treatment increased of free amino acids and γ-aminobutyric acid (GABA) in rice and soybeans due to improved proteolysis and amino acid metabolism. Improvement of antioxidant activity and alteration of polyphenolic-compounds composition in food materials were also demonstrated by HP treatment. The HP-induced activations on food materials could contribute towards processing technologies for food quality improvement.

  18. Sleep Quality Improves During Treatment With Bryophyllum pinnatum

    PubMed Central

    Hassani, Taziri Al; Müller-Hübenthal, Boris; Pittl, Sandra; Kuck, Angela; Meden, Harald; Eberhard, Jutta; Decker, Michael; Fürer, Karin; von Mandach, Ursula

    2015-01-01

    Hypothesis. Cancer patients frequently suffer from poor sleep quality. Bryophyllum pinnatum is a herbal medication used in anthroposophic medicine, which has been shown to be associated with improvements in sleep quality during pregnancy with only few and minor or moderate side-effects reported. In this study, the sleep quality of cancer patients during treatment with B pinnatum was investigated. Study Design. In this prospective, observational study, cancer patients suffering from sleep problems were treated with B pinnatum (350 mg tablets, corresponding to 50% of leaf pressed juice [Weleda AG, Arlesheim, Switzerland], dosage at physician’s consideration, but most frequently 2 tablets with evening meal and 2 before going to bed). Methods. Sleep quality (Pittsburgh Sleep Quality Index [PSQI]), daily sleepiness (Epworth Sleeping Scale [ESS]), and fatigue (Fatigue Severity Scale [FSS]) were assessed at the beginning of the treatment and after 3 weeks. Possible adverse drug reactions perceived by the patients during the treatment were recorded. From the 28 recruited patients, 20 completed both questionnaires and were considered in the present analysis. Data are expressed as mean ± standard deviation. Results. Patients were 61 ± 10.4 years old and the majority were female (17 out of 20). During treatment with B pinnatum, the PSQI decreased from 12.2 ± 3.62 to 9.1 ± 3.61 (P < .01), and ESS changed from 8.4 ± 3.18 to 7.1 ± 3.98 (P < .05). There was no change in FSS. The treatment was well tolerated by the majority of patients, with only 6 patients reporting discomfort that might have been caused by B pinnatum (fatigue n = 3, dry throat n = 1, agitation n = 1, difficult digestion n = 1). No serious adverse drug reactions were detected. Conclusion. B pinnatum may be a suitable treatment for sleep problems of cancer patients. Controlled, randomized clinical trials of the use of B pinnatum in sleep disorders are urgently needed. PMID:25873294

  19. Innovative Tools for Water Quality/Quantity Management: New York City's Operations Support Tool

    NASA Astrophysics Data System (ADS)

    Wang, L.; Schaake, J. C.; Day, G. N.; Porter, J.; Sheer, D. P.; Pyke, G.

    2011-12-01

    statistical algorithm is a relatively simple and versatile, but lacks short-term skill critical for water quality and spill management. To improve short-term skill, OST will ultimately operate with meteorologically driven hydrologic forecasts provided by the National Weather Service (NWS). OST functionalities will support a wide range of DEP uses, including short term operational projections, outage planning and emergency management, operating rule development, and water supply planning. A core use of OST will be to inform reservoir management strategies to control and mitigate turbidity events while ensuring water supply reliability. OST will also allow DEP to manage its complex reservoir system to meet multiple objectives, including ecological flows, tailwater fisheries and recreational releases, and peak flow mitigation for downstream communities.

  20. Improving Forecast Skill by Assimilation of Quality Controlled AIRS Version 5 Temperature Soundings

    NASA Technical Reports Server (NTRS)

    Susskind, Joel; Reale, Oreste

    2009-01-01

    The AIRS Science Team Version 5 retrieval algorithm has been finalized and is now operational at the Goddard DAAC in the processing (and reprocessing) of all AIRS data. The AIRS Science Team Version 5 retrieval algorithm contains two significant improvements over Version 4: 1) Improved physics allows for use of AIRS observations in the entire 4.3 micron CO2 absorption band in the retrieval of temperature profile T(p) during both day and night. Tropospheric sounding 15 micron CO2 observations are now used primarily in the generation of cloud cleared radiances R(sub i). This approach allows for the generation of accurate values of R(sub i) and T(p) under most cloud conditions. 2) Another very significant improvement in Version 5 is the ability to generate accurate case-by-case, level-by-level error estimates for the atmospheric temperature profile, as well as for channel-by-channel error estimates for R(sub i). These error estimates are used for Quality Control of the retrieved products. We have conducted forecast impact experiments assimilating AIRS temperature profiles with different levels of Quality Control using the NASA GEOS-5 data assimilation system. Assimilation of Quality Controlled T(p) resulted in significantly improved forecast skill compared to that obtained from analyses obtained when all data used operationally by NCEP, except for AIRS data, is assimilated. We also conducted an experiment assimilating AIRS radiances uncontaminated by clouds, as done operationally by ECMWF and NCEP. Forecast resulting from assimilated AIRS radiances were of poorer quality than those obtained assimilating AIRS temperatures.

  1. Making quality improvement stick and stay: Two lines of insurance.

    PubMed

    Weaver, Lynda; Bossé, Isabelle; Sinclair, Dionne; Blais, Bernard; Pereira, José

    2016-01-01

    This article examines issues related to sustaining Quality Improvement (QI) initiatives in a Canadian subacute care hospital and recommends strategies to address them. The authors define two levels of sustainability, the QI project and the corporate/organizational and how they influence a LEADS (Lead Self, Engage Others, Achieve Results, Develop Coalition and System Transformation) culture. The authors then reflect on the differing factors for QI sustainability and present them under five essential categories of accountability, education, communication, monitoring and reporting, and structure and processes. PMID:26656388

  2. Reliably Addressing "What Matters" Through a Quality Improvement Process.

    PubMed

    Rutherford, Patricia A

    2016-02-01

    Oncology nurses have a critical role in mitigating the intense vulnerability, loss of control, and fear of the unknown that characterizes the experiences of patients with cancer and their family members. Reliably inquiring about the issues that are at the forefront for patients and their loved ones can encourage a deeper dialogue-where nurses can understand and address the issues that are most important to them. A practical quality improvement approach can help to ensure that processes are in place to assist nurses in devoting time to reliably inquire about "what matters" to each patient at every encounter.

  3. Learning leadership skills in practice through quality improvement.

    PubMed

    Gamble, James; Vaux, Emma

    2014-02-01

    The development of leadership skills in doctors in training is essential to support both their professional development and the future supply of clinical leaders the NHS so desperately needs. There is, however, limited opportunity in current training programmes for trainees to learn and develop these skills, and what opportunity there is has often focused on management rather than leadership skills. Involvement in trainee-led supported quality improvement projects can teach these skills. We summarise the current limitations in leadership training and discuss how the College's 'Learning To Make a Difference' programme, and others like it, are helping to teach leadership.

  4. Independent component analysis for improving the quality of interferometric products

    NASA Astrophysics Data System (ADS)

    Saqellari Likoka, A.; Vafeiadi-Bila, E.; Karathanassi, V.

    2016-05-01

    The accuracy of InSAR DEMs is affected by the temporal decorrelation of SAR images which is due to atmosphere, land use/cover, soil moisture, and roughness changes. Elimination of the temporal decorrelation of the master and slave image improves the DEMs accuracy. In this study, the Independent Component Analysis was applied before interferometric process. It was observed that using three ICA entries, ICA independent sources can be interpreted as background and changed images. ICA when performed on the master and slave images using the same couple of additional images produces two background images which enable the production of high quality DEMs. However, limitations exist in the proposed approach.

  5. Making quality improvement stick and stay: Two lines of insurance.

    PubMed

    Weaver, Lynda; Bossé, Isabelle; Sinclair, Dionne; Blais, Bernard; Pereira, José

    2016-01-01

    This article examines issues related to sustaining Quality Improvement (QI) initiatives in a Canadian subacute care hospital and recommends strategies to address them. The authors define two levels of sustainability, the QI project and the corporate/organizational and how they influence a LEADS (Lead Self, Engage Others, Achieve Results, Develop Coalition and System Transformation) culture. The authors then reflect on the differing factors for QI sustainability and present them under five essential categories of accountability, education, communication, monitoring and reporting, and structure and processes.

  6. Improving HIV outcomes in resource-limited countries: the importance of quality indicators

    PubMed Central

    2012-01-01

    Background Resource-limited countries increasingly depend on quality indicators to improve outcomes within HIV treatment programs, but indicators of program performance suitable for use at the local program level remain underdeveloped. Methods Using the existing literature as a guide, we applied standard quality improvement (QI) concepts to the continuum of HIV care from HIV diagnosis, to enrollment and retention in care, and highlighted critical service delivery process steps to identify opportunities for performance indicator development. We then identified existing indicators to measure program performance, citing examples used by pivotal donor agencies, and assessed their feasibility for use in surveying local program performance. Clinical delivery steps without existing performance measures were identified as opportunities for measure development. Using National Quality Forum (NQF) criteria as a guide, we developed measurement concepts suitable for use at the local program level that address existing gaps in program performance assessment. Results This analysis of the HIV continuum of care identified seven critical process steps providing numerous opportunities for performance measurement. Analysis of care delivery process steps and the application of NQF criteria identified 24 new measure concepts that are potentially useful for improving operational performance in HIV care at the local level. Conclusion An evidence-based set of program-level quality indicators is critical for the improvement of HIV care in resource-limited settings. These performance indicators should be utilized as treatment programs continue to grow. PMID:23176556

  7. Air Quality in Mexico City: Policies Implemented for its Improvement

    NASA Astrophysics Data System (ADS)

    Paramo, V.

    2007-12-01

    Ozone and suspended particles (PM) are two pollutants in the atmosphere of Mexico City Metropolitan Area (MCMA) that still exceed the recommended Mexican health standards. The other criteria pollutants very seldom exceed their corresponding standards. In 2006, the maximum ozone concentrations were above the health standard (0.11 ppm in 1 hour) during 59 percent of the days for an average of 2.2 hours and 130 points of the Air Quality Index (Índice Metropolitano de la Calidad del Aire - IMECA). In contrast, in 1991, 98 percent of the days exceeded the ozone health standard for an average of 6.6 hours and 200 IMECA points. With regards to PM10, in 2006, 80 percent of the sampled concentrations were below the health standard of 120 µg/m3 in 24 hours. However, the annual health standard of 50 µg/m3 is still exceeded. The air quality management in the MCMA is a difficult task due to several adverse factors. The main one is the large population that increased from nearly 15 million in 1992 to more than 18 million at present. As a result, the urban area grows in the adjoined municipalities of the State of Mexico. The vehicular fleet increases also to almost 4 million and the number of industrial facilities is at present 50,000. Consequently, the fuel consumption is very high. The daily energy consumption is estimated to be 44 million liters of equivalent of gasoline. Despite the fact that the air quality has improved in recent years, the related health standards are still exceeded and therefore it is necessary to continue applying the most cost-effective actions to improve the environment quality. Some actions that have contributed most to the reduction of pollutant emissions are the following: Continuous update of the inspection and maintenance program of the vehicular fleet; substitution of the catalytic converters at the end of their useful life; self-regulation of the diesel fleet; use of alternative fuels; update the No-Driving-Day program; establishment of more

  8. Multi-hospital Community NICU Quality Improvement Improves Survival of ELBW Infants.

    PubMed

    Owens, Jack D; Soltau, Thomas; McCaughn, Danny; Miller, Jason; O'Mara, Patrick; Robbins, Kenny; Temple, David M; Wender, David F

    2015-08-01

    Quality improvement or high reliability in medicine is an evolving science where we seek to integrate evidence-based medicine, structural resources, process management, leadership models, culture, and education. Newborn Associates is a community-based neonatology practice that staffs and manages neonatal intensive care units (NICU's) at Central Mississippi Medical Center, Mississippi Baptist Medical Center, River Oaks Hospital, St Dominic's Hospital and Woman's Hospital within the Jackson, Mississippi, metropolitan area. These hospitals participate in the Vermont-Oxford Neonatal Network (VON), which is a voluntary national network of about 1000 NICU groups that submit data allowing them to benchmark their patient outcome. This network currently holds data on 1.5 million infants. Participation may also include the Newborn Improvement Quality Collaborative (NICQ) which is an intensive quality improvement program where 40-60 of the almost 1000 VON centers participate each year or the iNICQ, which is an internet-based collaborative involving about 150 centers per year. From 2008-2009, our group concentrated efforts on quality improvement which included consolidating resources of three corporately managed hospitals to allow focused care of babies under 800-1000 grams at a single center, expanding participation in the VON NICQ to include all physicians and centers, and establishing a group QI focused committee aimed at sharing practice bundles and adopting quality improvement methodology. The goal of this article is to report the impact of these QI activities on survival of the smallest preterm infants who weigh less than 1500 grams at birth. Two epochs were compared: 2006-2009, and 2010-2013. 551 VLBW (< 1 500 grams) infants from epoch I were compared to 583 VLBW infants from epoch 2. Mortality in this group decreased from 18% to 11.1% (OR 0.62,95% CI 0.44-0.88). Mortality in the 501-750 grams birth weight category decreased from 45.7% to 18% (OR 0.39,95% CI 0

  9. Multi-hospital Community NICU Quality Improvement Improves Survival of ELBW Infants.

    PubMed

    Owens, Jack D; Soltau, Thomas; McCaughn, Danny; Miller, Jason; O'Mara, Patrick; Robbins, Kenny; Temple, David M; Wender, David F

    2015-08-01

    Quality improvement or high reliability in medicine is an evolving science where we seek to integrate evidence-based medicine, structural resources, process management, leadership models, culture, and education. Newborn Associates is a community-based neonatology practice that staffs and manages neonatal intensive care units (NICU's) at Central Mississippi Medical Center, Mississippi Baptist Medical Center, River Oaks Hospital, St Dominic's Hospital and Woman's Hospital within the Jackson, Mississippi, metropolitan area. These hospitals participate in the Vermont-Oxford Neonatal Network (VON), which is a voluntary national network of about 1000 NICU groups that submit data allowing them to benchmark their patient outcome. This network currently holds data on 1.5 million infants. Participation may also include the Newborn Improvement Quality Collaborative (NICQ) which is an intensive quality improvement program where 40-60 of the almost 1000 VON centers participate each year or the iNICQ, which is an internet-based collaborative involving about 150 centers per year. From 2008-2009, our group concentrated efforts on quality improvement which included consolidating resources of three corporately managed hospitals to allow focused care of babies under 800-1000 grams at a single center, expanding participation in the VON NICQ to include all physicians and centers, and establishing a group QI focused committee aimed at sharing practice bundles and adopting quality improvement methodology. The goal of this article is to report the impact of these QI activities on survival of the smallest preterm infants who weigh less than 1500 grams at birth. Two epochs were compared: 2006-2009, and 2010-2013. 551 VLBW (< 1 500 grams) infants from epoch I were compared to 583 VLBW infants from epoch 2. Mortality in this group decreased from 18% to 11.1% (OR 0.62,95% CI 0.44-0.88). Mortality in the 501-750 grams birth weight category decreased from 45.7% to 18% (OR 0.39,95% CI 0

  10. Improvement of the environmental and operational characteristics of vehicles through decreasing the motor fuel density.

    PubMed

    Magaril, Elena

    2016-04-01

    The environmental and operational characteristics of motor transport, one of the main consumers of motor fuel and source of toxic emissions, soot, and greenhouse gases, are determined to a large extent by the fuel quality which is characterized by many parameters. Fuel density is one of these parameters and it can serve as an indicator of fuel quality. It has been theoretically substantiated that an increased density of motor fuel has a negative impact both on the environmental and operational characteristics of motor transport. The use of fuels with a high density leads to an increase in carbonization within the engine, adversely affecting the vehicle performance and increasing environmental pollution. A program of technological measures targeted at reducing the density of the fuel used was offered. It includes a solution to the problem posed by changes in the refining capacities ratio and the temperature range of gasoline and diesel fuel boiling, by introducing fuel additives and adding butanes to the gasoline. An environmental tax has been developed which allows oil refineries to have a direct impact on the production of fuels with improved environmental performance, taking into account the need to minimize the density of the fuel within a given category of quality. PMID:26662790

  11. Improvement of the environmental and operational characteristics of vehicles through decreasing the motor fuel density.

    PubMed

    Magaril, Elena

    2016-04-01

    The environmental and operational characteristics of motor transport, one of the main consumers of motor fuel and source of toxic emissions, soot, and greenhouse gases, are determined to a large extent by the fuel quality which is characterized by many parameters. Fuel density is one of these parameters and it can serve as an indicator of fuel quality. It has been theoretically substantiated that an increased density of motor fuel has a negative impact both on the environmental and operational characteristics of motor transport. The use of fuels with a high density leads to an increase in carbonization within the engine, adversely affecting the vehicle performance and increasing environmental pollution. A program of technological measures targeted at reducing the density of the fuel used was offered. It includes a solution to the problem posed by changes in the refining capacities ratio and the temperature range of gasoline and diesel fuel boiling, by introducing fuel additives and adding butanes to the gasoline. An environmental tax has been developed which allows oil refineries to have a direct impact on the production of fuels with improved environmental performance, taking into account the need to minimize the density of the fuel within a given category of quality.

  12. The practical problem of improving quality in multicenter dialysis facilities.

    PubMed

    Balter, Paul

    2003-01-01

    Multifacility dialysis groups are frequently interested in improving overall quality and find that there are major differences between individual units. Upper management must consider what strategy is needed for the whole company and what strategy must be formulated by individual facilities. To make substantive changes, management must decide to adopt a new culture of true teamwork, drive out fear, and emphasize leadership and education both at the management level and in the individual unit. Both at the corporate and unit levels, leaders must be chosen who are able to recognize people who have the ability, the educational background, the enthusiasm, and the time to direct change. Empowering the individual units and individual employees to make changes and be enthusiastic about improvement is the key to success. PMID:14629606

  13. Improving Reports Turnaround Time: An Essential Healthcare Quality Dimension.

    PubMed

    Khan, Mustafa; Khalid, Parwaiz; Al-Said, Youssef; Cupler, Edward; Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Turnaround time is one of the most important healthcare performance indicators. King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia worked on reducing the reports turnaround time of the neurophysiology lab from more than two weeks to only five working days for 90% of cases. The main quality improvement methodology used was the FOCUS PDCA. Using root cause analysis, Pareto analysis and qualitative survey methods, the main factors contributing to the delay of turnaround time and the suggested improvement strategies were identified and implemented, through restructuring transcriptionists daily tasks, rescheduling physicians time and alerting for new reports, engaging consultants, consistent coordination and prioritizing critical reports. After implementation; 92% of reports are verified within 5 days compared to only 6% before implementation. 7% of reports were verified in 5 days to 2 weeks and only 1% of reports needed more than 2 weeks compared to 76% before implementation. PMID:27350505

  14. Balancing stakeholder needs in the evaluation of healthcare quality improvement

    PubMed Central

    Leviton, Laura C; Melichar, Lori

    2016-01-01

    Quality improvement (QI) efforts affect a broader range of people than we often assume. These are the potential stakeholders for QI and its evaluation, and they have valuable perspectives to offer when they are consulted in planning, conducting and interpreting evaluations. QI practitioners are accustomed to consulting stakeholders to assess unintended consequences or assess patient experiences of care, but in many cases there are additional benefits to a broad inclusion of stakeholders. These benefits are better adherence to ethical standards, to assure that all legitimate interests take part, more useful and relevant evaluation information and better political buy-in to improve impact. Balancing various stakeholder needs for information requires skill for both politics and research management. These challenges have few pat answers, but several preferred practices, which are illustrated with practical examples. PMID:26893512

  15. Improving Efficiency and Quality in a Computerized ICU

    PubMed Central

    Bradshaw, Karen E.; Sittig, Dean F.; Gardner, Reed M.; Pryor, T. Allan; Budd, Marge

    1988-01-01

    Ongoing efforts have been made to improve the efficiency and quality of care available in ICU's at LDS Hospital. ICU's have been computerized, and patient data collection, storage and presentation have been improved. Nurse care plans and charting have been computerized, and effects of these changes have been evaluated. Work sampling studies showed a decrease in direct patient care (49.1% to 43.2%) and an increase in nurse charting (18.2% to 24.2%) after implementation of computerized nurse charting. These changes were accounted for by a decrease in patient severity of illness. Implementation of the computerized nurse charting system had no significant impact on daily ICU nursing activities. Time savings are not automatic, but could be realized through management practices designed to maximize benefits of the nurse charting system and to make best use of available nursing resources.

  16. Quality assurance and improvement: the Pediatric Regional Anesthesia Network.

    PubMed

    Polaner, David M; Martin, Lynn D

    2012-01-01

    Quality assurance and improvement (QA/QI) is a critical activity in medicine. The use of large-scale collaborative databases is increasingly essential to obtain enough reports with which to establish standards of practice and define the incidence of complications and risk/benefit ratios for rare events. Such projects can enhance local QA/QI endeavors by enabling institutions to obtain benchmark data against which to compare their performance and can be used for prospective analyses of inter-institutional differences to determine 'best practice'. The pediatric regional anesthesia network (PRAN) is such a project. The first data cohort is currently being analyzed and offers insight into how such data can be used to detect trends in adverse events and improve care.

  17. All teach, all learn, all improve?: The role of interorganizational learning in quality improvement collaboratives

    PubMed Central

    Nembhard, Ingrid M.

    2016-01-01

    Background Quality improvement collaboratives are an increasingly common strategy for implementing evidence-based practices in health care. However, research shows that many participating organizations do not achieve the level of performance improvement desired. Purpose This study examined the use of interorganizational learning activities (inter-OLAs) as an explanation for mixed performance improvement among collaborative participants. We tested the hypotheses that inter-OLA use is positively associated with participants’ performance improvement and that this relationship is moderated by the use of intraorganizational learning activities (intra-OLAs) and quality-focused human resource (Q-HR) practices. Methodology We conducted a survey of organizational teams participating in 4 Institute for Healthcare Improvement Breakthrough Series collaboratives. Survey responses from 52 teams, regarding the use of inter-OLAs, intra-OLAs and Q-HR practices, were linked to performance improvement data obtained from the Institute for Healthcare Improvement and demographic data obtained from secondary sources. Findings The more collaborative teams used inter-OLAs, the more their organizations’ performance improved. Contrary to our hypothesis, the use of intra-OLAs did not moderate this relationship; teams’ use of intra-OLAs added to, but did not multiply, the effect of inter-OLA use. In contrast, an organization's use of Q-HR practices multiplied the performance benefit of inter-OLA use. Practice Implications Our findings suggest that organizations that participate in collaboratives are more likely to improve their performance if they use the inter-OLAs offered by the collaborative. Our results also suggest that complementing high use of inter-OLAs with intra-OLA use and Q-HR practices enhances performance improvement. For collaborative sponsors, our findings imply that including activities that facilitate interorganizational and intraorganizational learning are worthwhile

  18. Receiver operating characteristic analysis improves diagnosis by radionuclide ventriculography

    SciTech Connect

    Dickinson, C.Z.; Forman, M.B.; Vaugh, W.K.; Sandler, M.P.; Kronenberg, M.W.

    1985-05-01

    Receiver operating characteristic analysis (ROC) evaluates continuous variables to define diagnostic criteria for the optimal sensitivity (SENS) and specificity (SPEC) of a test. The authors studied exercise-induced chest pain (CP), ST-changes on electrocardiography (ECG) and rest-exercise gated radionuclide ventriculography (RVG) using ROC to clarify the optimal criteria for detecting myocardial ischemia due to coronary artherosclerosis (CAD). The data of 95 consecutive patients studied with coronary angiography, rest-exercise RVG and ECG were reviewed. 77 patients had ''significant'' CAD (greater than or equal to50% lesions). Exercise-induced CP, ECG abnormalities (ST-T shifts) and RVG abnormalities (change in ejection fraction, 2-view regional wall motion change and relative end-systolic volume) were evaluated to define optimal SENS/SPEC of each and for the combined data. ROC curves were constructed by multiple logistic regression (MLR). By MLR, RVG alone was superior to ECG and CP. The combination of all three produced the best ROC curve for the entire group and for clinical subsets based on the number of diseased vessels and the presence or absence of prior myocardial infarction. When CP, ECG and RVG were combined, the optimal SENS/SPEC for detection of single vessel disease was 88/86. The SENS/SPEC for 3 vessel disease was 93/95. Thus, the application of RVG for the diagnosis of myocardial ischemia is improved with the inclusion of ECG and CP data by the use of a multiple logistic regression model. ROC analysis allows clinical application of multiple data for diagnosing CAD at desired SENS/SPEC rather than by arbitrary single-standard criteria.

  19. Applying Quality Function Deployment Model in Burn Unit Service Improvement.

    PubMed

    Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

    2016-01-01

    Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives.

  20. Applying Quality Function Deployment Model in Burn Unit Service Improvement.

    PubMed

    Keshtkaran, Ali; Hashemi, Neda; Kharazmi, Erfan; Abbasi, Mehdi

    2016-01-01

    Quality function deployment (QFD) is one of the most effective quality design tools. This study applies QFD technique to improve the quality of the burn unit services in Ghotbedin Hospital in Shiraz, Iran. First, the patients' expectations of burn unit services and their priorities were determined through Delphi method. Thereafter, burn unit service specifications were determined through Delphi method. Further, the relationships between the patients' expectations and service specifications and also the relationships between service specifications were determined through an expert group's opinion. Last, the final importance scores of service specifications were calculated through simple additive weighting method. The findings show that burn unit patients have 40 expectations in six different areas. These expectations are in 16 priority levels. Burn units also have 45 service specifications in six different areas. There are four-level relationships between the patients' expectations and service specifications and four-level relationships between service specifications. The most important burn unit service specifications have been identified in this study. The QFD model developed in the study can be a general guideline for QFD planners and executives. PMID:23884047

  1. The HIV specialist improves quality of care and outcomes.

    PubMed

    Valenti, William M

    2002-05-01

    HAART has raised the bar for standards of care for HIV/AIDS. As patient outcomes improve, efforts are under way to address the infrastructure needed to continue to provide high-quality HIV care. Standards of care and treatment guidelines are updated regularly in an effort to keep up with our rapidly evolving understanding of HIV medicine. Two professional organizations have been formed in the past several years to address the needs of HIV care providers and patients. While there is slight variation between the 2 groups, both organizations define the HIV specialist in terms of clinical experience and continuing education and recognize that HIV care providers are a diverse group committed to managing this critical and constantly evolving epidemic. Several states have also developed initiatives that address the importance of health care quality and outcomes for people with HIV/AIDS. New York and California lead the way, and surely other states will follow. To ensure quality of care and continued good outcomes for our patients, managed care organizations and other providers of HIV care can now measure their own competence against these existing standards. PMID:12056114

  2. Evaluation and measurement for improvement in service-level quality improvement initiatives.

    PubMed

    Russell, Nicholas C C; Wallace, Louise M; Ketley, Diane

    2011-11-01

    The National Health Service (NHS) in England, as with other health services worldwide, currently faces the need to reduce costs and to improve the quality of patient care. Evidence gathered through effective and appropriate measurement and evaluation, is essential to achieving this. Through interviews with service improvement managers and analysis of comments in a seminar of NHS staff involved in health service improvement, we found a lack of understanding regarding the definition and methodology of both measurement and evaluation, which decreases the likelihood that NHS staff will be competent to commission or provide these skills. In addition, we highlight the importance of managers assessing their organizations' 'readiness' to undergo change before embarking on a quality improvement (QI) initiative, to ensure that the initiative's impact can be adequately judged. We provide definitions of measurement for improvement and of evaluation, and propose a comparative framework from which to gauge an appropriate approach. Examples of two large-scale QI initiatives are also given, along with descriptions of some of their problems and solutions, to illustrate the use of the framework. We recommend that health service managers use the framework to determine the most appropriate approach to evaluation and measurement for improvement for their context, to ensure that their decisions are evidence based.

  3. SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence)

    PubMed Central

    Ogrinc, Greg; Davies, Louise; Goodman, Daisy; Batalden, Paul; Davidoff, Frank; Stevens, David

    2015-01-01

    In the past several years, the science of health care improvement has advanced considerably. In this article, we describe the development of SQUIRE 2.0 and its key components. We undertook the revision between 2012 and 2015 using (1) interviews and focus groups to evaluate SQUIRE 1.0 plus feedback from an international steering group, (2) face-to-face consensus meetings to develop interim drafts, and (3) pilot testing with authors and a public comment period. SQUIRE 2.0 emphasizes 3 key components of systematic efforts to improve the quality, value, and safety of health care: formal and informal theory in planning, implementing, and evaluating improvement work; the context in which the work is done; and the study of the intervention(s). SQUIRE 2.0 is intended for reporting the range of methods used to improve health care, recognizing that they can be complex and multidimensional. It provides common ground to share these discoveries in the scholarly literature (www.squire-statement.org). PMID:26497490

  4. Health benefits of improving air quality in Taiyuan, China.

    PubMed

    Tang, Deliang; Wang, Cuicui; Nie, Jiesheng; Chen, Renjie; Niu, Qiao; Kan, Haidong; Chen, Bingheng; Perera, Frederica

    2014-12-01

    Since 2000, the government in Shanxi province has mounted several initiatives and mandated factory shutdowns with the goal of reducing coal burning emissions and the environmental impacts of industrialization. We estimated the health benefits associated with air quality improvement from 2001 to 2010 in Taiyuan, Shanxi Province, using disability-adjusted life years (DALYs) and monetized the health benefits using value of statistical life (VOSL). Data were collected on annual average concentrations of particulate matter less than 10 μm in aerodynamic diameter (PM10) and relevant health outcomes in Taiyuan from 2001 to 2010. Selected exposure-response functions were used to calculate the cases of death or disease attributable to PM10 annually over a 10-year period. These were summed to calculate the DALYs lost and their monetary value associated with PM10 each year between 2001 and 2010. Air quality improvement from 2001 to 2010 was estimated to have prevented 2810 premature deaths, 951 new cases of chronic bronchitis, 141,457 cases of outpatient visits, 969 cases of emergency-room visits and 31,810 cases of hospital admissions. The DALYs (VOSL) decreased by 56.92% (52.68%) from 52,937 (7274 million Yuan) in 2001 to 22,807 (3442 million Yuan) in 2010. Premature deaths accounted for almost 95% of the total DALYs. Our analysis demonstrates that air pollution abatement during the last decade in Taiyuan has generated substantial health benefits. PMID:25168129

  5. Method to improve optical parametric oscillator beam quality

    DOEpatents

    Smith, Arlee V.; Alford, William J.; Bowers, Mark S.

    2003-11-11

    A method to improving optical parametric oscillator (OPO) beam quality having an optical pump, which generates a pump beam at a pump frequency greater than a desired signal frequency, a nonlinear optical medium oriented so that a signal wave at the desired signal frequency and a corresponding idler wave are produced when the pump beam (wave) propagates through the nonlinear optical medium, resulting in beam walk off of the signal and idler waves, and an optical cavity which directs the signal wave to repeatedly pass through the nonlinear optical medium, said optical cavity comprising an equivalently even number of non-planar mirrors that produce image rotation on each pass through the nonlinear optical medium. Utilizing beam walk off where the signal wave and said idler wave have nonparallel Poynting vectors in the nonlinear medium and image rotation, a correlation zone of distance equal to approximately .rho.L.sub.crystal is created which, through multiple passes through the nonlinear medium, improves the beam quality of the OPO output.

  6. Implementing quality/productivity improvement initiatives in an engineering environment

    NASA Technical Reports Server (NTRS)

    Ruda, R. R.

    1985-01-01

    Quality/Productivity Improvement (QPI) initiatives in the engineering environment at McDonnell Douglas-Houston include several different, distinct activities, each having its own application, yet all targeted toward one common goal - making continuous improvement a way of life. The chief executive and the next two levels of management demonstrate their commitment to QPI with hands-on involvement in several activities. Each is a member of a QPI Council which consists of six panels - Participative Management, Communications, Training, Performance/Productivity, Human Resources Management and Strategic Management. In addition, each manager conducts Workplace Visits and Bosstalks, to enhance communications with employees and to provide a forum for the identification of problems - both real and perceived. Quality Circles and Project Teams are well established within McConnel Douglas as useful and desirable employee involvement teams. The continued growth of voluntary membership in the circles program is strong evidence of the employee interest and management support that have developed within the organization.

  7. National Endoscopy Quality Improvement Program Remains Suboptimal in Korea

    PubMed Central

    Cha, Jae Myung; Moon, Jeong Seop; Chung, Il-Kwun; Kim, Jin-Oh; Im, Jong Pil; Cho, Yu Kyung; Kim, Hyun Gun; Lee, Sang Kil; Lee, Hang Lak; Jang, Jae Young; Kim, Eun Sun; Jung, Yunho; Moon, Chang Mo; Kim, Yeol; Park, Bo Young

    2016-01-01

    Background/Aims We evaluated the characteristics of the National Cancer Screening Program (NCSP) and opinions regarding the National Endoscopy Quality Improvement Program (NEQIP). Methods We surveyed physicians performing esophagogastroduodenoscopy and/or colonoscopy screenings as part of the NCSP via e-mail between July and August in 2015. The 32-item survey instrument included endoscopic capacity, sedation, and reprocessing of endoscopes as well as opinions regarding the NEQIP. Results A total of 507 respondents were analyzed after the exclusion of 40 incomplete answers. Under the current capacity of the NCSP, the typical waiting time for screening endoscopy was less than 4 weeks in more than 90% of endoscopy units. Performance of endoscopy reprocessing was suboptimal, with 28% of respondents using unapproved disinfectants or not knowing the main ingredient of their disinfectants and 15% to 17% of respondents not following reprocessing protocols. Agreement with the NEQIP was optimal, because only 5.7% of respondents did not agree with NEQIP; however, familiarity with the NEQIP was suboptimal, because only 37.3% of respondents were familiar with the NEQIP criteria. Conclusions The NEQ-IP remains suboptimal in Korea. Given the suboptimal performance of endoscopy reprocessing and low familiarity with the NEQIP, improved quality in endoscopy reprocessing and better understanding of the NEQIP should be emphasized in Korea. PMID:27282270

  8. Liquid cement premix for improved abandonment and workover operations

    SciTech Connect

    Rae, P.; Johnston, N.

    1996-12-31

    Many cementing operations, such as well abandonment, work-over, etc., incur logistical, personnel and operational problems, and costs, disproportionate to the size of the cementing operation. A typical example being offshore well abandonment on a platform which has limited accommodation, no conventional cementing equipment, and where access, space or weight restrictions preclude its installation. This paper outlines the problems of abandonment and remote locations; it describes the concept, laboratory development, pilot testing, introduction and field use of a liquid cement premix. This novel approach helps reduce waste and minimize the environmental impact of the cementing operation and may be particularly suitable where small volumes of accurately mixed slurry are required, for example in coil tubing applications. It is, however, equally applicable for large volumes since the process lends itself to automation. The technique offers radical changes to cementing operations and equipment requirements, and direct savings to the operator through reduction in the costs of personnel, equipment mobilization, transport, installation, and material wastage.

  9. Improving Small Signal Stability through Operating Point Adjustment

    SciTech Connect

    Huang, Zhenyu; Zhou, Ning; Tuffner, Francis K.; Chen, Yousu; Trudnowski, Daniel J.; Mittelstadt, William; Hauer, John F.; Dagle, Jeffery E.

    2010-09-30

    ModeMeter techniques for real-time small signal stability monitoring continue to mature, and more and more phasor measurements are available in power systems. It has come to the stage to bring modal information into real-time power system operation. This paper proposes to establish a procedure for Modal Analysis for Grid Operations (MANGO). Complementary to PSS’s and other traditional modulation-based control, MANGO aims to provide suggestions such as increasing generation or decreasing load for operators to mitigate low-frequency oscillations. Different from modulation-based control, the MANGO procedure proactively maintains adequate damping for all time, instead of reacting to disturbances when they occur. Effect of operating points on small signal stability is presented in this paper. Implementation with existing operating procedures is discussed. Several approaches for modal sensitivity estimation are investigated to associate modal damping and operating parameters. The effectiveness of the MANGO procedure is confirmed through simulation studies of several test systems.

  10. Corporatization as a means of improving water quality: the experience in Victoria, Australia.

    PubMed

    Martin, Narelle

    Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements. PMID:15371224

  11. Corporatization as a means of improving water quality: the experience in Victoria, Australia.

    PubMed

    Martin, Narelle

    Factors including fragmentation, a lack of direction, poor accountability, poor water quality, and a sizable state government subsidy contributed to the rural water industry in Victoria, Australia, in 1993. In 1993 the state government set out parameters for reform to change the size, structure, performance, and culture of the water industry. The path taken was not privatization, but corporatization. Tools used included amalgamation of organizations; separating water provisions from local government; changing the composition and reporting mechanisms of the boards; establishing clear benchmarks and performance criteria; making information publicly available; and providing a commercial orientation. The outcomes of the reforms were to be a focus on water quality and effluent management. In 2001, 15 water authorities were in place. There were significant improvements in accountability, finances, and performance. The authorities provided information on performance to both the state and the public. Reductions of operating costs have been in the range of 20-35%, with savings put back into new infrastructure. Water quality has significantly improved in a number of parameters and effluent management has also improved. This paper describes the challenges faced before the reform process, the reforms initiated, and the outcomes. It argues that privatization is not the only path to improvement: Developing a corporate structure and accountability can also deliver substantial improvements.

  12. Improving the quality of parameter estimates obtained from slug tests

    USGS Publications Warehouse

    Butler, J.J.; McElwee, C.D.; Liu, W.

    1996-01-01

    The slug test is one of the most commonly used field methods for obtaining in situ estimates of hydraulic conductivity. Despite its prevalence, this method has received criticism from many quarters in the ground-water community. This criticism emphasizes the poor quality of the estimated parameters, a condition that is primarily a product of the somewhat casual approach that is often employed in slug tests. Recently, the Kansas Geological Survey (KGS) has pursued research directed it improving methods for the performance and analysis of slug tests. Based on extensive theoretical and field research, a series of guidelines have been proposed that should enable the quality of parameter estimates to be improved. The most significant of these guidelines are: (1) three or more slug tests should be performed at each well during a given test period; (2) two or more different initial displacements (Ho) should be used at each well during a test period; (3) the method used to initiate a test should enable the slug to be introduced in a near-instantaneous manner and should allow a good estimate of Ho to be obtained; (4) data-acquisition equipment that enables a large quantity of high quality data to be collected should be employed; (5) if an estimate of the storage parameter is needed, an observation well other than the test well should be employed; (6) the method chosen for analysis of the slug-test data should be appropriate for site conditions; (7) use of pre- and post-analysis plots should be an integral component of the analysis procedure, and (8) appropriate well construction parameters should be employed. Data from slug tests performed at a number of KGS field sites demonstrate the importance of these guidelines.

  13. Improving the quality of parameter estimates obtained from slug tests

    SciTech Connect

    Butler, J.J. Jr.; McElwee, C.D.; Liu, W.

    1996-05-01

    The slug test is one of the most commonly used field methods for obtaining in situ estimates of hydraulic conductivity. Despite its prevalence, this method has received criticism from many quarters in the ground-water community. This criticism emphasizes the poor quality of the estimated parameters, a condition that is primarily a product of the somewhat casual approach that is often employed in slug tests. Recently, the Kansas Geological Survey (KGS) has pursued research directed at improving methods for the performance and analysis of slug tests. Based on extensive theoretical and field research, a series of guidelines have been proposed that should enable the quality of parameter estimates to be improved. The most significant of these guidelines are: (1) three or more slug tests should be performed at each well during a given test period; (2) two or more different initial displacements (H{sub 0}) should be used at each well during a test period; (3) the method used to initiate a test should enable the slug to e introduced in a near-instantaneous manner and should allow a good estimate of H{sub 0} to be obtained; (4) data-acquisition equipment that enables a large quantity of high quality data to be collected should be employed; (5) if an estimate of the storage parameter is needed, an observation well other than the test well should be employed; (6) the method chosen for analysis of the slug-test data should be appropriate for site conditions; (7) use of pre- and post-analysis plots should be an integral component of the analysis procedure, and (8) appropriate well construction parameters should be employed. Data from slug tests performed at a number of KGS field sites demonstrate the importance of these guidelines.

  14. Improving productivity and profitability of a bioanalytical business through sales and operation planning.

    PubMed

    Islam, Rafiqul

    2013-07-01

    Today's bioanalytical CROs face increasing global competition, highly variable demand, high fixed costs, pricing pressure, and increasing demand for quality and speed. Most bioanalytical laboratories have responded to these challenges by implementing automation and by implementing process improvement methodologies (e.g., Six Sigma). These solutions have not resulted in a significant improvement in productivity and profitability since none of them are able to predict the upturn or downturn in demand. High volatility of demand causes long lead times and high costs during peak demand and poor productivity during trough demand. Most bioanalytical laboratories lack the tools to align supply efficiently to meet changing demand. In this paper, sales and operation planning (S&OP) has been investigated as a tool to balance supply and demand. The S&OP process, when executed effectively, can be the single greatest determinant of profitability for a bioanalytical business.

  15. [Company Wide Quality Control (total quality): methodological principles and intervention techniques for step-by-step improvement].

    PubMed

    Corbara, F; Di Cristofaro, E

    1996-01-01

    quality and ongoing improvement. The Authors describe for each of the previous criteria approaching methods and best operative techniques, according C.W.Q.C.

  16. [Company Wide Quality Control (total quality): methodological principles and intervention techniques for step-by-step improvement].

    PubMed

    Corbara, F; Di Cristofaro, E

    1996-01-01

    quality and ongoing improvement. The Authors describe for each of the previous criteria approaching methods and best operative techniques, according C.W.Q.C. PMID:8682262

  17. A strategy for improvement of postthaw quality of bison sperm.

    PubMed

    Hussain, S A; Lessard, C; Anzar, M

    2013-01-01

    The objective was to improve the postthaw quality of bison semen using zwitterion (ZI)-based extenders, glycerol addition at a lower temperature (4 °C), adding reduced glutathione (GSH) in extender, or treating bison sperm with cholesterol-loaded cyclodextrin (CLC) before freezing. Postthaw sperm motility and structural characteristics were analyzed using a computer-assisted sperm analyzer and flow cytometer respectively, at 0 and 3 hours postthaw incubation at 37 °C. In experiment 1, each ejaculate (N = 11) was diluted in Triladyl extender (control) or in ZI extenders (Tes-Tris or HEPES-Tris). In addition, glycerol in semen was added either at 37 °C or 4 °C before cryopreservation. Extenders had no significant effect on postthaw sperm motilities at 0 hour. However, sperm velocity parameters were higher (P < 0.05) in ZI extenders than in Triladyl. Sperm population with intact plasma membrane (IPM) and acrosomes (IACR) were higher in Triladyl than in ZI extenders (P < 0.05). Postthaw sperm total and progressive motilities, average path velocity, straight-line velocity, IPM, and IPM-IACR did not improve with the addition of glycerol at 4 °C. In experiment 2, semen was diluted (50 × 10(6) sperm per mL) in Triladyl extender containing 0 (control), 0.5, 1.0, or 2.0 mM GSH (an antioxidant) at 37 °C. Postthaw sperm motility and structural characteristics at 0 hour and percentage declined after 3 hour incubation, but did not differ because of GSH in the extender (P > 0.05). In experiment 3, fresh bison sperm (100 × 10(6) sperm in 1 mL) were pretreated with 0, 1, 2, or 3 mg/mL of CLC at 22 °C for 15 minutes and diluted to 50 × 10(6) sperm per mL in Tris-citric acid-egg yolk-glycerol extender before cryopreservation. The CLC pretreated sperm had higher (P < 0.05) postthaw total and progressive motilities, IPM, and IACR at 0 hour and less percentage of decline in these characteristics after 3 hour postthaw incubation. In conclusion, zwitterion extenders (Tes

  18. Improving the acute care of COPD patients across Gloucestershire: a quality improvement project.

    PubMed

    Miller, Craig; Cushley, Claire; Redler, Kasey; Mitchell, Claire; Aynsley Day, Elizabeth; Mansfield, Helen; Nye, Abigail

    2015-01-01

    Admissions for exacerbations of chronic obstructive pulmonary disease (COPD) present a significant proportion of patients in the acute medical take. The British Thoracic Society (BTS) provides guidelines for time specific interventions, that should be delivered to those with an acute exacerbation of COPD through the admission care bundle. These include correct diagnosis, correct assessment of oxygenation, early administration of treatment, recognition of respiratory failure, and specialist review. Gloucestershire Hospitals NHS Foundation Trust (GHNHSFT) chose improvement in acute COPD care to be a local Commissioning for Quality and Innovation (CQUIN) scheme, which enables commissioners to reward excellence by linking a proportion of English healthcare providers' income to the achievement of local quality improvement goals. The effects of initiatives put in place by senior clinicians had waned, and further improvements were required to meet the CQUIN target. The aim of the scheme was to improve compliance with the BTS guidelines and CQUIN scheme for patients admitted with an exacerbation of COPD. Specific bundle paperwork to be used for all patients admitted to the Trust with an exacerbation of COPD was introduced to the Trust in June 2014, with training and education of medical staff at that time. This had improved compliance rates from 10% to 63% by September 2014. Compliance with each intervention was audited through the examination of notes of patients admitted with an exacerbation of COPD. Compliance rates had plateaued over the last three months, and so a focus group involving junior medical staff met in September 2014 to try to increase awareness further, in order to drive greater improvements in care, and meet the CQUIN requirements. Their strategies were implemented, and then compliance with the CQUIN requirements was reaudited as described above. The December 2014 audit results showed a further improvement in overall COPD care, with 73% of patients

  19. An Improved Power Quality Based Sheppard-Taylor Converter Fed BLDC Motor Drive

    NASA Astrophysics Data System (ADS)

    Singh, Bhim; Bist, Vashist

    2015-12-01

    This paper deals with the design and analysis of a power factor correction based Sheppard-Taylor converter fed brushless dc motor (BLDCM) drive. The speed of the BLDCM is controlled by adjusting the dc link voltage of the voltage source inverter (VSI) feeding BLDCM. Moreover, a low frequency switching of the VSI is used for electronically commutating the BLDCM for reduced switching losses. The Sheppard-Taylor converter is designed to operate in continuous conduction mode to achieve an improved power quality at the ac mains for a wide range of speed control and supply voltage variation. The BLDCM drive is designed and its performance is simulated in a MATLAB/Simulink environment to achieve the power quality indices within the limits of the international power quality standard IEC-61000-3-2.

  20. Improving critical care discharge summaries: a collaborative quality improvement project using PDSA

    PubMed Central

    Goulding, Lucy; Parke, Hannah; Maharaj, Ritesh; Loveridge, Robert; McLoone, Anne; Hadfield, Sophie; Helme, Eloise; Hopkins, Philip; Sandall, Jane

    2015-01-01

    Around 110,000 people spend time in critical care units in England and Wales each year. The transition of care from the intensive care unit to the general ward exposes patients to potential harms from changes in healthcare providers and environment. Nurses working on general wards report anxiety and uncertainty when receiving patients from critical care. An innovative form of enhanced capability critical care outreach called ‘iMobile’ is being provided at King's College Hospital (KCH). Part of the remit of iMobile is to review patients who have been transferred from critical care to general wards. The iMobile team wished to improve the quality of critical care discharge summaries. A collaborative evidence-based quality improvement project was therefore undertaken by the iMobile team at KCH in conjunction with researchers from King's Improvement Science (KIS). Plan, Do, Study, Act (PDSA) methodology was used. Three PDSA cycles were undertaken. Methods adopted comprised: a scoping literature review to identify relevant guidelines and research evidence to inform all aspects of the quality improvement project; a process mapping exercise; informal focus groups / interviews with staff; patient story-telling work with people who had experienced critical care and subsequent discharge to a general ward; and regular audits of the quality of both medical and nursing critical care discharge summaries. The following behaviour change interventions were adopted, taking into account evidence of effectiveness from published systematic reviews and considering the local context: regular audit and feedback of the quality of discharge summaries, feedback of patient experience, and championing and education delivered by local opinion leaders. The audit results were mixed across the trajectory of the project, demonstrating the difficulty of sustaining positive change. This was particularly important as critical care bed occupancy and through-put fluctuates which then impacts on work