Disease management as a performance improvement strategy.

PubMed

McClatchey, S

2001-11-01

Disease management is a strategy of organizing care and services for a patient population across the continuum. It is characterized by a population database, interdisciplinary and interagency collaboration, and evidence-based clinical information. The effectiveness of a disease management program has been measured by a combination of clinical, financial, and quality of life outcomes. In early 1997, driven by a strategic planning process that established three Centers of Excellence (COE), we implemented disease management as the foundation for a new approach to performance improvement utilizing five key strategies. The five implementation strategies are outlined, in addition to a review of the key elements in outcome achievement.

Change in MSW characteristics under recent management strategies in Taiwan.

PubMed

Chang, Yu-Min; Liu, Chien-Chung; Hung, Chao-Yang; Hu, Allen; Chen, Shiao-Shing

2008-12-01

Reduction and recycling initiatives such as producer responsibility and pay-as-you-throw are being implemented in Taiwan. This paper presents a study assessing the impact of recently implemented municipal solid waste (MSW) reduction and recycling management strategies on the characteristics of waste feedstock for incineration in Taiwan. Through the periodic sampling of two typical MSW incineration plants, proximate and ultimate analyses were conducted according to standard methods to explore the influence of MSW reduction and recycling management strategies on incineration feed waste characteristics. It was observed that the annual amount of MSW generated in 2005 decreased by about 10% compared to 2003 and that the characteristics of MSW have changed significantly due to recent management strategies. The heating value of the MSW generated in Taiwan increased yearly by about 5% after program implementation. A comparison of the monthly variations in chemical concentrations indicated that the chlorine content in MSW has changed. This change results from usage reduction of PVC plastic due to the recycling fund management (RFM) program, and the food waste as well as salt content reduction due to the total recycling for kitchen garbage program. This achievement will improve the reduction of dioxin emissions from MSW incineration. In summary, management strategies must be conducted in tandem with the global trend to achieve a zero-waste-discharge country. When implementing these strategies and planning for future MSW management systems, it is important to consider the changes that may occur in the composition and characteristics of MSW over time.

Implementation strategies for load center automation on the space station module/power management and distribution testbed

NASA Technical Reports Server (NTRS)

Watson, Karen

1990-01-01

The Space Station Module/Power Management and Distribution (SSM/PMAD) testbed was developed to study the tertiary power management on modules in large spacecraft. The main goal was to study automation techniques, not necessarily develop flight ready systems. Because of the confidence gained in many of automation strategies investigated, it is appropriate to study, in more detail, implementation strategies in order to find better trade-offs for nearer to flight ready systems. These trade-offs particularly concern the weight, volume, power consumption, and performance of the automation system. These systems, in their present implementation are described.

Strategies in disability management. Corporate disability management programs implemented at the work site.

PubMed

Kalina, C M

1999-10-30

Managers are challenged to demonstrate all programs as economically essential to the business, generating an appreciable return on investment. Further challenge exists to blend and integrate clinical and business objectives in program development. Disability management programs must be viewed as economically essential to the financial success of the business to assure management support for clinical interventions and return-to-work strategies essential for a successful program. This paper discusses a disability management program integrating clinical and business goals and objectives in return-to-work strategies to effect positive clinical, social-cultural, and business results. Clinical, educational, social, and economic challenges in the development, implementation, and continued management of a disability program at a large corporation with multiple global work sites are defined. Continued discussion addresses the effective clinical interventions and educational strategies utilized successfully within the workplace environment in response to each defined challenge. A multiple disciplinary team approach, clinical and business outcome measures, and quality assurance indicators are discussed as major program components. This article discusses a successful program approach focusing on business process and methodology. These parameters are used to link resources to strategy, developing a product for implementing and managing a program demonstrating economic value added through effective clinical medical case management.

System Wide Information Management (SWIM)

NASA Technical Reports Server (NTRS)

Hritz, Mike; McGowan, Shirley; Ramos, Cal

2004-01-01

This viewgraph presentation lists questions regarding the implementation of System Wide Information Management (SWIM). Some of the questions concern policy issues and strategies, technology issues and strategies, or transition issues and strategies.

Applying the balanced scorecard in healthcare provider organizations.

PubMed

Inamdar, Noorein; Kaplan, Robert S; Bower, Marvin

2002-01-01

Several innovative healthcare executives have recently introduced a new business strategy implementation tool: the Balanced Scorecard. The scorecard's measurement and management system provides the following potential benefits to healthcare organizations: It aligns the organization around a more market-oriented, customer-focused strategy It facilitates, monitors, and assesses the implementation of the strategy It provides a communication and collaboration mechanism It assigns accountability for performance at all levels of the organization It provides continual feedback on the strategy and promotes adjustments to marketplace and regulatory changes. We surveyed executives in nine provider organizations that were implementing the Balanced Scorecard. We asked about the following issues relating to its implementation and effect: 1. The role of the Balanced Scorecard in relation to a well-defined vision, mission, and strategy 2. The motivation for adopting the Balanced Scorecard 3. The difference between the Balanced Scorecard and other measurement systems 4. The process followed to develop and implement the Balanced Scorecard 5. The challenges and barriers during the development and implementation process 6. The benefits gained by the organization from adoption and use. The executives reported that the Balanced Scorecard strategy implementation and performance management tool could be successfully applied in the healthcare sector, enabling organizations to improve their competitive market positioning, financial results, and customer satisfaction. This article concludes with guidelines for other healthcare provider organizations to capture the benefits of the Balanced Scorecard performance management system.

From sacred cows to sacrificial lambs: implementing agricultural phosphorus science and management to combat eutrophication

USDA-ARS?s Scientific Manuscript database

Experience with implementing agricultural phosphorus (P) strategies highlights successes and uncertainty over outcomes. We examine case studies from the USA, UK, and Sweden to examine P management under voluntary, litigated and regulatory settings. In the USA, voluntary strategies to curtail P loadi...

Improving Teachers' In-Service Professional Development in Mathematics and Science: The Role of Postsecondary Institutions.

ERIC Educational Resources Information Center

Desimone Laura; Garet, Michael S.; Birman, Beatrice F.; Porter, Andrew; Yoon, Kwang Suk

2003-01-01

As part of national evaluation of Eisenhower Professional Development Program, examines management and implementation strategies contributing to high-quality inservice teacher professional development in mathematics and science. Finds higher quality professional development is related to management and implementation strategies such as continuous…

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

PubMed

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

2015-07-01

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

Volume II: Ecosystem management: principles and applications.

Treesearch

M.E. Jensen; P.S. Bourgeron

1994-01-01

This document provides land managers with practical suggestions for implementing ecosystem management. It contains 28 papers organized into five sections: historical perspectives, ecological principles, sampling design, case studies, and implementation strategies.

Managing implementation: roles of line managers, senior managers, and human resource professionals in an occupational health intervention.

PubMed

Hasson, Henna; Villaume, Karin; von Thiele Schwarz, Ulrica; Palm, Kristina

2014-01-01

To contrast line managers', senior managers', and (human resource) HR professionals' descriptions of their roles, tasks, and possibilities to perform them during the implementation of an occupational health intervention. Interviews with line managers (n = 13), senior managers (n = 7), and HR professionals (n = 9) 6 months after initiation of an occupational health intervention at nine organizations. The groups' roles were described coherently, except for the HR professionals. These roles were seldom performed in practice, and two main reasons appeared: use of individuals' engagement rather than an implementation strategy, and lack of integration of the intervention with other stakeholders and organizational processes. Evaluation of stakeholders' perceptions of each other's and their own roles is important, especially concerning HR professionals. Clear role descriptions and implementation strategies, and aligning an intervention to organizational processes, are crucial for efficient intervention management.

[The Effectiveness of a Strategy for the Flexible Management of Nursing Human Resources: A Pilot Study].

PubMed

Huang, Chung-I; Lu, Meei-Shiow

2017-12-01

The flexibility of a hospital's nursing-related human resource management policies affects the working willingness and retention of nurses. To explore the effectiveness of a flexible nursing-related human resource management strategy. This quasi-experimental research used a one group pretest-posttest design. Supervisors at participating hospitals attended the "Application of Flexible Nursing Human Resources Management Strategies" workshop, which introduced the related measures and assessed nurses' pretest satisfaction. After these measures were implemented at the participating hospitals, implementation-related problems were investigated and appropriate consultation was provided. The posttest was implemented after the end of the project. Data were collected from nurses at the participating hospitals who had served in their present hospital for more than three months. The participating hospitals were all nationally certified healthcare providers, including 13 medical centers, 17 regional hospitals, and 3 district hospitals. A total of nurses 2,810 nurses took the pretest and 2,437 took the posttest. The research instruments included the "Satisfaction with working conditions and system flexibility" scale and the "Flexible nursing human resource management strategies". The effectiveness of the implemented strategy was assessed using independent samples t-test and variance analysis. The result of implementing the flexible strategies shows that the total mean of pretest satisfaction (Likert 5 scores) was 3.47 (SD = 0.65), and the posttest satisfaction was 3.52 (SD = 0.65), with significant statistical differences in task, numerical, divisional, and leading flexibility. Due to the good implementation effectiveness, the authors strongly suggest that all of the participating hospitals continue to apply this strategic model to move toward a more flexible nursing system and work.

Deployment strategies of managed lanes on arterials.

DOT National Transportation Integrated Search

2015-02-01

This report investigates issues related to planning, financing, deployment, and operation of managed : lanes on arterials. In this report, a strategy for managed lanes refers to a combination of the managed : lane type, the design and implementation,...

Evidence-based management of ambulatory electronic health record system implementation: an assessment of conceptual support and qualitative evidence.

PubMed

McAlearney, Ann Scheck; Hefner, Jennifer L; Sieck, Cynthia; Rizer, Milisa; Huerta, Timothy R

2014-07-01

While electronic health record (EHR) systems have potential to drive improvements in healthcare, a majority of EHR implementations fall short of expectations. Shortcomings in implementations are often due to organizational issues around the implementation process rather than technological problems. Evidence from both the information technology and healthcare management literature can be applied to improve the likelihood of implementation success, but the translation of this evidence into practice has not been widespread. Our objective was to comprehensively study and synthesize best practices for managing ambulatory EHR system implementation in healthcare organizations, highlighting applicable management theories and successful strategies. We held 45 interviews with key informants in six U.S. healthcare organizations purposively selected based on reported success with ambulatory EHR implementation. We also conducted six focus groups comprised of 37 physicians. Interview and focus group transcripts were analyzed using both deductive and inductive methods to answer research questions and explore emergent themes. We suggest that successful management of ambulatory EHR implementation can be guided by the Plan-Do-Study-Act (PDSA) quality improvement (QI) model. While participants did not acknowledge nor emphasize use of this model, we found evidence that successful implementation practices could be framed using the PDSA model. Additionally, successful sites had three strategies in common: 1) use of evidence from published health information technology (HIT) literature emphasizing implementation facilitators; 2) focusing on workflow; and 3) incorporating critical management factors that facilitate implementation. Organizations seeking to improve ambulatory EHR implementation processes can use frameworks such as the PDSA QI model to guide efforts and provide a means to formally accommodate new evidence over time. Implementing formal management strategies and incorporating new evidence through the PDSA model is a key element of evidence-based management and a crucial way for organizations to position themselves to proactively address implementation and use challenges before they are exacerbated. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Expert recommendations for implementing change (ERIC): protocol for a mixed methods study

PubMed Central

2014-01-01

Background Identifying feasible and effective implementation strategies that are contextually appropriate is a challenge for researchers and implementers, exacerbated by the lack of conceptual clarity surrounding terms and definitions for implementation strategies, as well as a literature that provides imperfect guidance regarding how one might select strategies for a given healthcare quality improvement effort. In this study, we will engage an Expert Panel comprising implementation scientists and mental health clinical managers to: establish consensus on a common nomenclature for implementation strategy terms, definitions and categories; and develop recommendations to enhance the match between implementation strategies selected to facilitate the use of evidence-based programs and the context of certain service settings, in this case the U.S. Department of Veterans Affairs (VA) mental health services. Methods/Design This study will use purposive sampling to recruit an Expert Panel comprising implementation science experts and VA mental health clinical managers. A novel, four-stage sequential mixed methods design will be employed. During Stage 1, the Expert Panel will participate in a modified Delphi process in which a published taxonomy of implementation strategies will be used to establish consensus on terms and definitions for implementation strategies. In Stage 2, the panelists will complete a concept mapping task, which will yield conceptually distinct categories of implementation strategies as well as ratings of the feasibility and effectiveness of each strategy. Utilizing the common nomenclature developed in Stages 1 and 2, panelists will complete an innovative menu-based choice task in Stage 3 that involves matching implementation strategies to hypothetical implementation scenarios with varying contexts. This allows for quantitative characterizations of the relative necessity of each implementation strategy for a given scenario. In Stage 4, a live web-based facilitated expert recommendation process will be employed to establish expert recommendations about which implementations strategies are essential for each phase of implementation in each scenario. Discussion Using a novel method of selecting implementation strategies for use within specific contexts, this study contributes to our understanding of implementation science and practice by sharpening conceptual distinctions among a comprehensive collection of implementation strategies. PMID:24669765

Freeway ramp management in Pennsylvania.

DOT National Transportation Integrated Search

2011-03-31

This research identified the opportunities to implement ramp management strategies on freeways in Pennsylvania. The research : explored the need to integrate local arterial traffic signal systems with ramp management strategies to reduce the impacts ...

Implementation of multidimensional knowledge translation strategies to improve procedural pain in hospitalized children.

PubMed

Stevens, Bonnie J; Yamada, Janet; Promislow, Sara; Stinson, Jennifer; Harrison, Denise; Victor, J Charles

2014-11-25

Despite extensive research, institutional policies, and practice guidelines, procedural pain remains undertreated in hospitalized children. Knowledge translation (KT) strategies have been employed to bridge the research to practice gap with varying success. The most effective single or combination of KT strategies has not been found. A multifaceted KT intervention, Evidence-based Practice for Improving Quality (EPIQ), that included tailored KT strategies was effective in improving pain practices and clinical outcomes at the unit level in a prospective comparative cohort study in 32 hospital units (16 EPIQ intervention and 16 Standard Care), in eight pediatric hospitals in Canada. In a study of the 16 EPIQ units (two at each hospital) only, the objectives were to: determine the effectiveness of evidence-based KT strategies implemented to achieve unit aims; describe the KT strategies implemented and their influence on pain assessment and management across unit types; and identify facilitators and barriers to their implementation. Data were collected from each EPIQ intervention unit on targeted pain practices and KT strategies implemented, through chart review and a process evaluation checklist, following four intervention cycles over a 15-month period. Following the completion of the four cycle intervention, 78% of 23 targeted pain practice aims across units were achieved within 80% of the stated aims. A statistically significant improvement was found in the proportion of children receiving pain assessment and management, regardless of pre-determined aims (p < 0.001). The median number of KT strategies implemented was 35 and included reminders, educational outreach and materials, and audit and feedback. Units successful in achieving their aims implemented more KT strategies than units that did not. No specific type of single or combination of KT strategies was more effective in improving pain assessment and management outcomes. Tailoring KT strategies to unit context, support from unit leadership, staff engagement, and dedicated time and resources were identified as facilitating effective implementation of the strategies. Further research is required to better understand implementation outcomes, such as feasibility and fidelity, how context influences the effectiveness of multifaceted KT strategies, and the sustainability of improved pain practices and outcomes over time.

Financial Decentralization in Malaysian Schools: Strategies for Effective Implementation

ERIC Educational Resources Information Center

Radzi, Norfariza Mohd; Ghani, Muhammad Faizal A.; Siraj, Saedah; Afshari, Mojgan

2013-01-01

This article presents findings on the essential strategies required at the school site and the relevant people responsible for the effective implementation of school-based financial management in Malaysia. Many lessons have been learned since more than a decade of the school-based financial management reform in Malaysia through the establishment…

Spatial strategies for managing visitor impacts in National Parks

USGS Publications Warehouse

Leung, Y.-F.; Marion, J.L.

1999-01-01

Resource and social impacts caused by recreationists and tourists have become a management concern in national parks and equivalent protected areas. The need to contain visitor impacts within acceptable limits has prompted park and protected area managers to implement a wide variety of strategies and actions, many of which are spatial in nature. This paper classifies and illustrates the basic spatial strategies for managing visitor impacts in parks and protected areas. A typology of four spatial strategies was proposed based on the recreation and park management literature. Spatial segregation is a common strategy for shielding sensitive resources from visitor impacts or for separating potentially conflicting types of use. Two forms of spatial segregation are zoning and closure. A spatial containment strategy is intended to minimize the aggregate extent of visitor impacts by confining use to limited designated or established Iocations. In contrast, a spatial dispersal strategy seeks to spread visitor use, reducing the frequency of use to levels that avoid or minimize permanent resource impacts or visitor crowding and conflict. Finally, a spatial configuration strategy minimizes impacting visitor behavior though the judicious spatial arrangement of facilities. These four spatial strategics can be implemented separately or in combination at varying spatial scales within a single park. A survey of national park managers provides an empirical example of the diversity of implemented spatial strategies in managing visitor impacts. Spatial segregation is frequently applied in the form of camping restrictions or closures to protect sensitive natural or cultural resources and to separate incompatible visitor activities. Spatial containment is the most widely applied strategy for minimizing the areal extent of resource impacts. Spatial dispersal is commonly applied to reduce visitor crowding or conflicts in popular destination areas but is less frequently applied or effective in minimizing resource impacts. Spatial configuration was only minimally evaluated, as it was not included in the survey. The proposed typology of spatial strategies offers a useful means of organizing and understanding the wide variety of management strategies and actions applied in managing visitor impacts in parks and protected areas. Examples from U.S. national parks demonstrate the diversity of these basic strategies and their flexibility in implementation at various spatial scales. Documentation of these examples helps illustrate their application and inform managers of the multitude of options. Further analysis from the spatial perspective is needed Io extend the applicability of this typology to other recreational activities and management issues.

Survival tactics for managing the hospital marketing effort.

PubMed

Schaupp, D L; Ponzurick, T G; Schaupp, F W

1994-01-01

Hospital marketing is an intricate and complex process. Especially difficult is the transition the hospital marketer must make from designing marketing strategies to implementing those strategies. This transition usually causes the marketer to call upon a different set of skills. These skills involve managing the personnel needed to implement the designed marketing strategy. Unfortunately, little in the way of formal training is provided the marketer for developing these management skills. Therefore, the authors have comprised a series of tactical procedures designed to assist the hospital marketer to survive this transition. Using these tactics for decision-making guidelines may help to improve the management of the hospital's marketing effort.

Evaluating the implementation of "managing the risk of suicide: a suicide prevention strategy for the ACT 2009-2014".

PubMed

Sheehan, Johann; Griffiths, Kathleen; Rickwood, Debra; Carron-Arthur, Bradley

2015-01-01

Over the past two decades, governments have invested significantly in policies and strategies to prevent the tragic loss of life to suicide. However, there has been little focus on evaluating the implementation of such policies. This paper reports on the evaluation of the implementation of "Managing the Risk of Suicide: A Suicide Prevention Strategy for the ACT 2009-2014," the Australian Capital Territory's (ACT) suicide prevention strategy. We sought to answer two questions: (1) Could agencies provide data reporting on their progress in implementing the activities for which they were responsible?; and (2) Could a judgment about implementation progress be made and, if so, to what extent was the activity implemented? Individually tailored electronic surveys were sent to 18 ACT agencies annually over 4 years to measure their progress in implementing activities for which they had responsibility. By year four, full data were provided for 64% of activities, maximal partial data for 9%, and minimal partial data for 27%. Forty-two per cent of activities were fully implemented, 20% were partially implemented, and 38% were not implemented or could not be measured. It is possible to measure implementation of suicide prevention strategies, but appropriate processes and dedicated resources must be in place at the outset.

[Strategies to prevent the transmission of multidrug-resistant pathogens and their practical implementation in oupatient care].

PubMed

Adler, A C; Spegel, H; Wilke, J; Höller, C; Herr, C

2012-10-01

Multidrugresistant pathogens which are highly relevant for infection control in hospitals and other health-care facilities are a serious public health problem and a big challenge for all players in the health sector. In order to prevent the spread of multi-resistant pathogens the Commission for Hospital Hygiene of the Robert Koch-Institute (RKI) has published guidelines. These recommendations refer to the consequent implementation of an infection control management in all health care settings, including outpatient care. In Germany there are only few data available concerning infection control management and the implementation of preventive strategies in outpatient care. To what extent are national guidelines concerning infection control of multidrugresistant pathogens (i.e. methicillin-resistant Staphylococcus aureus, MRSA) feasible and practicable in outpatient care? And what are the reasons not to practice these strategies. In outpatient care the status of the infection control management and the implementation of prevention strategies was surveyed and assessed. Data were collected by structured interviews - a face to face method. Guidelines concerning infection control management are not always sufficiently implemented in outpatient care. There are multiple reasons for this, such as, e.g., lack of compliance with the recommendations as well as structural problems in the health-care system, and special challenges of outpatient care. Implementation of an infection control management concerning multidrug-resistant pathogens in outpatient care is problematic. Prevention strategies are commonly not known or not adequately implemented into daily practice. Actions to improve the situation should focus at the individual level (e.g., trainings in the context of the initiative "clean hands" ), the institutional level (improving networking, bonus schemes) and the social level (financial and legal support for outpatient care centres to bear the expenses of infection control management, "search and destroy"). © Georg Thieme Verlag KG Stuttgart · New York.

What would it take? Stakeholders' views and preferences for implementing a health care manager program in community mental health clinics under health care reform.

PubMed

Cabassa, Leopoldo J; Gomes, Arminda P; Lewis-Fernández, Roberto

2015-02-01

Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders' recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. © The Author(s) 2014.

What Would It Take? Stakeholders’ Views and Preferences for Implementing a Health Care Manager Program in Community Mental Health Clinics Under Health Care Reform

PubMed Central

Cabassa, Leopoldo J.; Gomes, Arminda P.; Lewis-Fernández, Roberto

2015-01-01

Health care manager interventions can improve the physical health of people with serious mental illness (SMI). In this study, we used concepts from the theory of diffusion of innovations, the consolidated framework for implementation research and a taxonomy of implementation strategies to examine stakeholders’ recommendations for implementing a health care manager intervention in public mental health clinics serving Hispanics with SMI. A purposive sample of 20 stakeholders was recruited from mental health agencies, primary care clinics, and consumer advocacy organizations. We presented participants a vignette describing a health care manager intervention and used semistructured qualitative interviews to examine their views and recommendations for implementing this program. Interviews were recorded, professionally transcribed, and content analyzed. We found that a blend of implementation strategies that demonstrates local relative advantage, addresses cost concerns, and enhances compatibility to organizations and the client population is critical for moving health care manager interventions into practice. PMID:25542194

Planning and Implementing Social Service Information Systems: A Guide for Management and Users. Human Services Monograph Series Number 25. Project Share.

ERIC Educational Resources Information Center

Cotter, Barbara

Intended to aid administrators and users of social services in establishing information systems, this comprehensive guide to the design of such systems identifies the elements, effective strategies, and potential pitfalls involved in their planning, implementation, and utilization. Detailed discussions of management strategies for system…

Developing an active implementation model for a chronic disease management program.

PubMed

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-04-01

Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council's model for complex interventions and the Chronic Care Model. We used the Medical Research Council's five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council's model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council's model added transparency to the design phase which further facilitated the process of implementing the program. http://www.clinicaltrials.gov/(NCT01228708).

Optimal environmental management strategy and implementation for groundwater contamination prevention and restoration.

PubMed

Wang, Mingyu

2006-04-01

An innovative management strategy is proposed for optimized and integrated environmental management for regional or national groundwater contamination prevention and restoration allied with consideration of sustainable development. This management strategy accounts for availability of limited resources, human health and ecological risks from groundwater contamination, costs for groundwater protection measures, beneficial uses and values from groundwater protection, and sustainable development. Six different categories of costs are identified with regard to groundwater prevention and restoration. In addition, different environmental impacts from groundwater contamination including human health and ecological risks are individually taken into account. System optimization principles are implemented to accomplish decision-makings on the optimal resources allocations of the available resources or budgets to different existing contaminated sites and projected contamination sites for a maximal risk reduction. Established management constraints such as budget limitations under different categories of costs are satisfied at the optimal solution. A stepwise optimization process is proposed in which the first step is to select optimally a limited number of sites where remediation or prevention measures will be taken, from all the existing contaminated and projected contamination sites, based on a total regionally or nationally available budget in a certain time frame such as 10 years. Then, several optimization steps determined year-by-year optimal distributions of the available yearly budgets for those selected sites. A hypothetical case study is presented to demonstrate a practical implementation of the management strategy. Several issues pertaining to groundwater contamination exposure and risk assessments and remediation cost evaluations are briefly discussed for adequately understanding implementations of the management strategy.

Nurse managers' work life quality and their participation in knowledge management: a correlational study.

PubMed

Hashemi Dehaghi, Zahra; Sheikhtaheri, Abbas; Dehnavi, Fariba

2015-01-01

The association between quality of work life and participation in knowledge management is unknown. This study aimed to discover the association between quality of work life of nurse managers and their participation in implementing knowledge management. This was a correlational study. All nurse managers (71 people) from 11 hospitals affiliated with the Social Security Organization in Tehran, Iran, were included. They were asked to rate their participation in knowledge management and their quality of work life. Data was gathered by a researcher-made questionnaire (May-June 2012). The questionnaire was validated by content and construct validity approaches. Cronbach's alpha was used to evaluate reliability. Finally, 50 questionnaires were analyzed. The answers were scored and analyzed using mean of scores, T-test, ANOVA (or nonparametric test, if appropriate), Pearson's correlation coefficient and linear regression. Nurse managers' performance to implement knowledge management strategies was moderate. A significant correlation was found between quality of work life of nurse managers and their participation in implementing knowledge management strategies (r = 0.82; P < 0.001). The strongest correlations were found between implementation of knowledge management and participation of nurse managers in decision making (r = 0.82; P < 0.001). Improvement of nurse managers' work life quality, especially in decision-making, may increase their participation in implementing knowledge management.

Assessing the effectiveness of strategies to implement clinical guidelines for the management of chronic diseases at primary care level in EU Member States: a systematic review.

PubMed

Brusamento, Serena; Legido-Quigley, Helena; Panteli, Dimitra; Turk, Eva; Knai, Cecile; Saliba, Vanessa; Car, Josip; McKee, Martin; Busse, Reinhard

2012-10-01

This review aimed to evaluate the effectiveness of strategies to implement clinical guidelines for chronic disease management in primary care in EU Member States. We conducted a systematic review of interventional studies assessing the implementation of clinical guidelines. We searched five databases (EMBASE, MEDLINE, CENTRAL, Eppi-Centre and Clinicaltrials.gov) following a strict Cochrane methodology. We included studies focusing on the management of chronic diseases in adults in primary care. A total of 21 studies were found. The implementation strategy was fully effective in only four (19%), partially effective in eight (38%), and not effective in nine (43%). The probability that an intervention would be effective was only slightly higher with multifaceted strategies, compared to single interventions. However, effect size varied across studies; therefore it was not possible to determine the most successful strategy. Only eight studies evaluated the impact on patients' health and only two of those showed significant improvement, while in five there was an improvement in the process of care which did not translate into an improvement in health outcomes. Only four studies reported any data on the cost of the implementation but none undertook a cost-effectiveness analysis. Only one study presented data on the barriers to the implementation of guidelines, noting a lack of awareness and agreement about clinical guidelines. Our results reveal that there are only a few rigorous studies which assess the effectiveness of a strategy to implement clinical guidelines in Europe. Moreover, the results are not consistent in showing which strategy is the most appropriate to facilitate their implementation. Therefore, further research is needed to develop more rigorous studies to evaluate health outcomes associated with the implementation of clinical guidelines; to assess the cost-effectiveness of implementing clinical guidelines; and to investigate the perspective of service users and health service staff. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A systematic review of instruments that assess the implementation of hospital quality management systems.

PubMed

Groene, Oliver; Botje, Daan; Suñol, Rosa; Lopez, Maria Andrée; Wagner, Cordula

2013-10-01

Health-care providers invest substantial resources to establish and implement hospital quality management systems. Nevertheless, few tools are available to assess implementation efforts and their effect on quality and safety outcomes. This review aims to (i) identify instruments to assess the implementation of hospital quality management systems, (ii) describe their measurement properties and (iii) assess the effects of quality management on quality improvement and quality of care outcomes. We performed a systematic literature search from 1990 to 2011 in PubMed, CINAHL, EMBASE, Cochrane Library and Web of Science. In addition, we used snowball strategies, screened the reference lists of eligible papers, reviewed grey literature and contacted experts in the field. and data extraction Two reviewers screened eligible papers based on pre-defined inclusion and exclusion criteria and all authors extracted data. Eligible papers are described in terms of general characteristics (settings, type and level of respondents, mode of data collection), methodological properties (sampling strategy, item derivation, conceptualization of quality management, assessment of reliability and validity, scoring) and application/implementation (accounting for context, organizational adaptations, sensitivity to change, deployment and effect size). Eighteen papers were deemed eligible for inclusion. While some common domains emerged in measurement conceptualization, substantial differences in scope persist. The instruments' measurement properties were insufficiently described and only few instruments assessed links between the implementation of quality management systems (QMS) and improvement strategies or outcomes. There is currently no well-established measure to assess the implementation and effectiveness of quality management systems. Future research should address this gap.

Strategies to Improve Management of Acute Watery Diarrhea during a Military Deployment: A Cost Effectiveness Analysis.

PubMed

Schrader, Andrew J; Tribble, David R; Riddle, Mark S

2017-12-01

To inform policy and decision makers, a cost-effectiveness model was developed to predict the cost-effectiveness of implementing two hypothetical management strategies separately and concurrently on the mitigation of deployment-associated travelers' diarrhea (TD) burden. The first management strategy aimed to increase the likelihood that a deployed service member with TD will seek medical care earlier in the disease course compared with current patterns; the second strategy aimed to optimize provider treatment practices through the implementation of a Department of Defense Clinical Practice Guideline. Outcome measures selected to compare management strategies were duty days lost averted (DDL-averted) and a cost effectiveness ratio (CER) of cost per DDL-averted (USD/DDL-averted). Increasing health care and by seeking it more often and earlier in the disease course as a stand-alone management strategy produced more DDL (worse) than the base case (up to 8,898 DDL-gained per year) at an increased cost to the Department of Defense (CER $193). Increasing provider use of an optimal evidence-based treatment algorithm through Clinical Practice Guidelines prevented 5,299 DDL per year with overall cost savings (CER -$74). A combination of both strategies produced the greatest gain in DDL-averted (6,887) with a modest cost increase (CER $118). The application of this model demonstrates that changes in TD management during deployment can be implemented to reduce DDL with likely favorable impacts on mission capability and individual health readiness. The hypothetical combination strategy evaluated prevents the most DDL compared with current practice and is associated with a modest cost increase.

The Balanced Scorecard of acute settings: development process, definition of 20 strategic objectives and implementation.

PubMed

Groene, Oliver; Brandt, Elimer; Schmidt, Werner; Moeller, Johannes

2009-08-01

Strategy development and implementation in acute care settings is often restricted by competing challenges, the pace of policy reform and the existence of parallel hierarchies. To describe a generic approach to strategy development, illustrate the use of the Balanced Scorecard as a tool to facilitate strategy implementation and demonstrate how to break down strategic goals into measurable elements. Multi-method approach using three different conceptual models: Health Promoting Hospitals Standards and Strategies, the European Foundation for Quality Management (EFQM) Model and the Balanced Scorecard. A bundle of qualitative and quantitative methods were used including in-depth interviews, standardized organization-wide surveys on organizational values, staff satisfaction and patient experience. Three acute care hospitals in four different locations belonging to a German holding group. Chief executive officer, senior medical officers, working group leaders and hospital staff. Development and implementation of the Balanced Scorecard. Twenty strategic objectives with corresponding Balanced Scorecard measures. A stepped approach from strategy development to implementation is presented to identify key themes for strategy development, drafting a strategy map and developing strategic objectives and measures. The Balanced Scorecard, in combination with the EFQM model, is a useful tool to guide strategy development and implementation in health care organizations. As for other quality improvement and management tools not specifically developed for health care organizations, some adaptations are required to improve acceptability among professionals. The step-wise approach of strategy development and implementation presented here may support similar processes in comparable organizations.

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

PubMed

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

2016-09-01

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

Study protocol for "Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET)": a pragmatic trial comparing implementation strategies.

PubMed

Gold, Rachel; Hollombe, Celine; Bunce, Arwen; Nelson, Christine; Davis, James V; Cowburn, Stuart; Perrin, Nancy; DeVoe, Jennifer; Mossman, Ned; Boles, Bruce; Horberg, Michael; Dearing, James W; Jaworski, Victoria; Cohen, Deborah; Smith, David

2015-10-16

Little research has directly compared the effectiveness of implementation strategies in any setting, and we know of no prior trials directly comparing how effectively different combinations of strategies support implementation in community health centers. This paper outlines the protocol of the Study of Practices Enabling Implementation and Adaptation in the Safety Net (SPREAD-NET), a trial designed to compare the effectiveness of several common strategies for supporting implementation of an intervention and explore contextual factors that impact the strategies' effectiveness in the community health center setting. This cluster-randomized trial compares how three increasingly hands-on implementation strategies support adoption of an evidence-based diabetes quality improvement intervention in 29 community health centers, managed by 12 healthcare organizations. The strategies are as follows: (arm 1) a toolkit, presented in paper and electronic form, which includes a training webinar; (arm 2) toolkit plus in-person training with a focus on practice change and change management strategies; and (arm 3) toolkit, in-person training, plus practice facilitation with on-site visits. We use a mixed methods approach to data collection and analysis: (i) baseline surveys on study clinic characteristics, to explore how these characteristics impact the clinics' ability to implement the tools and the effectiveness of each implementation strategy; (ii) quantitative data on change in rates of guideline-concordant prescribing; and (iii) qualitative data on the "how" and "why" underlying the quantitative results. The outcomes of interest are clinic-level results, categorized using the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework, within an interrupted time-series design with segmented regression models. This pragmatic trial will compare how well each implementation strategy works in "real-world" practices. Having a better understanding of how different strategies support implementation efforts could positively impact the field of implementation science, by comparing practical, generalizable methods for implementing clinical innovations in community health centers. Bridging this gap in the literature is a critical step towards the national long-term goal of effectively disseminating and implementing effective interventions into community health centers. ClinicalTrials.gov, NCT02325531.

Implementing interorganizational cooperation in labour market reintegration: a case study.

PubMed

Ståhl, Christian

2012-06-01

To bring people with complex medical, social and vocational needs back to the labour market, interorganizational cooperation is often needed. Yet, studies of processes and strategies for achieving sustainable interorganizational cooperation are sparse. The aim of this study was to analyse the implementation processes of Swedish legislation on financial coordination, with specific focus on different strategies for and perspectives on implementing interorganizational cooperation. A multiple-case study was used, where two local associations for financial coordination were studied in order to elucidate and compare the development of cooperative work in two settings. The material, collected during a 3-year period, consisted of documents, individual interviews with managers, and focus groups with officials. Two different implementation strategies were identified. In case 1, a linear strategy was used to implement cooperative projects, which led to difficulties in maintaining cooperative work forms due to a fragmented and time-limited implementation process. In case 2, an interactive strategy was used, where managers and politicians were continuously involved in developing a central cooperation team that became a central part of a developing structure for interorganizational cooperation. An interactive cooperation strategy with long-term joint financing was here shown to be successful in overcoming organizational barriers to cooperation. It is suggested that a strategy based on adaptation to local conditions, flexibility and constant evaluation is preferred for developing sustainable interorganizational cooperation when implementing policies or legislation affecting interorganizational relationships.

Achieving competitive advantage through strategic human resource management.

PubMed

Fottler, M D; Phillips, R L; Blair, J D; Duran, C A

1990-01-01

The framework presented here challenges health care executives to manage human resources strategically as an integral part of the strategic planning process. Health care executives should consciously formulate human resource strategies and practices that are linked to and reinforce the broader strategic posture of the organization. This article provides a framework for (1) determining and focusing on desired strategic outcomes, (2) identifying and implementing essential human resource management actions, and (3) maintaining or enhancing competitive advantage. The strategic approach to human resource management includes assessing the organization's environment and mission; formulating the organization's business strategy; assessing the human resources requirements based on the intended strategy; comparing the current inventory of human resources in terms of numbers, characteristics, and human resource management practices with respect to the strategic requirements of the organization and its services or product lines; formulating the human resource strategy based on the differences between the assessed requirements and the current inventory; and implementing the appropriate human resource practices to reinforce the strategy and attain competitive advantage.

Information Technology Management Strategies to Implement Knowledge Management Systems

ERIC Educational Resources Information Center

McGee, Mary Jane Christy

2017-01-01

More than 38% of the U.S. public workforce will likely retire by 2030, which may result in a labor shortage. Business leaders may adopt strategies to mitigate knowledge loss within their organizations by capturing knowledge in a knowledge management system (KMS). The purpose of this single case study was to explore strategies that information…

Facilitating Elementary Science Teachers' Implementation of Inquiry-Based Science Teaching

ERIC Educational Resources Information Center

Qablan, Ahmad M.; DeBaz, Theodora

2015-01-01

Preservice science teachers generally feel that the implementation of inquiry-based science teaching is very difficult to manage. This research project aimed at facilitating the implementation of inquiry-based science teaching through the use of several classroom strategies. The evaluation of 15 classroom strategies from 80 preservice elementary…

Fault Management Design Strategies

NASA Technical Reports Server (NTRS)

Day, John C.; Johnson, Stephen B.

2014-01-01

Development of dependable systems relies on the ability of the system to determine and respond to off-nominal system behavior. Specification and development of these fault management capabilities must be done in a structured and principled manner to improve our understanding of these systems, and to make significant gains in dependability (safety, reliability and availability). Prior work has described a fundamental taxonomy and theory of System Health Management (SHM), and of its operational subset, Fault Management (FM). This conceptual foundation provides a basis to develop framework to design and implement FM design strategies that protect mission objectives and account for system design limitations. Selection of an SHM strategy has implications for the functions required to perform the strategy, and it places constraints on the set of possible design solutions. The framework developed in this paper provides a rigorous and principled approach to classifying SHM strategies, as well as methods for determination and implementation of SHM strategies. An illustrative example is used to describe the application of the framework and the resulting benefits to system and FM design and dependability.

Resources Management Strategy For Mud Crabs (Scylla spp.) In Pemalang Regency

NASA Astrophysics Data System (ADS)

Purnama Fitri, Aristi Dian; Boesono, Herry; Sabdono, Agus; Adlina, Nadia

2017-02-01

The aim of this research is to develop resources management strategies of mud crab (Scylla spp.) in Pemalang Regency. The method used is descriptive survey in a case study. This research used primary data and secondary data. Primary data were collected through field observations and in-depth interviews with key stakeholders. Secondary data were collected from related publications and documents issued by the competent institutions. SWOT Analysis was used to inventory the strengths, weaknesses, opportunities and threats. TOWS matrix was used to develop an alternative of resources management strategies. SWOT analysis was obtained by 6 alternative strategies that can be applied for optimization of fisheries development in Pemalang Regency. The strategies is the control of mud crab fishing gear, restricted size allowable in mud crab, control of mud crab fishing season, catch monitoring of mud crab, needs a management institutions which ensure the implementation of the regulation, and implementation for mud crab aquaculture. Each alternative strategy can be synergized to optimize the resources development in Pemalang Regency.

ACTIVE SURVEILLANCE FOR PAPILLARY THYROID MICROCARCINOMA: NEW CHALLENGES AND OPPORTUNITIES FOR THE HEALTH CARE SYSTEM

PubMed Central

Haser, Grace C.; Tuttle, R. Michael; Su, Henry K.; Alon, Eran E.; Bergman, Donald; Bernet, Victor; Brett, Elise; Cobin, Rhoda; Dewey, Eliza H.; Doherty, Gerard; Dos Reis, Laura L.; Harris, Jeffrey; Klopper, Joshua; Lee, Stephanie L.; Levine, Robert A.; Lepore, Stephen J.; Likhterov, Ilya; Lupo, Mark A.; Machac, Josef; Mechanick, Jeffrey I.; Mehra, Saral; Milas, Mira; Orloff, Lisa A.; Randolph, Gregory; Revenson, Tracey A.; Roberts, Katherine J.; Ross, Douglas S.; Rowe, Meghan E.; Smallridge, Robert C.; Terris, David; Tufano, Ralph P.; Urken, Mark L.

2017-01-01

Objective The dramatic increase in papillary thyroid carcinoma (PTC) is primarily a result of early diagnosis of small cancers. Active surveillance is a promising management strategy for papillary thyroid microcarcinomas (PTMCs). However, as this management strategy gains traction in the U.S., it is imperative that patients and clinicians be properly educated, patients be followed for life, and appropriate tools be identified to implement the strategy. Methods We review previous active surveillance studies and the parameters used to identify patients who are good candidates for active surveillance. We also review some of the challenges to implementing active surveillance protocols in the U.S. and discuss how these might be addressed. Results Trials of active surveillance support nonsurgical management as a viable and safe management strategy. However, numerous challenges exist, including the need for adherence to protocols, education of patients and physicians, and awareness of the impact of this strategy on patient psychology and quality of life. The Thyroid Cancer Care Collaborative (TCCC) is a portable record keeping system that can manage a mobile patient population undergoing active surveillance. Conclusion With proper patient selection, organization, and patient support, active surveillance has the potential to be a long-term management strategy for select patients with PTMC. In order to address the challenges and opportunities for this approach to be successfully implemented in the U.S., it will be necessary to consider psychological and quality of life, cultural differences, and the patient’s clinical status. PMID:26799628

Sustainable water management in the southwestern United States: reality or rhetoric?

PubMed

Marshall, Robert M; Robles, Marcos D; Majka, Daniel R; Haney, Jeanmarie A

2010-07-21

While freshwater sustainability is generally defined as the provisioning of water for both people and the environment, in practice it is largely focused only on supplying water to furnish human population growth. Symptomatic of this is the state of Arizona, where rapid growth outside of the metropolitan Phoenix-Tucson corridor relies on the same groundwater that supplies year-round flow in rivers. Using Arizona as a case study, we present the first study in the southwestern United States that evaluates the potential impact of future population growth and water demand on streamflow depletion across multiple watersheds. We modeled population growth and water demand through 2050 and used four scenarios to explore the potential effects of alternative growth and water management strategies on river flows. Under the base population projection, we found that rivers in seven of the 18 study watersheds could be dewatered due to municipal demand. Implementing alternative growth and water management strategies, however, could prevent four of these rivers from being dewatered. The window of opportunity to implement water management strategies is narrowing. Because impacts from groundwater extraction are cumulative and cannot be immediately reversed, proactive water management strategies should be implemented where groundwater will be used to support new municipal demand. Our approach provides a low-cost method to identify where alternative water and growth management strategies may have the most impact, and demonstrates that such strategies can maintain a continued water supply for both people and the environment.

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

PubMed

White, D B

2000-01-01

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

Beyond PARR - PMEL's Integrated Data Management Strategy

NASA Astrophysics Data System (ADS)

Burger, E. F.; O'Brien, K.; Manke, A. B.; Schweitzer, R.; Smith, K. M.

2016-12-01

NOAA's Pacific Marine Environmental Laboratory (PMEL) hosts a wide range of scientific projects that span a number of scientific and environmental research disciplines. Each of these 14 research projects have their own data streams that are as diverse as the research. With its requirements for public access to federally funded research results and data, the 2013 White House Office of Science and Technology memo on Public Access to Research Results (PARR) changed the data management landscape for Federal agencies. In 2015, with support from the PMEL Director, Dr. Christopher Sabine, PMEL's Science Data Integration Group (SDIG) initiated a multi-year effort to formulate and implement an integrated data-management strategy for PMEL research efforts. Instead of using external requirements, such as PARR, to define our approach, we focussed on strategies to provide PMEL science projects with a unified framework for data submission, interoperable data access, data storage, and easier data archival to National Data Centers. This improves data access to PMEL scientists, their collaborators, and the public, and also provides a unified lab framework that allows our projects to meet their data management objectives, as well as those required by the PARR. We are implementing this solution in stages that allows us to test technology and architecture choices before comitting to a large scale implementation. SDIG developers have completed the first year of development where our approach is to reuse and leverage existing frameworks and standards. This presentation will describe our data management strategy, explain our phased implementation approach, the software and framework choices, and how these elements help us meet the objectives of this strategy. We will share the lessons learned in dealing with diverse and complex datasets in this first year of implementation and how these outcomes will shape our decisions for this ongoing effort. The data management capabilities now available to scientific projects, and other services being developed to manage and preserve PMEL's scientific data assets for our researchers, their collaborators, and future generations, will be described.

How CEOs use management information systems for strategy implementation in hospitals.

PubMed

Naranjo-Gil, David; Hartmann, Frank

2007-04-01

Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals' top managers' use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs' professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined.

Implementing optimal thinning strategies

Treesearch

Kurt H. Riitters; J. Douglas Brodie

1984-01-01

Optimal thinning regimes for achieving several management objectives were derived from two stand-growth simulators by dynamic programming. Residual mean tree volumes were then plotted against stand density management diagrams. The results supported the use of density management diagrams for comparing, checking, and implementing the results of optimization analyses....

Preventing Challenging Behaviors in Preschool: Effective Strategies for Classroom Teachers

ERIC Educational Resources Information Center

Coleman, Janelle C.; Crosby, Megan G.; Irwin, Heather K.; Dennis, Lindsay R.; Simpson, Cynthia G.; Rose, Chad A.

2013-01-01

This article provides practical strategies and techniques that early childhood educators can implement in their classrooms to effectively manage challenging behaviors. The specific strategies addressed fall under the following categories: (a) classroom management, (b) reinforcement, and (c) communication. Suggestions are made for how parents can…

Experiences of primary health care nurses in implementing integrated management of childhood illnesses strategy at selected clinics of Limpopo Province.

PubMed

Vhuromu, E N; Davhana-Maselesele, M

2009-09-01

Treatment of the under five years is a national priority as an attempt in curbing deaths and deformities affecting children. Primary health care was implemented in the clinics in order to help in the treatment of illnesses affecting the community, including children. As a result of childhood illnesses; the World Health Organization (WHO) and United Nation Children's Fund (UNICEF) came up with Integrated Management of Childhood illnesses (IMCI) strategy to enhance treatment of such illnesses in developing countries. Primary health care nurses (PHCNS) in Limpopo Province were also trained to implement the strategy. This study is intended to explore and describe the experiences of PHCNS in implementing the IMCI strategy at selected clinics in Vhembe District in the Limpopo Province. A qualitative, explorative, descriptive and contextual design was used. In-depth interviews were conducted with PHCNS who are IMCI trained and have implemented the strategy for a period of not less than two years. Data analysis was done through using Tesch 's method of open coding for qualitative analysis. Findings revealed that PHCNS had difficulty in rendering IMCI services due to lack of resources and poor working conditions. Recommendations address the difficulties experienced by PHCNS when implementing the IMCI strategy.

Implementing active traffic management strategies in the U.S.

DOT National Transportation Integrated Search

2010-10-01

Limited public funding for roadway expansion and improvement projects, coupled with continued growth in travel along congested urban freeway corridors, creates a pressing need for innovative congestion management approaches. Strategies to address con...

Developing an active implementation model for a chronic disease management program

PubMed Central

Smidth, Margrethe; Christensen, Morten Bondo; Olesen, Frede; Vedsted, Peter

2013-01-01

Background Introduction and diffusion of new disease management programs in healthcare is usually slow, but active theory-driven implementation seems to outperform other implementation strategies. However, we have only scarce evidence on the feasibility and real effect of such strategies in complex primary care settings where municipalities, general practitioners and hospitals should work together. The Central Denmark Region recently implemented a disease management program for chronic obstructive pulmonary disease (COPD) which presented an opportunity to test an active implementation model against the usual implementation model. The aim of the present paper is to describe the development of an active implementation model using the Medical Research Council’s model for complex interventions and the Chronic Care Model. Methods We used the Medical Research Council’s five-stage model for developing complex interventions to design an implementation model for a disease management program for COPD. First, literature on implementing change in general practice was scrutinised and empirical knowledge was assessed for suitability. In phase I, the intervention was developed; and in phases II and III, it was tested in a block- and cluster-randomised study. In phase IV, we evaluated the feasibility for others to use our active implementation model. Results The Chronic Care Model was identified as a model for designing efficient implementation elements. These elements were combined into a multifaceted intervention, and a timeline for the trial in a randomised study was decided upon in accordance with the five stages in the Medical Research Council’s model; this was captured in a PaTPlot, which allowed us to focus on the structure and the timing of the intervention. The implementation strategies identified as efficient were use of the Breakthrough Series, academic detailing, provision of patient material and meetings between providers. The active implementation model was tested in a randomised trial (results reported elsewhere). Conclusion The combination of the theoretical model for complex interventions and the Chronic Care Model and the chosen specific implementation strategies proved feasible for a practice-based active implementation model for a chronic-disease-management-program for COPD. Using the Medical Research Council’s model added transparency to the design phase which further facilitated the process of implementing the program. Trial registration: http://www.clinicaltrials.gov/(NCT01228708). PMID:23882169

Improving service user self-management: development and implementation of a strategy for the Richmond Response and Rehabilitation Team.

PubMed

Sanders, Julie; Fitzpatrick, Joanne M

2017-01-01

Community rapid response and rehabilitation teams are used to prevent avoidable hospital admissions for adults living with multiple long-term conditions and to support early hospital discharge by providing short-term intensive multidisciplinary support. Supporting self-management is an important service intervention if desired outcomes are to be achieved. A Care Quality Commission inspection of the Richmond Response and Rehabilitation Team in 2014 identified that self-management plans were not routinely developed with service users and reported this as requiring improvement. This quality improvement project aimed to develop and implement a self-management strategy for service users and for 90% of service users to have a personalised self-management plan within 3 months. The quality improvement intervention used the Plan-Do-Study-Act model comprising: (1) the development of a self-management plan, (2) staff education to support service users to self-manage using motivational interviewing techniques, (3) piloting the self-management plan with service users, (4) implementation of the self-management plan and (5) monthly audit and feedback. Evaluation involved an audit of the number and quality of self-management plans developed with service users and a survey of staff knowledge and confidence to support service users to self-manage. Following implementation of the intervention, the number of self-management plans developed in collaboration with service users increased from 0 to 187 over a 4-week period. Monthly audit data confirmed that this improvement has been sustained. Results indicated that staff knowledge and confidence improved after an education intervention. Quality improvement methods facilitated development and operationalisation of a self-management strategy by a community rapid response and rehabilitation team. The next phase of the project is to evaluate the impact of the self-management strategy on key service outcomes including self-efficacy, unplanned and emergency hospital admissions and early discharges.

Implementation strategies influence the structure, process and outcome of quality systems: an empirical study of hospital departments in Sweden.

PubMed

Kunkel, S; Rosenqvist, U; Westerling, R

2009-02-01

To analyse whether the organisation of quality systems (structure, process, and outcome) is related to how these systems were implemented (implementation prerequisites, cooperation between managers and staff, and source of initiative). A questionnaire was developed, piloted and distributed to 600 hospital departments. Questions were included to reflect implementation prerequisites (adequate resources, competence, problem-solving capacity and high expectations), cooperative implementation, source of initiative (manager, staff and purchaser), structure (resources and administration), process (culture and cooperation) and outcome (goal evaluation and competence development). The adjusted response rate was 75%. Construct validity and reliability was assessed by confirmatory factor analysis, and Cronbach alpha scores were calculated. The relationships among the variables were analysed with structural equation modelling with LISREL. Implementation prerequisites were highly related to structure (0.51) and process (0.33). Cooperative implementation was associated with process (0.26) and outcome (0.34). High manager initiative was related to structure (0.19) and process (0.17). The numbers in parentheses can be interpreted as correlations. Construct validity was good, and reliability was excellent for all factors (Cronbach alpha>0.78). The model was a good representation of reality (model fit p value = 0.082). The implementation of organisationally demanding quality systems may require managers to direct and lead the process while assuring that their staff get opportunities to contribute to the planning and designing of the new system. This would correspond to a cooperative implementation strategy rather than to top-down or bottom-up strategies. The results of this study could be used to adjust implementation processes.

Integrated corridor management : implementation guide and lessons learned.

DOT National Transportation Integrated Search

2012-02-01

This implementation guide is intended for use by adopters of integrated corridor management (ICM) approaches and strategies to address congestion and travel time reliability issues within specific travel corridors. It introduces the topic of ICM and ...

What drives successful implementation of pollution prevention and cleaner technology strategy? The role of innovative capability.

PubMed

Bhupendra, Kumar Verma; Sangle, Shirish

2015-05-15

Firms that are dynamic and prepared to implement environmental strategies have a potential competitive advantage over their industry counterparts. Therefore, it is important to understand, what capabilities are required to implement proactive environmental strategies. The paper discusses the attributes of innovative capability required by firms in order to adopt pollution prevention and cleaner technology strategies. Empirical results show that process and behavioral innovativeness are required by firms to implement a pollution prevention strategy. In addition to process and behavioral innovativeness, firms need a top management with high risk-taking ability as well as market, product, and strategic innovativeness to implement a cleaner technology strategy. The paper proposes some important managerial implications on the basis of the above research findings. Copyright © 2015 Elsevier Ltd. All rights reserved.

Building a new waste management strategy in Puerto Rico

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

Boltz, C.

1995-06-01

Puerto Rico traditionally has not had a centrally organized waste management system. Most municipalities have provided service for their own residents, and the island used 62 unlined landfills before 32 of those closed in April 1994. But waste management on this Caribbean island is changing as the government-a self-governing commonwealth associated voluntarily with the US government-begins implementing its strategy for developing efficient, state-of-the-art waste management. This strategy includes plans to build an integrated system of collection, transfer stations, and disposal sites whose centerpieces are market-drives recycling, partnerships between the public and private sectors, and public education. The details of thismore » plan coincide with the mission statement of the Puerto Rico Solid Waste Management Authority (SWMA, San Juan), to ``develop and implement the necessary infrastructure for the efficient management of solid waste in Puerto Rico.« less

Developments in weather responsive traffic management strategies.

DOT National Transportation Integrated Search

2011-06-01

This report provides a comprehensive overview of weather-responsive traffic management practices. It focuses on what WRTM strategies exist, where they have been used, the benefits realized, what improvements are needed, and how to implement and evalu...

Nurse Managers’ Work Life Quality and Their Participation in Knowledge Management: A Correlational Study

PubMed Central

Hashemi Dehaghi, Zahra; Sheikhtaheri, Abbas; Dehnavi, Fariba

2014-01-01

Background: The association between quality of work life and participation in knowledge management is unknown. Objectives: This study aimed to discover the association between quality of work life of nurse managers and their participation in implementing knowledge management. Materials and Methods: This was a correlational study. All nurse managers (71 people) from 11 hospitals affiliated with the Social Security Organization in Tehran, Iran, were included. They were asked to rate their participation in knowledge management and their quality of work life. Data was gathered by a researcher-made questionnaire (May-June 2012). The questionnaire was validated by content and construct validity approaches. Cronbach’s alpha was used to evaluate reliability. Finally, 50 questionnaires were analyzed. The answers were scored and analyzed using mean of scores, T-test, ANOVA (or nonparametric test, if appropriate), Pearson’s correlation coefficient and linear regression. Results: Nurse managers’ performance to implement knowledge management strategies was moderate. A significant correlation was found between quality of work life of nurse managers and their participation in implementing knowledge management strategies (r = 0.82; P < 0.001). The strongest correlations were found between implementation of knowledge management and participation of nurse managers in decision making (r = 0.82; P < 0.001). Conclusions: Improvement of nurse managers’ work life quality, especially in decision-making, may increase their participation in implementing knowledge management. PMID:25763267

The use of on-site visits to assess compliance and implementation of quality management at hospital level.

PubMed

Wagner, C; Groene, O; Dersarkissian, M; Thompson, C A; Klazinga, N S; Arah, O A; Suñol, R

2014-04-01

Stakeholders of hospitals often lack standardized tools to assess compliance with quality management strategies and the implementation of clinical quality activities in hospitals. Such assessment tools, if easy to use, could be helpful to hospitals, health-care purchasers and health-care inspectorates. The aim of our study was to determine the psychometric properties of two newly developed tools for measuring compliance with process-oriented quality management strategies and the extent of implementation of clinical quality strategies at the hospital level. We developed and tested two measurement instruments that could be used during on-site visits by trained external surveyors to calculate a Quality Management Compliance Index (QMCI) and a Clinical Quality Implementation Index (CQII). We used psychometric methods and the cross-sectional data to explore the factor structure, reliability and validity of each of these instruments. The sample consisted of 74 acute care hospitals selected at random from each of 7 European countries. The psychometric properties of the two indices (QMCI and CQII). Overall, the indices demonstrated favourable psychometric performance based on factor analysis, item correlations, internal consistency and hypothesis testing. Cronbach's alpha was acceptable for the scales of the QMCI (α: 0.74-0.78) and the CQII (α: 0.82-0.93). Inter-scale correlations revealed that the scales were positively correlated, but distinct. All scales added sufficient new information to each main index to be retained. This study has produced two reliable instruments that can be used during on-site visits to assess compliance with quality management strategies and implementation of quality management activities by hospitals in Europe and perhaps other jurisdictions.

Design and Implementation of Training to Improve Management of Pediatric Overweight

ERIC Educational Resources Information Center

Beno, Luke; Hinchman, Josephine; Kibbe, Debra; Trowbridge, Frederick

2005-01-01

Introduction: Clinicians report a low proficiency in treating overweight children and using behavioral management strategies. This paper documents the design and implementation of a training program to improve clinicians' skills in the assessment and behavioral management of pediatric overweight. Methods: Two one-hour CME trainings were designed…

Fuels planning: science synthesis and integration; social issues fact sheet 13: Strategies for managing fuels and visual quality

Treesearch

Christine Esposito

2006-01-01

The public's acceptance of forest management practices, including fuels reduction, is heavily based on how forests look. Fuels managers can improve their chances of success by considering aesthetics when making management decisions. This fact sheet reviews a three-part general strategy for managing fuels and visual quality: planning, implementation, and monitoring...

Towards a resilience management framework for complex enterprise systems upgrade implementation

NASA Astrophysics Data System (ADS)

Teoh, Say Yen; Yeoh, William; Zadeh, Hossein Seif

2017-05-01

The lack of knowledge of how resilience management supports enterprise system (ES) projects accounts for the failure of firms to leverage their investments in costly ES implementations. Using a structured-pragmatic-situational (SPS) case study research approach, this paper reports on an investigation into the resilience management of a large utility company as it implemented an ES upgrade. Drawing on the literature and on the case study findings, we developed a process-based resilience management framework that involves three strategies (developing situation awareness, demystifying threats, and executing restoration plans) and four organisational capabilities that transform resilience management concepts into practices. We identified the crucial phases of ES upgrade implementation and developed indicators for how different strategies and capabilities of resilience management can assist managers at different stages of an ES upgrade. This research advances the state of existing knowledge by providing specific and verifiable propositions for attaining a state of resilience, the knowledge being grounded in the empirical reality of a case study. Moreover, the framework offers ES practitioners a roadmap to better identify appropriate responses and levels of preparedness.

Putting Climate Adaptation on the Map: Developing Spatial Management Strategies for Whitebark Pine in the Greater Yellowstone Ecosystem.

PubMed

Ireland, Kathryn B; Hansen, Andrew J; Keane, Robert E; Legg, Kristin; Gump, Robert L

2018-06-01

Natural resource managers face the need to develop strategies to adapt to projected future climates. Few existing climate adaptation frameworks prescribe where to place management actions to be most effective under anticipated future climate conditions. We developed an approach to spatially allocate climate adaptation actions and applied the method to whitebark pine (WBP; Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). WBP is expected to be vulnerable to climate-mediated shifts in suitable habitat, pests, pathogens, and fire. We spatially prioritized management actions aimed at mitigating climate impacts to WBP under two management strategies: (1) current management and (2) climate-informed management. The current strategy reflected management actions permissible under existing policy and access constraints. Our goal was to understand how consideration of climate might alter the placement of management actions, so the climate-informed strategies did not include these constraints. The spatial distribution of actions differed among the current and climate-informed management strategies, with 33-60% more wilderness area prioritized for action under climate-informed management. High priority areas for implementing management actions include the 1-8% of the GYE where current and climate-informed management agreed, since this is where actions are most likely to be successful in the long-term and where current management permits implementation. Areas where climate-informed strategies agreed with one another but not with current management (6-22% of the GYE) are potential locations for experimental testing of management actions. Our method for spatial climate adaptation planning is applicable to any species for which information regarding climate vulnerability and climate-mediated risk factors is available.

Putting Climate Adaptation on the Map: Developing Spatial Management Strategies for Whitebark Pine in the Greater Yellowstone Ecosystem

NASA Astrophysics Data System (ADS)

Ireland, Kathryn B.; Hansen, Andrew J.; Keane, Robert E.; Legg, Kristin; Gump, Robert L.

2018-06-01

Natural resource managers face the need to develop strategies to adapt to projected future climates. Few existing climate adaptation frameworks prescribe where to place management actions to be most effective under anticipated future climate conditions. We developed an approach to spatially allocate climate adaptation actions and applied the method to whitebark pine (WBP; Pinus albicaulis) in the Greater Yellowstone Ecosystem (GYE). WBP is expected to be vulnerable to climate-mediated shifts in suitable habitat, pests, pathogens, and fire. We spatially prioritized management actions aimed at mitigating climate impacts to WBP under two management strategies: (1) current management and (2) climate-informed management. The current strategy reflected management actions permissible under existing policy and access constraints. Our goal was to understand how consideration of climate might alter the placement of management actions, so the climate-informed strategies did not include these constraints. The spatial distribution of actions differed among the current and climate-informed management strategies, with 33-60% more wilderness area prioritized for action under climate-informed management. High priority areas for implementing management actions include the 1-8% of the GYE where current and climate-informed management agreed, since this is where actions are most likely to be successful in the long-term and where current management permits implementation. Areas where climate-informed strategies agreed with one another but not with current management (6-22% of the GYE) are potential locations for experimental testing of management actions. Our method for spatial climate adaptation planning is applicable to any species for which information regarding climate vulnerability and climate-mediated risk factors is available.

The impact of the great recession on community-based mental health organizations: an analysis of top managers' perceptions of the economic downturn's effects and adaptive strategies used to manage the consequences in Ohio.

PubMed

Sweeney, Helen Anne; Knudsen, Kraig

2014-04-01

The Great Recession of 2007-2009 adversely affected the financial stability of the community-based mental health infrastructure in Ohio. This paper presents survey results of the type of adaptive strategies used by Ohio community-based mental health organizations to manage the consequences of the economic downturn. Results were aggregated into geographical classifications of rural, mid-sized urban, and urban. Across all groups, respondents perceived, to varying degrees, that the Great Recession posed a threat to their organization's survival. Urban organizations were more likely to implement adaptive strategies to expand operations while rural and midsized urban organizations implemented strategies to enhance internal efficiencies.

Effective Strategies for Enhancing Waste Management at University Campuses

ERIC Educational Resources Information Center

Ebrahimi, Kianoosh; North, Leslie A.

2017-01-01

Purpose: The purpose of this study is to identify and assess the waste management strategies that should be priorities for higher education institutions. The role of policy instruments (i.e. purchasing policies and recycling initiatives) in implementing sustainable zero-waste management programs at higher education institutions was investigated…

Time Management in the Digital Era

ERIC Educational Resources Information Center

Wodarz, Nan

2013-01-01

School business officials can strike a balance between setting a long-term strategy and responding to short-term situations by implementing time management strategies. This article presents tips for time management that could help boost productivity and save time in this digital era. Tips include decreasing meeting times via Skype or…

Green campus management based on conservation program in Universitas Negeri Semarang

NASA Astrophysics Data System (ADS)

Prihanto, Teguh

2018-03-01

Universitas Negeri Semarang (UNNES) has a great commitment in the development of higher education programs in line with its vision as a conservation - minded and internationally reputable university. Implementation of conservation programs with respect to the rules or conservation aspects of sustainable use, preservation, provisioning, protection, restoration and conservation of nature. In order to support the implementation of UNNES conservation program more focused, development strategies and development programs for each conservation scope are covered: (1) Biodiversity management; (2) Internal transportation management; (3) energy management; (4) Green building management; (5) Waste and water management; (6) Cultural conservation management. All related to conservation development strategies and programs are managed in the form of green campus management aimed at realizing UNNES as a green campus, characterized and reputable at the regional and global level.

A framework for engaging stakeholders on the management of alien species.

PubMed

Novoa, Ana; Shackleton, Ross; Canavan, Susan; Cybèle, Cathleen; Davies, Sarah J; Dehnen-Schmutz, Katharina; Fried, Jana; Gaertner, Mirijam; Geerts, Sjirk; Griffiths, Charles L; Kaplan, Haylee; Kumschick, Sabrina; Le Maitre, David C; Measey, G John; Nunes, Ana L; Richardson, David M; Robinson, Tamara B; Touza, Julia; Wilson, John R U

2018-01-01

Alien species can have major ecological and socioeconomic impacts in their novel ranges and so effective management actions are needed. However, management can be contentious and create conflicts, especially when stakeholders who benefit from alien species are different from those who incur costs. Such conflicts of interests mean that management strategies can often not be implemented. There is, therefore, increasing interest in engaging stakeholders affected by alien species or by their management. Through a facilitated workshop and consultation process including academics and managers working on a variety of organisms and in different areas (urban and rural) and ecosystems (terrestrial and aquatic), we developed a framework for engaging stakeholders in the management of alien species. The proposed framework for stakeholder engagement consists of 12 steps: (1) identify stakeholders; (2) select key stakeholders for engagement; (3) explore key stakeholders' perceptions and develop initial aims for management; (4) engage key stakeholders in the development of a draft management strategy; (5) re-explore key stakeholders' perceptions and revise the aims of the strategy; (6) co-design general aims, management objectives and time frames with key stakeholders; (7) co-design a management strategy; (8) facilitate stakeholders' ownership of the strategy and adapt as required; and (9) implement the strategy and monitor management actions to evaluate the need for additional or future actions. In case additional management is needed after these actions take place, some extra steps should be taken: (10) identify any new stakeholders, benefits, and costs; (11) monitor engagement; and (12) revise management strategy. Overall, we believe that our framework provides an effective approach to minimize the impact of conflicts created by alien species management. Copyright © 2017 Elsevier Ltd. All rights reserved.

An empirical analysis of strategy implementation process and performance of construction companies

NASA Astrophysics Data System (ADS)

Zaidi, F. I.; Zawawi, E. M. A.; Nordin, R. M.; Ahnuar, E. M.

2018-02-01

Strategy implementation is known as action stage where it is to be considered as the most difficult stage in strategic planning. Strategy implementation can influence the whole texture of a company including its performance. The aim of this research is to provide the empirical relationship between strategy implementation process and performance of construction companies. This research establishes the strategy implementation process and how it influences the performance of construction companies. This research used quantitative method approached via questionnaire survey. Respondents were G7 construction companies in Klang Valley, Selangor. Pearson correlation analysis indicate a strong positive relationship between strategy implementation process and construction companies’ performance. The most importance part of strategy implementation process is to provide sufficient training for employees which directly influence the construction companies’ profit growth and employees’ growth. This research results will benefit top management in the construction companies to conduct strategy implementation in their companies. This research may not reflect the whole construction industry in Malaysia. Future research may be resumed to small and medium grades contractors and perhaps in other areas in Malaysia.

The integrated rangeland fire management strategy actionable science plan

USGS Publications Warehouse

Aldridge, Cameron L.; Berg, Ken; Boyd, Chad S.; Boyte, Stephen P.; Bradford, John B.; Brunson, Ed; Cissel, John H.; Conway, Courtney J.; Chalfoun, Anna D.; Chambers, Jeanne C.; Clark, Patrick; Coates, Peter S.; Crist, Michele R.; Davis, Dawn M.; DeCrappeo, Nicole; Deibert, Patricia A.; Doherty, Kevin E.; Evers, Louisa B.; Finch, Deborah M.; Finn, Sean P.; Germino, Matthew J.; Glenn, Nancy F.; Gucker, Corey; Hall, John A.; Hanser, Steven E.; Havlina, Douglas W.; Heinrichs, Julie; Heller, Matt; Homer, Collin G.; Hunter, Molly E.; Jacobs, Ruth W.; Karl, Jason W.; Kearney, Richard; Kemp, Susan K; Kilkenny, Francis F.; Knick, Steven T.; Launchbaugh, Karen; Manier, Daniel J.; Mayer, Kenneth E.; Meyer, Susan E.; Monroe, Adrian; MontBlanc, Eugénie; Newingham, Beth A.; Pellant, Michael L.; Phillips, Susan L.; Pilliod, David S.; Ricca, Mark A.; Richardson, Bryce A.; Rose, Jeffrey A.; Shaw, Nancy; Sheley, Roger L.; Shinneman, Douglas J.; Wiechman , Lief A.; Wylie, Bruce K.

2016-01-01

The Integrated Rangeland Fire Management Strategy (hereafter Strategy, DOI 2015) outlined the need for coordinated, science-based adaptive management to achieve long-term protection, conservation, and restoration of the sagebrush (Artemisia spp.) ecosystem. A key component of this management approach is the identification of knowledge gaps that limit implementation of effective strategies to meet current management challenges. The tasks and actions identified in the Strategy address several broad topics related to management of the sagebrush ecosystem. This science plan is organized around these topics and specifically focuses on fire, invasive plant species and their effects on altering fire regimes, restoration, sagebrush and greater sage-grouse (Centrocercus urophasianus), and climate and weather.

[The implementation of strategy of medicinal support in multi-type hospital].

PubMed

Ludupova, E Yu

2016-01-01

The article presents brief review of implementation of strategy of medicinal support of population of the Russian Federation and experience of application of at the level of regional hospital. The necessity and importance of implementation into practice of hospitals of methodology of pharmaco-economical management of medicinal care using modern technologies of XYZ-, ABC and VEN-analysis is demonstrated. The stages of development and implementation of process of medicinal support of multifield hospital applying principles of system of quality management (processing and systemic approaches, risk management) on the basis of standards ISO 9001 are described. The significance of monitoring of results ofprocess of medicinal support of the basis of implementation of priority target programs (prevention of venous thrombo-embolic complications, system od control of anti-bacterial therapy) are demonstrated in relation to multi-field hospital using technique of ATC/DDD-analysis for evaluating indices of effectiveness and efficiency.

User Perceptions of the Implementation of an Electronic Medication Management System in a Paediatric Setting.

PubMed

Hardie, Rae-Anne; Baysari, Melissa T; Lake, Rebecca; Richardson, Lauren; McCullagh, Cheryl; Westbrook, Johanna I

2017-01-01

The roll-out of a hospital-wide electronic medication management system (eMMS) is a challenging task, requiring planning, coordination, communication and change management. This research aimed to explore the views of doctors and nurses about the strategy used to implement an eMM system in a paediatric hospital. Semi-structured interviews were performed during the first week of the implementation on each ward, and were then followed up three and six weeks post implementation. In total, 90 users (60 nurses and 30 doctors) were asked about their impressions of the implementation, as well as their perceptions of training and IT support. Qualitative thematic analysis was performed by three researchers. Most users perceived the implementation of the eMM to be positive overall. Although perceptions of the implementation process remained largely consistent across the six weeks, users identified several areas where improvements were needed, especially early in implementation, including resources, planning, roll-out strategy and training. These findings are useful for future implementations of eMM systems in paediatric hospitals.

Uncovering middle managers' role in healthcare innovation implementation

PubMed Central

2012-01-01

Background Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Discussion Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Summary Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation. PMID:22472001

Uncovering middle managers' role in healthcare innovation implementation.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J

2012-04-03

Middle managers have received little attention in extant health services research, yet they may have a key role in healthcare innovation implementation. The gap between evidence of effective care and practice may be attributed in part to poor healthcare innovation implementation. Investigating middle managers' role in healthcare innovation implementation may reveal an opportunity for improvement. In this paper, we present a theory of middle managers' role in healthcare innovation implementation to fill the gap in the literature and to stimulate research that empirically examines middle managers' influence on innovation implementation in healthcare organizations. Extant healthcare innovation implementation research has primarily focused on the roles of physicians and top managers. Largely overlooked is the role of middle managers. We suggest that middle managers influence healthcare innovation implementation by diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. Teamwork designs have become popular in healthcare organizations. Because middle managers oversee these team initiatives, their potential to influence innovation implementation has grown. Future research should investigate middle managers' role in healthcare innovation implementation. Findings may aid top managers in leveraging middle managers' influence to improve the effectiveness of healthcare innovation implementation.

Total Quality Management Implementation Plan Defense Depot Memphis

DTIC Science & Technology

1989-07-01

W.ungilon. 0 t :0.O. )RT DATE 3. REPORT TYPE AND DATES COVERED I July 1989 _ 4. TITLE AND SUBTITLE 5. FUNDING NUMBERS Total Quality Management Implementation...improvement goals, implementation strategy and milestones. 6’ SEP 291989 /; ELECTE i= E 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Depot...changing work environment where change is the norm. We are talking about changes in attitudes and habits. Total Quality Management is not a panacea

Issues in Planning and Implementing National Literacy Programmes.

ERIC Educational Resources Information Center

Carron, G., Ed.; Bordia, A., Ed.

The following papers were produced by participants and resource persons on specific issues of planning, management and implementation of literacy and post-literacy strategies: "People's Participation and Mobilization: Characteristics of the Literacy Campaigns in China" (Yanwei); "Strategies for Mobilization and Participation of…

A Knowledge Management Approach to Support Software Process Improvement Implementation Initiatives

NASA Astrophysics Data System (ADS)

Montoni, Mariano Angel; Cerdeiral, Cristina; Zanetti, David; Cavalcanti da Rocha, Ana Regina

The success of software process improvement (SPI) implementation initiatives depends fundamentally of the strategies adopted to support the execution of such initiatives. Therefore, it is essential to define adequate SPI implementation strategies aiming to facilitate the achievement of organizational business goals and to increase the benefits of process improvements. The objective of this work is to present an approach to support the execution of SPI implementation initiatives. We also describe a methodology applied to capture knowledge related to critical success factors that influence SPI initiatives. This knowledge was used to define effective SPI strategies aiming to increase the success of SPI initiatives coordinated by a specific SPI consultancy organization. This work also presents the functionalities of a set of tools integrated in a process-centered knowledge management environment, named CORE-KM, customized to support the presented approach.

The effectiveness of strategies similar to the Magnet model to create positive work environments on nurse satisfaction.

PubMed

Kol, Emine; İlaslan, Emine; Turkay, Mehtap

2017-08-01

The objective of this study was to identify the satisfaction levels of nurses with positive environment initiatives and positive management strategies. In total, 235 and 259 nurses participated in the study before and after the application of the initiatives and strategies, respectively. Strategies adopted from the magnet model to create positive work environments and management styles were executed according to the forces of magnetism. Data related to satisfaction were collected twice, once before and once after the strategies to create positive working environments were implemented. The rates of working environment satisfaction in the nurses' department were 57.07% in 2011 and 69.01% in 2013. The rate of satisfaction with governance differed significantly between 2011 and 2013, especially in terms of the merit system, equity and equality, information flow between the administration and the employees, and the influence of the nursing managers on institutional decision making. This study showed that 24 months after the implementation of these strategies, nurse satisfaction with their work environment and management style increased significantly. © 2017 John Wiley & Sons Australia, Ltd.

Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan.

PubMed

Pradhan, Nousheen Akber; Rizvi, Narjis; Sami, Neelofar; Gul, Xaher

2013-07-05

Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition - the main targets of the strategy. The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities' survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies, while 4 out of 16 facilities had 56% of the required IMCI drug stock. The mean availability of supplies ranged from 36.6 to 66%, while the mean availability of drugs ranged from 45.8 to 56.7%. Our findings indicate that the Matiari district has sound implementation potential; however, bottlenecks at health care facility and at health care management level have badly constrained the implementation process. An interdependency exists among the constraining factors, such as lack of sound planning resulting in unclear understanding of the strategy; leading to ambiguous roles and responsibilities among stakeholders which manifest as inadequate availability of supplies and drugs at PHC facilities. Addressing these barriers is likely to have a cumulative effect on facilitating IMCI implementation. On the basis of these findings, we recommend that the provincial Ministry of Health (MoH) and provincial Maternal Neonatal and Child Health (MNCH) program jointly assess the situation and streamline IMCI implementation in the district through sound planning, training, supervision, and logistic support.

The Implementation and Evaluation of the Patient Admission Prediction Tool: Assessing Its Impact on Decision-Making Strategies and Patient Flow Outcomes in 2 Australian Hospitals.

PubMed

Crilly, Julia L; Boyle, Justin; Jessup, Melanie; Wallis, Marianne; Lind, James; Green, David; FitzGerald, Gerry

2015-01-01

To evaluate the implementation of a Patient Admission Prediction Tool (PAPT) in terms of patient flow outcomes and decision-making strategies. The PAPT was implemented in 2 Australian public teaching hospitals during October-December 2010 (hospital A) and October-December 2011 (hospital B). A multisite prospective, comparative (before and after) design was used. Patient flow outcomes measured included access block and hospital occupancy. Daily and weekly data were collected from patient flow reports and routinely collected emergency department information by the site champion and researchers. Daily decision-making strategies ranged from business as usual to use of overcensus beds. Weekly strategies included advanced approval to use of overcensus beds and prebooking nursing staff. These strategies resulted in improved weekend discharges to manage incoming demand for the following week. Following the introduction of the PAPT and workflow guidelines, patient access and hospital occupancy levels could be maintained despite increases in patient presentations (hospital A). The use of a PAPT, embedded in patient flow management processes and championed by a manager, can benefit bed and staff management. Further research that incorporates wider evaluation of the use of the tool at other sites is warranted.

Senior managers' viewpoints toward challenges of implementing clinical governance: a national study in iran.

PubMed

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-11-01

Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government's intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers' viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers' attitude toward CG and ultimately affected the success of quality improvement activities.

Integrated corridor management : implementation guide and lessons learned (final report version 2.0).

DOT National Transportation Integrated Search

2015-09-01

This implementation guide is intended for use by adopters of integrated corridor management (ICM) approaches and strategies to address congestion and travel time reliability issues within specific travel corridors. It introduces the topic of ICM and ...

Implementation of a Self-Management System for Students with Disabilities in General Education Settings

ERIC Educational Resources Information Center

Schulze, Margaret A.

2016-01-01

Despite the fact that self-management procedures have a robust literature base attesting to their efficacy with students with disabilities, the use of these strategies in general education settings remains limited. This mixed methods study examined the implementation of self-management procedures using both quantitative and qualitative methods.…

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

PubMed

Bayuo, Jonathan; Munn, Zachary; Campbell, Jared

2017-09-01

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

Self-Managed Work Teams in Nursing Homes: Implementing and Empowering Nurse Aide Teams

ERIC Educational Resources Information Center

Yeatts, Dale E.; Cready, Cynthia; Ray, Beth; DeWitt, Amy; Queen, Courtney

2004-01-01

Purpose: This article describes the progress of our study to examine the advantages and costs of using self-managed nurse aide teams in nursing homes, steps that are being taken to implement such teams, and management strategies being used to manage the teams. Design and Methods: A quasi-experimental design is underway where certified nurse aide…

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana.

PubMed

Mupara, Lucia U; Lubbe, Johanna C

2016-01-01

Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana.

Incentivizing around the Globe: Educating for the Challenge of Developing Culturally Considerate Work Motivation Strategies

ERIC Educational Resources Information Center

Mills, Maura J.

2017-01-01

Work motivation has long been considered a driving force behind optimal employee management. However, as the workscape continues its path toward increased globalization, today's managers must consider cultural influences on employee motivation to implement the most appropriate human capital management strategies within any given context. The…

Implementing a strategy to promote lifelong learning in the primary care workforce: an evaluation of leadership roles, change management approaches, interim challenges and achievements.

PubMed

McLaren, Susan; Woods, Leslie; Boudioni, Markella; Lemma, Ferew; Tavabie, Abdol

2008-01-01

To identify and explore leadership roles and responsibilities for implementing the workforce development strategy; to identify approaches used to implement and disseminate the strategy; and to identify and explore challenges and achievements in the first 18 months following implementation. A formative evaluation with qualitative methods was used. Documentary analysis, interviews (n = 29) and two focus groups (n = 12) were conducted with a purposive sample of individuals responsible for strategy implementation. Data were transcribed and analysed thematically using framework analysis. Regional health area in Kent, Surrey and Sussex: 24 primary care trusts (PCTs) and 900 general practices. Primary care workforce tutors, lifelong learning advisors, GP tutors, patch associate GP deans and chairs of PCT education committees all had vital leadership roles, some existing and others newly developed. Approaches used to implement the strategy encompassed working within and across organisational boundaries, communication and dissemination of information. Challenges encountered by implementers were resistance to change - evident in some negative attitudes to uptake of training and development opportunities - and role diversity and influence. Achievements included successes in embedding appraisal and protected learning time, and changes in educational practices and services. The use of key leadership roles and change-management approaches had brought about early indications of positive transition in lifelong learning cultures.

The effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare: a systematic review.

PubMed

Sarkies, Mitchell N; Bowles, Kelly-Ann; Skinner, Elizabeth H; Haas, Romi; Lane, Haylee; Haines, Terry P

2017-11-14

It is widely acknowledged that health policy and management decisions rarely reflect research evidence. Therefore, it is important to determine how to improve evidence-informed decision-making. The primary aim of this systematic review was to evaluate the effectiveness of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The secondary aim of the review was to describe factors perceived to be associated with effective strategies and the inter-relationship between these factors. An electronic search was developed to identify studies published between January 01, 2000, and February 02, 2016. This was supplemented by checking the reference list of included articles, systematic reviews, and hand-searching publication lists from prominent authors. Two reviewers independently screened studies for inclusion, assessed methodological quality, and extracted data. After duplicate removal, the search strategy identified 3830 titles. Following title and abstract screening, 96 full-text articles were reviewed, of which 19 studies (21 articles) met all inclusion criteria. Three studies were included in the narrative synthesis, finding policy briefs including expert opinion might affect intended actions, and intentions persisting to actions for public health policy in developing nations. Workshops, ongoing technical assistance, and distribution of instructional digital materials may improve knowledge and skills around evidence-informed decision-making in US public health departments. Tailored, targeted messages were more effective in increasing public health policies and programs in Canadian public health departments compared to messages and a knowledge broker. Sixteen studies (18 articles) were included in the thematic synthesis, leading to a conceptualisation of inter-relating factors perceived to be associated with effective research implementation strategies. A unidirectional, hierarchal flow was described from (1) establishing an imperative for practice change, (2) building trust between implementation stakeholders and (3) developing a shared vision, to (4) actioning change mechanisms. This was underpinned by the (5) employment of effective communication strategies and (6) provision of resources to support change. Evidence is developing to support the use of research implementation strategies for promoting evidence-informed policy and management decisions in healthcare. The design of future implementation strategies should be based on the inter-relating factors perceived to be associated with effective strategies. This systematic review was registered with Prospero (record number: 42016032947).

Embedding care management in the medical home: a case study.

PubMed

Daaleman, Timothy P; Hay, Sherry; Prentice, Amy; Gwynne, Mark D

2014-04-01

Care managers are playing increasingly significant roles in the redesign of primary care and in the evolution of patient-centered medical homes (PCMHs), yet their adoption within day-to-day practice remains uneven and approaches for implementation have been minimally reported. We introduce a strategy for incorporating care management into the operations of a PCMH and assess the preliminary effectiveness of this approach. A case study of the University of North Carolina at Chapel Hill Family Medicine Center used an organizational model of innovation implementation to guide the parameters of implementation and evaluation. Two sources were used to determine the effectiveness of the implementation strategy: data elements from the care management informatics system in the health record and electronic survey data from the Family Medicine Center providers and care staff. A majority of physicians (75%) and support staff (82%) reported interactions with the care manager, primarily via face-to-face, telephone, or electronic means, primarily for facilitating referrals for behavioral health services and assistance with financial and social and community-based resources. Trend line suggests an absolute decrease of 8 emergency department visits per month for recipients of care management services and an absolute decrease of 7.5 inpatient admissions per month during the initial 2-year implementation period. An organizational model of innovation implementation is a potentially effective approach to guide the process of incorporating care management services into the structure and workflows of PCMHs.

Improving and ensuring best practice continence management in residential aged care.

PubMed

Heckenberg, Gayle

2008-06-01

Background  Continence Management within residential aged care is an every day component of care that requires assessment, implementation of strategies, resource allocation and evaluation. At times the management of incontinence of aged residents can be challenging and unsuccessful. The project chosen through the Clinical Fellowship program was Continence Management with the aim of raising awareness of best practice to assist in improving and providing person-centred resident care. Aims/objectives •  Review the literature on best practice management of incontinence •  Evaluate current practice in continence management for elderly residents within residential aged care services •  Improve adherence to best practice strategies of care for incontinence •  Raise awareness within the nursing home of the best practice management of incontinence •  Promote appropriate and effective use of resources for continence management •  Deliver individualised person-centred care to residents. •  Ensure best practice in continence management Methods  The Joanna Briggs Institute (JBI) Practical Application of Clinical Evidence System clinical audit tool was utilised to measure current practice against best practice. The results identify gaps that require improvement. The Getting Research into Practice process then allowed analysis of the level of compliance with each of the audit criteria, which would identify any barriers in implementing a selected course of action and aim to improve compliance. The project team was consulted with additional stakeholder consultation to form an action plan and implement strategies to improve practice. Results  Although 100% compliance with all audit criteria in audit 1 and 2 was not achieved, there was improvement in the criteria concerning the documented fluid intake for residents. Further strategies have been identified and implemented and this continues to be a 'work in progress'. Staff now have an acute awareness of what best practice means and the impact their practices have on continence management. The JBI clinical audit and feedback cycle will continue to facilitate the measuring and implementation of best practice for resident outcomes in residential aged care. © 2008 The Author. Journal Compilation © Blackwell Publishing Asia Pty Ltd.

A new combined strategy to implement a community occupational therapy intervention: designing a cluster randomized controlled trial

PubMed Central

2011-01-01

Background Even effective interventions for people with dementia and their caregivers require specific implementation efforts. A pilot study showed that the highly effective community occupational therapy in dementia (COTiD) program was not implemented optimally due to various barriers. To decrease these barriers and make implementation of the program more effective a combined implementation (CI) strategy was developed. In our study we will compare the effectiveness of this CI strategy with the usual educational (ED) strategy. Methods In this cluster randomized, single-blinded, controlled trial, each cluster consists of at least two occupational therapists, a manager, and a physician working at Dutch healthcare organizations that deliver community occupational therapy. Forty-five clusters, stratified by healthcare setting (nursing home, hospital, mental health service), have been allocated randomly to either the intervention group (CI strategy) or the control group (ED strategy). The study population consists of the professionals included in each cluster and community-dwelling people with dementia and their caregivers. The primary outcome measures are the use of community OT, the adherence of OTs to the COTiD program, and the cost effectiveness of implementing the COTiD program in outpatient care. Secondary outcome measures are patient and caregiver outcomes and knowledge of managers, physicians and OTs about the COTiD program. Discussion Implementation research is fairly new in the field of occupational therapy, making this a unique study. This study does not only evaluate the effects of the CI-strategy on professionals, but also the effects of professionals' degree of implementation on client and caregiver outcomes. Clinical trials registration NCT01117285 PMID:21450063

Operational concepts and implementation strategies for the design configuration management process.

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

Trauth, Sharon Lee

2007-05-01

This report describes operational concepts and implementation strategies for the Design Configuration Management Process (DCMP). It presents a process-based systems engineering model for the successful configuration management of the products generated during the operation of the design organization as a business entity. The DCMP model focuses on Pro/E and associated activities and information. It can serve as the framework for interconnecting all essential aspects of the product design business. A design operation scenario offers a sense of how to do business at a time when DCMP is second nature within the design organization.

Digital echocardiography 2002: now is the time

NASA Technical Reports Server (NTRS)

Thomas, James D.; Greenberg, Neil L.; Garcia, Mario J.

2002-01-01

The ability to acquire echocardiographic images digitally, store and transfer these data using the DICOM standard, and routinely analyze examinations exists today and allows the implementation of a digital echocardiography laboratory. The purpose of this review article is to outline the critical components of a digital echocardiography laboratory, discuss general strategies for implementation, and put forth some of the pitfalls that we have encountered in our own implementation. The major components of the digital laboratory include (1) digital echocardiography machines with network output, (2) a switched high-speed network, (3) a high throughput server with abundant local storage, (4) a reliable low-cost archive, (5) software to manage information, and (6) support mechanisms for software and hardware. Implementation strategies can vary from a complete vendor solution providing all components (hardware, software, support), to a strategy similar to our own where standard computer and networking hardware are used with specialized software for management of image and measurement information.

Tracking implementation strategies: a description of a practical approach and early findings.

PubMed

Bunger, Alicia C; Powell, Byron J; Robertson, Hillary A; MacDowell, Hannah; Birken, Sarah A; Shea, Christopher

2017-02-23

Published descriptions of implementation strategies often lack precision and consistency, limiting replicability and slowing accumulation of knowledge. Recent publication guidelines for implementation strategies call for improved description of the activities, dose, rationale and expected outcome(s) of strategies. However, capturing implementation strategies with this level of detail can be challenging, as responsibility for implementation is often diffuse and strategies may be flexibly applied as barriers and challenges emerge. We describe and demonstrate the development and application of a practical approach to identifying implementation strategies used in research and practice that could be used to guide their description and specification. An approach to tracking implementation strategies using activity logs completed by project personnel was developed to facilitate identification of discrete strategies. This approach was piloted in the context of a multi-component project to improve children's access to behavioural health services in a county-based child welfare agency. Key project personnel completed monthly activity logs that gathered data on strategies used over 17 months. Logs collected information about implementation activities, intent, duration and individuals involved. Using a consensus approach, two sets of coders categorised each activity based upon Powell et al.'s (Med Care Res Rev 69:123-57, 2012) taxonomy of implementation strategies. Participants reported on 473 activities, which represent 45 unique strategies. Initial implementation was characterised by planning strategies followed by educational strategies. After project launch, quality management strategies predominated, suggesting a progression of implementation over time. Together, these strategies accounted for 1594 person-hours, many of which were reported by the leadership team that was responsible for project design, implementation and oversight. This approach allows for identifying discrete implementation strategies used over time, estimating dose, describing temporal ordering of implementation strategies, and pinpointing the major implementation actors. This detail could facilitate clear reporting of a full range of implementation strategies, including those that may be less observable. This approach could lead to a more nuanced understanding of what it takes to implement different innovations, the types of strategies that are most useful during specific phases of implementation, and how implementation strategies need to be adaptively applied throughout the course of a given initiative.

Public perceptions about climate change mitigation in British Columbia's forest sector

PubMed Central

Hagerman, Shannon; Kozak, Robert; Hoberg, George

2018-01-01

The role of forest management in mitigating climate change is a central concern for the Canadian province of British Columbia. The successful implementation of forest management activities to achieve climate change mitigation in British Columbia will be strongly influenced by public support or opposition. While we now have increasingly clear ideas of the management opportunities associated with forest mitigation and some insight into public support for climate change mitigation in the context of sustainable forest management, very little is known with respect to the levels and basis of public support for potential forest management strategies to mitigate climate change. This paper, by describing the results of a web-based survey, documents levels of public support for the implementation of eight forest carbon mitigation strategies in British Columbia’s forest sector, and examines and quantifies the influence of the factors that shape this support. Overall, respondents ascribed a high level of importance to forest carbon mitigation and supported all of the eight proposed strategies, indicating that the British Columbia public is inclined to consider alternative practices in managing forests and wood products to mitigate climate change. That said, we found differences in levels of support for the mitigation strategies. In general, we found greater levels of support for a rehabilitation strategy (e.g. reforestation of unproductive forest land), and to a lesser extent for conservation strategies (e.g. old growth conservation, reduced harvest) over enhanced forest management strategies (e.g. improved harvesting and silvicultural techniques). We also highlighted multiple variables within the British Columbia population that appear to play a role in predicting levels of support for conservation and/or enhanced forest management strategies, including environmental values, risk perception, trust in groups of actors, prioritized objectives of forest management and socio-demographic factors. PMID:29684041

Public perceptions about climate change mitigation in British Columbia's forest sector.

PubMed

Peterson St-Laurent, Guillaume; Hagerman, Shannon; Kozak, Robert; Hoberg, George

2018-01-01

The role of forest management in mitigating climate change is a central concern for the Canadian province of British Columbia. The successful implementation of forest management activities to achieve climate change mitigation in British Columbia will be strongly influenced by public support or opposition. While we now have increasingly clear ideas of the management opportunities associated with forest mitigation and some insight into public support for climate change mitigation in the context of sustainable forest management, very little is known with respect to the levels and basis of public support for potential forest management strategies to mitigate climate change. This paper, by describing the results of a web-based survey, documents levels of public support for the implementation of eight forest carbon mitigation strategies in British Columbia's forest sector, and examines and quantifies the influence of the factors that shape this support. Overall, respondents ascribed a high level of importance to forest carbon mitigation and supported all of the eight proposed strategies, indicating that the British Columbia public is inclined to consider alternative practices in managing forests and wood products to mitigate climate change. That said, we found differences in levels of support for the mitigation strategies. In general, we found greater levels of support for a rehabilitation strategy (e.g. reforestation of unproductive forest land), and to a lesser extent for conservation strategies (e.g. old growth conservation, reduced harvest) over enhanced forest management strategies (e.g. improved harvesting and silvicultural techniques). We also highlighted multiple variables within the British Columbia population that appear to play a role in predicting levels of support for conservation and/or enhanced forest management strategies, including environmental values, risk perception, trust in groups of actors, prioritized objectives of forest management and socio-demographic factors.

Learning to manage a complex ecosystem: adaptive management and the Northwest Forest Plan.

Treesearch

George H. Stankey; Roger N. Clark; Bernard T. Bormann

2006-01-01

The Northwest Forest Plan (the Plan) identifies adaptive management as a central strategy for effective implementation. Despite this, there has been a lack of any systematic evaluation of its performance. This study is based on an extensive literature review, 50 interviews with resource managers and scientists involved with the Plan’s implementation, and a survey of...

Strategies Nurse Managers Used to Offset Challenges during Electronic Medical Records Implementation: A Case Study

ERIC Educational Resources Information Center

Easterling, Latasha

2015-01-01

The purpose of this qualitative, descriptive case study was to discover successful approaches used, by nurse managers, to reduce barriers during the implementation of electronic medical record system in one hospital. Fourteen nurse managers were interviewed from an academic health science center in Mississippi. A pilot study was conducted to…

An integrated approach to place Green Infrastructure strategies in marginalized communities and evaluate stormwater mitigation

NASA Astrophysics Data System (ADS)

Garcia-Cuerva, Laura; Berglund, Emily Zechman; Rivers, Louie

2018-04-01

Increasing urbanization augments impervious surface area, which results in increased run off volumes and peak flows. Green Infrastructure (GI) approaches are a decentralized alternative for sustainable urban stormwater and provide an array of ecosystem services and foster community building by enhancing neighborhood aesthetics, increasing property value, and providing shared green spaces. While projects involving sustainability concepts and environmental design are favored in privileged communities, marginalized communities have historically been located in areas that suffer from environmental degradation. Underprivileged communities typically do not receive as many social and environmental services as advantaged communities. This research explores GI-based management strategies that are evaluated at the watershed scale to improve hydrological performance by mitigating storm water run off volumes and peak flows. GI deployment strategies are developed to address environmental justice issues by prioritizing placement in communities that are underprivileged and locations with high outreach potential. A hydrologic/hydraulic stormwater model is developed using the Storm Water Management Model (SWMM 5.1) to simulate the impacts of alternative management strategies. Management scenarios include the implementation of rain water harvesting in private households, the decentralized implementation of bioretention cells in private households, the centralized implementation of bioretention cells in municipally owned vacant land, and combinations of those strategies. Realities of implementing GI on private and public lands are taken into account to simulate various levels of coverage and routing for bioretention cell scenarios. The effects of these strategies are measured by the volumetric reduction of run off and reduction in peak flow; social benefits are not evaluated. This approach is applied in an underprivileged community within the Walnut Creek Watershed in Raleigh, North Carolina.

Report: EPA Prepared to Implement Strategic Human Capital Management Activities But Challenges Remain

EPA Pesticide Factsheets

Report #2004-P-00024, September 20, 2004. EPA’s headquarters and regional offices are prepared to implement strategic human capital management activities, but an alignment of office-level activities to the Agency’s Strategy for Human Capital is lacking.

Rethinking Knowledge Management: Strategies for Enhancing District-Level Teacher and Leader Tacit Knowledge Sharing

ERIC Educational Resources Information Center

Edge, Karen

2013-01-01

Grounded within knowledge management (KM) theory and conceptions of tacit and explicit knowledge, this article draws on historical evidence from the Early Years Literacy Project (EYLP), a four-year instructional renewal strategy implemented across 100 schools in a large Canadian school district. The EYLP management approach included a series of…

Pharmacists' perspectives of the current status of pediatric asthma management in the U.S. community pharmacy setting.

PubMed

Elaro, Amanda; Bosnic-Anticevich, Sinthia; Kraus, Kathleen; Farris, Karen B; Shah, Smita; Armour, Carol; Patel, Minal R

2017-08-01

Objective To explore community pharmacists' continuing education, counseling and communication practices, attitudes and barriers in relation to pediatric asthma management. Setting Community pharmacies in Michigan, United States. Methods Between July and September 2015 a convenience sample of community pharmacists was recruited from southeastern Michigan and asked to complete a structured, self-reported questionnaire. The questionnaire elucidated information on 4 general domains relating to pharmacists' pediatric asthma management including: (1) guidelines and continuing education (CE); (2) counseling and medicines; (3) communication and self-management practices; (4) attitudes and barriers to practice. Regression analyses were conducted to determine predictors towards pharmacists' confidence/frequency of use of communication/counseling strategies. Main outcome measure Confidence in counseling skills around asthma. Results 105 pharmacists completed the study questionnaire. Fifty-four percent of pharmacists reported participating in asthma related CE in the past year. Over 70% of pharmacists reported confidence in general communication skills, while a lower portion reported confidence in engaging in higher order self-management activities that involved tailoring the regimen (58%), decision-making (50%) and setting short-term (47%) and long-term goals (47%) with the patient and caregiver for managing asthma at home. Pharmacists who reported greater use of recommended communication/self-management strategies were more likely to report confidence in implementing these communication/self-management strategies when counseling caregivers and children with asthma [Beta (B) Estimate 0.58 SE (0.08), p < 0.001]. Female pharmacists [B Estimate -2.23 SE (1.01), p < 0.05] and those who reported beliefs around doctors being the sole provider of asthma education [B Estimate -1.00 SE (0.32), p < 0.01] were less likely to report confidence in implementing communication/self-management strategies. Conclusion A pharmacists' confidence may influence their ability to implement recommended self-management counseling strategies. This study showed that community pharmacists are confident in general communication. However pharmacists are reporting lower confidence levels in counseling on higher order self-management strategies with patients. More appropriate and targeted continuing education programs for pharmacists around asthma self-management education are recommended.

Self-Development: The Nine Basic Skills for Business Success.

ERIC Educational Resources Information Center

Dobbins, Richard; Pettman, Barrie O.

1997-01-01

Business skills described are as follows: think creatively, set goals, implement a winning business strategy, implement a winning marketing strategy, be excellent at selling, negotiate better deals, give leadership, understand financial implications, and manage time well. A bibliography contains 90 references categorized by the nine skills. (SK)

A Contingent Analysis of the Relationship between IS Implementation Strategies and IS Success.

ERIC Educational Resources Information Center

Kim, Sang-Hoon; Lee, Jinjoo

1991-01-01

Considers approaches to dealing with user attitudes toward newly implemented information systems (IS), and suggests that behavioral management strategies relevant to IS fall into three categories: (1) empirical/rational; (2) normative/reeducative; and (3) power/coercive, based on "planned change" theories. An integrative contingent model…

Qualitative study on maintenance management in Moroccan industries

NASA Astrophysics Data System (ADS)

Naji, Amal; El Oumami, Mohamed; Bouksour, Otmane; Beidouri, Zitouni

2018-05-01

Maintenance management is, and has been studied in depth, especially for strategies to be implemented in industry, even though, authors note that there is a gap between literature and management adopted by industries. In this paper, we present a qualitative study in five Moroccan industries to investigate “how maintenance is managed” rather than “how it should be”. The questionnaire utilized for the study consists on semi-structured and open-ended questions. We consider factors and variables related to maintenance management and we explore the relationships between those factors. The original contribution of this paper is to provide a «real view »about maintenance management in Moroccan industries, which could help to improve understanding of barriers to implementing maintenance strategy.

Summary of the consultation on a strategy for services for chronic obstructive pulmonary disease (COPD) in England.

PubMed

Jones, Rupert; Gruffydd-Jones, Kevin; Pinnock, Hilary; Peffers, Sarah-Jane; Lawrence, Judith; Scullion, Jane; White, Patrick; Holmes, Steve

2010-12-01

The Consultation on a Strategy for Services for COPD in England is the culmination of five years' work by respiratory specialists from all disciplines, as well as representatives from the voluntary sector, patients, carers and planners. It has been led by the Department of Health in England and the joint National Directors for the programme, Professor Sue Hill and Dr Robert Winter. The Strategy outlines service standards for providers of COPD care and is complementary to the UK National Institute for Health and Clinical Excellence (NICE) guidelines on the management of COPD. Its key elements are: • preventing the development and progression of COPD • diagnosing COPD accurately and at an early stage • developing structured care based on national guidance • promoting self-management education • reducing the number of people admitted to hospital • improving access to end-of-life care • promoting good asthma services. In essence this is an aspirational strategy which aims to change the way that the NHS in England delivers care for people with COPD by identifying them earlier and managing them optimally in order to reduce the likelihood of progression to the more severe stages of the disease. An economic impact assessment shows that implementing the Strategy will save approximately £1billion over 10 years as well as sparing many people from a debilitating illness. This supplement is based on the Strategy Consultation document as well as the NICE guidelines for COPD management. It aims to elucidate practical implementation of the COPD Strategy, and includes verbatim the Strategy recommendations as well as highly relevant clinical information from the NICE guidelines. Implementation of the Strategy recommendations should lead to optimum care for patients with COPD.

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

Goldston, W.T.

DOE issued Order 435.1, ''Radioactive Waste Management,'' on July 9, 1999 for immediate implementation. The requirements for Low Level Mixed, Transuranic, and High Level Waste have been completely rewritten. The entire DOE complex has been struggling with how to implement these new requirements within the one year required timeframe. This paper will chronicle the implementation strategy and actual results of the work to carry out that strategy at the Savannah River Site.

Middle Managers' Experiences and Role in Implementing an Interactive Tailored Patient Assessment eHealth Intervention in Clinical Practice.

PubMed

Varsi, Cecilie; Ekstedt, Mirjam; Gammon, Deede; Børøsund, Elin; Ruland, Cornelia M

2015-06-01

The role of nurse and physician managers is considered crucial for implementing eHealth interventions in clinical practice, but few studies have explored this. The aim of the current study was to examine the perceptions of nurse and physician managers regarding facilitators, barriers, management role, responsibility, and action taken in the implementation of an eHealth intervention called Choice into clinical practice. Individual qualitative interviews were conducted with six nurses and three physicians in management positions at five hospital units. The findings revealed that nurse managers reported conscientiously supporting the implementation, but workloads prevented them from participating in the process as closely as they wanted. Physician managers reported less contribution. The implementation process was influenced by facilitating factors such as perceptions of benefits from Choice and use of implementation strategies, along with barriers such as physician resistance, contextual factors and difficulties for front-line providers in learning a new way of communicating with the patients. The findings suggest that role descriptions for both nurse and physician managers should include implementation knowledge and implementation skills. Managers could benefit from an implementation toolkit. Implementation management should be included in management education for healthcare managers to prepare them for the constant need for implementation and improvement in clinical practice.

Public sector energy management: A strategy for catalyzing energy efficiency in Malaysia

NASA Astrophysics Data System (ADS)

Roy, Anish Kumar

To date the public sector role in facilitating the transition to a sustainable energy future has been envisaged mainly from a regulatory perspective. In such a role, the public sector provides the push factors---enforcing regulations and providing incentives---to correct market imperfections that impede energy transitions. An alternative and complementary role of the public sector that is now gaining increasing attention is that of catalyzing energy transitions through public sector energy management initiatives. This dissertation offers a conceptual framework to rationalize such a role for the public sector by combining recent theories of sustainable energy transition and public management. In particular, the framework identifies innovative public management strategies (such as performance contracting and procurement) for effectively implementing sustainable energy projects in government facilities. The dissertation evaluates a model of sustainable public sector energy management for promoting energy efficiency in Malaysia. The public sector in Malaysia can be a major player in leading and catalyzing energy efficiency efforts as it is not only the largest and one of the most influential energy consumers, but it also plays a central role in setting national development strategy. The dissertation makes several recommendations on how a public sector energy management strategy can be implemented in Malaysia. The US Federal Energy Management Program (FEMP) is used as a practical model. The analysis, however, shows that in applying the FEMP model to the Malaysian context, there are a number of limitations that will have to be taken into consideration to enable a public sector energy management strategy to be effectively implemented. Overall the analysis of this dissertation contributes to a rethinking of the public sector role in sustainable energy development that can strengthen the sector's credibility both in terms of governance and institutional performance. In addition, it links theory with practice by offering a strategy that can effectively address critical issues arising from the energy-development-policy nexus of the sustainable energy development debate.

Essentials of total quality management: a meta-analysis.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

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

Risk management for food and beverage industry using Australia/New Zealand 4360 Standard

NASA Astrophysics Data System (ADS)

Kristina, S.; Wijaya, B. M.

2017-12-01

This research aims to identifying, measuring and establishing risk in food and beverage industry. The risk management is implemented by referring to Australia/New Zealand 4360 Standard which has four phases such as problem formulation, risk analysis, risk characterization, and risk management. The implementation of risk management is done by case study at Back Alley Café. Based on the risk identification result, there are 59 risks were found in Back Alley Café. The risk identification is conducted based on observation and interview with the café manager who understand the condition of Back Alley Café properly. Based on the assessment of impact and probability, the risk mapping produced four risks at extreme level, 16 risks at high level, 24 risks at medium level, and 18 risks at low level. The strategy was designed as the risk mitigation after the risk mapping for the extreme and high level. The strategy which is given as the prevention or treatment of risk in Back Alley Café is divided into three. There are reducing the risk, sharing the risk and accepting the risk. The strategy is then implemented for each relevant activities.

Risk Management Implementation Tool

NASA Technical Reports Server (NTRS)

Wright, Shayla L.

2004-01-01

Continuous Risk Management (CM) is a software engineering practice with processes, methods, and tools for managing risk in a project. It provides a controlled environment for practical decision making, in order to assess continually what could go wrong, determine which risk are important to deal with, implement strategies to deal with those risk and assure the measure effectiveness of the implemented strategies. Continuous Risk Management provides many training workshops and courses to teach the staff how to implement risk management to their various experiments and projects. The steps of the CRM process are identification, analysis, planning, tracking, and control. These steps and the various methods and tools that go along with them, identification, and dealing with risk is clear-cut. The office that I worked in was the Risk Management Office (RMO). The RMO at NASA works hard to uphold NASA s mission of exploration and advancement of scientific knowledge and technology by defining and reducing program risk. The RMO is one of the divisions that fall under the Safety and Assurance Directorate (SAAD). I worked under Cynthia Calhoun, Flight Software Systems Engineer. My task was to develop a help screen for the Continuous Risk Management Implementation Tool (RMIT). The Risk Management Implementation Tool will be used by many NASA managers to identify, analyze, track, control, and communicate risks in their programs and projects. The RMIT will provide a means for NASA to continuously assess risks. The goals and purposes for this tool is to provide a simple means to manage risks, be used by program and project managers throughout NASA for managing risk, and to take an aggressive approach to advertise and advocate the use of RMIT at each NASA center.

Insight into implementation of facility-based integrated management of childhood illness strategy in a rural district of Sindh, Pakistan

PubMed Central

Akber Pradhan, Nousheen; Rizvi, Narjis; Sami, Neelofar; Gul, Xaher

2013-01-01

Background Integrated management of childhood illnesses (IMCI) strategy has been proven to improve health outcomes in children under 5 years of age. Pakistan, despite being in the late implementation phase of the strategy, continues to report high under-five mortality due to pneumonia, diarrhea, measles, and malnutrition – the main targets of the strategy. Objective The study determines the factors influencing IMCI implementation at public-sector primary health care (PHC) facilities in Matiari district, Sindh, Pakistan. Design An exploratory qualitative study with an embedded quantitative strand was conducted. The qualitative part included 16 in-depth interviews (IDIs) with stakeholders which included planners and policy makers at a provincial level (n=5), implementers and managers at a district level (n=3), and IMCI-trained physicians posted at PHC facilities (n=8). Quantitative part included PHC facility survey (n=16) utilizing WHO health facility assessment tool to assess availability of IMCI essential drugs, supplies, and equipments. Qualitative content analysis was used to interpret the textual information, whereas descriptive frequencies were calculated for health facility survey data. Results The major factors reported to enhance IMCI implementation were knowledge and perception about the strategy and need for separate clinic for children aged under 5 years as potential support factors. The latter can facilitate in strategy implementation through allocated workforce and required equipments and supplies. Constraint factors mainly included lack of clear understanding of the strategy, poor planning for IMCI implementation, ambiguity in defined roles and responsibilities among stakeholders, and insufficient essential supplies and drugs at PHC centers. The latter was further substantiated through health facilities’ survey findings, which indicated that none of the facilities had 100% stock of essential supplies and drugs. Only one out of all 16 surveyed facilities had 75% of the total supplies, while 4 out of 16 facilities had 56% of the required IMCI drug stock. The mean availability of supplies ranged from 36.6 to 66%, while the mean availability of drugs ranged from 45.8 to 56.7%. Conclusion Our findings indicate that the Matiari district has sound implementation potential; however, bottlenecks at health care facility and at health care management level have badly constrained the implementation process. An interdependency exists among the constraining factors, such as lack of sound planning resulting in unclear understanding of the strategy; leading to ambiguous roles and responsibilities among stakeholders which manifest as inadequate availability of supplies and drugs at PHC facilities. Addressing these barriers is likely to have a cumulative effect on facilitating IMCI implementation. On the basis of these findings, we recommend that the provincial Ministry of Health (MoH) and provincial Maternal Neonatal and Child Health (MNCH) program jointly assess the situation and streamline IMCI implementation in the district through sound planning, training, supervision, and logistic support. PMID:23830574

Changing practice to support self-management and recovery in mental illness: application of an implementation model.

PubMed

Harris, Melanie; Jones, Phil; Heartfield, Marie; Allstrom, Mary; Hancock, Janette; Lawn, Sharon; Battersby, Malcolm

2015-01-01

Health services introducing practice changes need effective implementation methods. Within the setting of a community mental health service offering recovery-oriented psychosocial support for people with mental illness, we aimed to: (i) identify a well-founded implementation model; and (ii) assess its practical usefulness in introducing a new programme for recovery-oriented self-management support. We reviewed the literature to identify implementation models applicable to community mental health organisations, and that also had corresponding measurement tools. We used one of these models to inform organisational change strategies. The literature review showed few models with corresponding tools. The Promoting Action on Research Implementation in Health Services (PARIHS) model and the related Organisational Readiness to Change Assessment (ORCA) tool were used. The PARIHS proposes prerequisites for health service change and the ORCA measures the extent to which these prerequisites are present. Application of the ORCA at two time points during implementation of the new programme showed strategy-related gains for some prerequisites but not for others, reflecting observed implementation progress. Additional strategies to address target prerequisites could be drawn from the PARIHS model. The PARIHS model and ORCA tool have potential in designing and monitoring practice change strategies in community mental health organisations. Further practical use and testing of implementation models appears justified in overcoming barriers to change.

Team Culture and Business Strategy Simulation Performance

ERIC Educational Resources Information Center

Ritchie, William J.; Fornaciari, Charles J.; Drew, Stephen A. W.; Marlin, Dan

2013-01-01

Many capstone strategic management courses use computer-based simulations as core pedagogical tools. Simulations are touted as assisting students in developing much-valued skills in strategy formation, implementation, and team management in the pursuit of superior strategic performance. However, despite their rich nature, little is known regarding…

Environmental management practices in the Lebanese pharmaceutical industries: implementation strategies and challenges.

PubMed

Massoud, May A; Makarem, N; Ramadan, W; Nakkash, R

2015-03-01

This research attempts to provide an understanding of the Lebanese pharmaceutical industries' environmental management strategies, priorities, and perceptions as well as drivers, barriers, and incentives regarding the implementation of the voluntary ISO 14001 Environmental Management System. Accordingly, a semistructured in-depth interview was conducted with the pharmaceutical industries. The findings revealed a significant lack of knowledge about the standard among the industries. The main perceived drivers for adopting the ISO 14001 are improving the companies' image and overcoming international trade. The main perceived barriers for acquiring the standard are the lack of government support and the fact that ISO 14001 is not being legally required or enforced by the government. Moreover, results revealed that adopting the ISO 14001 standard is not perceived as a priority for the Lebanese pharmaceutical industries. Although the cost of certification was not considered as a barrier for the implementation of ISO 14001, the majority of the pharmaceutical industries are neither interested nor willing to adopt the Standard if they are not exposed to any regulatory pressure or external demand. They are more concerned with quality and safety issues with the most adopted international standard among the industries being the ISO 9001 quality management system. This study highlights the aspect that financial barriers are not always the hurdles for implementing environmental management strategies in developing countries and underscores the need for regulatory frameworks and enforcement.

Economic evaluation of an implementation strategy for the management of low back pain in general practice.

PubMed

Jensen, Cathrine Elgaard; Riis, Allan; Petersen, Karin Dam; Jensen, Martin Bach; Pedersen, Kjeld Møller

2017-05-01

In connection with the publication of a clinical practice guideline on the management of low back pain (LBP) in general practice in Denmark, a cluster randomised controlled trial was conducted. In this trial, a multifaceted guideline implementation strategy to improve general practitioners' treatment of patients with LBP was compared with a usual implementation strategy. The aim was to determine whether the multifaceted strategy was cost effective, as compared with the usual implementation strategy. The economic evaluation was conducted as a cost-utility analysis where cost collected from a societal perspective and quality-adjusted life years were used as outcome measures. The analysis was conducted as a within-trial analysis with a 12-month time horizon consistent with the follow-up period of the clinical trial. To adjust for a priori selected covariates, generalised linear models with a gamma family were used to estimate incremental costs and quality-adjusted life years. Furthermore, both deterministic and probabilistic sensitivity analyses were conducted. Results showed that costs associated with primary health care were higher, whereas secondary health care costs were lower for the intervention group when compared with the control group. When adjusting for covariates, the intervention was less costly, and there was no significant difference in effect between the 2 groups. Sensitivity analyses showed that results were sensitive to uncertainty. In conclusion, the multifaceted implementation strategy was cost saving when compared with the usual strategy for implementing LBP clinical practice guidelines in general practice. Furthermore, there was no significant difference in effect, and the estimate was sensitive to uncertainty.

Stakeholder management for conservation projects: a case study of Ream National Park, Cambodia.

PubMed

De Lopez, T T

2001-07-01

The paper gives an account of the development and implementation of a stakeholder management framework at Ream National Park, Cambodia. Firstly, the concept of stakeholder is reviewed in management and in conservation literatures. Secondly, the context in which the stakeholder framework was implemented is described. Thirdly, a five-step methodological framework is suggested: (1) stakeholder analysis, (2) stakeholder mapping, (3) development of generic strategies and workplan, (4) presentation of the workplan to stakeholders, and (5) implementation of the workplan. This framework classifies stakeholders according to their level of influence on the project and their potential for the conservation of natural resources. In a situation characterized by conflicting claims on natural resources, park authorities were able to successfully develop specific strategies for the management of stakeholders. The conclusion discusses the implications of the Ream experience and the generalization of the framework to other protected areas.

Development and assessment of an active strategy for the implementation of a collaborative care approach for depression in primary care (the INDI·i project).

PubMed

Aragonès, Enric; Palao, Diego; López-Cortacans, Germán; Caballero, Antonia; Cardoner, Narcís; Casaus, Pilar; Cavero, Myriam; Monreal, José Antonio; Pérez-Sola, Víctor; Cirera, Miquel; Loren, Maite; Bellerino, Eva; Tomé-Pires, Catarina; Palacios, Laura

2017-12-13

Primary care is the principal clinical setting for the management of depression. However, significant shortcomings have been detected in its diagnosis and clinical management, as well as in patient outcomes. We developed the INDI collaborative care model to improve the management of depression in primary care. This intervention has been favorably evaluated in terms of clinical efficacy and cost-effectiveness in a clinical trial. Our aim is to bring this intervention from the scientific context into clinical practice. Objective: To test for the feasibility and impact of a strategy for implementing the INDI model for depression in primary care. A quasi-experiment conducted in primary care. Several areas will be established to implement the new program and other, comparable areas will serve as control group. The study constitutes the preliminary phase preceding generalization of the model in the Catalan public healthcare system. The target population of the intervention are patients with major depression. The implementation strategy will also involve healthcare professionals, primary care centers, as well as management departments and the healthcare organization itself in the geographical areas where the study will be conducted: Camp de Tarragona and Vallès Occidental (Catalonia). The INDI model is a program for improving the management of depression involving clinical, instructional, and organizational interventions including the participation of nurses as care managers, the efficacy and efficiency of which has been proven in a clinical trial. We will design an active implementation strategy for this model based on the PARIHS (Promoting Action on Research Implementation in Health Services) framework. Qualitative and quantitative measures will be used to evaluate variables related to the successful implementation of the model: acceptability, utility, penetration, sustainability, and clinical impact. This project tests the transferability of a healthcare intervention supported by scientific research to clinical practice. If implementation is successful in this experimental phase, we will use the information and experience obtained to propose and plan the generalization of the INDI model for depression in the Catalan healthcare system. We expect the program to benefit patients, the healthcare system, and society. ClinicalTrials.gov identifier: NCT03285659 ; Registered 12th September, 2017.

Implementing practice management strategies to improve patient care: the EPIC project.

PubMed

Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna

2012-01-01

Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.

A 7-Step Strategy for the Implementation of Worksite Lifestyle Interventions: Helpful or Not?

PubMed

Wierenga, Debbie; Engbers, Luuk H; Van Empelen, Pepjin; van Mechelen, Willem

2016-05-01

The aim of this study was to evaluate the use of and adherence to a 7-step strategy for the development, implementation, and continuation of a comprehensive, multicomponent lifestyle program. Strategy use and adherence was assessed with 12 performance indicators. Data were collected by combining onsite monitoring with semi-structured interviews at baseline and follow-up (6, 12, and 18 months). Not all performance indicators were met so partial strategy adherence was obtained. The strategy could be improved on the following aspects: support among management, project structure, adaptation to needs of employees, planning, and maintenance. The results of this evaluation indicate that strategy adherence facilitated structured development and implementation. On the basis of the qualitative data, this study suggests that when improvements will be made on both the content and performance, the 7-step strategy could be an effective tool to successfully implement a multicomponent WHPP.

Implementation of the Integrated Management of Childhood Illnesses strategy: challenges and recommendations in Botswana

PubMed Central

Mupara, Lucia U.; Lubbe, Johanna C.

2016-01-01

Background Under-five mortality has been a major public health challenge from time immemorial. In response to this challenge, the World Health Organization and the United Nations Children's Fund developed the Integrated Management of Childhood Illnesses (IMCI) strategy and presented it to the whole world as a key approach to reduce child morbidity and mortality. Botswana started to implement the IMCI strategy in 1998. Reductions in the under-five mortality rate (U5MR) have been documented, although the reduction is not on par with the expected Millennium Development Goal 4 predictions. Design A quantitative study was done to identify the problems IMCI implementers face when tending children under 5 years in the Gaborone Health District of Botswana. The study population was made up of all the IMCI-trained and registered nurses, and systematic sampling was used to randomly select study participants. Questionnaires were used to collect data. Results The study findings indicated challenges related to low training coverage, health systems, and the unique features of the IMCI strategy. Conclusions The comprehensive implementation of the IMCI strategy has the potential to significantly influence the U5MR in Botswana. PMID:26899774

Strategies for Implementation: The El Camino College Total Quality Management Story.

ERIC Educational Resources Information Center

Schauerman, Sam; Peachy, Burt

1994-01-01

Traces the development of the principles and practices of Total Quality Management (TQM) at El Camino College, in California. Discusses institutional resistance to change and the need for careful implementation analysis and constituent group involvement. Includes a nine-item bibliography of theoretical and descriptive works. (MAB)

Patient Blood Management Implementation Strategies and Their Effect on Physicians' Risk Perception, Clinical Knowledge and Perioperative Practice – the Frankfurt Experience

PubMed Central

Fischer, Dania P.; Zacharowski, Kai D.; Müller, Markus M.; Geisen, Christof; Seifried, Erhard; Müller, Heiko; Meybohm, Patrick

2015-01-01

Introduction A multicomponent, evidence-based and interdisciplinary Patient Blood Management (PBM) program was introduced at the University Hospital Frankfurt in July 2013. The implementation strategy included practical and tactical components aimed to increase knowledge on the risks of preoperative anemia, to standardize hemotherapy, and to facilitate PBM components. Methods This article analyzes barriers to PBM implementation and outlines a strategy to introduce and manifest PBM. The effects in Frankfurt were measured in a before and after questionnaire study distributed among groups of physicians immediately before and 1 year after PBM implementation. Results 142 clinicians completed the questionnaire in July 2013 and 101 clinicians in August 2014. Absolute certainty that the treatment of preoperative anemia favorably influences morbidity and mortality rose from 25 to 37%. Transfusion behavior seems to have been affected: In 2014, 56% of clinicians stated that they clinically reassess the patient and analyze hemoglobin following each single red blood cell unit compared to only 38% stating this in 2013. Conclusion These results show that our implementation strategy was effective in changing physicians' risk perception, attitude, and knowledge on PBM principles. Our experience highlights key success factors for the implementation of a comprehensive PBM program. PMID:26019704

Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care

PubMed Central

2013-01-01

Background A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists’ (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. Methods A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. Results The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs’ skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of expertise or not their responsibility. All professionals perceived inter-professional collaboration to be a facilitator for effective implementation, and general practitioners were perceived as key partners in this collaboration. However, collaboration was not always optimal. OTs indicated that increasing the referral rate was most effective when promoting OT via other disciplines within a physician’s network. Conclusion Our data suggests that a first step in successful implementation should be to make sure that individual and organizational barriers are resolved. In addition, implementation should be network-based and encourage inter-professional collaboration. Initial promotion of COTiD should focus on physicians that have a positive attitude toward non-pharmacological interventions. PMID:24195975

Determinants for the effectiveness of implementing an occupational therapy intervention in routine dementia care.

PubMed

Döpp, Carola M E; Graff, Maud J L; Rikkert, Marcel G M Olde; Nijhuis van der Sanden, Maria W G; Vernooij-Dassen, Myrra J F J

2013-11-07

A multifaceted implementation (MFI) strategy was used to implement an evidence-based occupational therapy program for people with dementia (COTiD program). This strategy was successful in increasing the number of referrals, but not in improving occupational therapists' (OTs) adherence. Therefore, a process evaluation was conducted to identify factors that influenced the effectiveness of the MFI strategy. A mixed-method approach of qualitative and quantitative research was used to evaluate the implementation process. The MFI strategy as planned and as executed were reported and evaluated based on the framework of Hulscher et al. (2003; 2006). Data on OTs attitudes and expected barriers were collected at baseline from 94 OTs using a 19-item questionnaire. Data on the experiences were collected after finishing the implementation using focus groups with OTs and telephone interviews with physicians and managers. For quantitative data, frequencies and correlations were calculated and qualitative data were analyzed using inductive content analysis. The implementation strategy as executed had a stronger focus than planned on increasing OTs promotional skills due to an initial lack of referrals. This resulted in less attention for increasing OTs' skills in using the COTiD program as initially intended. At baseline, OTs had a positive attitude toward the program, however, 75% did not feel experienced enough and only 14.3% felt competent in using the program. Focus groups and interviews revealed various determinants that influenced implementation. Most managers were positive about the program. However, the degree of operational support of managers for OTs regarding the implementation was not always adequate. Managers stated that a well-defined place for occupational therapy within the dementia care network was lacking although this was perceived necessary for successful implementation. Several physicians perceived psychosocial interventions not to be in their area of expertise or not their responsibility. All professionals perceived inter-professional collaboration to be a facilitator for effective implementation, and general practitioners were perceived as key partners in this collaboration. However, collaboration was not always optimal. OTs indicated that increasing the referral rate was most effective when promoting OT via other disciplines within a physician's network. Our data suggests that a first step in successful implementation should be to make sure that individual and organizational barriers are resolved. In addition, implementation should be network-based and encourage inter-professional collaboration. Initial promotion of COTiD should focus on physicians that have a positive attitude toward non-pharmacological interventions.

Effective strategies for comprehensive corridor management

DOT National Transportation Integrated Search

2004-10-01

Despite the increasing importance of comprehensive corridor management at the state and local government level, questions remain regarding effective methods for developing and implementing corridor management plans. Further insight is also needed int...

Employing Knowledge Transfer to Support IS Implementation in SMEs

ERIC Educational Resources Information Center

Wynn, Martin; Turner, Phillip; Abas, Hanida; Shen, Rui

2009-01-01

Information systems strategy is an increasingly important component of overall business strategy in small and medium-sized enterprises (SMEs). The need for readily available and consistent management information, drawn from integrated systems based on sound and upgradeable technologies, has led many senior company managers to review the business…

A Study of Preservice Educators' Dispositions to Change Behavior Management Strategies

ERIC Educational Resources Information Center

Shook, Alison C.

2012-01-01

Student behavior problems contribute to poor academic achievement and poor teacher retention. This study investigated preservice teachers' dispositions to implement positive and proactive strategies for managing behavior in the general education elementary urban classroom. The author interviewed 19 preservice teachers in a large urban school…

Quality management, a directive approach to patient safety.

PubMed

Ayuso-Murillo, Diego; de Andrés-Gimeno, Begoña; Noriega-Matanza, Concha; López-Suárez, Rafael Jesús; Herrera-Peco, Ivan

Nowadays the implementation of effective quality management systems and external evaluation in healthcare is a necessity to ensure not only transparency in activities related to health but also access to health and patient safety. The key to correctly implementing a quality management system is support from the managers of health facilities, since it is managers who design and communicate to health professionals the strategies of action involved in quality management systems. This article focuses on nursing managers' approach to quality management through the implementation of cycles of continuous improvement, participation of improvement groups, monitoring systems and external evaluation quality models (EFQM, ISO). The implementation of a quality management system will enable preventable adverse effects to be minimized or eliminated, and promote patient safety and safe practice by health professionals. Copyright © 2017 Elsevier España, S.L.U. All rights reserved.

Implementation Evaluation in a Private Nonprofit Setting: A Mixed-Methods Approach

ERIC Educational Resources Information Center

Walker, Jacquelyn Ann

2013-01-01

Demand for quality service provision in the human services industry requires that private nonprofit organizations have the administrative and management capacities to ensure successful implementation and sustain staff development programs. Unfamiliarity with implementation challenges, and limited awareness of implementation strategies, can trigger…

A containment and disposition strategy for tritium-contaminated groundwater at the Savannah River Site, South Carolina, United States

Treesearch

Daniel R. Hitckcock; Christopher D. Barton; Karin T. Rebel; Julian Singer; John C. Seanman; J. Dan Strawbridge; Susan J. Riha; John I. Blake

2005-01-01

A containment and disposition water management strategy has been implemented at the Savannah River Site to minimize the discharge of tritiated groundwater from the Old Radioactive Waste Burial Ground to Fourmile Branch, a tributary of the Savannah River. This paper presents a general overview of the water management strategy, which includes a two-component (pond and...

Strategy for Intelligence, Surveillance, and Reconnaissance

DTIC Science & Technology

2013-02-14

Marine Corps School of Advanced Warfighting. He was the commander of the 13th Intelligence Squadron (Distributed Ground System – 2) and served in the...military campaigns and major operations. The root cause of these difficulties is adherence to a centralized, Cold War collection management doctrine...current collection management doctrine creates for implementing ISR strategy. It will then propose an alternative framework for ISR strategy using a

Implementing a Just Culture: Perceptions of Nurse Managers of Required Knowledge, Skills and Attitudes.

PubMed

Freeman, Michelle; Morrow, Linda A; Cameron, Margo; McCullough, Karen

2016-01-01

Healthcare organizations have been challenged to create a just culture as part of their culture of safety. To explore perceptions of nurse managers in developing personal competencies in order to enable them to effectively implement a just culture in their units. Qualitative content analysis of semi-structured interviews with nine nurse managers identified themes. Data were independently analyzed by three members of the research team. Analysis of interview transcripts identified the following four themes: need for education of managers and employees, need for a variety of new skills for nurse managers, need to change attitudes from the long-standing punitive culture and fault of individual and challenges in implementation because of time constraints. Implementing a just culture is complex. Education of nurse managers is crucial. A series of educational strategies is recommended. Findings support the need for new competencies to enable nurse managers to effectively implement a just culture in their units.

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

PubMed Central

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

2017-01-01

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

From strategy to action: how top managers' support increases middle managers' commitment to innovation implementation in health care organizations.

PubMed

Birken, Sarah A; Lee, Shoou-Yih Daniel; Weiner, Bryan J; Chin, Marshall H; Chiu, Michael; Schaefer, Cynthia T

2015-01-01

Evidence suggests that top managers' support influences middle managers' commitment to innovation implementation. What remains unclear is how top managers' support influences middle managers' commitment. Results may be used to improve dismal rates of innovation implementation. We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 U.S. health centers to assess whether top managers' support directly influences middle managers' commitment; by allocating implementation policies and practices; or by moderating the influence of implementation policies and practices on middle managers' commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. We found support for each hypothesized relationship: Results suggest that top managers increase middle managers' commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = .09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95% confidence interval [0.03, 0.17]); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Top managers can demonstrate their support directly by conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers' support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation.

Public acceptance of disturbance-based forest management: a study of the Blue River Landscape Strategy in the Central Cascades Adaptive Management Area.

Treesearch

Bruce Shindler; Angela L. Mallon

2009-01-01

This report examines public perspectives on disturbance-based management conducted in the central Cascade Range in Oregon as part of the Blue River Landscape Strategy. A mail survey to local residents was used to describe the public’s understanding of this form of management, identify perceived associated risks and potential barriers to implementation, and the overall...

Improving the Standards-Based Management-Recognition initiative to provide high-quality, equitable maternal health services in Malawi: an implementation research protocol.

PubMed

Mumtaz, Zubia; Salway, Sarah; Nyagero, Josephat; Osur, Joachim; Chirwa, Ellen; Kachale, Fannie; Saunders, Duncan

2016-01-01

The Government of Malawi is seeking evidence to improve implementation of its flagship quality of care improvement initiative-the Standards Based Management-Recognition for Reproductive Health (SBM-R(RH)). This implementation study will assess the quality of maternal healthcare in facilities where the SBM-R(RH) initiative has been employed, identify factors that support or undermine effectiveness of the initiative and develop strategies to further enhance its operation. Data will be collected in 4 interlinked modules using quantitative and qualitative research methods. Module 1 will develop the programme theory underlying the SBM-R(RH) initiative, using document review and in-depth interviews with policymakers and programme managers. Module 2 will quantitatively assess the quality and equity of maternal healthcare provided in facilities where the SBM-R(RH) initiative has been implemented, using the Malawi Integrated Performance Standards for Reproductive Health. Module 3 will conduct an organisational ethnography to explore the structures and processes through which SBM-R(RH) is currently operationalised. Barriers and facilitators will be identified. Module 4 will involve coordinated co-production of knowledge by researchers, policymakers and the public, to identify and test strategies to improve implementation of the initiative. The research outcomes will provide empirical evidence of strategies that will enhance the facilitators and address the barriers to effective implementation of the initiative. It will also contribute to the theoretical advances in the emerging science of implementation research.

Critical elements in implementations of just-in-time management: empirical study of cement industry in Pakistan.

PubMed

Qureshi, Muhammad Imran; Iftikhar, Mehwish; Bhatti, Mansoor Nazir; Shams, Tauqeer; Zaman, Khalid

2013-01-01

In recent years, inventory management is continuous challenge for all organizations not only due to heavy cost associated with inventory holding, but also it has a great deal to do with the organizations production process. Cement industry is a growing sector of Pakistan's economy which is now facing problems in capacity utilization of their plants. This study attempts to identify the key strategies for successful implementation of just-in-time (JIT) management philosophy on the cement industry of Pakistan. The study uses survey responses from four hundred operations' managers of cement industry in order to know about the advantages and benefits that cement industry have experienced by Just in time (JIT) adoption. The results show that implementing the quality, product design, inventory management, supply chain and production plans embodied through the JIT philosophy which infect enhances cement industry competitiveness in Pakistan. JIT implementation increases performance by lower level of inventory, reduced operations & inventory costs was reduced eliminates wastage from the processes and reduced unnecessary production which is a big challenge for the manufacturer who are trying to maintain the continuous flow processes. JIT implementation is a vital manufacturing strategy that reaches capacity utilization and minimizes the rate of defect in continuous flow processes. The study emphasize the need for top management commitment in order to incorporate the necessary changes that need to take place in cement industry so that JIT implementation can take place in an effective manner.

Implementing Strategic Change: A Practical Guide for Business.

ERIC Educational Resources Information Center

Grundy, Tony

This book is designed to serve as a practical guide to planning and managing change within a business, and as a text for graduate business students studying change strategies. It focuses on the rationale for change, managing the change process, tools for change, creating a strategic vision for change, and checklists for implementing strategic…

How Do District Management and Implementation Strategies Relate to the Quality of the Professional Development That Districts Provide to Teachers?

ERIC Educational Resources Information Center

Desimone, Laura; Porter, Andrew C.; Birman, Beatrice F.; Garet, Michael S.; Yoon, Kwang Suk

2002-01-01

Examined policy mechanisms and processes that districts used to provide high quality inservice professional development to teachers. Data from a national probability sample of professional development coordinators in districts that received federal funding for professional development highlighted specific management and implementation strategies…

Using Simulation to Explore Lean Manufacturing Implementation Strategies

ERIC Educational Resources Information Center

Shannon, Patrick W.; Krumwiede, Kip R.; Street, Jeffrey N.

2010-01-01

Lean manufacturing, an outgrowth of the Toyota Production System, has spread far beyond the automobile industry and is seen by many leaders as a key management philosophy in the battle to compete on an international scale. Successful implementation of lean requires that managers and employees be educated in the proper application of lean tools and…

The Development and Implementation of a Diversity Management Curriculum: Organizational Change through Exploration and Exploitation

ERIC Educational Resources Information Center

Danowitz, Mary Ann; Hanappi-Egger, Edeltraud; Hofmann, Roswitha

2009-01-01

Purpose: The purpose of this paper is to provide concepts and strategies to successfully introduce and implement curricular change; especially, related to incorporating diversity management into academic programs. Design/methodology/approach: Utilizing documents and accounts from two agents involved in the change process and an outside observer,…

Real estate strategies for 2005.

PubMed

Dunbar, Donald R

2005-05-01

Today's healthcare real estate strategies involve: assessing and prioritizing capital availability for building projects, carefully planning and implementing the process for the project Making beneficial decisions regarding facility management and maintenance.

A Grounded Theory of Behavior Management Strategy Selection, Implementation, and Perceived Effectiveness Reported by First-Year Elementary Teachers

ERIC Educational Resources Information Center

Smart, Julie B.; Igo, L. Brent

2010-01-01

In this grounded theory study, 19 teachers were interviewed and then, in constant comparative fashion, the interview data were analyzed. The theoretical model that emerged from the data describes novice teachers' tendencies to select and implement differing strategies related to the severity of student behavior. When confronting mild student…

Identifying and ranking implicit leadership strategies to promote evidence-based practice implementation in addiction health services.

PubMed

Guerrero, Erick G; Padwa, Howard; Fenwick, Karissa; Harris, Lesley M; Aarons, Gregory A

2016-05-14

Despite a solid research base supporting evidence-based practices (EBPs) for addiction treatment such as contingency management and medication-assisted treatment, these services are rarely implemented and delivered in community-based addiction treatment programs in the USA. As a result, many clients do not benefit from the most current and efficacious treatments, resulting in reduced quality of care and compromised treatment outcomes. Previous research indicates that addiction program leaders play a key role in supporting EBP adoption and use. The present study expanded on this previous work to identify strategies that addiction treatment program leaders report using to implement new practices. We relied on a staged and iterative mixed-methods approach to achieve the following four goals: (a) collect data using focus groups and semistructured interviews and conduct analyses to identify implicit managerial strategies for implementation, (b) use surveys to quantitatively rank strategy effectiveness, (c) determine how strategies fit with existing theories of organizational management and change, and (d) use a consensus group to corroborate and expand on the results of the previous three stages. Each goal corresponded to a methodological phase, which included data collection and analytic approaches to identify and evaluate leadership interventions that facilitate EBP implementation in community-based addiction treatment programs. Findings show that the top-ranked strategies involved the recruitment and selection of staff members receptive to change, offering support and requesting feedback during the implementation process, and offering in vivo and hands-on training. Most strategies corresponded to emergent implementation leadership approaches that also utilize principles of transformational and transactional leadership styles. Leadership behaviors represented orientations such as being proactive to respond to implementation needs, supportive to assist staff members during the uptake of new practices, knowledgeable to properly guide the implementation process, and perseverant to address ongoing barriers that are likely to stall implementation efforts. These findings emphasize how leadership approaches are leveraged to facilitate the implementation and delivery of EBPs in publicly funded addiction treatment programs. Findings have implications for the content and structure of leadership interventions needed in community-based addiction treatment programs and the development of leadership interventions in these and other service settings.

Effective Strategies to Spread Redesigning Care Processes Among Healthcare Teams.

PubMed

Lavoie-Tremblay, Mélanie; O'Connor, Patricia; Lavigne, Geneviève L; Briand, Anaïck; Biron, Alain; Baillargeon, Sophie; MacGibbon, Brenda; Ringer, Justin; Cyr, Guylaine

2015-07-01

The purpose of this study was to describe how spread strategies facilitate the successful implementation of the Transforming Care at the Bedside (TCAB) program and their impact on healthcare workers and patients in a major Canadian healthcare organization. This study used a qualitative and descriptive design with focus groups and individual interviews held in May 2014. Participants included managers and healthcare providers from eight TCAB units in a university health center in Quebec, Canada. The sample was composed of 43 individuals. The data were analyzed using NVivo according to the method proposed by Miles and Huberman. The first two themes that emerged from the analysis are related to context (organizational transition requiring many changes) and spread strategies for the TCAB program (senior management support, release time and facilitation, rotation of team members, learning from previous TCAB teams, and engaging patients). The last theme that emerged from the analysis is the impact on healthcare professionals (providing front-line staff and managers with the training they need to make changes, team leadership, and increasing receptivity to hearing patients' and families' needs and requests). This study describes the perspectives of managers and team members to provide a better understanding of how spread strategies can facilitate the successful implementation of the TCAB program in a Canadian healthcare organization. Spread strategies facilitate the implementation of changes to improve the quality and safety of care provided to patients. © 2015 Sigma Theta Tau International.

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

PubMed

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

2014-04-01

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

Should Quality School Education Be a Kaizen (Improvement) or an Innovation?

ERIC Educational Resources Information Center

Sun-Keung Pang, Nicholas

1998-01-01

Reviews Hong Kong's School Management Initiative implementation strategies (rational-empirical, power-coercive, and normative-reeducative), compares them with New South Wales, Australia's strategies, and suggests an appropriate strategy for future reforms. In Australia, changes were radical and thorough (using power-coercive strategies), whereas…

A Simulation-Based Approach for Teaching the Systems Perspective of Strategic Performance Management

ERIC Educational Resources Information Center

Capelo, Carlos; Lopes, Ana; Mata, Ana

2015-01-01

Kaplan and Norton introduced the balanced scorecard (BSC), which is based on a systems perspective of the business strategy and performance measurement. Many organisations around the world use the BSC to define, implement and manage strategy. Nevertheless, there are studies that identify problems and limitations associated with the implementation…

Strengthening the regulatory system through the implementation and use of a quality management system.

PubMed

Eisner, Reinhold; Patel, Rakeshkumar

2017-04-20

Quality management systems (QMS), based on ISO 9001 requirements, are applicable to government service organizations such as Health Canada's Biologics and Genetic Therapies Directorate (BGTD). This communication presents the process that the BGTD followed since the early 2000s to implement a quality management system and describes how the regulatory system was improved as a result of this project. BGTD undertook the implementation of a quality management system based on ISO 9001 and containing aspects of ISO 17025 with the goal of strengthening the regulatory system through improvements in the people, processes, and services of the organization. We discuss the strategy used by BGTD to implement the QMS and the benefits that were realized from the various stages of implementation. The eight quality principals upon which the QMS standards of the ISO 9000 series are based were used by senior management as a framework to guide QMS implementation.

A Stitch in Time: Strategic Self-Control in High School and College Students.

PubMed

Duckworth, Angela L; White, Rachel E; Matteucci, Alyssa J; Shearer, Annie; Gross, James J

2016-04-01

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent.

A Stitch in Time: Strategic Self-Control in High School and College Students

PubMed Central

Duckworth, Angela L.; White, Rachel E.; Matteucci, Alyssa J.; Shearer, Annie; Gross, James J.

2015-01-01

A growing body of research indicates that self-control is critical to academic success. Surprisingly little is known, however, about the diverse strategies students use to implement self-control or how well these strategies work. To address these issues, we conducted a naturalistic investigation of self-control strategies (Study 1) and two field experiments (Studies 2 and 3). In Study 1, high school students described the strategies they use to manage interpersonal conflicts, get academic work done, eat healthfully, and manage other everyday self-control challenges. The majority of strategies in these self-nominated incidents as well as in three hypothetical academic scenarios (e.g., studying instead of texting friends) were reliably classified using the process model of self-control. As predicted by the process model, students rated strategies deployed early in the impulse-generation process (situation selection, situation modification) as being dramatically more effective than strategies deployed later (attentional deployment, cognitive change, response modulation). In Study 2, high school students randomly assigned to implement situation modification were more likely to meet their academic goals during the following week than students assigned either to implement response modulation or no strategy at all. In Study 3, college students randomly assigned to implement situation modification were also more successful in meeting their academic goals, and this effect was partially mediated by decreased feelings of temptation throughout the week. Collectively, these findings suggest that students might benefit from learning to initiate self-control when their impulses are still nascent. PMID:27158155

Solid waste management in the hospitality industry: a review.

PubMed

Pirani, Sanaa I; Arafat, Hassan A

2014-12-15

Solid waste management is a key aspect of the environmental management of establishments belonging to the hospitality sector. In this study, we reviewed literature in this area, examining the current status of waste management for the hospitality sector, in general, with a focus on food waste management in particular. We specifically examined the for-profit subdivision of the hospitality sector, comprising primarily of hotels and restaurants. An account is given of the causes of the different types of waste encountered in this sector and what strategies may be used to reduce them. These strategies are further highlighted in terms of initiatives and practices which are already being implemented around the world to facilitate sustainable waste management. We also recommended a general waste management procedure to be followed by properties of the hospitality sector and described how waste mapping, an innovative yet simple strategy, can significantly reduce the waste generation of a hotel. Generally, we found that not many scholarly publications are available in this area of research. More studies need to be carried out on the implementation of sustainable waste management for the hospitality industry in different parts of the world and the challenges and opportunities involved. Copyright © 2014 Elsevier Ltd. All rights reserved.

TQM and lean strategy deployment in Italian hospitals.

PubMed

Chiarini, Andrea; Baccarani, Claudio

2016-10-03

Purpose This paper aims to contribute to the debate concerning total quality management (TQM)-Lean strategy in public healthcare by analyzing the deployment path for implementation, the possible benefits that can be achieved and the encountered pitfalls. Design/methodology/approach Three case studies are drawn from three large Italian hospitals with more than 500 beds each and structured with many departments. The hospitals are located in Tuscany, Italy. These three hospitals have embraced TQM and Lean, starting from strategic objectives and their deployment. At the same time, they have also implemented many TQM-Lean tools. The case studies are based on interviews held with four managers in each of these three public hospitals. Findings Results from the interviews show that there is a specific deployment path for TQM-Lean implementation. The hospitals have also achieved benefits linked to patient satisfaction and improved organizational performances. Problems related to organizational and cultural issues, such as senior managers' commitment, staff management, manufacturing culture and tools adaptation, could affect the benefits. Research limitations/implications The research has been carried out in just three Italian public hospitals. Hence, similar investigations could be managed in other countries. Researchers could also use a larger sample and investigate these issues by means of quantitative inquiry. Practical implications Practitioners could try to apply the deployment path revealed by these case studies in other public and private hospitals. Originality/value The results of this research show that there is a specific, new deployment path for implementing TQM-Lean strategy in some public hospitals.

Blood management issues using blood management strategies.

PubMed

Stulberg, Bernard N; Zadzilka, Jayson D

2007-06-01

Blood management strategies is a term used to address a coordinated approach to the management of blood loss in the perioperative period for total joint arthroplasty. The premise of any blood management strategy is that each patient, surgeon, and operative intervention experiences different risks of requiring transfusion, that those risks can be identified, and that a plan can be implemented to address them. A surgeon's decision to transfuse should be based on physiologic assessment of the patient's response to anemia and not on an arbitrary number ("transfusion trigger"). Intervention strategies can be applied preoperatively, intraoperatively, and postoperatively. Patient-specific planning allows for the appropriate use of patient, hospital, and system resources, ensuring that the consequences of anemia are minimized and that the patient's recovery process is optimized.

Technological Innovation and Developmental Strategies for Sustainable Management of Aquatic Resources in Developing Countries

NASA Astrophysics Data System (ADS)

Agboola, Julius Ibukun

2014-12-01

Sustainable use and allocation of aquatic resources including water resources require implementation of ecologically appropriate technologies, efficient and relevant to local needs. Despite the numerous international agreements and provisions on transfer of technology, this has not been successfully achieved in developing countries. While reviewing some challenges to technological innovations and developments (TID), this paper analyzes five TID strategic approaches centered on grassroots technology development and provision of localized capacity for sustainable aquatic resources management. Three case studies provide examples of successful implementation of these strategies. Success requires the provision of localized capacity to manage technology through knowledge empowerment in rural communities situated within a framework of clear national priorities for technology development.

Technological innovation and developmental strategies for sustainable management of aquatic resources in developing countries.

PubMed

Agboola, Julius Ibukun

2014-12-01

Sustainable use and allocation of aquatic resources including water resources require implementation of ecologically appropriate technologies, efficient and relevant to local needs. Despite the numerous international agreements and provisions on transfer of technology, this has not been successfully achieved in developing countries. While reviewing some challenges to technological innovations and developments (TID), this paper analyzes five TID strategic approaches centered on grassroots technology development and provision of localized capacity for sustainable aquatic resources management. Three case studies provide examples of successful implementation of these strategies. Success requires the provision of localized capacity to manage technology through knowledge empowerment in rural communities situated within a framework of clear national priorities for technology development.

Land use and management change under climate change adaptation and mitigation strategies: a U.S. case study

USGS Publications Warehouse

Mu, Jianhong E.; Wein, Anne; McCarl, Bruce

2015-01-01

We examine the effects of crop management adaptation and climate mitigation strategies on land use and land management, plus on related environmental and economic outcomes. We find that crop management adaptation (e.g. crop mix, new species) increases Greenhouse gas (GHG) emissions by 1.7 % under a more severe climate projection while a carbon price reduces total forest and agriculture GHG annual flux by 15 % and 9 %, respectively. This shows that trade-offs are likely between mitigation and adaptation. Climate change coupled with crop management adaptation has small and mostly negative effects on welfare; mitigation, which is implemented as a carbon price starting at $15 per metric ton carbon dioxide (CO2) equivalent with a 5 % annual increase rate, bolsters welfare carbon payments. When both crop management adaptation and carbon price are implemented the effects of the latter dominates.

FY 2013 INL SITE SUSTAINABILITY PLAN WITH THE FY 2012 ANNUAL REPORT

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

Ernest L. Fossum; Steve A. Birrer

2012-12-01

It is the policy of the Department of Energy (DOE) that sustainable energy and transportation fuels management will be integrated into DOE operations to meet obligations under Executive Order (EO) 13423 "Strengthening Federal Environmental, Energy, and Transportation Management," the Instructions for Implementation of EO 13423, as well as Guidance Documents issued in accordance thereto and any modifcations or amendments that may be issued from time to time. In furtherance of this obligation, DOE established strategic performance-based energy and transportation fuels goals and strategies through the Transformational Energy Action Management (TEAM) Initiative, which were incorporated into DOE Order 430.2B "Departmental Energy,more » Renewable energy, and Transportation Management" and were also identified in DOE Order 450.1A, "Environmental Protection Program." These goals and accompanying strategies are to be implemented by DOE sites through the integration of energy and transportation fuels management into site Environmental Management Systems (EMS).« less

Implementation of pregnancy weight management and obesity guidelines: a meta-synthesis of healthcare professionals' barriers and facilitators using the Theoretical Domains Framework.

PubMed

Heslehurst, N; Newham, J; Maniatopoulos, G; Fleetwood, C; Robalino, S; Rankin, J

2014-06-01

Obesity in pregnancy is rising and is associated with severe health consequences for both the mother and the child. There is an increasing international focus on guidelines to manage the clinical risks of maternal obesity, and for pregnancy weight management. However, passive dissemination of guidelines is not effective and more active strategies are required for effective guideline implementation into practice. Implementation of guidelines is a form of healthcare professional behaviour change, and therefore implementation strategies should be based on appropriate behaviour change theory. This systematic review aimed to identify the determinants of healthcare professionals' behaviours in relation to maternal obesity and weight management. Twenty-five studies were included. Data synthesis of the existing international qualitative and quantitative evidence base used the Theoretical Domains Framework to identify the barriers and facilitators to healthcare professionals' maternal obesity and weight management practice. The domains most frequently identified included 'knowledge', 'beliefs about consequences' and 'environmental context and resources'. Healthcare professionals' weight management practice had the most barriers compared with any other area of maternal obesity practice. The results of this review will be used to inform the development of an intervention to support healthcare professional behaviour change. © 2014 The Authors. obesity reviews © 2014 International Association for the Study of Obesity.

The Research on Integrated Strategy of Supply Chain Information Systems in the Automobile Industry Based on Order-To-Delivery Mode

NASA Astrophysics Data System (ADS)

Li, Ming; Gan, Lianzhen; He, Xuefeng

The automotive industry there are different degrees of impairment of many companies supply chain IT strategy. In this paper, in which the automotive industry supply chain management business cooperation between enterprises loose, poor exchange of information leading to the presence or delays in product customization, supply of raw materials, material control, production planning and control, sales and service and a fast response propose a series of typical problems of scientific and rational supply chain information integration strategy. The strategy through the development system integration platform, improve internal ERP system, implementation of supply chain management and other methods. Put some protection principles in the information process, to ensure the correct implementation of supply chain IT strategy, and ultimately achieve collaborative business development concept and enhance the automotive industry as a whole level of information.

Teaching Strategies to Increase Nursing Student Acceptance and Management of Unconscious Bias.

PubMed

Schultz, Paula L; Baker, Janet

2017-11-01

Medical providers' unconscious biases may contribute to health disparities. Awareness and self-reflection strategies commonly used to teach cultural competence in academic settings are generally ineffective in reducing unconscious bias or motivating change. This article describes the innovative teaching strategies implemented in a graduate setting (N = 75) to increase nursing learners' acceptance and management of unconscious bias. Strategies used guided the debriefing and feedback that incorporated implicit association testing, interactive audience polling, categorized management strategies, and perspective taking. Strategies resulted in positive learner feedback, including a high likelihood to learn more about unconscious bias, acceptance of unconscious bias influence on health disparities, and importance of using management strategies to address personal bias. Increasingly diverse patient populations require nurses who have the skills to understand, assess, and correct unconscious biases. To accomplish this goal, consistent exposure to unconscious bias curricula that includes focused debriefing, feedback, and management strategies is needed at all levels of nursing education. [J Nurs Educ. 2017;56(11):692-696.]. Copyright 2017, SLACK Incorporated.

Development, implementation, and evaluation of a mental rehearsal strategy to improve clinical performance and reduce stress: A mixed methods study.

PubMed

Ignacio, Jeanette; Dolmans, Diana; Scherpbier, Albert; Rethans, Jan-Joost; Lopez, Violeta; Liaw, Sok Ying

2016-02-01

Mental rehearsal is a form of mental training that has been used by physicians and nurses to improve performance of clinical skills, and as a vital component of stress management training. To help novice nurses deal with often stressful clinical events that require the processing of information essential to patient management, a mental rehearsal strategy was developed and implemented in a Year 3 nursing simulation program. Inherent to mental rehearsal is imagery, which facilitates cognitive and affective modification, and reduction of extraneous cognitive load. As such, it was expected that the mental rehearsal strategy would improve students' performance and reduce stress in managing deteriorating patients. The study used a mixed methods design. Eighteen Year 3 nursing students participated in the pre- and post-design study, which consisted of the development and implementation of a mental rehearsal strategy. The Rescuing A Patient In Deteriorating Situations (RAPIDS) tool was used to assess performance. Heart rates and systolic blood pressures were used to measure stress. The State-Trait Anxiety Inventory (STAI) was used as a psychological measure of stress/anxiety. Five participants were involved in a focus group discussion that evaluated the usefulness of the mental rehearsal strategy. There was a significant improvement in performance (P<0.05). However, post-test heart rate and systolic blood pressure were not significantly different from pre-test measures. A comparison of STAI results did not show significant differences between pre- and post-test state anxiety and pre- and post-test trait anxiety. Three themes emerged from the focus group interview: managing stress, using a mental framework, and integrating realistic simulations with the mental rehearsal strategy. The mental rehearsal strategy for deteriorating patient management can be valuable based on the findings on performance and based on the participants' feedback. Its role in reducing stress, however, needs further evaluation. Copyright © 2015 Elsevier Ltd. All rights reserved.

Crossing the implementation chasm: a proposal for bold action.

PubMed

Lorenzi, Nancy M; Novak, Laurie L; Weiss, Jacob B; Gadd, Cynthia S; Unertl, Kim M

2008-01-01

As health care organizations dramatically increase investment in information technology (IT) and the scope of their IT projects, implementation failures become critical events. Implementation failures cause stress on clinical units, increase risk to patients, and result in massive costs that are often not recoverable. At an estimated 28% success rate, the current level of investment defies management logic. This paper asserts that there are "chasms" in IT implementations that represent risky stages in the process. Contributors to the chasms are classified into four categories: design, management, organization, and assessment. The American College of Medical Informatics symposium participants recommend bold action to better understand problems and challenges in implementation and to improve the ability of organizations to bridge these implementation chasms. The bold action includes the creation of a Team Science for Implementation strategy that allows for participation from multiple institutions to address the long standing and costly implementation issues. The outcomes of this endeavor will include a new focus on interdisciplinary research and an inter-organizational knowledge base of strategies and methods to optimize implementations and subsequent achievement of organizational objectives.

Simulation of targeted pollutant-mitigation-strategies to reduce nitrate and sediment hotspots in agricultural watershed.

PubMed

Teshager, Awoke Dagnew; Gassman, Philip W; Secchi, Silvia; Schoof, Justin T

2017-12-31

About 50% of U.S. water pollution problems are caused by non-point source (NPS) pollution, primarily sediment and nutrients from agricultural areas, despite the widespread implementation of agricultural Best Management Practices (BMPs). However, the effectiveness of implementation strategies and type of BMPs at watershed scale are still not well understood. In this study, the Soil and Water Assessment Tool (SWAT) ecohydrological model was used to assess the effectiveness of pollutant mitigation strategies in the Raccoon River watershed (RRW) in west-central Iowa, USA. We analyzed fourteen management scenarios based on systematic combinations of five strategies: fertilizer/manure management, changing row-crop land to perennial grass, vegetative filter strips, cover crops and shallower tile drainage systems, specifically aimed at reducing nitrate and total suspended sediment yields from hotspot areas in the RRW. Moreover, we assessed implications of climate change on management practices, and the impacts of management practices on water availability, row crop yield, and total agricultural production. Our results indicate that sufficient reduction of nitrate load may require either implementation of multiple management practices (38.5% with current setup) or conversion of extensive areas into perennial grass (up to 49.7%) to meet and maintain the drinking water standard. However, climate change may undermine the effectiveness of management practices, especially late in the 21st century, cutting the reduction by up to 65% for nitrate and more for sediment loads. Further, though our approach is targeted, it resulted in a slight decrease (~5%) in watershed average crop yield and hence an overall reduction in total crop production, mainly due to the conversion of row-crop lands to perennial grass. Such yield reductions could be quite spatially heterogeneously distributed (0 to 40%). Copyright © 2017 Elsevier B.V. All rights reserved.

Program Implementation Approaches to Build and Sustain Health Care Coordination for Type 2 Diabetes.

PubMed

Fitzgerald, Tania M; Williams, Pam A; Dodge, Julia A; Quinn, Martha; Heminger, Christina L; Moultrie, Rebecca; Taylor, Olivia; Nelson, Belinda W; Lewis, Megan A

2017-03-01

As more people enter the U.S. health care system under the Affordable Care Act (ACA), it is increasingly critical to deliver coordinated, high-quality health care. The ACA supports implementation and sustainability of efficient health care models, given expected limits in available resources. This article highlights implementation strategies to build and sustain care coordination, particularly ones consistent with and reinforced by the ACA. It focuses on disease self-management programs to improve the health of patients with type 2 diabetes, exemplified by grantees of the Alliance to Reduce Disparities in Diabetes. We conducted interviews with grantee program representatives throughout their 5-year programs and conducted a qualitative framework analysis of data to identify key themes related to care coordination. The most promising care coordination strategies that grantee programs described included establishing clinic-community collaborations, embedding community health workers within care management teams, and sharing electronic data. Establishing provider buy-in was crucial for these strategies to be effective. This article adds new insights into strategies promoting effective care coordination. The strategies that grantees implemented throughout the program align with ACA requirements, underscoring their relevance to the changing U.S. health care environment and the likelihood of further support for program sustainability.

Customs Service Modernization: Impact of New Trade Compliance Strategy Needs to Be Assessed.

DTIC Science & Technology

1999-12-01

The Mod Act fundamentally altered the relationship between importers and Customs by shifting from Customs to the importer the legal responsibility...New Trade Compliance Strategy B-280470 • account management : Customs ’ approach to managing its work through accounts (importing companies) rather...assessment, account management , and Customs ’ responses to noncompliant importers have been implemented but have not yet reached many of the intended

Organizational Strategies to Implement Hospital Pressure Ulcer Prevention Programs: Findings from a National Survey

PubMed Central

SOBAN, LYNN M.; KIM, LINDA; YUAN, ANITA H.; MILTNER, REBECCA S.

2017-01-01

Aim To describe the presence and operationalization of organizational strategies to support implementation of pressure ulcer prevention programs across acute care hospitals in a large, integrated healthcare system. Background Comprehensive pressure ulcer programs include nursing interventions such as use of a risk assessment tool and organizational strategies such as policies and performance monitoring to embed these interventions into routine care. The current literature provides little detail about strategies used to implement pressure ulcer prevention programs. Methods Data were collected by an email survey to all Chief Nursing Officers in Veterans Health Administration acute care hospitals. Descriptive and bivariate statistics were used to summarize survey responses and evaluate relationships between some variables. Results Organizational strategies that support pressure ulcer prevention program implementation (policy, committee, staff education, wound care specialists, and use of performance data) were reported at high levels. Considerable variations were noted in how these strategies were operationalized within individual hospitals. Conclusion Organizational strategies to support implementation of pressure ulcer preventive programs are often not optimally operationalized to achieve consistent, sustainable performance. Implications for Nursing Management The results of this study highlight the role and influence of nurse leaders on pressure ulcer prevention program implementation. PMID:27487972

Challenges and leadership strategies for managers of nurse practitioners.

PubMed

Reay, Trish; Golden-Biddle, Karen; Germann, Kathy

2003-11-01

The aim of this paper is to report on the findings from our research into the recent introduction of nurse practitioners in Alberta, Canada. Through an organizational research perspective, we identify the critical role of health care managers in developing a sustainable nurse practitioner role. Previous literature has focused on nurse practitioners themselves as the key factor in their integration into the health care system. Although they are qualified and organizationally well placed, managers of nurse practitioners have been overlooked as a critical part of implementation strategies. We interviewed 25 nurse practitioners and seven of their managers. Through our data analysis we identified three major challenges for managers: (1) clarifying the reallocation of tasks; (2) managing altered working relationships within the team; (3) continuing to manage the team in an evolving situation. Associated with these challenges, we propose leadership strategies that managers may find useful as they work through the consequences of introducing the nurse practitioner role. These strategies are: * encourage all team members to sort out 'who does what'; * ensure that task reallocation preserves job motivating properties; * give consideration to how tasks have been allocated when issues identified as 'personal conflict' arise; * pay attention to all perspectives of the working relationships within the team; * facilitate positive relationships between team members; * lead from a 'balcony' perspective; * work with the team to develop goals that are not over focused on the nurse practitioner; * regularly share with other managers the experiences and lessons learned in introducing nurse practitioners. For managers to be most effective, they need to address three challenges that are of a managerial, not clinical, nature. By implementing specific leadership strategies, managers of nurse practitioners can facilitate the introduction of the new role and improve its sustainability in health organizations.

Knowledge, attitudes, beliefs and behaviour intentions for three bowel management practices in intensive care: effects of a targeted protocol implementation for nursing and medical staff.

PubMed

Knowles, Serena; Lam, Lawrence T; McInnes, Elizabeth; Elliott, Doug; Hardy, Jennifer; Middleton, Sandy

2015-01-01

Bowel management protocols have the potential to minimize complications for critically ill patients. Targeted implementation can increase the uptake of protocols by clinicians into practice. The theory of planned behaviour offers a framework in which to investigate clinicians' intention to perform the behaviour of interest. This study aimed to evaluate the effect of implementing a bowel management protocol on intensive care nursing and medical staffs' knowledge, attitude, subjective norms, perceived behavioural control, behaviour intentions, role perceptions and past behaviours in relation to three bowel management practices. A descriptive before and after survey using a self-administered questionnaire sent to nursing and medical staff working within three intensive care units before and after implementation of our bowel management protocol (pre: May - June 2008; post: Feb - May 2009). Participants had significantly higher knowledge scores post-implementation of our protocol (pre mean score 17.6; post mean score 19.3; p = 0.004). Post-implementation there was a significant increase in: self-reported past behaviour (pre mean score 5.38; post mean score 7.11; p = 0.002) and subjective norms scores (pre mean score 3.62; post mean score 4.18; p = 0.016) for bowel assessment; and behaviour intention (pre mean score 5.22; post mean score 5.65; p = 0.048) for administration of enema. This evaluation, informed by the theory of planned behaviour, has provided useful insights into factors that influence clinician intentions to perform evidence-based bowel management practices in intensive care. Addressing factors such as knowledge, attitudes and beliefs can assist in targeting implementation strategies to positively affect clinician behaviour change. Despite an increase in clinicians' knowledge scores, our implementation strategy did not, however, significantly change clinician behaviour intentions for all three bowel management practices. Further research is required to explore the influence of opinion leaders and organizational culture on clinicians' behaviour intentions related to bowel management for intensive care patients.

Ten steps for managing organizational change.

PubMed

Bolton, L B; Aydin, C; Popolow, G; Ramseyer, J

1992-06-01

Managing interdepartmental relations in healthcare organizations is a major challenge for nursing administrators. The authors describe the implementation process of an organization-wide change effort involving individuals from departments throughout the medical center. These strategies can serve as a model to guide effective planning in other institutions embarking on change projects, resulting in smoother and more effective implementation of interdepartmental change.

Enabling Joint Interdependence through Capability Portfolio Management

DTIC Science & Technology

2008-06-13

7 Habits of Highly Effective People , author Stephen Covey notes that “you...incentives to implement the strategy, they 5 Stephen R. Covey, The 7 Habits of Highly Effective People (New York: Simon and Schuster, 1989), 229...and Implement the Best Strategy for Your Business. Boston, MA: Harvard Business School Press, 2005. Covey, Stephen R. The 7 Habits of Highly Effective People .

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts.

PubMed

Stelmach, Rafael; Cerci Neto, Alcindo; Fonseca, Ana Cristina de Carvalho Fernandez; Ponte, Eduardo Vieira; Alves, Gerardo; Araujo-Costa, Ildely Niedia; Lasmar, Laura Maria de Lima Belizário Facury; Castro, Luci Keiko Kuromoto de; Lenz, Maria Lucia Medeiros; Silva, Paulo; Cukier, Alberto; Alves, Alexssandra Maia; Lima-Matos, Aline Silva; Cardoso, Amanda da Rocha Oliveira; Fernandes, Ana Luisa Godoy; São-José, Bruno Piassi de; Riedi, Carlos Antônio; Schor, Deborah; Peixoto, Décio Medeiros; Brandenburg, Diego Djones; Camillo, Elineide Gomes Dos Santos; Serpa, Faradiba Sarquis; Brandão, Heli Vieira; Lima, João Antonio Bonfadini; Pio, Jorge Eduardo; Fiterman, Jussara; Anderson, Maria de Fátima; Cardoso, Maria do Socorro de Lucena; Rodrigues, Marcelo Tadday; Pereira, Marilyn Nilda Esther Urrutia; Antila, Marti; Martins, Sonia Maria; Guimarães, Vanessa Gonzaga Tavares; Mello, Yara Arruda Marques; Andrade, Wenderson Clay Correia de; Salibe-Filho, William; Caldeira, Zelina Maria da Rocha; Cruz-Filho, Álvaro Augusto Souza da; Camargos, Paulo

2015-01-01

To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero.

Identity and Access Management and Security in Higher Education.

ERIC Educational Resources Information Center

Bruhn, Mark; Gettes, Michael; West, Ann

2003-01-01

Discusses the drivers for an identity management system (IdM), components of this system, and its role within a school security strategy, focusing on: basic access management; requirements for access management; middleware support for an access management system; IdM implementation considerations (e.g., access eligibilities, authentication…

Managing livestock using animal behavior: Mixed-species stocking and flerds

USDA-ARS?s Scientific Manuscript database

Mixed-species stocking can foster sound landscape management while offering economic and ecological advantages compared to mono-species stocking. Producers contemplating a mixed-species enterprise should reflect on several considerations before implementing this animal management strategy. Factors...

Linking Strategic Planning and Management Control.

DTIC Science & Technology

1984-03-01

contribution it intends to make to its shareholders, employees, customers, and communities . Corporate strategy defines the businesses in which a...identifies six factors to consider regarding strategy implementation. How to communicate the 42 .................... . -.......... . corporate goals is...D. Irwin, Inc., 1975. Anthony, R. N., and Welsch, G. A., Fundamentals of Management Accounting, Richard D. Irwin, Inc., 1974. Argenti , J., Corporate

Relative influence of the components of timber harvest strategies on landscape pattern

Treesearch

Eric J. Gustafson

2007-01-01

Forest managers seek to produce healthy landscape patterns by implementing harvest strategies that are composed of multiple management components such as cutblock size, rotation length, even-aged or uneven-aged residual stand structure, conversion to plantations, and the spatial dispersion of harvest units. With use of the HARVEST model and neutral landscapes, a...

The central role of national programme management for the achievement of malaria elimination: a cross case-study analysis of nine malaria programmes.

PubMed

Smith Gueye, Cara; Newby, Gretchen; Tulloch, Jim; Slutsker, Laurence; Tanner, Marcel; Gosling, Roland D

2016-09-22

A malaria eradication goal has been proposed, at the same time as a new global strategy and implementation framework. Countries are considering the strategies and tools that will enable progress towards malaria goals. The eliminating malaria case-study series reports were reviewed to identify successful programme management components using a cross-case study analytic approach. Nine out of ten case-study reports were included in the analysis (Bhutan, Cape Verde, Malaysia, Mauritius, Namibia, Philippines, Sri Lanka, Turkey, Turkmenistan). A conceptual framework for malaria elimination programme management was developed and data were extracted and synthesized. Findings were reviewed at a consultative workshop, which led to a revision of the framework and further data extraction and synthesis. Success factors of implementation, programme choices and changes, and enabling factors were distilled. Decentralized programmes enhanced engagement in malaria elimination by sub-national units and communities. Integration of the malaria programme into other health services was also common. Decentralization and integration were often challenging due to the skill and experience levels of newly tasked staff. Accountability for programme impact was not clarified for most programmes. Motivation of work force was a key factor in maintaining programme quality but there were few clear, detailed strategies provided. Different incentive schemes targeted various stakeholders. Training and supervision, although not well described, were prioritized by most programmes. Multi-sectoral collaboration helped some programmes share information, build strategies and interventions and achieve a higher quality of implementation. In most cases programme action was spurred by malaria outbreaks or a new elimination goal with strong leadership. Some programmes showed high capacity for flexibility through introduction of new strategies and tools. Several case-studies described methods for monitoring implementation quality and coverage; however analysis and feedback to those implementing malaria elimination in the periphery was not well described. Political commitment and sustained financing contributed to malaria programme success. Consistency of malaria programmes depends on political commitment, human and financial resources, and leadership. Operational capacity of the programme and the overall health system structure and strength are also important aspects. Malaria eradication will require adaptive, well-managed malaria programmes that are able to tailor implementation of evidence-based strategies, founded upon strong sub-national surveillance and response, with adequate funding and human resources.

Strategic Planning and Financial Management

ERIC Educational Resources Information Center

Conneely, James F.

2010-01-01

Strong financial management is a strategy for strategic planning success in student affairs. It is crucial that student affairs professionals understand the necessity of linking their strategic planning with their financial management processes. An effective strategic planner needs strong financial management skills to implement the plan over…

Stress Prevention@Work: a study protocol for the evaluation of a multifaceted integral stress prevention strategy to prevent employee stress in a healthcare organization: a cluster controlled trial.

PubMed

Hoek, Rianne J A; Havermans, Bo M; Houtman, Irene L D; Brouwers, Evelien P M; Heerkens, Yvonne F; Zijlstra-Vlasveld, Moniek C; Anema, Johannes R; van der Beek, Allard J; Boot, Cécile R L

2017-07-17

Adequate implementation of work-related stress management interventions can reduce or prevent work-related stress and sick leave in organizations. We developed a multifaceted integral stress-prevention strategy for organizations from several sectors that includes a digital platform and collaborative learning network. The digital platform contains a stepwise protocol to implement work-related stress-management interventions. It includes stress screeners, interventions and intervention providers to facilitate access to and the selection of matching work-related stress-management interventions. The collaborative learning network, including stakeholders from various organizations, plans meetings focussing on an exchange of experiences and good practices among organizations for the implementation of stress prevention measures. This paper describes the design of an integral stress-prevention strategy, Stress Prevention@Work, and the protocol for the evaluation of: 1) the effects of the strategy on perceived stress and work-related outcomes, and 2) the barriers and facilitators for implementation of the strategy. The effectiveness of Stress Prevention@Work will be evaluated in a cluster controlled trial, in a large healthcare organization in the Netherlands, at six and 12 months. An independent researcher will match teams on working conditions and size and allocate the teams to the intervention or control group. Teams in the intervention group will be offered Stress Prevention@Work. For each intervention team, one employee is responsible for applying the strategy within his/her team using the digital platform and visiting the collaborative learning network. Using a waiting list design, the control group will be given access to the strategy after 12 months. The primary outcome is the employees' perceived stress measured by the stress subscale of the Depression, Anxiety, and Stress Scale (DASS-21). Secondary outcome measures are job demands, job resources and the number of preventive stress measures implemented at the team level. Alongside the trial, a process evaluation, including barriers and facilitators of the implementation of Stress Prevention@Work, will be conducted in one healthcare organisation. If Stress Prevention@Work is found to be effective in one healthcare organisation, further implementation on a broader scale might lead to increased productivity and decreased stress and sick leave in other organizations. Results are expected in 2018. NTR5527 . Registered 7 Dec 2015.

Identifying governance strategies that effectively support ecosystem services, resource sustainability, and biodiversity

PubMed Central

Kenward, R. E.; Whittingham, M. J.; Arampatzis, S.; Manos, B. D.; Hahn, T.; Terry, A.; Simoncini, R.; Alcorn, J.; Bastian, O.; Donlan, M.; Elowe, K.; Franzén, F.; Karacsonyi, Z.; Larsson, M.; Manou, D.; Navodaru, I.; Papadopoulou, O.; Papathanasiou, J.; von Raggamby, A.; Sharp, R. J. A.; Söderqvist, T.; Soutukorva, Å.; Vavrova, L.; Aebischer, N. J.; Leader-Williams, N.; Rutz, C.

2011-01-01

Conservation scientists, national governments, and international conservation groups seek to devise, and implement, governance strategies that mitigate human impact on the environment. However, few studies to date have systematically investigated the performance of different systems of governance in achieving successful conservation outcomes. Here, we use a newly-developed analytic framework to conduct analyses of a suite of case studies, linking different governance strategies to standardized scores for delivering ecosystem services, achieving sustainable use of natural resources, and conserving biodiversity, at both local and international levels. Our results: (i) confirm the benefits of adaptive management; and (ii) reveal strong associations for the role of leadership. Our work provides a critical step toward implementing empirically justified governance strategies that are capable of improving the management of human-altered environments, with benefits for both biodiversity and people. PMID:21402916

Grant Funding to Implement PREPaRE Training in Your School District

ERIC Educational Resources Information Center

Paige, Leslie Z.

2010-01-01

Implementing an effective crisis management program in a school district has associated costs. The most precious resource in a school system is time. Time is necessary for acquiring and practicing new skills, and for developing and implementing strategies to introduce and expand the change throughout a school or district. Implementing an effective…

A 'movement for improvement'? A qualitative study of the adoption of social movement strategies in the implementation of a quality improvement campaign.

PubMed

Waring, Justin; Crompton, Amanda

2017-09-01

Given the difficulties of implementing 'top-down' quality improvements, health service leaders have turned to methods that empower clinicians to co-produce 'bottom-up' improvements. This has involved the adoption of strategies and activities associated with social movements, with clinicians encouraged to participate in collective action towards the shared goal of improvement. This paper examines the adoption of social movement methods by hospital managers as a strategy for implementing a quality improvement 'campaign'. Our case study suggests that, despite the claim of empowering clinicians to develop 'bottom-up' improvements, the use of social movement methods can be more narrowly concerned with engaging clinicians in pre-determined programmes of 'top-down' change. It finds a prominent role for 'hybrid' clinical leaders and other staff representatives in the mobilisation of the campaign, especially for enrolling clinicians in change activities. The work of these 'hybrids' suggests some degree of creative mediation between clinical and managerial interests, but more often alignment with the aspirations of management. The study raises questions about the translation of social movement's theories as a strategy for managing change and re-inventing professionalism. © 2017 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.

Ecological control line: A decade of exploration and an innovative path of ecological land management for megacities in China.

PubMed

Hong, Wuyang; Yang, Chengyun; Chen, Liuxin; Zhang, Fangfang; Shen, Shaoqing; Guo, Renzhong

2017-04-15

Ecological control line is a system innovation in the field of ecological environment protection in China and it has become as an important strategy of national ecological protection. Ten years have passed since the first ecological control line in Shenzhen was delimited in 2005. This study examines the connotations of ecological control line and the current study status in China and abroad, and then takes a brief description about the delimitation background and existing problems of the ecological control line in Shenzhen. The problem-solving strategy is gradually transforming from extensive management to refined management. This study proposes a differential ecological space management model that merges the space system, management system, and support system. The implementation paths include the following five aspects: delimiting ecological bottom lines to protect core ecological resources; formulating access systems for new construction projects to strictly control new construction; implementing construction land inventory reclamation assisted by market means; regulating boundary adjusting procedures and processes; and constructing ecological equity products by using multiple means to implement rights relief. Finally, this study illustrates the progress of the implementation and discusses the rigorousness and flexibility problems of ecological control line and calls for the promotion of the legislation. The management model and implementation paths proposed in this study have referential significance for developing countries and megacities to achieve ecological protection and sustainable development. Copyright © 2017 Elsevier Ltd. All rights reserved.

43 CFR 46.145 - Using adaptive management.

Code of Federal Regulations, 2011 CFR

2011-10-01

... implementation decisions. The NEPA analysis conducted in the context of an adaptive management approach should identify the range of management options that may be taken in response to the results of monitoring and should analyze the effects of such options. The environmental effects of any adaptive management strategy...

43 CFR 46.145 - Using adaptive management.

Code of Federal Regulations, 2010 CFR

2010-10-01

... implementation decisions. The NEPA analysis conducted in the context of an adaptive management approach should identify the range of management options that may be taken in response to the results of monitoring and should analyze the effects of such options. The environmental effects of any adaptive management strategy...

77 FR 39554 - Self-Regulatory Organizations; NYSE Arca, Inc.; Order Granting Approval of Proposed Rule Change...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-03

... investment objective by implementing a ``top-down'' portfolio management style. This management style begins...'' portfolio management style utilizes a tactical and globally diversified allocation strategy in an attempt to... open-end management investment company.\\4\\ The [[Page 39555

Development of a stormwater best management practice placement strategy for the Virginia Department of Transportation.

DOT National Transportation Integrated Search

2003-01-01

Since the implementation of the federal and state stormwater management regulations, the Virginia Department of Transportation (VDOT) has constructed hundreds of best management practices (BMPs) for controlling stormwater runoff from highways and its...

South Dakota Department of Transportation (SDDOT) regional traveler information system for weather responsive traffic management.

DOT National Transportation Integrated Search

2016-01-01

FHWAs Road Weather Management Program partnered with the South Dakota DOT to develop and implement a Weather Responsive Traffic Management (WRTM) strategy that involves mobile data collection and traveler information dissemination during weather e...

Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success.

PubMed

Rangachari, Pavani

2018-01-01

In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as "innovation implementation failure" in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on "innovation implementation" in hospitals and health systems over the last decade, since the spotlight was cast on "innovation implementation failure" in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the "what"), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the "how"). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues.

Managing Air Quality - Program Implementation

EPA Pesticide Factsheets

Describes elements for the set of activities to ensure that control strategies are put into effect and that air quality goals and standards are fulfilled, permitting programs, and additional resources related to implementation under the Clean Air Act.

A Water Demand Management Strategy For The Namibian Tourism Sector

NASA Astrophysics Data System (ADS)

Schachtschneider, K.; Winter, K.

The arid conditions of Namibia are forcing its decision-makers to resort to new wa- ter resource management approaches, including Water Demand Management (WDM). When Namibia achieved its independence from South Africa 1990, a new opportunity arose to rewrite certain restrictive laws and policies in order to bring about redress, development and transformation. The new Water Policy is one example in which the mindset is changed from a supply to a demand oriented water management ap- proach. Legal support for WDM within the new Water Act is a critical component that will support the implementation of WDM in all economic sectors, such as agri- culture, mining and tourism. It is argued that an appropriate WDM strategy should be designed specifically for each sector, once the typical water use patterns in a sec- tor are understood and key water resource managers at all levels are identified. The Namibian tourism sector is geographically dispersed and control over its operations is compounded by the fact that it is frequently located in extremely remote areas that are arid and ecologically sensitive. In general, WDM is rarely practised, because it is not yet supported by law and there are currently no institutional arrangements to con- trol water use in this geographically dispersed industrial sector through which WDM could be enforced either through metering and/or payments. Managers of tourist en- terprises undertake most of the water management themselves, and have been identi- fied as being crucial to the implementation of WDM strategies. A study of six tourist facilities determined the willingness and motivation of these managers to undertake various WDM initiatives. The study identified three factors which appear to influence the actions of managers, namely external controls, economics and company ethics. It is recommended that a tourism sector WDM strategy should focus on these three factors in order to transform the WDM aims and objectives on the policy level into practical implementation at the tourist facility level.

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

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

Ha, Miae; Wu, May

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

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

DOE PAGES

Ha, Miae; Wu, May

2015-09-08

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

[Application of marketing strategies for the management of public hospitals from the viewpoint of the staff members].

PubMed

Riveros S, Jorge; Berné M, Carmen

2006-03-01

The implementation of the marketing strategies in public hospitals provides management advantages and improves the relationship between customers and staff. To analyze the application of marketing strategies in a public hospital, from the perspective of the staff. A structured survey that asked about perceptions in 50 items about communication between personnel and customers/users, customer satisfaction, participation in the development of new policies and incentives for efficiency was applied to a stratified sample of the staff. Factorial and regression analyses were performed to define the impact of marketing strategies on the degree of preoccupation and orientation of the organization towards the satisfaction of customer needs. The survey was applied to 74 males and 122 females. The survey showed that the orientation of the hospital towards the satisfaction of its beneficiaries basically depends on the generation of an organizational culture oriented towards them and the implementation of adequate policies in staff management and quality of service. These basic aspects can be accompanied with practices associated to the new marketing approaches such as a market orientation, customer orientation and relational marketing. All these factors presented positive and significant relations. New marketing strategies should be applied, to achieve an efficient and customer oriented hospital management.

Supporting Community Pharmacies with Implementation of a Web-Based Medication Management Application.

PubMed

Turner, Kea; Renfro, Chelsea; Ferreri, Stefanie; Roberts, Kim; Pfeiffenberger, Trista; Shea, Christopher M

2018-04-01

 Community pharmacists' role in clinical care is expanding in the United States and information systems are needed that extend beyond a dispensing workflow. As pharmacies adopt new systems, implementation support will be needed. This study identifies the barriers and facilitators experienced by community pharmacies in implementing a Web-based medication management application and describes the implementation strategies used to support these pharmacies.  Semistructured interviews were conducted with 28 program and research staff that provides support to community pharmacies participating in a statewide pharmacy network. Interviews were recorded, transcribed verbatim, and analyzed for themes using the Expert Recommendations for Implementing Change (ERIC).  Findings suggest that leadership support, clinical training, and computer literacy facilitated implementation, while lack of system integration, staff resistance to change, and provider reluctance to share data served as barriers. To overcome the barriers, implementation support was provided, such as assessing readiness for implementation, developing a standardized and interoperable care plan, and audit and feedback of documentation quality.  Participants used a wide array of strategies to support community pharmacies with implementation and tailored approaches to accommodate pharmacy-specific preferences. Most of the support was delivered preimplementation or in the early phase of implementation and by program or research staff rather than peer-to-peer. Implementing new pharmacy information system requires a significant amount of implementation support to help end-users learn about program features, how to integrate the software into workflow, and how to optimize the software to improve patient care. Future research should identify which implementation strategies are associated with program performance. Schattauer.

Implementing health care reform in Israel: organizational response to perceived incentives.

PubMed

Gross, Revital

2003-08-01

Devising new incentives was a main element of health care reform in Israel, which created a regulated market that embodies many principles of managed competition. This study examined sick fund directors' perceptions of the new incentives and their strategic responses to these incentives, enabling the testing of how managed competition works in practice. The methodology used was a multiple case study of Israel's four sick funds. Data were gathered through in-depth interviews with 160 senior officials, analysis of national health insurance legislation, and analysis of published and unpublished archival documents, newspaper articles, public statements of senior managers, and other published data on the sick funds' behavior. The study revealed discrepancies between planned and perceived incentives and highlighted the effect of the latter on strategy formulation. Analysis of sick fund strategies showed that their responses to managed competition incentives deviated from theoretical expectations, compromising some of the objectives of the reform. The study also shows that contextual features account for the specific model of managed competition that was implemented and for the specific strategies employed by the sick funds. The study concludes by highlighting the need to build a process that will enable policy makers to consider local contextual factors when planning and implementing reform, involving health care providers in designing incentives, continuously monitoring processes and outcomes in the reformed system, and allowing for flexibility in policy making.

Health benefit modelling and optimization of vehicular pollution control strategies

NASA Astrophysics Data System (ADS)

Sonawane, Nayan V.; Patil, Rashmi S.; Sethi, Virendra

2012-12-01

This study asserts that the evaluation of pollution reduction strategies should be approached on the basis of health benefits. The framework presented could be used for decision making on the basis of cost effectiveness when the strategies are applied concurrently. Several vehicular pollution control strategies have been proposed in literature for effective management of urban air pollution. The effectiveness of these strategies has been mostly studied as a one at a time approach on the basis of change in pollution concentration. The adequacy and practicality of such an approach is studied in the present work. Also, the assessment of respective benefits of these strategies has been carried out when they are implemented simultaneously. An integrated model has been developed which can be used as a tool for optimal prioritization of various pollution management strategies. The model estimates health benefits associated with specific control strategies. ISC-AERMOD View has been used to provide the cause-effect relation between control options and change in ambient air quality. BenMAP, developed by U.S. EPA, has been applied for estimation of health and economic benefits associated with various management strategies. Valuation of health benefits has been done for impact indicators of premature mortality, hospital admissions and respiratory syndrome. An optimization model has been developed to maximize overall social benefits with determination of optimized percentage implementations for multiple strategies. The model has been applied for sub-urban region of Mumbai city for vehicular sector. Several control scenarios have been considered like revised emission standards, electric, CNG, LPG and hybrid vehicles. Reduction in concentration and resultant health benefits for the pollutants CO, NOx and particulate matter are estimated for different control scenarios. Finally, an optimization model has been applied to determine optimized percentage implementation of specific control strategies with maximization of social benefits, when these strategies are applied simultaneously.

Health care managers' views on and approaches to implementing models for improving care processes.

PubMed

Andreasson, Jörgen; Eriksson, Andrea; Dellve, Lotta

2016-03-01

To develop a deeper understanding of health-care managers' views on and approaches to the implementation of models for improving care processes. In health care, there are difficulties in implementing models for improving care processes that have been decided on by upper management. Leadership approaches to this implementation can affect the outcome. In-depth interviews with first- and second-line managers in Swedish hospitals were conducted and analysed using grounded theory. 'Coaching for participation' emerged as a central theme for managers in handling top-down initiated process development. The vertical approach in this coaching addresses how managers attempt to sustain unit integrity through adapting and translating orders from top management. The horizontal approach in the coaching refers to managers' strategies for motivating and engaging their employees in implementation work. Implementation models for improving care processes require a coaching leadership built on close manager-employee interaction, mindfulness regarding the pace of change at the unit level, managers with the competence to share responsibility with their teams and engaged employees with the competence to share responsibility for improving the care processes, and organisational structures that support process-oriented work. Implications for nursing management are the importance of giving nurse managers knowledge of change management. © 2015 John Wiley & Sons Ltd.

A mixed methods multiple case study of implementation as usual in children’s social service organizations: study protocol

PubMed Central

2013-01-01

Background Improving quality in children’s mental health and social service settings will require implementation strategies capable of moving effective treatments and other innovations (e.g., assessment tools) into routine care. It is likely that efforts to identify, develop, and refine implementation strategies will be more successful if they are informed by relevant stakeholders and are responsive to the strengths and limitations of the contexts and implementation processes identified in usual care settings. This study will describe: the types of implementation strategies used; how organizational leaders make decisions about what to implement and how to approach the implementation process; organizational stakeholders’ perceptions of different implementation strategies; and the potential influence of organizational culture and climate on implementation strategy selection, implementation decision-making, and stakeholders’ perceptions of implementation strategies. Methods/design This study is a mixed methods multiple case study of seven children’s social service organizations in one Midwestern city in the United States that compose the control group of a larger randomized controlled trial. Qualitative data will include semi-structured interviews with organizational leaders (e.g., CEOs/directors, clinical directors, program managers) and a review of documents (e.g., implementation and quality improvement plans, program manuals, etc.) that will shed light on implementation decision-making and specific implementation strategies that are used to implement new programs and practices. Additionally, focus groups with clinicians will explore their perceptions of a range of implementation strategies. This qualitative work will inform the development of a Web-based survey that will assess the perceived effectiveness, relative importance, acceptability, feasibility, and appropriateness of implementation strategies from the perspective of both clinicians and organizational leaders. Finally, the Organizational Social Context measure will be used to assess organizational culture and climate. Qualitative, quantitative, and mixed methods data will be analyzed and interpreted at the case level as well as across cases in order to highlight meaningful similarities, differences, and site-specific experiences. Discussion This study is designed to inform efforts to develop more effective implementation strategies by fully describing the implementation experiences of a sample of community-based organizations that provide mental health services to youth in one Midwestern city. PMID:23961701

A Longitudinal Study of the Relationship between User Attitudes and the Success of the MAJCOM and AFRCE Work Information Management System.

DTIC Science & Technology

1985-09-01

now focus on one of the most neglected and difficult to perform system strategies identified by Multinovich and Vlahovich ; the evaluation of the system...201). Multinovich and Vlahovich (33) have outlined several strategies which they feel will increase the probability of successfully implementing a...Management. Cincinnati: South-Western Publishing Company, 1975. 148 . . .2 * * T. 7° 33. Multinovich, Jugoslav S. and Vladimir Vlahovich . "A Strategy

42 CFR 438.202 - State responsibilities.

Code of Federal Regulations, 2010 CFR

2010-10-01

... strategy whenever significant changes are made. (2) Regular reports on the implementation and effectiveness... written strategy for assessing and improving the quality of managed care services offered by all MCOs and PIHPs. (b) Obtain the input of recipients and other stakeholders in the development of the strategy and...

Risk Management for the International Space Station

NASA Technical Reports Server (NTRS)

Sebastian, J.; Brezovic, Philip

2002-01-01

The International Space Station (ISS) is an extremely complex system, both technically and programmatically. The Space Station must support a wide range of payloads and missions. It must be launched in numerous launch packages and be safely assembled and operated in the harsh environment of space. It is being designed and manufactured by many organizations, including the prime contractor, Boeing, the NASA institutions, and international partners and their contractors. Finally, the ISS has multiple customers, (e.g., the Administration, Congress, users, public, international partners, etc.) with contrasting needs and constraints. It is the ISS Risk Management Office strategy to proactively and systematically manages risks to help ensure ISS Program success. ISS program follows integrated risk management process (both quantitative and qualitative) and is integrated into ISS project management. The process and tools are simple and seamless and permeate to the lowest levels (at a level where effective management can be realized) and follows the continuous risk management methodology. The risk process assesses continually what could go wrong (risks), determine which risks need to be managed, implement strategies to deal with those risks, and measure effectiveness of the implemented strategies. The process integrates all facets of risk including cost, schedule and technical aspects. Support analysis risk tools like PRA are used to support programatic decisions and assist in analyzing risks.

Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya

PubMed Central

2010-01-01

Abstract Background The home-management of malaria strategy seeks to improve prompt and effective anti-malarial drug use through the informal sector, with a potential channel being the Private Medicine Retailers (PMRs). Previous evaluations of PMR programmes focused on their impact on retailer knowledge and practices, with limited evidence about the influence of implementation processes on the impacts at scale. This paper examines how the implementation processes of three PMR programmes in Kenya, each scaled up within a district, contributed to the outcomes observed. These were a Ministry of Health programme in Kwale district; and two programmes supported by non-governmental organizations in collaboration with government in Kisii Central and Bungoma districts. Methods The research methods included 24 focus group discussions with clients and PMRs, 19 in-depth interviews with implementing actors, document review and a diary of events. The data were analysed using the combination of a broad policy analysis framework and more specific scaling up/diffusion of innovations frameworks. Results The Kisii programme, a case study of successful implementation, was underpinned by good relationships between district health managers and a “resource team”, supported by a memorandum of understanding which enabled successful implementation. It had flexible budgetary and decision making processes which were responsive to local contexts, and took account of local socio-economic activities. In contrast, the Kwale programme, which had implementation challenges, was characterised by a complex funding process, with lengthy timelines, that was tied to the government financial management system which constrained implementation Although there was a flexible funding system in Bungoma, a perceived lack of transparency in fund management, inadequate management of inter-organisational relationships, and inability to adapt and respond to changing circumstances led to implementation difficulties. Conclusions For effective scaling up of PMR programmes, the provision of technical support and adequate resources are vital, but not sufficient on their own. An active strategy to manage relationships between implementing actors through effective communication mechanisms is essential. Successful outcomes may be realised if a strong and transparent management system, including management of financial resources, is put in place. This study provides evidence of the value of assessing implementation processes as part of impact evaluation for public health programmes. PMID:20594373

Importance of strategic management in the implementation of private medicine retailer programmes: case studies from three districts in Kenya.

PubMed

Abuya, Timothy; Amin, Abdinasir; Molyneux, Sassy; Akhwale, Willis; Marsh, Vicki; Gilson, Lucy

2010-07-02

The home-management of malaria strategy seeks to improve prompt and effective anti-malarial drug use through the informal sector, with a potential channel being the Private Medicine Retailers (PMRs). Previous evaluations of PMR programmes focused on their impact on retailer knowledge and practices, with limited evidence about the influence of implementation processes on the impacts at scale. This paper examines how the implementation processes of three PMR programmes in Kenya, each scaled up within a district, contributed to the outcomes observed. These were a Ministry of Health programme in Kwale district; and two programmes supported by non-governmental organizations in collaboration with government in Kisii Central and Bungoma districts. The research methods included 24 focus group discussions with clients and PMRs, 19 in-depth interviews with implementing actors, document review and a diary of events. The data were analysed using the combination of a broad policy analysis framework and more specific scaling up/diffusion of innovations frameworks. The Kisii programme, a case study of successful implementation, was underpinned by good relationships between district health managers and a "resource team", supported by a memorandum of understanding which enabled successful implementation. It had flexible budgetary and decision making processes which were responsive to local contexts, and took account of local socio-economic activities. In contrast, the Kwale programme, which had implementation challenges, was characterised by a complex funding process, with lengthy timelines, that was tied to the government financial management system which constrained implementation Although there was a flexible funding system in Bungoma, a perceived lack of transparency in fund management, inadequate management of inter-organisational relationships, and inability to adapt and respond to changing circumstances led to implementation difficulties. For effective scaling up of PMR programmes, the provision of technical support and adequate resources are vital, but not sufficient on their own. An active strategy to manage relationships between implementing actors through effective communication mechanisms is essential. Successful outcomes may be realised if a strong and transparent management system, including management of financial resources, is put in place. This study provides evidence of the value of assessing implementation processes as part of impact evaluation for public health programmes.

The Balanced Scorecard as a management tool for assessing and monitoring strategy implementation in health care organizations.

PubMed

Bisbe, Josep; Barrubés, Joan

2012-10-01

Both prior literature and reported managerial practices have claimed that the Balanced Scorecard is a management tool that can help organizations to effectively implement strategies. In this article, we examine some of the contributions, dilemmas, and limitations of Balanced Scorecards in health care organizations. First, we describe the evolution of Balanced Scorecards from multidimensional performance measurement systems to causal representations of formulated strategies, and analyze the applicability of Balanced Scorecards in health care settings. Next, we discuss several issues under debate regarding Balanced Scorecard adoption in health care organizations. We distinguish between issues related to the design of Balanced Scorecards and those related to the use of these tools. We conclude that the Balanced Scorecard has the potential to contribute to the implementation of strategies through the strategically-oriented performance measurement systems embedded within it. However, effective adoption requires the adaptation of the generic instrument to the specific realities of health care organizations. Full English text available from:www.revespcardiol.org. Copyright © 2012 Sociedad Española de Cardiología. Published by Elsevier Espana. All rights reserved.

78 FR 9917 - The President's Management Advisory Board (PMAB); Notification of Upcoming Public Advisory Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-02-12

...) portfolio and project management; Senior Executive Service (SES) leadership development and SES performance... effective strategies for the implementation of best business practices to improve Federal Government...

Knowledge Management: Opportunity for the Secretary of the Future.

ERIC Educational Resources Information Center

Strassmann, Paul A.

1987-01-01

Discuses future trends in the role of the secretary. Suggests that secretaries will, in the next decade, become information managers. Recommends strategies that secretaries can implement to be ready for change. (CH)

76 FR 30902 - Shasta Lake Management Unit, Shasta-Trinity National Forest; California; Green-Horse Habitat...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-05-27

... management strategy to allow modification of treatments if necessary during implementation. A project-level... to 15 tons per acre for those two management prescriptions. This project-level amendment is proposed... Management Unit, Shasta-Trinity National Forest; California; Green-Horse Habitat Restoration and Maintenance...

Forest operations for ecosystem management

Treesearch

Robert B. Rummer; John Baumgras; Joe McNeel

1997-01-01

The evolution of modern forest resource management is focusing on ecologically sensitive forest operations. This shift in management strategies is producing a new set of functional requirements for forest operations. Systems to implement ecosystem management prescriptions may need to be economically viable over a wider range of piece sizes, for example. Increasing...

Effects of performance measure implementation on clinical manager and provider motivation.

PubMed

Damschroder, Laura J; Robinson, Claire H; Francis, Joseph; Bentley, Douglas R; Krein, Sarah L; Rosland, Ann-Marie; Hofer, Timothy P; Kerr, Eve A

2014-12-01

Clinical performance measurement has been a key element of efforts to transform the Veterans Health Administration (VHA). However, there are a number of signs that current performance measurement systems used within and outside the VHA may be reaching the point of maximum benefit to care and in some settings, may be resulting in negative consequences to care, including overtreatment and diminished attention to patient needs and preferences. Our research group has been involved in a long-standing partnership with the office responsible for clinical performance measurement in the VHA to understand and develop potential strategies to mitigate the unintended consequences of measurement. Our aim was to understand how the implementation of diabetes performance measures (PMs) influences management actions and day-to-day clinical practice. This is a mixed methods study design based on quantitative administrative data to select study facilities and quantitative data from semi-structured interviews. Sixty-two network-level and facility-level executives, managers, front-line providers and staff participated in the study. Qualitative content analyses were guided by a team-based consensus approach using verbatim interview transcripts. A published interpretive motivation theory framework is used to describe potential contributions of local implementation strategies to unintended consequences of PMs. Implementation strategies used by management affect providers' response to PMs, which in turn potentially undermines provision of high-quality patient-centered care. These include: 1) feedback reports to providers that are dissociated from a realistic capability to address performance gaps; 2) evaluative criteria set by managers that are at odds with patient-centered care; and 3) pressure created by managers' narrow focus on gaps in PMs that is viewed as more punitive than motivating. Next steps include working with VHA leaders to develop and test implementation approaches to help ensure that the next generation of PMs motivate truly patient-centered care and are clinically meaningful.

The EPA-Wide Plan to Provide Solid Waste Management Capacity Assistance to Tribes

EPA Pesticide Factsheets

This Plan is a strategy for building tribal capacity to manage solid waste. The Plan promotes the development and implementation of integrated waste management plans and describes how EPA will prioritize its resources to maximize environmental benefits.

Innovation Implementation in the Context of Hospital QI: Lessons Learned and Strategies for Success

PubMed Central

Rangachari, Pavani

2018-01-01

In 1999, the Institute of Medicine reported that 98,000 people die each year due to medical errors. In the following years, the focus on hospital quality was intensified nationally, with policymakers providing evidence-based practice guidelines for improving health care quality. However, these innovations (evidence-based guidelines) that were being produced at policy levels were not translating to clinical practice at the hospital organizational level easily, and stark variations continued to persist, in the quality of health care. Circa 2009, nearly a decade after the release of the IOM report, the health care organizational literature began referring to this challenge as “innovation implementation failure” in health care organizations (HCOs), ie, failure to implement an evidence-based practice that is new to a HCO. This stream of literature drew upon management research to explain why innovation implementation failure occurs in HCOs and what could be done to prevent it. This paper conducts an integrative review of the literature on “innovation implementation” in hospitals and health systems over the last decade, since the spotlight was cast on “innovation implementation failure” in HCOs. The review reveals that while some studies have retrospectively sought to identify the key drivers of innovation implementation, through surveys and interviews of practitioners (the “what”), other studies have prospectively sought to understand how innovation implementation occurs in hospitals and health systems (the “how”). Both make distinctive contributions to identifying strategies for success in innovation implementation. While retrospective studies have helped identify the key drivers of innovation implementation, prospective studies have shed light on how these drivers could be attained, thereby helping to develop context-sensitive management strategies for success. The literature has called for more prospective research on the implementation and sustainability of health care innovations. This paper summarizes the lessons learned from the literature, discusses the relevance of management research on innovation implementation in HCOs, and identifies future research avenues. PMID:29546884

Hospital implementation of health information technology and quality of care: are they related?

PubMed

Restuccia, Joseph D; Cohen, Alan B; Horwitt, Jedediah N; Shwartz, Michael

2012-09-27

Recently, there has been considerable effort to promote the use of health information technology (HIT) in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI) practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians. We conducted surveys of quality managers and front-line clinicians (physicians and nurses) in 470 short-term, general hospitals to obtain data on hospitals' extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR) file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures. Controlling for potential confounders, we found that hospitals with high levels of HIT implementation engaged in a statistically significant greater number of QI practices and strategies, and had significantly better performance on mortality rates, patient satisfaction measures, and assessments of patient care quality by hospital quality managers; there was weaker evidence of higher assessments of patient care quality by front-line clinicians. Hospital implementation of HIT was positively associated with activities intended to improve patient care quality and with higher performance on four of six performance measures.

Improving customer satisfaction: emerging lessons about strategy and implementation, Part 2.

PubMed

Morton, J

1995-01-01

This article describes a six-phase strategy designed to systematically improve customer satisfaction across an entire managed care system. Part 1 (Spring 1995) of this two-part series summarized the theoretical underpinnings of the approach and highlighted the first two phases of the improvement strategy. Those phases involve systematically listening to the organization's customers and using customer information to strategically target key areas for improvement. This article describes the specifics of the last four phases of the strategy; these phases involve achieving and sustaining unprecedented levels of improvement in targeted areas. Initial results and emerging lessons associated with the implementation of this strategy are summarized.

Diagnosing and Resolving Conflict Created by Strategic Plans: Where Outreach Strategies and Execution Meet at an Academic Health Center.

PubMed

Edwards, Robert L; Wollner, Samuel B; Weddle, Jessica; Zembrodt, James W; Birdwhistell, Mark D

2017-01-01

The imperative for strategic change at academic health centers has never been stronger. Underpinning the success of strategic change is an effective process to implement a strategy. Healthcare organizations, however, often fail to execute on strategy because they do not activate the requisite capabilities and management processes. The University of Kentucky HealthCare recently defined its 2020 strategic plan to adapt to emerging market conditions. The authors outline the strategic importance of strengthening partnership networks and the initial challenges faced in executing their strategy. The findings are a case study in how one academic health center has approached strategy implementation.

Marketing strategies of hospital service organizations in Nigeria: a study of selected privately owned hospitals in Port Harcourt.

PubMed

Okwandu, Gabriel A

2002-01-01

This study was centered on the identification of the marketing strategies of hospitals and the factors that militate against their effective adoption and implementation. A total of 80 hospitals in Port Harcourt responded to a structured questionnaire administered on them. It was found, among other things, that many hospital organizations apply marketing strategies, and that hospitals that adopt effective marketing strategies perform better than those that do not. Some of the factors militating against the effective adoption and implementation of marketing strategies include lack of planning, lack of top management support, and non-utilization of all the promotional mix elements.

Making Strategic Planning Work: Experiences from a Private University. AIR 1986 Annual Forum Paper.

ERIC Educational Resources Information Center

Chan, Susy S.

Issues in implementating strategic planning in higher education management are considered, along with successful strategies and problem areas in implementing an integrated planning and budgeting process at DePaul University, a comprehensive Catholic university. Key implementation issues are as follows: (1) maintaining an organizational balance…

Lessons from the business sector for successful knowledge management in health care: a systematic review.

PubMed

Kothari, Anita; Hovanec, Nina; Hastie, Robyn; Sibbald, Shannon

2011-07-25

The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. 83 articles were reviewed and data were extracted to: (1) uncover reasons for initiating knowledge management strategies, (2) identify potential knowledge management strategies/solutions, and (3) describe facilitators and barriers to knowledge management. KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate) knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build.

Lessons from the business sector for successful knowledge management in health care: A systematic review

PubMed Central

2011-01-01

Background The concept of knowledge management has been prevalent in the business sector for decades. Only recently has knowledge management been receiving attention by the health care sector, in part due to the ever growing amount of information that health care practitioners must handle. It has become essential to develop a way to manage the information coming in to and going out of a health care organization. The purpose of this paper was to summarize previous studies from the business literature that explored specific knowledge management tools, with the aim of extracting lessons that could be applied in the health domain. Methods We searched seven databases using keywords such as "knowledge management", "organizational knowledge", and "business performance". We included articles published between 2000-2009; we excluded non-English articles. Results 83 articles were reviewed and data were extracted to: (1) uncover reasons for initiating knowledge management strategies, (2) identify potential knowledge management strategies/solutions, and (3) describe facilitators and barriers to knowledge management. Conclusions KM strategies include such things as training sessions, communication technologies, process mapping and communities of practice. Common facilitators and barriers to implementing these strategies are discussed in the business literature, but rigorous studies about the effectiveness of such initiatives are lacking. The health care sector is at a pinnacle place, with incredible opportunities to design, implement (and evaluate) knowledge management systems. While more research needs to be done on how best to do this in healthcare, the lessons learned from the business sector can provide a foundation on which to build. PMID:21787403

Community and District Empowerment for Scale-up (CODES): a complex district-level management intervention to improve child survival in Uganda: study protocol for a randomized controlled trial.

PubMed

Waiswa, Peter; O'Connell, Thomas; Bagenda, Danstan; Mullachery, Pricila; Mpanga, Flavia; Henriksson, Dorcus Kiwanuka; Katahoire, Anne Ruhweza; Ssegujja, Eric; Mbonye, Anthony K; Peterson, Stefan Swartling

2016-03-11

Innovative and sustainable strategies to strengthen districts and other sub-national health systems and management are urgently required to reduce child mortality. Although highly effective evidence-based and affordable child survival interventions are well-known, at the district level, lack of data, motivation, analytic and planning capacity often impedes prioritization and management weaknesses impede implementation. The Community and District Empowerment for Scale-up (CODES) project is a complex management intervention designed to test whether districts when empowered with data and management tools can prioritize and implement evidence-based child survival interventions equitably. The CODES strategy combines management, diagnostic, and evaluation tools to identify and analyze the causes of bottlenecks to implementation, build capacity of district management teams to implement context-specific solutions, and to foster community monitoring and social accountability to increase demand for services. CODES combines UNICEF tools designed to systematize priority setting, allocation of resources and problem solving with Community dialogues based on Citizen Report Cards and U-Reports used to engage and empower communities in monitoring health service provision and to demand for quality services. Implementation and all data collection will be by the districts teams or local Community-based Organizations who will be supported by two local implementing partners. The study will be evaluated as a cluster randomized trial with eight intervention and eight comparison districts over a period of 3 years. Evaluation will focus on differences in uptake of child survival interventions and will follow an intention-to-treat analysis. We will also document and analyze experiences in implementation including changes in management practices. By increasing the District Health Management Teams' capacity to prioritize and implement context-specific solutions, and empowering communities to become active partners in service delivery, coverage of child survival interventions will increase. Lessons learned on strengthening district-level managerial capacities and mechanisms for community monitoring may have implications, not only in Uganda but also in other similar settings, especially with regard to accelerating effective coverage of key child survival interventions using locally available resources. ISRCTN15705788 , Date of registration; 24 July 2015.

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times

PubMed Central

2013-01-01

Background Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. Methods A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Results Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Conclusions Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations. PMID:23742217

Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

PubMed

Pomey, Marie-Pascale; Forest, Pierre-Gerlier; Sanmartin, Claudia; Decoster, Carolyn; Clavel, Nathalie; Warren, Elaine; Drew, Madeleine; Noseworthy, Tom

2013-06-06

Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

Sustainability of knowledge implementation in a low- and middle- income context: Experiences from a facilitation project in Vietnam targeting maternal and neonatal health

PubMed Central

Bergström, Anna; Hoa, Dinh Thi Phuong; Nga, Nguyen Thu; Eldh, Ann Catrine

2017-01-01

Background In a previous trial in Vietnam, a facilitation strategy to secure evidence-based practice in primary care resulted in reduced neonatal mortality over a period of three years. While little is known as to what ensures sustainability in the implementation of community-based strategies, the aim of this study was to investigate factors promoting or hindering implementation, and sustainability of knowledge implementation strategies, by means of the former Neonatal Knowledge Into Practice (NeoKIP) trial. Methods In 2014 we targeted all levels in the Vietnamese healthcare system: six individual interviews with representatives at national, provincial and district levels, and six focus group discussions with representatives at the commune level. The interviews were transcribed verbatim, translated to English, and analysed using inductive and deductive thematic analysis. Results To achieve successful implementation and sustained effect of community-based knowledge implementation strategies, engagement of leaders and key stakeholders at all levels of the healthcare system is vital–prior to, during and after a project. Implementation and sustainability require thorough needs assessment, tailoring of the intervention, and consideration of how to attain and manage funds. The NeoKIP trial was characterised by a high degree of engagement at the primary healthcare system level. Further, three years post trial, maternal and neonatal care was still high on the agenda for healthcare workers and leaders, even though primary aspects such as stakeholder engagement at all levels, and funding had been incomplete or lacking. Conclusions The current study illustrates factors to support successful implementation and sustain effects of community-based strategies in projects in low- and middle-income settings; some but not all factors were represented during the post-NeoKIP era. Most importantly, trials in this and similar contexts require deliberate management throughout and beyond the project lifetime, and engagement of key stakeholders, in order to promote and sustain knowledge implementation. PMID:28806744

Strategies for Mentoring Pedagogical Knowledge

ERIC Educational Resources Information Center

Hudson, Peter

2013-01-01

Fundamental for mentoring a preservice teacher is the mentor's articulation of pedagogical knowledge, which in this research draws upon specific practices, viz.: planning, timetabling lessons, preparation, teaching strategies, content knowledge, problem solving, questioning, classroom management, implementation, assessment and viewpoints for…

Nurse managers' strategies for feeling less drained by their work: an action research and reflection project for developing emotional intelligence.

PubMed

Taylor, Bev; Roberts, Sue; Smyth, Therese; Tulloch, Moira

2015-10-01

To raise nurse managers' critical awareness of practice problems; uncover practice constraints and improve work effectiveness. Nurse management requires skills and knowledge, underscored by emotional intelligence. The research improved participants' practice and personal insights. Purposive sampling targeted nurse managers interested in improving their practice. Three experienced female nurse managers met fortnightly in a group, for 1 hour, for 10 meetings. The methods included: writing and sharing de-identified journal reflections; critically analysing practice stories; identifying a thematic concern; generating action strategies; and instituting and revising the action plan. Phase One resulted in the identification of the issue of 'being drained by the intensity of nurse managers' work'. The participants adopted five strategies: debriefing problematic situations; deflecting multiple requests; diffusing issues; naming dysfunctional behaviours; and regrouping. In Phase Two, participants implemented and revised the action plan strategies, which resulted in them feeling less drained by their work. Strategies can lessen nurse managers' sense of personal depletion. However, strategies cannot guarantee success every time because the emotional intelligence is integral to nurse management. Action research and reflection assist nurse managers to improve their practice and develop their emotional intelligence. © 2014 John Wiley & Sons Ltd.

Perspectives, perceptions and experiences in postoperative pain management in developing countries: A focus group study conducted in Rwanda

PubMed Central

Johnson, Ana P; Mahaffey, Ryan; Egan, Rylan; Twagirumugabe, Theogene; Parlow, Joel L

2015-01-01

BACKGROUND: Access to postoperative acute pain treatment is an important component of perioperative care and is frequently managed by a multidisciplinary team of anesthesiologists, surgeons, pharmacists, technicians and nurses. In some developing countries, treatment modalities are often not performed due to scarce health care resources, knowledge deficiencies and cultural attitudes. OBJECTIVES: In advance of a comprehensive knowledge translation initiative, the present study aimed to determine the perspectives, perceptions and experiences of anesthesia residents regarding postoperative pain management strategies. METHODS: The present study was conducted using a qualitative assessment strategy in a large teaching hospital in Rwanda. During two sessions separated by seven days, a 10-participant semistructured focus group needs analysis was conducted with anesthesia residents at the Centre Hospitalier Universitaire de Kigali (Kigali, Rwanda). Field notes were analyzed using interpretative and descriptive phenomenological approaches. Participants were questioned regarding their perspectives, perceptions and experiences in pain management. RESULTS: The responses from the focus groups were related to five general areas: general patient and medical practice management; knowledge base regarding postoperative pain management; pain evaluation; institutional/system issues related to protocol implementation; and perceptions about resource allocation. Within these areas, challenges (eg, communication among stakeholders and with patients) and opportunities (eg, on-the-job training, use of protocols, routine pain assessment, participation in resource allocation decisions) were identified. CONCLUSIONS: The present study revealed the prevalent challenges residents perceive in implementing postoperative pain management strategies, and offers practical suggestions to overcoming them, primarily through training and the implementation of practice recommendations. PMID:26448971

A workshop on asthma management programs and centers in Brazil: reviewing and explaining concepts*

PubMed Central

Stelmach, Rafael; Neto, Alcindo Cerci; Fonseca, Ana Cristina de Carvalho Fernandez; Ponte, Eduardo Vieira; Alves, Gerardo; Araujo-Costa, Ildely Niedia; Lasmar, Laura Maria de Lima Belizário Facury; de Castro, Luci Keiko Kuromoto; Lenz, Maria Lucia Medeiros; Silva, Paulo; Cukier, Alberto; Alves, Alexssandra Maia; Lima-Matos, Aline Silva; Cardoso, Amanda da Rocha Oliveira; Fernandes, Ana Luisa Godoy; de São-José, Bruno Piassi; Riedi, Carlos Antônio; Schor, Deborah; Peixoto, Décio Medeiros; Brandenburg, Diego Djones; Camillo, Elineide Gomes dos Santos; Serpa, Faradiba Sarquis; Brandão, Heli Vieira; Lima, João Antonio Bonfadini; Pio, Jorge Eduardo; Fiterman, Jussara; Anderson, Maria de Fátima; Cardoso, Maria do Socorro de Lucena; Rodrigues, Marcelo Tadday; Pereira, Marilyn Nilda Esther Urrutia; Antila, Marti; Martins, Sonia Maria; Guimarães, Vanessa Gonzaga Tavares; Mello, Yara Arruda Marques; de Andrade, Wenderson Clay Correia; Salibe-Filho, William; Caldeira, Zelina Maria da Rocha; da Cruz-Filho, Álvaro Augusto Souza; Camargos, Paulo

2015-01-01

Objective: To report the results of a workshop regarding asthma management programs and centers (AMPCs) in Brazil, so that they can be used as a tool for the improvement and advancement of current and future AMPCs. Methods: The workshop consisted of five presentations and the corresponding group discussions. The working groups discussed the following themes: implementation of asthma management strategies; human resources needed for AMPCs; financial resources needed for AMPCs; and operational maintenance of AMPCs. Results: The workshop involved 39 participants, from all regions of the country, representing associations of asthma patients (n = 3), universities (n = 7), and AMPCs (n = 29). We found a direct relationship between a lack of planning and the failure of AMPCs. Based on the experiences reported during the workshop, the common assumptions about AMPCs in Brazil were the importance of raising awareness of managers; greater community participation; interdependence between primary care and specialized care; awareness of regionalization; and use of medications available in the public health system. Conclusions: Brazil already has a core of experience in the area of asthma management programs. The implementation of strategies for the management of chronic respiratory disease and their incorporation into health care system protocols would seem to be a natural progression. However, there is minimal experience in this area. Joint efforts by individuals with expertise in AMPCs could promote the implementation of asthma management strategies, thus speeding the creation of treatment networks, which might have a multiplier effect, precluding the need for isolated centers to start from zero. PMID:25750669

BLM Unmanned Aircraft Systems (UAS) Resource Management Operations

NASA Astrophysics Data System (ADS)

Hatfield, M. C.; Breen, A. L.; Thurau, R.

2016-12-01

The Department of the Interior Bureau of Land Management is funding research at the University of Alaska Fairbanks to study Unmanned Aircraft Systems (UAS) Resource Management Operations. In August 2015, the team conducted flight research at UAF's Toolik Field Station (TFS). The purpose was to determine the most efficient use of small UAS to collect low-altitude airborne digital stereo images, process the stereo imagery into close-range photogrammetry products, and integrate derived imagery products into the BLM's National Assessment, Inventory and Monitoring (AIM) Strategy. The AIM Strategy assists managers in answering questions of land resources at all organizational levels and develop management policy at regional and national levels. In Alaska, the BLM began to implement its AIM strategy in the National Petroleum Reserve-Alaska (NPR-A) in 2012. The primary goals of AIM-monitoring at the NPR-A are to implement an ecological baseline to monitor ecological trends, and to develop a monitoring network to understand the efficacy of management decisions. The long-term AIM strategy also complements other ongoing NPR-A monitoring processes, collects multi-use and multi-temporal data, and supports understanding of ecosystem management strategies in order to implement defensible natural resource management policy. The campaign measured vegetation types found in the NPR-A, using UAF's TFS location as a convenient proxy. The vehicle selected was the ACUASI Ptarmigan, a small hexacopter (based on DJI S800 airframe and 3DR autopilot) capable of carrying a 1.5 kg payload for 15 min for close-range environmental monitoring missions. The payload was a stereo camera system consisting of Sony NEX7's with various lens configurations (16/20/24/35 mm). A total of 77 flights were conducted over a 4 ½ day period, with 1.5 TB of data collected. Mission variables included camera height, UAS speed, transect overlaps, and camera lenses/settings. Invaluable knowledge was gained as to limitations and opportunities for field deployment of UAS relative to local conditions and vegetation type. Future efforts will focus of refining data analysis techniques and further optimizing UAS/sensor combinations and flight profiles.

Is Europe putting theory into practice? A qualitative study of the level of self-management support in chronic care management approaches

PubMed Central

2013-01-01

Background Self-management support is a key component of effective chronic care management, yet in practice appears to be the least implemented and most challenging. This study explores whether and how self-management support is integrated into chronic care approaches in 13 European countries. In addition, it investigates the level of and barriers to implementation of support strategies in health care practice. Methods We conducted a review among the 13 participating countries, based on a common data template informed by the Chronic Care Model. Key informants presented a sample of representative chronic care approaches and related self-management support strategies. The cross-country review was complemented by a Dutch case study of health professionals’ views on the implementation of self-management support in practice. Results Self-management support for chronically ill patients remains relatively underdeveloped in Europe. Similarities between countries exist mostly in involved providers (nurses) and settings (primary care). Differences prevail in mode and format of support, and materials used. Support activities focus primarily on patients’ medical and behavioral management, and less on emotional management. According to Dutch providers, self-management support is not (yet) an integral part of daily practice; implementation is hampered by barriers related to, among others, funding, IT and medical culture. Conclusions Although collaborative care for chronic conditions is becoming more important in European health systems, adequate self-management support for patients with chronic disease is far from accomplished in most countries. There is a need for better understanding of how we can encourage both patients and health care providers to engage in productive interactions in daily chronic care practice, which can improve health and social outcomes. PMID:23530744

Are health interventions implemented where they are most needed? District uptake of the integrated management of childhood illness strategy in Brazil, Peru and the United Republic of Tanzania.

PubMed Central

Victora, C. G.; Huicho, L.; Amaral, J. J.; Armstrong-Schellenberg, J.; Manzi, F.; Mason, E.; Scherpbier, R.

2006-01-01

OBJECTIVE: To describe geographical patterns of implementation of the Integrated Management of Childhood Illness (IMCI) strategy in three countries and to assess whether the strategy was implemented in areas with the most pressing child health needs. METHODS: We conducted interviews with key informants at the national and district levels in Brazil, Peru and the United Republic of Tanzania, and an ecological study of factors associated with health worker training in IMCI. Explanatory factors included district population, distance from the capital, human development index, other socioeconomic indicators and baseline mortality rates in children younger than five years. FINDINGS: In line with recommendations by WHO, early implementation districts were characterized by proximity to the capital and suitable training sites, presence of motivated health managers and a functioning health system. In the expansion phase, IMCI tended to be adopted by other districts with similar characteristics. In Brazil, uptake by poor and small municipalities and those further away from the state capital was significantly lower. In Peru, there was no association with distance from Lima, and a non-significant trend for IMCI adoption by small and poor departments. In the United Republic of Tanzania, the only statistically significant finding was a lower uptake by remote districts. Implementation was not associated with baseline mortality levels in any country studied. CONCLUSION: Whereas clear and reasonable guidelines are provided for selection of early use districts, no criteria for promoting IMCI expansion had been issued, and areas of greatest need were not prioritized. Equity analyses based on the geographical deployment of new programmes and strategies can contribute to assessing whether they are reaching those who need them most. PMID:17128359

Case management for the subacute patient in a skilled nursing facility.

PubMed

Carr, D D

2000-01-01

The goal of case management has always been to manage care, cost, and outcomes. The Balanced Budget Act of 1997 and the subsequent implementation of managed care and the prospective payment system have introduced many challenges to the postacute care delivery system. The implementation of sound clinical, fiscal, and operational strategies is critical to the continued delivery of quality services and the maximization of revenue. The implementation of case management principles provides an opportunity to balance care with cost. This article focuses on the development and implementation of a case management program at a skilled nursing facility that specifically addresses the needs of a subacute population. The program's purpose is to promote efficiency, efficacy, and effectiveness of services for short-term subacute patients who will eventually return to the community. The long-term goal of the program is to classify all patients into case management categories and assign them to RN case managers or social workers, based on acuity and need.

A knowledge base architecture for distributed knowledge agents

NASA Technical Reports Server (NTRS)

Riedesel, Joel; Walls, Bryan

1990-01-01

A tuple space based object oriented model for knowledge base representation and interpretation is presented. An architecture for managing distributed knowledge agents is then implemented within the model. The general model is based upon a database implementation of a tuple space. Objects are then defined as an additional layer upon the database. The tuple space may or may not be distributed depending upon the database implementation. A language for representing knowledge and inference strategy is defined whose implementation takes advantage of the tuple space. The general model may then be instantiated in many different forms, each of which may be a distinct knowledge agent. Knowledge agents may communicate using tuple space mechanisms as in the LINDA model as well as using more well known message passing mechanisms. An implementation of the model is presented describing strategies used to keep inference tractable without giving up expressivity. An example applied to a power management and distribution network for Space Station Freedom is given.

Implementing complex innovations: factors influencing middle manager support.

PubMed

Chuang, Emmeline; Jason, Kendra; Morgan, Jennifer Craft

2011-01-01

Middle manager resistance is often described as a major challenge for upper-level administrators seeking to implement complex innovations such as evidence-based protocols or new skills training. However, factors influencing middle manager support for innovation implementation are currently understudied in the U.S. health care literature. This article examined the factors that influence middle managers' support for and participation in the implementation of work-based learning, a complex innovation adopted by health care organizations to improve the jobs, educational pathways, skills, and/or credentials of their frontline workers. We conducted semistructured interviews and focus groups with 92 middle managers in 17 health care organizations. Questions focused on understanding middle managers' support for work-based learning as a complex innovation, facilitators and barriers to the implementation process, and the systems changes needed to support the implementation of this innovation. Factors that emerged as influential to middle manager support were similar to those found in broader models of innovation implementation within the health care literature. However, our findings extend previous research by developing an understanding about how middle managers perceived these constructs and by identifying specific strategies for how to influence middle manager support for the innovation implementation process. These findings were generally consistent across different types of health care organizations. Study findings suggest that middle manager support was highest when managers felt the innovation fit their workplace needs and priorities and when they had more discretion and control over how it was implemented. Leaders seeking to implement innovations should consider the interplay between middle managers' control and discretion, their narrow focus on the performance of their own departments or units, and the dedication of staff and other resources for empowering their managers to implement these complex innovations.

Evaluation of the implementation of an integrated primary care network for prevention and management of cardiometabolic risk in Montréal.

PubMed

Provost, Sylvie; Pineault, Raynald; Tousignant, Pierre; Hamel, Marjolaine; Da Silva, Roxane Borgès

2011-11-10

The goal of this project is to evaluate the implementation of an integrated and interdisciplinary program for prevention and management of cardiometabolic risk (PCMR). The intervention is based on the Chronic Care Model. The study will evaluate the implementation of the PCMR in 6 of the 12 health and social services centres (CSSS) in Montréal, and the effects of the PCMR on patients and the practice of their primary care physicians up to 40 months following implementation, as well as the sustainability of the program. Objectives are: 1-to evaluate the effects of the PCMR and their persistence on patients registered in the program and the practice of their primary care physicians, by implementation site and degree of exposure to the program; 2-to assess the degree of implementation of PCMR in each CSSS territory and identify related contextual factors; 3-to establish the relationships between the effects observed, the degree of PCMR implementation and the related contextual factors; 4-to assess the impact of the PCMR on strengthening local services networks. The evaluation will use a mixed design that includes two complementary research strategies. The first strategy is similar to a quasi-experimental "before-after" design, based on a quantitative approach; it will look at the program's effects and their variations among the six territories. The effects analysis will use data from a clinical database and from questionnaires completed by participating patients and physicians. Over 3000 patients will be recruited. The second strategy corresponds to a multiple case study approach, where each of the six CSSS constitutes a case. With this strategy, qualitative methods will set out the context of implementation using data from semi-structured interviews with program managers. The quantitative data will be analyzed using linear or multilevel models complemented with an interpretive approach to qualitative data analysis. Our study will identify contextual factors associated with the effectiveness, successful implementation and sustainability of such a program. The contextual information will enable us to extrapolate our results to other contexts with similar conditions. ClinicalTrials.gov: NCT01326130.

Improving therapeutic use of homework: suggestions from mental health clinicians.

PubMed

Kelly, Peter J; Deane, Frank P

2011-10-01

The majority of mental health clinicians report the use of homework to support their case management, but practitioner surveys indicate that homework is not routinely used. To examine barriers that mental health case managers experience in implementing homework and to identify strategies to promote successful homework administration. One hundred thirty-four surveys were completed by mental health case managers. The survey examined their use of homework for individuals diagnosed with a severe mental health problem. It also asked them to identify barriers to regularly implement homework and describe strategies to promote more regular use of homework. On average, homework was used at 50% of clinical contacts. The primary reasons for not using homework included allocating insufficient time at appointments, perceived client resistance for using homework and concerns that the client was too unwell. Strategies used to overcome these difficulties included prioritising the use of homework and ensuring that homework assignments were achievable. Clinicians are able to identify a range of practical strategies to promote the use of homework. Discussion focuses on the application of the suggested strategies to promote regular use of homework. This includes discussion of possible training approaches to enhance systematic homework administration.

77 FR 11109 - Environmental Impacts Statements; Notice of Availability

Federal Register 2010, 2011, 2012, 2013, 2014

2012-02-24

...-Native Plant Control Project, Proposes a Forest-Wide Integrated Management Strategy to Control the Spread..., Final EIS, USFS, SD, Steamboat Project, Proposes to Implement Multiple Resource Management Actions... EIS, USFS, WA, South George Vegetation and Fuels Management Project, To Improve Forest Health and...

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

PubMed Central

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

2013-01-01

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

Building Research Relationships With Managed Care Organizations: Issues and Strategies.

PubMed

Lein, Catherine; Collins, Clare; Lyles, Judith S; Hillman, Donald; Smith, Robert C

2003-06-01

Managed care is now the dominant form of healthcare in the United States. The need for clinical research about the organization, delivery, and outcomes of primary care services in managed care models is high, yet access to managed care organizations as sites for clinical research may be problematic. The purpose of this article is to describe issues involved in obtaining access to managed care settings for clinical research and practical strategies for successful collaboration using literature review and case description. Three steps for developing collaborative relationships with managed care organizations (MCOs) are presented: 1) assessment of organizational structure, history, and culture; 2) finding common ground; and 3) project implementation. These steps are discussed within the context of MCO systems issues and a relationship-centered approach to communication between researchers and individuals from the MCO. Successful relationships with MCOs for clinical research are possible when careful attention is paid to inclusion of MCOs as collaborators in the development of the research questions and design, and as partners in the research implementation process.

Identifying potential environmental impacts of waste handling strategies in textile industry.

PubMed

Yacout, Dalia M M; Hassouna, M S

2016-08-01

Waste management is a successful instrument to minimize generated waste and improve environmental conditions. In spite of the large share of developing countries in the textile industry, limited information is available concerning the waste management strategies implemented for textiles on those countries and their environmental impacts. In the current study, two waste management approaches for hazardous solid waste treatment of acrylic fibers (landfill and incineration) were investigated. The main research questions were: What are the different impacts of each waste management strategy? Which waste management strategy is more ecofriendly? Life cycle assessment was employed in order to model the environmental impacts of each waste streaming approach separately then compare them together. Results revealed that incineration was the more ecofriendly approach. Highest impacts of both approaches were on ecotoxicity and carcinogenic potentials due to release of metals from pigment wastes. Landfill had an impact of 46.8 % on human health as compared to 28 % by incineration. Incineration impact on ecosystem quality was higher than landfill impact (68.4 and 51.3 %, respectively). As for resources category, incineration had a higher impact than landfill (3.5 and 2.0 %, respectively). Those impacts could be mitigated if state-of-the-art landfill or incinerator were used and could be reduced by applying waste to energy approaches for both management systems In conclusion, shifting waste treatment from landfill to incineration would decrease the overall environmental impacts and allow energy recovery. The potential of waste to energy approach by incineration with heat recovery could be considered in further studies. Future research is needed in order to assess the implementation of waste management systems and the preferable waste management strategies in the textile industry on developing countries.

Implementation of Enterprise Imaging Strategy at a Chinese Tertiary Hospital.

PubMed

Li, Shanshan; Liu, Yao; Yuan, Yifang; Li, Jia; Wei, Lan; Wang, Yuelong; Fei, Xiaolu

2018-01-04

Medical images have become increasingly important in clinical practice and medical research, and the need to manage images at the hospital level has become urgent in China. To unify patient identification in examinations from different medical specialties, increase convenient access to medical images under authentication, and make medical images suitable for further artificial intelligence investigations, we implemented an enterprise imaging strategy by adopting an image integration platform as the main tool at Xuanwu Hospital. Workflow re-engineering and business system transformation was also performed to ensure the quality and content of the imaging data. More than 54 million medical images and approximately 1 million medical reports were integrated, and uniform patient identification, images, and report integration were made available to the medical staff and were accessible via a mobile application, which were achieved by implementing the enterprise imaging strategy. However, to integrate all medical images of different specialties at a hospital and ensure that the images and reports are qualified for data mining, some further policy and management measures are still needed.

Developing a holistic strategy for integrated waste management within municipal planning: challenges, policies, solutions and perspectives for Hellenic municipalities in the zero-waste, low-cost direction.

PubMed

Zotos, G; Karagiannidis, A; Zampetoglou, S; Malamakis, A; Antonopoulos, I-S; Kontogianni, S; Tchobanoglous, G

2009-05-01

The present position paper addresses contemporary waste management options, weaknesses and opportunities faced by Hellenic local authorities. It focuses on state-of-the-art, tested as well as innovative, environmental management tools on a municipal scale and identifies a range of different collaboration schemes between local authorities and related service providers. Currently, a policy implementation gap is still experienced among Hellenic local authorities; it appears that administration at the local level is inadequate to manage and implement many of the general policies proposed; identify, collect, monitor and assess relevant data; and safeguard efficient and effective implementation of MSWM practices in the framework of integrated environmental management as well. This shortfall is partly due to the decentralisation of waste management issues to local authorities without a parallel substantial budgetary and capacity support, thus resulting in local activity remaining often disoriented and isolated from national strategies, therefore yielding significant planning and implementation problems and delays against pressing issues at hand as well as loss or poor use of available funds. This paper develops a systemic approach for MSWM at both the household and the non-household level, summarizes state-of-the-art available tools and compiles a set of guidelines for developing waste management master plans at the municipal level. It aims to provide a framework in the MSWM field for municipalities in Greece as well as other countries facing similar problems under often comparable socioeconomic settings.

Differentiated strategy, business performance, and intellectual capital: Evidence small medium enterprise from Indonesia

NASA Astrophysics Data System (ADS)

Hariyati; Venusita, L.; Dyani, Z. F.

2018-01-01

Small and Medium Enterprises (SMEs) have a very important position in Indonesian economics. Implementation of the differentiated strategy has been impacted on improving the business performance of SMEs where the role of intellectual capital strongly supports the success of the implementation of the differentiated strategy. This study applied quantitative research which used survey method. This research examines the relationship between differentiated strategy to the performance of SMEs with mediated by intellectual capital. The results of this study show that intellectual capital mediates the relationship between differentiation strategies and business performance of SMEs. This study theoretically proves the importance of contextual variables in contingency theory. The practical results of this study contribute to raising awareness of business unit managers or other equivalent positions, especially managers in East Java to understand the importance of the role of intellectual capital, this is because intellectual capital meets the criteria as a unique source of the company that is able to create competitive advantage and increase the firm’s value.

Implementation and Evaluation of Weather Responsive Traffic Estimation and Prediction System

DOT National Transportation Integrated Search

2012-06-01

The objective of the project is to develop a framework and procedures for implementing and evaluating weather-responsive traffic management (WRTM) strategies using Traffic Estimation and Prediction System (TrEPS) methodologies. In a previous FHWA-fun...

The German clinical risk management survey for hospitals: Implementation levels and areas for improvement in 2015.

PubMed

Manser, Tanja; Frings, Janina; Heuser, Gregory; Mc Dermott, Fiona

2016-01-01

Despite the growing recognition of the need to implement systematic approaches for managing the risks associated with healthcare, few studies have investigated the level of implementation for clinical risk management (CRM) at a national level. Therefore, this study aimed to assess the current level of CRM implementation in German hospitals and to explore differences across hospital types. From March to June 2015, persons responsible for CRM in 2,617 hospitals and rehabilitation clinics in Germany were invited to participate in a voluntary online survey assessing the level of implementation for various aspects of CRM: CRM strategy, structures and processes; risk assessment (risk identification, risk analysis, risk evaluation) with a focus on incident reporting systems; risk mitigation measures; and risk monitoring and reporting. 572 hospitals participated in the survey (response rate 22 %). Most of these hospitals had a formalised, binding CRM strategy (72 %). 66 % had a centralised and 34 % a decentralised CRM structure. We also found that, despite a broad range of risk assessment methods being applied, there was a lack of integration of risk information from different data sources. Hospitals also reported a high level of implementation of critical incident reporting systems with a strong preference for local (74 %) over transorganisational systems. This study provides relevant data to inform targeted interventions concerning CRM implementation at a national level and to consider the specific context of different types of hospitals more carefully in this process. The approach to CRM assessment illustrated in this article could be the basis of a system for monitoring CRM over time and, thus, for evaluating the impact of strategy decisions at the policy level on CRM development. Copyright © 2016. Published by Elsevier GmbH.

Implementation of A Better Choice Healthy Food and Drink Supply Strategy for staff and visitors in government-owned health facilities in Queensland, Australia.

PubMed

Miller, Jane; Lee, Amanda; Obersky, Natalie; Edwards, Rachael

2015-06-01

The present paper reports on a quality improvement activity examining implementation of A Better Choice Healthy Food and Drink Supply Strategy for Queensland Health Facilities (A Better Choice). A Better Choice is a policy to increase supply and promotion of healthy foods and drinks and decrease supply and promotion of energy-dense, nutrient-poor choices in all food supply areas including food outlets, staff dining rooms, vending machines, tea trolleys, coffee carts, leased premises, catering, fundraising, promotion and advertising. An online survey targeted 278 facility managers to collect self-reported quantitative and qualitative data. Telephone interviews were sought concurrently with the twenty-five A Better Choice district contact officers to gather qualitative information. Public sector-owned and -operated health facilities in Queensland, Australia. One hundred and thirty-four facility managers and twenty-four district contact officers participated with response rates of 48.2% and 96.0%, respectively. Of facility managers, 78.4% reported implementation of more than half of the A Better Choice requirements including 24.6% who reported full strategy implementation. Reported implementation was highest in food outlets, staff dining rooms, tea trolleys, coffee carts, internal catering and drink vending machines. Reported implementation was more problematic in snack vending machines, external catering, leased premises and fundraising. Despite methodological challenges, the study suggests that policy approaches to improve the food and drink supply can be implemented successfully in public-sector health facilities, although results can be limited in some areas. A Better Choice may provide a model for improving food supply in other health and workplace settings.

The importance of organizational climate and implementation strategy at the introduction of a new working tool in primary health care.

PubMed

Carlfjord, S; Andersson, A; Nilsen, P; Bendtsen, P; Lindberg, M

2010-12-01

The transmission of research findings into routine care is a slow and unpredictable process. Important factors predicting receptivity for innovations within organizations have been identified, but there is a need for further research in this area. The aim of this study was to describe contextual factors and evaluate if organizational climate and implementation strategy influenced outcome, when a computer-based concept for lifestyle intervention was introduced in primary health care (PHC). The study was conducted using a prospective intervention design. The computer-based concept was implemented at six PHC units. Contextual factors in terms of size, leadership, organizational climate and political environment at the units included in the study were assessed before implementation. Organizational climate was measured using the Creative Climate Questionnaire (CCQ). Two different implementation strategies were used: one explicit strategy, based on Rogers' theories about the innovation-decision process, and one implicit strategy. After 6 months, implementation outcome in terms of the proportion of patients who had been referred to the test, was measured. The CCQ questionnaire response rates among staff ranged from 67% to 91% at the six units. Organizational climate differed substantially between the units. Managers scored higher on CCQ than staff at the same unit. A combination of high CCQ scores and explicit implementation strategy was associated with a positive implementation outcome. Organizational climate varies substantially between different PHC units. High CCQ scores in combination with an explicit implementation strategy predict a positive implementation outcome when a new working tool is introduced in PHC. © 2010 Blackwell Publishing Ltd.

Using Getting To Outcomes to facilitate the use of an evidence-based practice in VA homeless programs: a cluster-randomized trial of an implementation support strategy.

PubMed

Chinman, Matthew; McCarthy, Sharon; Hannah, Gordon; Byrne, Thomas Hugh; Smelson, David A

2017-03-09

Incorporating evidence-based integrated treatment for dual disorders into typical care settings has been challenging, especially among those serving Veterans who are homeless. This paper presents an evaluation of an effort to incorporate an evidence-based, dual disorder treatment called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Veterans Edition (MISSION-Vet) into case management teams serving Veterans who are homeless, using an implementation strategy called Getting To Outcomes (GTO). This Hybrid Type III, cluster-randomized controlled trial assessed the impact of GTO over and above MISSION-Vet Implementation as Usual (IU). Both conditions received standard MISSION-Vet training and manuals. The GTO group received an implementation manual, training, technical assistance, and data feedback. The study occurred in teams at three large VA Medical Centers over 2 years. Within each team, existing sub-teams (case managers and Veterans they serve) were the clusters randomly assigned. The trial assessed MISSION-Vet services delivered and collected via administrative data and implementation barriers and facilitators, via semi-structured interview. No case managers in the IU group initiated MISSION-Vet while 68% in the GTO group did. Seven percent of Veterans with case managers in the GTO group received at least one MISSION-Vet session. Most case managers appreciated the MISSION-Vet materials and felt the GTO planning meetings supported using MISSION-Vet. Case manager interviews also showed that MISSION-Vet could be confusing; there was little involvement from leadership after their initial agreement to participate; the data feedback system had a number of difficulties; and case managers did not have the resources to implement all aspects of MISSION-Vet. This project shows that GTO-like support can help launch new practices but that multiple implementation facilitators are needed for successful execution of a complex evidence-based program like MISSION-Vet. ClinicalTrials.gov NCT01430741.

Evaluation of pre-emption and transition strategies for Northern Virginia Smart Traffic Signal Systems (NVSTSS).

DOT National Transportation Integrated Search

2008-01-01

Modern traffic signal control systems provide emergency vehicle preemption (EVP) capabilities by utilizing advanced sensors and communication technologies. EVP strategies are widely implemented by urban transportation management agencies. One of the ...

Expert Recommended Strategies for Classroom Management for Beginning Teachers Placed in Hard-to-Staff Schools in Urban School Districts

ERIC Educational Resources Information Center

Alexis, Chelly C.

2014-01-01

Purpose: The purpose of this study was to get the opinion of a panel of experts as to which classroom management strategies should be implemented in urban school district mentoring programs to help beginning teachers who are placed in hard-to-staff schools in Los Angeles County, California. Methodology: This Delphi study included 20 expert mentors…

Design-for-Six-Sigma To Develop a Bioprocess Knowledge Management Framework.

PubMed

Junker, Beth; Maheshwari, Gargi; Ranheim, Todd; Altaras, Nedim; Stankevicz, Michael; Harmon, Lori; Rios, Sandra; D'anjou, Marc

2011-01-01

Owing to the high costs associated with biopharmaceutical development, considerable pressure has developed for the biopharmaceutical industry to increase productivity by becoming more lean and flexible. The ability to reuse knowledge was identified as one key advantage to streamline productivity, efficiently use resources, and ultimately perform better than the competition. A knowledge management (KM) strategy was assembled for bioprocess-related information using the technique of Design-for-Six-Sigma (DFSS). This strategy supported quality-by-design and process validation efforts for pipeline as well as licensed products. The DFSS technique was selected because it was both streamlined and efficient. These characteristics permitted development of a KM strategy with minimized team leader and team member resources. DFSS also placed a high emphasis on the voice of the customer, information considered crucial to the selection of solutions most appropriate for the current knowledge-based challenges of the organization. The KM strategy developed was comprised of nine workstreams, constructed from related solution buckets which in turn were assembled from the individual solution tasks that were identified. Each workstream's detailed design was evaluated against published and established best practices, as well as the KM strategy project charter and design inputs. Gaps and risks were identified and mitigated as necessary to improve the robustness of the proposed strategy. Aggregated resources (specifically expense/capital funds and staff) and timing were estimated to obtain vital management sponsorship for implementation. Where possible, existing governance and divisional/corporate information technology efforts were leveraged to minimize the additional bioprocess resources required for implementation. Finally, leading and lagging indicator metrics were selected to track the success of pilots and eventual implementation. A knowledge management framework was assembled for bioprocess-related information using a streamlined and efficient technique that minimized team leader and member resources. The technique also highly emphasized input from the staff, who generated and used the knowledge, information considered crucial to selection of solutions most appropriate for the current knowledge-based challenges in the organization. The framework developed was comprised of nine workstreams, constructed from related solution buckets which were assembled from individual solution tasks that were identified. Each workstream's detailed design was evaluated against published and established best practices, as well as the project charter and design inputs. Gaps and risks were identified and mitigated to improve robustness of the proposed framework. Aggregated resources (specifically expense/capital funds and staff) and timing were estimated to obtain vital management sponsorship for implementation. Where possible, existing governance and information technology efforts were leveraged to minimize additional bioprocess resources required for implementation. Finally, metrics were selected to track the success of pilots and eventual implementation.

Implementation of effective alcohol control strategies is needed at large sports and entertainment events.

PubMed

Lyne, Mark; Galloway, Andrew

2012-02-01

To assess the implementation and effectiveness of strategies and actions to eliminate and/or reduce alcohol-related problems at large sports and entertainment events in New Zealand. We conducted site visits and monitoring observations at venues before, during and after a variety of large events between March 2009 and November 2010. Thirteen events were attended at nine different venues. Events included rugby, rugby league and cricket matches, motor racing, rowing, horse racing, an outdoor music festival, and food and wine festivals. Most large events appeared to pass with few or no alcohol-related problems. The exceptions were one of the horse-race meetings, a rugby league match and one food and wine festival. Common contexts at events where alcohol-related problems were seen included: inadequate alcohol control and management by security staff; the ability to purchase four alcoholic drinks (rather than two) at a time; inexperienced bar staff untrained in responsible alcohol service; no or little promotion of low and non-alcoholic drinks; and a lack of monitoring and enforcement of the law on intoxication. An important approach to prevent and reduce alcohol-related problems at large spots and entertainment events is the use of specific alcohol-control strategies. The management of alcohol consumption is a major part of event management that must be planned with harm-minimisation strategies well in advance of the event itself. If strategies and actions are not properly implemented to manage the sale and supply of alcohol at large events, there is significant risk of alcohol-related problems and harm resulting from them. © 2012 The Authors. ANZJPH © 2012 Public Health Association of Australia.

Management practices associated with pain in cattle on western Canadian cow-calf operations: A mixed methods study.

PubMed

Moggy, M A; Pajor, E A; Thurston, W E; Parker, S; Greter, A M; Schwartzkopf-Genswein, K S; Campbell, J R; Windeyer, M C

2017-02-01

The implementation of on-farm pain mitigation strategies is dependent on feasibility and importance to producers. Currently, there is a lack of information regarding adoption of management practices associated with pain in cattle within the Canadian beef industry. The objective of this mixed methods study was to describe pain-associated practices implemented on farm and producer perceptions toward pain mitigation strategies. A questionnaire about calving management and calf processing was delivered to 109 cow-calf producers in western Canada. In addition, 15 respondents were purposively selected based on questionnaire responses to participate in individual semistructured, on-farm interviews. The prevalence of pain mitigation strategies used for dystocia and cesarean section by respondents were 46 and 100%, respectively. The majority of operations reported castrating and dehorning calves before 3 mo of age (95 and 89%, respectively). The majority of operations did not use pain mitigation strategies for castration and dehorning (90 and 85%, respectively). Branding was practiced by 57% of respondents, 4% of which used pain mitigation. Thematic content analysis revealed that producers' perception of pain were influenced by what they referred to as "common sense," relatability to cattle, visual evidence of pain, and age of the animal. Factors that influenced participant rationale for the implementation of pain mitigation practices included access to information and resources, age of the animal, benefit to the operation, cost and logistics, market demands, and personal conscience. Overall, management practices were generally in compliance with published Canadian guidelines. Results of this study may provide direction for future policy making, research, and extension efforts to encourage the adoption of pain mitigation strategies.

Establishing an Integrated Catchment Management (ICM) program in East Java, Indonesia.

PubMed

Booth, C A; Warianti, A; Wrigley, T

2001-01-01

The Brantas is one of Indonesia's most important catchments. It is the "rice bowl" of Java and nationally important for its industrial activity. Surabaya, Indonesia's second largest city, is located at the mouth of the Brantas River which is pivotal to the city's water supply. The challenges associated with the institutional framework for natural resource management in East Java parallels that of many states and provinces around the globe. It is multi-layered and complex. Integrated Catchment Management (ICM) may be defined as "the co-ordinated and sustainable management of land, water, soil vegetation, fauna and other natural resources on a water catchment basis". Over a period of six months, an ICM Strategy was researched and facilitated for the Brantas River Catchment in East Java via a short term advisor attachment. The aim of the Strategy is to improve coordination, co-operation, communication and consistency of government and community efforts towards sustaining the catchment's environmental, economic and social values. The attachment was part of the Pollution Control Implementation (PCI) Project funded by AusAid and the Indonesian Government. The ICM Strategy developed was broad based and addressed the priority natural resource management issues facing the Brantas Catchment. It was co-ordinated by BAPEDALDA, the Provincial Environmental Protection Agency, and developed by all agencies involved in natural resource management in the catchment. Various Universities and Non Government Organisations (NGOs) were also involved in the ICM process which developed the Strategy. At the conclusion of the attachment, a draft ICM Strategy and a proposed institutional framework had been developed. A working group of key agencies was also established to further enhance local "ownership", finalise timescales and implementation responsibilities within the Strategy and bring the institutional arrangements into being through a Governor's Decree.

Management strategies for the conservation of forest birds

Treesearch

Kathleen E. Franzreb; Deborah M. Finch; Petra Bohall Wood; David E. Capen

1999-01-01

We recommend that managers of forest-associated bird species follow a five-step hierarchy in establishing and implementing management programs. In essence, a manager must evaluate the composition and physiognomy of the landscape mosaic in the context of the regional and subregional goals and objectives. Then he/she can explore alternatives that allow manipulation of...

Site-Based Management in a Collective Bargaining Environment: Can We Mix Oil and Water?

ERIC Educational Resources Information Center

Fossey, Richard

Site-based management has become a popular school reform strategy. However, conflicts can arise when school districts with collective bargaining try to implement site-based management. Site-based management depends on collaboration and cooperation among educators, both of which conflict with collective bargaining's adversarial nature. There is…

77 FR 29429 - Self-Regulatory Organizations; NYSE Arca, Inc.; Notice of Filing of Proposed Rule Change Relating...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-17

... investment objective by implementing a ``top-down'' portfolio management style. This management style begins...'' portfolio management style utilizes a tactical and globally diversified allocation strategy in an attempt to... open-end management investment company.\\5\\ The investment adviser to the Fund is AdvisorShares...

The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada.

PubMed

Jaglal, S B; Hawker, G; Cameron, C; Canavan, J; Beaton, D; Bogoch, E; Jain, R; Papaioannou, A

2010-06-01

In the last decade, there have been a number of action plans published to highlight the importance of preventing osteoporosis and related fractures. In the province of Ontario Canada, the Ministry of Health provided funding for the Ontario Osteoporosis Strategy. The goal is to reduce morbidity, mortality, and costs from osteoporosis and related fractures through an integrated and comprehensive approach aimed at health promotion and disease management. This paper describes the components of the Ontario Osteoporosis Strategy and progress on implementation efforts as of March 2009. There are five main components: health promotion; bone mineral density testing, access, and quality; postfracture care; professional education; and research and evaluation. Responsibility for implementation of the initiatives within the components is shared across a number of professional and patient organizations and academic teaching hospitals with osteoporosis researchers. The lessons learned from each phase of the development, implementation, and evaluation of the Ontario Osteoporosis Strategy provides a tremendous opportunity to inform other jurisdictions embarking on implementing similar large-scale bone health initiatives.

Elaborating on theory with middle managers' experience implementing healthcare innovations in practice.

PubMed

Birken, Sarah A; DiMartino, Lisa D; Kirk, Meredith A; Lee, Shoou-Yih D; McClelland, Mark; Albert, Nancy M

2016-01-04

The theory of middle managers' role in implementing healthcare innovations hypothesized that middle managers influence implementation effectiveness by fulfilling the following four roles: diffusing information, synthesizing information, mediating between strategy and day-to-day activities, and selling innovation implementation. The theory also suggested several activities in which middle managers might engage to fulfill the four roles. The extent to which the theory aligns with middle managers' experience in practice is unclear. We surveyed middle managers (n = 63) who attended a nursing innovation summit to (1) assess alignment between the theory and middle managers' experience in practice and (2) elaborate on the theory with examples from middle managers' experience overseeing innovation implementation in practice. Middle managers rated all of the theory's hypothesized four roles as "extremely important" but ranked diffusing and synthesizing information as the most important and selling innovation implementation as the least important. They reported engaging in several activities that were consistent with the theory's hypothesized roles and activities such as diffusing information via meetings and training. They also reported engaging in activities not described in the theory such as appraising employee performance. Middle managers' experience aligned well with the theory and expanded definitions of the roles and activities that it hypothesized. Future studies should assess the relationship between hypothesized roles and the effectiveness with which innovations are implemented in practice. If evidence supports the theory, the theory should be leveraged to promote the fulfillment of hypothesized roles among middle managers, doing so may promote innovation implementation.

Carbon Management In the Post-Cap-and-Trade Carbon Economy

NASA Astrophysics Data System (ADS)

DeGroff, F. A.

2012-12-01

Global carbon management is a pressing issue and will remain so for the balance of the 21st century. Without a worldwide comprehensive carbon management strategy in place,the economic, social, military, and humanitarian impact of excess carbon in our biosphere will preoccupy humanity until an efficient and effective strategy for carbon pricing can be implemented. In this paper, we discuss a possible strategy and construct model for comprehensive carbon management for the balance of this century. The focus of our strategy is an economic model with a carbon construct and metric that assigns a value to all states and forms of carbon involved with any anthropogenic activity. Any changes in the state or form of carbon due to anthropogenic activity will thereby generate discrete, finite, and measurable economic costs, or tolls, for the associated activity. All activities within a jurisdiction (or between jurisdictions with equivalent carbon toll treatment) that lack any change in the state or form of carbon will be free of any carbon toll. All goods and services crossing jurisdictions with dissimilar toll treatment will be assessed (or credited) to reflect the carbon toll differential. This model has three clear advantages. First, the carbon pricing and cost scheme uses existing and generally accepted accounting and economic methodologies to ensure the veracity and verifiability of carbon management efforts with minimal effort and expense using standard, existing auditing protocols. Implementing this model will not require any new, special, unique, or additional training, tools, or systems for any entity to achieve their minimum carbon target goals within their jurisdictional framework. Second, given the wide spectrum of carbon affinities across jurisdictions worldwide, our strategy recognizes and provides for flexible carbon pricing regimes, but does not undermine or penalize domestic carbon-consuming producers subject to imports from exporters in lower carbon pricing jurisdictions. Thus, this strategy avoids a key shortcoming of cap-and-trade carbon pricing, and eliminates any incentive to shift carbon consumption to jurisdictions with lower carbon tolls. Third, the model is a comprehensive, efficient, and effective strategy that allows for the implementation of a carbon pricing structure without the complete, explicit agreement of carbon consumers worldwide.

Overcoming constraints to the implementation of water demand management in southern Africa

NASA Astrophysics Data System (ADS)

Mwendera, E. J.; Hazelton, D.; Nkhuwa, D.; Robinson, P.; Tjijenda, K.; Chavula, G.

This paper presents results of a study on water demand management status and overcoming constraints to implementation of water demand management in the southern African region, as part of Phase II of water demand management (WDM) programme implemented by the IUCN (The World Conservation Union). The study was conducted in Malawi, Namibia, South Africa, Swaziland, Zambia and Zimbabwe. The study methodology consisted of a survey of literature, and interviewing and communicating with stakeholders in order to learn from stakeholders on the critical constraints to WDM implementation and strategies to overcome them. The study has shown that, despite the potential savings that would accrue from implementation of WDM, the water sector across the southern African region continues to focus on water supply augmentation. There are inadequate financial and human resources for rehabilitation, operation and maintenance of water conveyance systems resulting in system leaks, which contribute to high levels of unaccounted-for water, a situation that masks the potential benefits of WDM. In most countries, the water sector operates on ad-hoc sub-sector water user objectives, which provided guidelines only for development and management purposes. Most of the institutional frameworks have remained diffuse, resulting into poor performance in the sector, and into crisis management in the water resources development. Though the WDM policy in most countries is already accessible through guidelines for catchment management institutions and water supply institutions; there is a lack of broad commitment to implementing them. In other countries the instruments are relatively new and have not been applied widely. Similarly, the effectiveness of instruments has not been well evaluated in most countries. In countries where policy is weak there is often a lack of clarity as to who is responsible for WDM implementation, and even less clarity on who is responsible for facilitating and monitoring implementation, and taking appropriate action when a serious case of non-performance occurs. Thus, one of the main strategies to overcome constraints to implementing WDM in the region is through high-level advocacy to increase awareness among the stakeholders at different levels on the needs and benefits of WDM. There is also need for capacity building that target the private and public sector planners responsible for development of proposals, as well as at scheme managers and operators who have to implement WDM. The results of study have indicated that it is not sufficient to know how to implement WDM. One needs to know what requires implementation, when to implement it, how to select and motivate the most appropriate parties to implement it and how to audit the results.

Document management: one paving stone in the path to EHR.

PubMed

Cottrell, Carlton M

2005-05-01

Reducing the use of paper records through a document management strategy is an essential first step in implementing the electronic health record. Efficient document management can help to decrease claim denials as well as days in accounts receivable-to name only a few benefits.

2014 National Asset Management Conference and Training on Implementation Strategies.

DOT National Transportation Integrated Search

2014-07-01

This report documents the major research activities conducted as part of the Federal Highway Administration (FHWA) : Transportation Pooled Fund (TPF) Program project, TPF-5(275) 2014 National Asset Management Conference and Training on : Implementati...

2014 National Asset Management Conference and training on implementation strategies.

DOT National Transportation Integrated Search

2014-07-01

This report documents the major research activities conducted as part of the Federal Highway Administration (FHWA) : Transportation Pooled Fund (TPF) Program project, TPF-5(275) 2014 National Asset Management Conference and Training on : Implementati...

Evaluation of Risk Management Strategies for a Low-Cost, High-Risk Project

NASA Technical Reports Server (NTRS)

Shishko, Robert; Jorgensen, Edward J.

1996-01-01

This paper summarizes work in progress to define and implement a risk management process tailored to a low-cost, high-risk, NASA mission -the Microrover Flight Experiment (MFEX, commonly called the Mars microrover).

Inspect, Detect, Correct: Structural Integrated Pest Management Strategies at School.

ERIC Educational Resources Information Center

Jochim, Jerry

2003-01-01

Describes a model integrated pest management (IPM) program for schools used in Monroe County, Indiana. Addresses how to implement an IPM program, specific school problem areas, specific pest problems and solutions, and common questions. (EV)

Multidisciplinary strategies in the management of early chronic kidney disease.

PubMed

Martínez-Ramírez, Héctor R; Cortés-Sanabria, Laura; Rojas-Campos, Enrique; Hernández-Herrera, Aurora; Cueto-Manzano, Alfonso M

2013-11-01

Chronic kidney disease (CKD) is a worldwide epidemic especially in developing countries, with clear deficiencies in identification and treatment. Better care of CKD requires more than only economic resources, utilization of health research in policy-making and health systems changes that produce better outcomes. A multidisciplinary approach may facilitate and improve management of patients from early CKD in the primary health-care setting. This approach is a strategy for improving comprehensive care, initiating and maintaining healthy behaviors, promoting teamwork, eliminating barriers to achieve goals and improving the processes of care. A multidisciplinary intervention may include educational processes guided by health professional, use of self-help groups and the development of a CKD management plan. The complex and fragmented care management of patients with CKD, associated with poor outcome, enhances the importance of implementing a multidisciplinary approach in the management of this disease from the early stages. Multidisciplinary strategies should focus on the needs of patients (to increase their empowerment) and should be adapted to the resources and health systems prevailing in each country; its systematic implementation can help to improve patient care and slow the progression of CKD. Copyright © 2013 IMSS. Published by Elsevier Inc. All rights reserved.

From Strategy to Action: How Top Managers’ Support Increases Middle Managers’ Commitment to Innovation Implementation in Healthcare Organizations

PubMed Central

Lee, Shoou-Yih Daniel; Weiner, Bryan J.; Chin, Marshall H.; Chiu, Michael; Schaefer, Cynthia T.

2014-01-01

Background Evidence suggests that top managers’ support influences middle managers’ commitment to innovation implementation. What remains unclear is how top managers’ support influences middle managers’ commitment. Results may be used to improve dismal rates of innovation implementation. Methods We used a mixed-method sequential design. We surveyed (n = 120) and interviewed (n = 16) middle managers implementing an innovation intended to reduce health disparities in 120 US health centers to assess whether top managers’ support influences middle managers’ commitment directly, by allocating implementation policies and practices, or by moderating the influence of implementation policies and practices on middle managers’ commitment. For quantitative analyses, multivariable regression assessed direct and moderated effects; a mediation model assessed mediating effects. We used template analysis to assess qualitative data. Findings We found support for each hypothesized relationship: Results suggest that top managers increase middle managers’ commitment by directly conveying to middle managers that innovation implementation is an organizational priority (β = 0.37, p = 0.09); allocating implementation policies and practices including performance reviews, human resources, training, and funding (bootstrapped estimate for performance reviews = 0.09; 95 percent CI: 0.03, 0.17); and encouraging middle managers to leverage performance reviews and human resources to achieve innovation implementation. Practice Implications Top managers can demonstrate their support by directly conveying to middle managers that an initiative is an organizational priority, allocating implementation policies and practices such as human resources and funding to facilitate innovation implementation, and convincing middle managers that innovation implementation is possible using available implementation policies and practices. Middle managers may maximize the influence of top managers’ support on their commitment by communicating with top managers about what kind of support would be most effective in increasing their commitment to innovation implementation. PMID:24566252

Demand management and case management: a conservation strategy.

PubMed

Bryant, C D R Anna K

2007-01-01

This article reviews the history and development of managed competition, and explores the possibilities of a new demand management strategy in the context of nurse case management to offer less costly, higher quality care for a greater number of patients. The article examines the history and principles of healthcare demand management, its implementation in the hospital and clinical practices of nurse case managers, and its impacts in reducing costs while maintaining care levels. The article develops and analyzes the conflicts and common ground between demand management and case management. First, demand-side strategies can be effective in reducing costs while maintaining quality of nursing care; second, nurse case managers should employ patient education, self-care, and staffing solutions to manage demand. Nurse case managers must apply demand management principles carefully. Their goal is not to restrict care, but to maintain the highest levels of care possible within the limits of their practice's resources and staffing. Two critical themes emerge: (1) demand management is a potential alternative to market-driven managed competition and (2) nursing case management can affect an effective form of demand management. However, the long-term implications of these nursing case management strategies on healthcare staffing need further exploration.

CRM System Implementation in a Multinational Enterprise

NASA Astrophysics Data System (ADS)

Mishra, Alok; Mishra, Deepti

The concept of customer relationship management (CRM) resonates with managers in today's competitive economy. As more and more organizations realize the significance of becoming customer-centric in today's competitive era, they embrace CRM as a core business strategy. CRM an integration of information technology and relationship marketing provides the infrastructure that facilitates long-term relationship building with customers at an enterprise-wide level. Successful CRM implementation is a complex, expensive and rarely technical projects. This paper presents the successful implementation of CRM in a multinational organization. This study will facilitate in understanding transition, constraints and implementation of CRM in multinational enterprises.

Quality Improvement and Performance Management Benefits of Public Health Accreditation: National Evaluation Findings.

PubMed

Siegfried, Alexa; Heffernan, Megan; Kennedy, Mallory; Meit, Michael

To identify the quality improvement (QI) and performance management benefits reported by public health departments as a result of participating in the national, voluntary program for public health accreditation implemented by the Public Health Accreditation Board (PHAB). We gathered quantitative data via Web-based surveys of all applicant and accredited public health departments when they completed 3 different milestones in the PHAB accreditation process. Leadership from 324 unique state, local, and tribal public health departments in the United States. Public health departments that have achieved PHAB accreditation reported the following QI and performance management benefits: improved awareness and focus on QI efforts; increased QI training among staff; perceived increases in QI knowledge among staff; implemented new QI strategies; implemented strategies to evaluate effectiveness and quality; used information from QI processes to inform decision making; and perceived achievement of a QI culture. The reported implementation of QI strategies and use of information from QI processes to inform decision making was greater among recently accredited health departments than among health departments that had registered their intent to apply but not yet undergone the PHAB accreditation process. Respondents from health departments that had been accredited for 1 year reported higher levels of staff QI training and perceived increases in QI knowledge than those that were recently accredited. PHAB accreditation has stimulated QI and performance management activities within public health departments. Health departments that pursue PHAB accreditation are likely to report immediate increases in QI and performance management activities as a result of undergoing the PHAB accreditation process, and these benefits are likely to be reported at a higher level, even 1 year after the accreditation decision.

Applying change management metaphors to a national e-Health strategy.

PubMed

Saunders, Chad; Scott, Richard E

2014-01-01

Recent attempts at a collective understanding of how to develop an e-Health strategy have addressed the individual organisation, collection of organisations, and national levels. At the national level the World Health Organisation's National eHealth Strategy Toolkit serves as an exemplar that consolidates knowledge in this area, guides practical implementations, and identifies areas for future research. A key implication of this toolkit is the considerable number of organisational changes required to successfully apply their ideas in practice. This study looks critically at the confluence of change management and e-Health strategy using metaphors that underpin established models of change management. Several of Morgan's organisational metaphors are presented (highlighting varied beliefs and assumptions regarding how change is enacted, who is responsible for the change, and guiding principles for that change), and used to provide a framework. Attention is then directed to several prominent models of change management that exemplify one or more of these metaphors, and these theoretical insights are applied to evaluate the World Health Organisation's National eHealth Strategy Toolkit. The paper presents areas for consideration when using the WHO/ITU toolkit, and suggestions on how to improve its use in practice. The goal is to seek insight regarding the optimal sequence of steps needed to ensure successful implementation and integration of e-health into health systems using change management models. No single model, toolkit, or guideline will offer all the needed answers, but clarity around the underlying metaphors informing the change management models being used provides valuable insight so potentially challenging areas can be avoided or mitigated.

Change Strategies and Associated Implementation Challenges: An Analysis of Online Counselling Sessions.

PubMed

Rodda, Simone N; Hing, Nerilee; Hodgins, David C; Cheetham, Alison; Dickins, Marissa; Lubman, Dan I

2017-09-01

Self-change is the most frequent way people limit or reduce gambling involvement and often the first choice of people experiencing gambling-related problems. Less well known is the range of change strategies gamblers use and how these are selected, initiated or maintained. This study examined change strategies discussed in counselling transcripts from 149 clients who accessed a national online gambling help service in Australia. Using thematic analysis, we identified the presence of six change strategies; cash control and financial management, social support, avoiding or limiting gambling, alternative activities, changing thoughts and beliefs, and self-assessment and monitoring. Four implementation issues were also identified; a mismatch between need and strategy selection or maintenance; importance and readiness versus the cost of implementation; poor or unplanned transitions between strategies; and failure to review the helpfulness of strategies resulting in premature abandonment or unhelpful prolonged application. This study is the first to identify change strategies discussed in online counselling sessions. This study suggests change strategies are frequently discussed in online counselling sessions and we identified multiple new actions associated with change strategies that had not previously been identified. However, multiple implementation issues were identified and further work is required to determine the helpfulness of change strategies in terms of their selection, initiation and maintenance.

Proposed Performance Measures and Strategies for Implementation of the Fatigue Risk Management Guidelines for Emergency Medical Services

DOT National Transportation Integrated Search

2018-01-11

Background: Performance measures are a key component of implementation, dissemination, and evaluation of evidence-based guidelines (EBGs). We developed performance measures for Emergency Medical Services (EMS) stakeholders to enable the implementatio...

Pain management and opioid risk mitigation in the military.

PubMed

Sharpe Potter, Jennifer; Bebarta, Vikhyat S; Marino, Elise N; Ramos, Rosemarie G; Turner, Barbara J

2014-05-01

Opioid analgesics misuse is a significant military health concern recognized as a priority issue by military leadership. Opioids are among those most commonly prescribed medications in the military for pain management. The military has implemented opioid risk mitigation strategies, including the Sole Provider Program and the Controlled Drug Management Analysis and Reporting Tool, which are used to identify and monitor for risk and misuse. However, there are substantial opportunities to build on these existing systems to better ensure safer opioid prescribing and monitor for misuse. Opioid risk mitigation strategies implemented by the civilian sector include establishing clinical guidelines for opioid prescribing and prescription monitoring programs. These strategies may help to inform opioid risk mitigation in the military health system. Reducing the risk of opioid misuse and improving quality of care for our Warfighters is necessary. This must be done through evidence-based approaches with an investment in research to improve patient care and prevent opioid misuse as well as its sequelae. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.

Technostress in Libraries and Media Centers: Case Studies and Coping Strategies.

ERIC Educational Resources Information Center

Hickey, Kate D., Ed.

1992-01-01

Discusses technostress--i.e., stress brought on by changes in technology--in libraries and media centers. Case studies are presented that show stress in community college libraries caused by the rapid implementation of new technologies; coping strategies for librarians and media specialists are discussed; and strategies for managers are suggested.…

Sticking Points: How School Districts Experience Implementing the Portfolio Strategy

ERIC Educational Resources Information Center

Lake, Robin; Posamentier, Jordan; Denice, Patrick; Hill, Paul

2016-01-01

The portfolio strategy is a change strategy for public education in a district or metropolitan area. It is founded on the idea of re-missioning government agencies from rigid bureaucratic entities that mostly manage compliance requirements and interest group politics to a new role: overseeing performance and a diverse range of school choices…

Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance.

PubMed

Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

2018-01-01

To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick's evaluation framework to identify effects at different levels. The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required.

Strengthening health district management competencies in Ghana, Tanzania and Uganda: lessons from using action research to improve health workforce performance

PubMed Central

Martineau, Tim; Raven, Joanna; Aikins, Moses; Alonso-Garbayo, Alvaro; Baine, Sebastian; Huss, Reinhard; Maluka, Stephen; Wyss, Kaspar

2018-01-01

Background To achieve Universal Health Coverage (UHC), more health workers are needed; also critical is supporting optimal performance of existing staff. Integrated human resource management (HRM) strategies, complemented by other health systems strategies, are needed to improve health workforce performance, which is possible at district level in decentralised contexts. To strengthen the capacity of district management teams to develop and implement workplans containing integrated strategies for workforce performance improvement, we introduced an action-research-based management strengthening intervention (MSI). This consisted of two workshops, follow-up by facilitators and meetings between participating districts. Although often used in the health sector, there is little evaluation of this approach in middle-income and low-income country contexts. The MSI was tested in three districts in Ghana, Tanzania and Uganda. This paper reports on the appropriateness of the MSI to the contexts and its effects. Methods Documentary evidence (workshop reports, workplans, diaries, follow-up visit reports) was collected throughout the implementation of the MSI in each district and interviews (50) and focus-group discussions (6) were conducted with managers at the end of the MSI. The findings were analysed using Kirkpatrick’s evaluation framework to identify effects at different levels. Findings The MSI was appropriate to the needs and work patterns of District Health Management Teams (DHMTs) in all contexts. DHMT members improved management competencies for problem analysis, prioritisation and integrated HRM and health systems strategy development. They learnt how to refine plans as more information became available and the importance of monitoring implementation. The MSI produced changes in team behaviours and confidence. There were positive results regarding workforce performance or service delivery; these would increase with repetition of the MSI. Conclusions The MSI is appropriate to the contexts where tested and can improve staff performance. However, for significant impact on service delivery and UHC, a method of scaling up and sustaining the MSI is required. PMID:29662692

Preparation for pain management during childbirth: the psychological aspects of coping strategy development in antenatal education.

PubMed

Escott, Diane; Slade, Pauline; Spiby, Helen

2009-11-01

During childbirth, in addition to or in place of analgesia, women manage pain using a range of coping strategies. Antenatal education provides an opportunity prior to birth to help women to prepare for an often painful event. However, this is usually carried out with little reference to the literature regarding psychological factors which influence the experience of pain. This review seeks to consider how recent developments in psychological knowledge could enhance care. Areas identified include range of coping strategies and factors influencing their efficacy and implementation. This draws on both the literature on management of acute pain in other scenarios and the limited literature related to childbirth related pain. The following recommendations for systematic evaluation in the context of antenatal education are made: (i) Increase the range of coping strategies currently utilized to include cognitive based strategies. (ii) Help women to identify and understand the nature of their own coping styles and preferences, including any unhelpful patterns of pain catastrophizing. (iii) Help women to develop their own unique set of coping strategies for labor. (iv) Strengthen feelings of coping self-efficacy by practice in class and reinforcement by the class teacher. (v) Develop implementation intentions which account for the changing context of childbirth and (vi) Actively develop prompting and reinforcement of use of identified coping strategies by birth partners.

Evidence-based practice beliefs and behaviors of nurses providing cancer pain management: a mixed-methods approach.

PubMed

Eaton, Linda H; Meins, Alexa R; Mitchell, Pamela H; Voss, Joachim; Doorenbos, Ardith Z

2015-03-01

To describe evidence-based practice (EBP) beliefs and behaviors of nurses who provide cancer pain management. Descriptive, cross-sectional with a mixed-methods approach. Two inpatient oncology units in the Pacific Northwest. 40 RNs.
 Data collected by interviews and web-based surveys. EBP beliefs, EBP implementation, evidence-based pain management. Nurses agreed with the positive aspects of EBP and their implementation ability, although implementation level was low. They were satisfied with their pain management practices. Oncology nursing certification was associated with innovativeness, and innovativeness was associated with EBP beliefs. Themes identified were (a) limited definition of EBP, (b) varied evidence-based pain management decision making, (c) limited identification of evidence-based pain management practices, and (d) integration of nonpharmacologic interventions into patient care. Nurses' low level of EBP implementation in the context of pain management was explained by their trust that standards of care and medical orders were evidence-based. Nurses' EBP beliefs and behaviors should be considered when developing strategies for sustaining evidence-based pain management practices. Implementation of the EBP process by nurses may not be realistic in the inpatient setting; therefore, hospital pain management policies need to be evidence-based and reinforced with nurses.

Managing the initiation and early implementation of health promotion interventions: a study of a parental support programme in primary care.

PubMed

Westerlund, Anna; Garvare, Rickard; Nyström, Monica E; Eurenius, Eva; Lindkvist, Marie; Ivarsson, Anneli

2017-03-01

Mental health problems are increasing among children and adolescents worldwide, and parental support programmes have been suggested as one preventive intervention. However, the actual impact and low rates of adoption and sustainability of prevention programmes have proven to be a concern, and thus, further studies on their implementation are needed. This study focused on the initial implementation of the International Child Development Programme (ICDP) in primary care. The aim was to investigate the involved actors' views on factors likely to affect implementation and the strategies used to manage them. A case study design with a mixed-methods approach combining quantitative and qualitative data from questionnaires and interviews was used. Eighty-two professionals at different positions in the involved organisations participated. Directed content analysis was used for analyses, focusing on perceived levels of importance and the manifestation of implementation factors. Interviews and questionnaires provided descriptions of factors influencing the initial ICDP implementation. Uncertainty on how to manage important factors and vague change strategies was reported. Discrepancies in the perceived levels of importance versus manifestation were found regarding several factors, including hands-on support, time and resources, communication and information, a comprehensive plan of action, follow-ups, and external and internal collaborations. Manifested factors were a need for change, motivation and the ICDP's compatibility with existing norms, values and practices. Implementing a parental support programme in a complex setting will benefit from being preceded by a thorough examination of the intervention and the target context and the development of clear implementation strategies based on the results of that examination. This study provides insights into how and by whom knowledge on implementation is applied during the launch of a health promotion programme, and these insights might help increase the rate of adoption and the use of such programmes and thereby increase their effectiveness. © 2016 Nordic College of Caring Science.

Essentials of Enrollment Management: Cases in the Field

ERIC Educational Resources Information Center

Black, Jim

2004-01-01

In AACRAO's new publication Essentials of Enrollment Management: Cases in the Field experts in enrollment management representing all types of institutions reveal the evolution of the enrollment strategies implemented at their institutions, the results, and the lessons learned. The introductory chapter provides an overview of themes and models…

10 Budget-Savvy Content Management Strategies

ERIC Educational Resources Information Center

Hillis, David J.

2004-01-01

Facing an overall budget reduction of 10 percent, most colleges or universities would postpone investing in a Web content management system. However, for California State University Monterey Bay (CSUMB), a large budget cut made Web content management even more important. CSUMB found an innovative way to purchase and implement a new Content…

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial.

PubMed

Jabbour, Mona; Curran, Janet; Scott, Shannon D; Guttman, Astrid; Rotter, Thomas; Ducharme, Francine M; Lougheed, M Diane; McNaughton-Filion, M Louise; Newton, Amanda; Shafir, Mark; Paprica, Alison; Klassen, Terry; Taljaard, Monica; Grimshaw, Jeremy; Johnson, David W

2013-05-22

The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for 'point of care' management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma--the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis--the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. ClinicalTrials.gov: NCT01815710.

Management of a CFD organization in support of space hardware development

NASA Technical Reports Server (NTRS)

Schutzenhofer, L. A.; Mcconnaughey, P. K.; Mcconnaughey, H. V.; Wang, T. S.

1991-01-01

The management strategy of NASA-Marshall's CFD branch in support of space hardware development and code validation implements various elements of total quality management. The strategy encompasses (1) a teaming strategy which focuses on the most pertinent problem, (2) quick-turnaround analysis, (3) the evaluation of retrofittable design options through sensitivity analysis, and (4) coordination between the chief engineer and the hardware contractors. Advanced-technology concepts are being addressed via the definition of technology-development projects whose products are transferable to hardware programs and the integration of research activities with industry, government agencies, and universities, on the basis of the 'consortium' concept.

Embracing technology? Using change management strategies to improve the use of continuous lateral rotation therapy.

PubMed

Cybulski, Pamela; Zantinge, Johanna; Abbott-McNeil, Deanna

2006-01-01

The purpose of this quality improvement initiative was to improve the utilization of continuous lateral rotation therapy (CLRT) in a nine-bed community hospital ICU within the context of a nurse-driven protocol. Nursing focus groups, analyzed using a strength, weakness, opportunity, threat (SWOT) approach, resulted in the implementation of four interventions over seven weeks. Change management strategies guided all aspects of the project. Results showed a modest increase in the utilization of CLRT. This initiative demonstrates that change management strategies may assist with the incorporation of technology into nursing practice by increasing empowerment and creating an attachment to and responsibility for outcomes.

A Qualitative Study of HR/OHS Stress Interventions in Australian Universities.

PubMed

Pignata, Silvia; Winefield, Anthony H; Boyd, Carolyn M; Provis, Chris

2018-01-09

To enhance the understanding of psychosocial factors and extend research on work stress interventions, we investigated the key human resource (HR)/occupational health and safety (OHS) stress interventions implemented at five Australian universities over a three-year period. Five senior HR Directors completed an online survey to identify the intervention strategies taken at their university in order to reduce stress and enhance employee well-being and morale. We also explored the types of individual-, organization-, and individual/organization-directed interventions that were implemented, and the strategies that were prioritized at each university. Across universities, the dominant interventions were strategies that aimed to balance the social exchange in the work contract between employee-organization with an emphasis on initiatives to: enhance training, career development and promotional opportunities; improve remuneration and recognition practices; and to enhance the fairness of organizational policies and procedures. Strategies to improve work-life balance were also prominent. The interventions implemented were predominantly proactive (primary) strategies focused at the organizational level and aimed at eliminating or reducing or altering work stressors. The findings contribute to the improved management of people at work by identifying university-specific HR/OHS initiatives, specifically leadership development and management skills programs which were identified as priorities at three universities.

A Qualitative Study of HR/OHS Stress Interventions in Australian Universities

PubMed Central

Winefield, Anthony H.; Boyd, Carolyn M.

2018-01-01

To enhance the understanding of psychosocial factors and extend research on work stress interventions, we investigated the key human resource (HR)/occupational health and safety (OHS) stress interventions implemented at five Australian universities over a three-year period. Five senior HR Directors completed an online survey to identify the intervention strategies taken at their university in order to reduce stress and enhance employee well-being and morale. We also explored the types of individual-, organization-, and individual/organization-directed interventions that were implemented, and the strategies that were prioritized at each university. Across universities, the dominant interventions were strategies that aimed to balance the social exchange in the work contract between employee-organization with an emphasis on initiatives to: enhance training, career development and promotional opportunities; improve remuneration and recognition practices; and to enhance the fairness of organizational policies and procedures. Strategies to improve work-life balance were also prominent. The interventions implemented were predominantly proactive (primary) strategies focused at the organizational level and aimed at eliminating or reducing or altering work stressors. The findings contribute to the improved management of people at work by identifying university-specific HR/OHS initiatives, specifically leadership development and management skills programs which were identified as priorities at three universities. PMID:29315278

Operations management approach to hospitals.

PubMed

Harvey, J; Duguay, C R

1988-06-01

An operations management systems approach can be a useful tool for coordinating and planning in a complex organization. The authors argue for adapting such an approach to health care from the manufacturing industries in order to facilitate strategy formulation, communication and implementation.

Integrated corridor management modeling results report : Dallas, Minneapolis, and San Diego.

DOT National Transportation Integrated Search

2012-02-01

This executive summary documents the analysis methodologies, tools, and performance measures used to analyze Integrated Corridor Management (ICM) strategies; and presents high-level results for the successful implementation of ICM at three Stage 2 Pi...

Obstetric simulation as a risk control strategy: course design and evaluation.

PubMed

Gardner, Roxane; Walzer, Toni B; Simon, Robert; Raemer, Daniel B

2008-01-01

Patient safety initiatives aimed at reducing medical errors and adverse events are being implemented in Obstetrics. The Controlled Risk Insurance Company (CRICO), Risk Management Foundation (RMF) of the Harvard Medical Institutions pursued simulation as an anesthesia risk control strategy. Encouraged by their success, CRICO/RMF promoted simulation-based team training as a risk control strategy for obstetrical providers. We describe the development, implementation, and evaluation of an obstetric simulation-based team training course grounded in crisis resource management (CRM) principles. We pursued systematic design of course development, implementation, and evaluation in 3 phases, including a 1-year or more posttraining follow-up with self-assessment questionnaires. The course was highly rated overall by participants immediately after the course and 1-year or more after the course. Most survey responders reported having experienced a critical clinical event since the course and that various aspects of their teamwork had significantly or somewhat improved as a result of the course. Most (86%) reported CRM principles as useful for obstetric faculty and most (59%) recommended repeating the simulation course every 2 years. A simulation-based team-training course for obstetric clinicians was developed and is a central component of CRICO/RMF's obstetric risk management incentive program that provides a 10% reduction in annual obstetrical malpractice premiums. The course was highly regarded immediately and 1 year or more after completing the course. Most survey responders reported improved teamwork and communication in managing a critical obstetric event in the interval since taking the course. Simulation-based CRM training can serve as a strategy for mitigating adverse perinatal events.

Obstacles to TQM success in health care systems.

PubMed

Mosadeghrad, Ali Mohammad

2013-01-01

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

The Advantage of Standardisation as a Management Instrument in Companies

DTIC Science & Technology

2003-09-01

possible synergistic effects between different but related business units and allocate all kinds of resources in the best possible way. The management... allocating the necessary resources. This pragmatic approach corresponds to the "structure follows strategy thesis". Under the term strategy this thesis...implementation of the necessary arrangements in the functional areas as well as the allocation of existing resources. In this connection the demand for

Blood and Blood Product Conservation: Results of Strategies to Improve Clinical Outcomes in Open Heart Surgery Patients at a Tertiary Hospital.

PubMed

Khan, Junaid H; Green, Emily A; Chang, Jimmin; Ayala, Alexandria M; Barkin, Marilyn S; Reinys, Emily E; Stanton, Jeffrey; Stanten, Russell D

2017-12-01

Blood product usage is a quality outcome for patients undergoing cardiac surgery. To address an increase in blood product usage since the discontinuation of aprotinin, blood conservation strategies were initiated at a tertiary hospital in Oakland, CA. Improving transfusion rates for open heart surgery patients requiring Cardiopulmonary bypass (CPB) involved multiple departments in coordination. Specific changes to conserve blood product usage included advanced CPB technology upgrades, and precise individualized heparin dose response titration assay for heparin and protamine management. Retrospective analysis of blood product usage pre-implementation, post-CPB changes and post-Hemostasis Management System (HMS) implementation was done to determine the effectiveness of the blood conservation strategies. Statistically significant decrease in packed red blood cells, fresh frozen plasma, cryoprecipitate, and platelet usage over the stepped implementation of both technologies was observed. New oxygenator and centrifugal pump technologies reduced active circuitry volume and caused less damage to blood cells. Individualizing heparin and protamine dosing to a patient using the HMS led to transfusion reductions as well. Overall trends toward reductions in hospital length of stay and intensive care unit stay, and as a result, blood product cost and total hospitalization cost are positive over the period of implementation of both CPB circuit changes and HMS implementation. Although they are multifactorial in nature, these trends provide positive enforcement to the changes implemented.

Implementation strategies in pediatric neurocritical care.

PubMed

Markham, Christopher; Proctor, Enola K; Pineda, Jose A

2017-06-01

Brain-directed critical care for children is a relatively new area of subspecialization in pediatric critical care. Pediatric neurocritical care teams combine the expertise of neurology, neurosurgery, and critical care medicine. The positive impact of delivering specialized care to pediatric patients with acute neurological illness is becoming more apparent, but the optimum way to implement and sustain the delivery of this is complicated and poorly understood. We aim to provide emerging evidence supporting that effective implementation of pediatric neurocritical care pathways can improve patient survival and outcomes. We also provide an overview of the most effective strategies across the field of implementation science that can facilitate deployment of neurocritical care pathways in the pediatric ICU. Implementation strategies can broadly be grouped according to six categories: planning, educating, restructuring, financing, managing quality, and attending to the policy context. Using a combination of these strategies in the last decade, several institutions have improved patient morbidity and mortality. Although much work remains to be done, emerging evidence supports that implementation of evidence-based care pathways for critically ill children with two common neurological diagnoses - status epilepticus and traumatic brain injury - improves outcomes. Pediatric and neonatal neurocritical care programs that support evidence-based care can be effectively structured using appropriately sequenced implementation strategies to improve outcomes across a variety of patient populations and in a variety of healthcare settings.

U.S. Forest Service Leads Climate Change Adaptation in the Western United States

NASA Astrophysics Data System (ADS)

Halofsky, J.; Peterson, D. L.

2014-12-01

Effective climate change engagement on public lands is characterized by (1) an enduring science-management partnership, (2) involvement of key stakeholders, (3) consideration of broad landscapes with multiple landowners, (4) science-based, peer-reviewed assessments of sensitivity of natural resources to climate change, (5) adaptation strategies and tactics developed by resource managers, (6) leadership and a workforce motivated to implement climate-smart practices in resource planning and project management. Using this approach, the U.S. Forest Service, in partnership with other organizations, has developed climate change vulnerability assessments and adaptation plans for diverse ecosystems and multiple resources in national forests and other lands in the western United States, although implementation (step 6) has been slow in some cases. Hundreds of meetings, strategies, plans, and panels have focused on climate change adaptation over the past decade, but only direct engagement between scientists and resource managers (less research, less planning, more action) has resulted in substantive outcomes and increased organizational capacity for climate-smart management.

Campsite impact management: A survey of National Park Service backcountry managers

USGS Publications Warehouse

Marion, J.L.; Stubbs, C.J.; Vander Stoep, Gail A.

1993-01-01

Though a central purpose for the creation and management of parks, visitation inevitably affects the natural resources of parks. This is particularly true at campsites, where visitation and its effects are concentrated. This paper presents partial results from a survey of National Park Service managers regarding general strategies and specific actions implemented by park managers to address campsite impact problems.

Critical challenges in ERP implementation: A qualitative case study in the Canadian oil and gas industry

NASA Astrophysics Data System (ADS)

Menon, Sreekumar A.

This exploratory qualitative single-case study examines critical challenges encountered during ERP implementation based on individual perspectives in four project roles: senior leaders, project managers, project team members, and business users, all specifically in Canadian oil and gas industry. Data was collected by interviewing participants belonging to these categories, and by analyzing project documentation about ERP implementation. The organization for the case study was a leading multinational oil and gas company having a substantial presence in the energy sector in Canada. The study results were aligned with the six management questions regarding critical challenges in ERP: (a) circumstances to implement ERP, (b) benefits and process improvements achieved, (c) best practices implemented, (d) critical challenges encountered, (e) strategies and mitigating actions used, and (f) recommendations to improve future ERP implementations. The study results highlight six key findings. First, the study provided valid circumstances for implementing ERP systems. Second, the study underscored the importance of benefits and process improvements in ERP implementation. Third, the study highlighted that adoption of best practices is crucial for ERP Implementation. Fourth, the study found that critical challenges are encountered in ERP Implementation and are significant during ERP implementation. Fifth, the study found that strategies and mitigating actions can overcome challenges in ERP implementation. Finally, the study provided ten major recommendations on how to improve future ERP implementations.

Proactive pavement asset management with climate change aspects

NASA Astrophysics Data System (ADS)

Zofka, Adam

2018-05-01

Pavement Asset Management System is a systematic and objective tool to manage pavement network based on the rational, engineering and economic principles. Once implemented and mature Pavement Asset Management System serves the entire range of users starting with the maintenance engineers and ending with the decision-makers. Such a system is necessary to coordinate agency management strategy including proactive maintenance. Basic inputs in the majority of existing Pavement Asset Management System approaches comprise the actual pavement inventory with associated construction history and condition, traffic information as well as various economical parameters. Some Pavement Management System approaches include also weather aspects which is of particular importance considering ongoing climate changes. This paper presents challenges in implementing the Pavement Asset Management System for those National Road Administrations that manage their pavement assets using more traditional strategies, e.g. worse-first approach. Special considerations are given to weather-related inputs and associated analysis to demonstrate the effects of climate change in a short- and long-term range. Based on the presented examples this paper concludes that National Road Administrations should account for the weather-related factors in their Pavement Management Systems as this has a significant impact on the system outcomes from the safety and economical perspective.

Why TQM does not work in Iranian healthcare organisations.

PubMed

Mosadeghrad, Ali Mohammad

2014-01-01

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

[Obstacle factors in implementation of integrated schistosomiasis prevention and control strategies with emphasis on infectious source in hilly endemic regions].

PubMed

Xu, Jia; Chen, Lin; Zhang, Yi; Wu, Jian-Jun; Wan, Xue-Xiang; Zhu, Rong; Xu, Hui-Rong; Liu, Qing; Huang, Liang; Wu, Zi-Song; Lu, Long-Ting; Zhong, Bo

2013-12-01

To analyze the main obstacles existing in the implementation of integrated schistosomiasis prevention and control strategies with emphasis on infection source in hilly endemic regions, and to find out the current priority issues in schistosomiasis prevention and control, so as to provide the evidence for further solutions. Two typical hilly schistosomiasis endemic regions in Sichuan Province, including Pujiang County of Chengdu City and Dongpo District of Meishan City, were selected as research areas. A framework of obstacle factors in the implementation of integrated schistosomiasis prevention and control strategies with emphasis on infectious source in hilly endemic regions was built by literature review, and the management and technical personnel who worked on schistosomiasis prevention and control in eight different industries (health, agriculture, forestry and so on) and five levels (provincial, city, county, township and village levels) were investigated by questionnaires in the way of nominal group. One hundred and fifty-three management and technical personnel in different industries and different levels were investigated. The questionnaire recovery rate (experts' positive coefficient) was 100%. The results showed that the first four problems needing to be concerned in the implementation of integrated schistosomiasis prevention and control strategies with emphasis on infection source were eliminating Oncomelania hupensis snails by projects, health education, examination and treatment for schistosomiasis persons, and harmless treatment of night-soil and safe water supply. The focuses of two counties in the implementation of integrated strategy measures were different. The harmless treatment of night-soil and safe water supply was the most important measure in Pujiang County, while the elimination of snails by projects was the most in Dong-po District. As the differences in the situation of epidemic areas and the existed condition of the prevention and treatment progress, the comprehensive schistosomiasis control measures should be adjusted according to the local conditions in the implementation of integrated schistosomiasis prevention and control strategies with emphasis on infection source.

A Change Management, Systems Thinking, or Organizational Development Approach to the No Child Left Behind Act

ERIC Educational Resources Information Center

Galloway, Dominique L.

2007-01-01

Problems with implementation of the No Child Left Behind Act (NCLB) can be assessed in light of change management theory. Viewing stakeholders collectively as a corporate entity supports employing change management strategies to make the NCLB work. Examining ways that organizational controls and change management can work together points to…

Operational and Clinical Strategies to Address Drug Cost Containment in the Acute Care Setting.

PubMed

McConnell, Karen J; Guzman, Oscar E; Pherwani, Nisha; Spencer, Dustin D; Van Cura, Jennifer D; Shea, Katherine M

2017-01-01

To provide clinical and operational strategies to generate drug cost savings in the hospital setting. A search of the PubMed database was performed with no time limit through July 2016. All original prospective and retrospective studies, peer-reviewed guidelines, consensus statements, review articles, and accompanying references were evaluated for inclusion. Only articles published in the English language were included. Investigators reviewed 937 abstracts. The review of the literature showed that acute care hospitals are under increasing financial pressures, and the pharmacy is often responsible for opportunities to manage drug costs. The literature also indicated that cost-containment strategies in the acute care setting range from pharmacy-directed activities to initiatives requiring interdisciplinary collaboration and strategic planning. Hospital pharmacies should consider establishing an interdisciplinary team that is responsible for systematically reviewing drug cost implications and leading any initiatives that are deemed necessary. Acute care settings can use various operational and clinical strategies to lower their expenditures on high-cost drugs. Operational strategies include various activities that pharmacy staff implement related to contracting, purchasing, and inventory management. Clinical strategies utilize clinical pharmacists working with interdisciplinary teams to develop and maintain a formulary, implement established-use criteria for select drugs, use dose optimization, and implement other clinical tactics aimed at cost containment. After initiatives are implemented, assessing the outcomes of the initiatives is important to determine how successful they were at lowering costs safely and effectively. Acute care hospitals can use various operational and clinical strategies to lower overall drug costs. A systematic stepwise approach is recommended to ensure relevant drugs are regularly reviewed and addressed as needed. © 2016 Pharmacotherapy Publications, Inc.

From Research to Flight: Thinking About Implementation While Performing Fundamental Research

NASA Technical Reports Server (NTRS)

Johnson, Les

2010-01-01

This slide presentation calls for a strategy to implement new technologies. Such a strategy would allow advanced space transportation technologies to mature for exploration beyond Earth orbit. It discusses the difference between technology push versus technology pull. It also reviews the three basic technology readiness levels (TRL). The presentation traces examples of technology development to flight application: the Space Shuttle Main Engine Advanced Health Management System, the Friction Stir Welding technology the (auto-adjustable pin tool). A couple of technologies currently not in flight, but are being reviewed for potential use are: cryogenic fluid management (CFM), and solar sail propulsion. There is also an attempt to explain why new technologies are so difficult to field.

Dissemination of sustainable irrigation strategies for almond and olive orchards via a participatory approach. Project LIFE+IRRIMAN

NASA Astrophysics Data System (ADS)

Garcia-Vila, Margarita; Gamero-Ojeda, Pablo; Ascension Carmona, Maria; Berlanga, Jose; Fereres, Elias

2017-04-01

Dissemination of sustainable irrigation strategies for almond and olive orchards via a participatory approach. Project LIFE+IRRIMAN Spain is the world's first and third largest producer of olive oil and almond, respectively. Despite huge efforts in the last years by the production sector towards intensification, cultural issues relative to the traditional rain-fed crop management know how, prevent farmers from adoption of sustainable irrigation management practices. Consequently, even though there has been progress in irrigation management research for these two crops, adoption of modern irrigation techniques by farmers has been slow. Sustainable irrigation strategies for olive and almond orchards are being designed, implemented, validated and disseminated under the framework of the LIFE+ IRRIMAN project, through a participatory approach. The implementation of the LIFE+ IRRIMAN innovative and demonstrative actions has been carried out in an irrigation district of Southern Spain (Genil-Cabra Irrigation Scheme, Andalusia). The approach designed has four phases: i) design and implementation of sustainable irrigation strategies in demonstration farms; ii) dissemination of best irrigation practices which were tested in the initial year throughout the irrigation scheme by the irrigation advisory service; iii) assessment of degree of adoption and re-design of the dissemination strategies; and, iv) based on the results obtained, elaboration of sustainable irrigation guidelines for knowledge transfer in the district at regional and national levels to promote changes in irrigation practices. Participatory approaches have proven to be effective tools for successful irrigation strategies design and diffusion, especially in traditional rain fed crops such as olive and almond trees in the Mediterranean countries. Acknowledgements This work has been funded by the European Union LIFE+ project IRRIMAN (LIFE13 ENV/ES/000539).

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

PubMed

Wang, Yingwen; Kong, Meijing; Ge, Youhong

2016-12-01

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

Assessment of nurse retention challenges and strategies in Lebanese hospitals: the perspective of nursing directors.

PubMed

El-Jardali, Fadi; Merhi, Mirvat; Jamal, Diana; Dumit, Nuhad; Mouro, Gladys

2009-05-01

Assess nurse retention challenges and strategies as perceived by nursing directors in Lebanese hospitals. The Kampala Health Workforce Declaration stressed the importance of retaining an effective, responsive and equitably distributed health workforce, particularly nurses. Little is known about nurse retention challenges and strategies in Lebanon. Nursing directors of 76 hospitals participated and were sent a two-page survey on perceived retention challenges and hospital-based retention strategies. Retention challenges included unsatisfactory salary, unsuitable shifts and working hours, as well as better opportunities in other areas within or outside Lebanon. Retention strategies included implementing financial rewards and benefits, a salary scale, staff development, praise and improving work environment. Nursing directors did not address all perceived challenges in their strategies. To better manage the nursing workforce, nursing directors should regularly measure and monitor nurse turnover rates and also their causes and predictors. Nursing directors should develop, implement and evaluate retention strategies. More information is needed on the management and leadership capacities of nursing directors in addition to their span of control. Nursing directors are facing challenges in retaining their nurses. If these problems are not addressed, Lebanon will continue to lose competent and skilled nurses.

Implementation strategies to enhance management of heavy alcohol consumption in primary health care: a meta-analysis.

PubMed

Keurhorst, Myrna; van de Glind, Irene; Bitarello do Amaral-Sabadini, Michaela; Anderson, Peter; Kaner, Eileen; Newbury-Birch, Dorothy; Braspenning, Jozé; Wensing, Michel; Heinen, Maud; Laurant, Miranda

2015-12-01

Screening and brief interventions (SBI) delivered in primary health care (PHC) are cost-effective in decreasing alcohol consumption; however, they are underused. This study aims to identify implementation strategies that focus on SBI uptake and measure impact on: (1) heavy drinking and (2) delivery of SBI in PHC. Meta-analysis was conducted of controlled trials of SBI implementation strategies in PHC to reduce heavy drinking. Key outcomes included alcohol consumption, screening, brief interventions and costs in PHC. Predictor measures concerned single versus multiple strategies, type of strategy, duration and physician-only input versus that including mid-level professionals. Standardized mean differences (SMD) were calculated to indicate the impact of implementation strategies on key outcomes. Effect sizes were aggregated using meta-regression models. The 29 included studies were of moderate methodological quality. Strategies had no overall impact on patients' reported alcohol consumption [SMD=0.07; 95% confidence interval (CI)=-0.02 to 0.16], despite improving screening (SMD=0.53; 95% CI=0.28-0.78) and brief intervention delivery (SMD=0.64;95% CI=0.27-1.02). Multi-faceted strategies, i.e. professional and/or organizational and/or patient-orientated strategies, seemed to have strongest effects on patients' alcohol consumption (P<0.05, compared with professional-orientated strategies alone). Regarding SBI delivery, combining professional with patient-orientated implementation strategies had the highest impact (P<0.05). Involving other staff besides physicians was beneficial for screening (P<0.05). To increase delivery of alcohol screening and brief interventions and decrease patients' alcohol consumption, implementation strategies should include a combination of patient-, professional- and organizational-orientated approaches and involve mid-level health professionals as well as physicians. © 2015 Society for the Study of Addiction.

Bridging the gap between preventive and restorative dentistry: identification of caries risk factors and strategies for minimizing risk.

PubMed

Maragliano-Muniz, Pamela

2013-10-01

Following the introduction of CAMBRA (Caries Management by Risk Assessment) in 2007, a number of recommendations for office protocols were introduced, and many companies have formulated products and procedures for implementing CAMBRA. As a result, the implementation of a caries management program can be confounding and overwhelming to a dental practitioner. Understanding risk factors as they contribute to the caries process can help mitigate confusion and guide the practitioner when selecting materials for their practice. Ultimately, knowing how the risk factors play a role in the progression of dental caries will lead to appropriate risk management and product recommendations. The purpose of this article is to discuss the contribution of risk factors to the caries process and to introduce strategies that restorative dentists can utilize to minimize caries risk.

Managing the human side of change in VA's transformation.

PubMed

Backer, T E

1997-01-01

Transformational change interventions often fail or short fall of their intended impact on organizations and systems. One main reason is that these interventions frequently do not strategically address the complex human dynamics of change. This happens despite awareness of and commitment to intervening at this level by top management and change leaders. The wisdom that "systems don't change; people change" is widely acknowledged but inadequately applied. These are exactly the conditions the U.S. Department of Veterans Affairs (VA) faces in deploying its new Veterans Integrated Services Networks (VISNs). Applying validated behavioral science strategies that address the human side of change will help VA implement VISNs effectively. Six strategies derived from many years of study and practice in the public and private sectors are discussed, along with suggestions for VISN managers about how to implement them.

Response of selected bermudagrass cultivars to bermudagrass stem maggot damage

USDA-ARS?s Scientific Manuscript database

Information regarding the susceptibility of currently grown bermudagrass [Cynodon dactylon (L.) Pers.] cultivars to the bermudagrass stem maggot (BSM; Atherigona reversura Villeneuve) could aid forage producers with the implementation of integrated pest management (IPM) strategies to manage this exo...

Planning for active traffic management in Virginia : international best practices and implementation strategies.

DOT National Transportation Integrated Search

2012-10-01

Active Traffic Management (ATM) applications, such as variable speed limits, queue warning systems, and dynamic : ramp metering, have been shown to offer mobility and safety benefits. Yet because they differ from conventional capacity : investments i...

HISTORICAL DEVELOPMENT OF WET-WEATHER FLOW MANAGEMENT

EPA Science Inventory

The management of wet-weather flow (WWF) is necessary to maintain the quality of urban water resources. Throughout history strategies were implemented to control WWF for reasons, e.g., flood and water quality control, aesthetic improvement, waste removal and others. A comprehen...

Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems.

PubMed

Palinkas, Lawrence A; Holloway, Ian W; Rice, Eric; Brown, C Hendricks; Valente, Thomas W; Chamberlain, Patricia

2013-11-14

Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice. Semi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions. Of those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network. Although the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies. NCT00880126.

Senior Managers’ Viewpoints Toward Challenges of Implementing Clinical Governance: A National Study in Iran

PubMed Central

Ravaghi, Hamid; Heidarpour, Peigham; Mohseni, Maryam; Rafiei, Sima

2013-01-01

Background: Quality improvement should be assigned as the main mission for healthcare providers. Clinical Governance (CG) is used not only as a strategy focusing on responding to public and government’s intolerance of poor healthcare standards, but also it is implemented for quality improvement in a number of countries. This study aims to identify the key contributing factors in the implementation process of CG from the viewpoints of senior managers in curative deputies of Medical Universities in Iran. Methods: A quantitative method was applied via a questionnaire distributed to 43 senior managers in curative deputies of Iran Universities of Medical Sciences. Data were analyzed using SPSS. Results: Analysis revealed that a number of items were important in the successful implementation of CG from the senior managers’ viewpoints. These items included: knowledge and attitude toward CG, supportive culture, effective communication, teamwork, organizational commitment, and the support given by top managers. Medical staff engagement in CG implementation process, presence of an official position for CG officers, adequate resources, and legal challenges were also regarded as important factors in the implementation process. Conclusion: Knowledge about CG, organizational culture, managerial support, ability to communicate goals and strategies, and the presence of effective structures to support CG, were all related to senior managers’ attitude toward CG and ultimately affected the success of quality improvement activities. PMID:24596887

Success Criteria for MIS Implementation and the Use of DSS as a Management Aid in Small Colleges in the United Kingdom. AIR 1986 Annual Forum Paper. Coombe Lodge Femis Paper, Information Bank Number 2106.

ERIC Educational Resources Information Center

Gibson, Dudley; Wickham, Derek

Successful strategies for implementing and operating the Further Education Management Information System (FEMIS) at colleges of further education in the United Kingdom are discussed, along with the development of associated microcomputer-based decision support systems. FEMIS has been targeted at the smaller institutions that do not generally have…

Proactive restoration: planning, implementation, and early results of silvicultural strategies for increasing resilience against gypsy moth infestation in upland oak forests on the Daniel Boone National Forest, Kentucky

Treesearch

Callie Schweitzer; Stacy L. Clark; Kurt W. Gottschalk; Jeff Stringer; Robbie Sitzlar

2014-01-01

Determining targets in forest restoration is a complicated task that can be facilitated by cooperative partnerships. Too often restoration plans are implemented after adverse events that cause widespread tree mortality, such as drought or insect outbreaks, have occurred. Reactive management precludes the use of preemptive management techniques that can result in more...

Motivation through Routine Documentation

ERIC Educational Resources Information Center

Koth, Laurie J.

2016-01-01

This informed commentary article offers a simple, effective classroom management strategy in which the teacher uses routine documentation to motivate students both to perform academically and to behave in a manner consistent with established classroom rules and procedures. The pragmatic strategy is grounded in literature, free to implement,…

Conflict Resolution, Can It Really Make a Difference in the Classroom: Conflict Resolution Strategies for Classroom Teachers

ERIC Educational Resources Information Center

Pollan, Savannah; Wilson-Younger, Dylinda

2012-01-01

This article discusses conflict and provides five resolutions for teachers on managing negative behaviors within the classroom. Acknowledging and implementing conflict resolution strategies in the classroom enables every student to fully participate in the learning process.

A Community College Roadmap for the Enrollment Management Journey

ERIC Educational Resources Information Center

Kerlin, Christine

2008-01-01

Institutions across the nation have strengthened their enrollments through such strategies and tactics as coordination of recruitment activities, enhancement of financial aid processing, implementation of effective retention strategies, development of new instructional programs, a focus on intensive marketing activities, creation of one-stop…

Towards Ubiquitous Peer Review Strategies to Sustain and Enhance a Clinical Knowledge Management Framework

PubMed Central

Rocha, Roberto A.; Bradshaw, Richard L.; Bigelow, Sharon M.; Hanna, Timothy P.; Fiol, Guilherme Del; Hulse, Nathan C.; Roemer, Lorrie K.; Wilkinson, Steven G.

2006-01-01

Widespread cooperation between domain experts and front-line clinicians is a key component of any successful clinical knowledge management framework. Peer review is an established form of cooperation that promotes the dissemination of new knowledge. The authors describe three peer collaboration scenarios that have been implemented using the knowledge management infrastructure available at Intermountain Healthcare. Utilization results illustrating the early adoption patterns of the proposed scenarios are presented and discussed, along with succinct descriptions of planned enhancements and future implementation efforts. PMID:17238422

Performance evaluation of canny edge detection on a tiled multicore architecture

NASA Astrophysics Data System (ADS)

Brethorst, Andrew Z.; Desai, Nehal; Enright, Douglas P.; Scrofano, Ronald

2011-01-01

In the last few years, a variety of multicore architectures have been used to parallelize image processing applications. In this paper, we focus on assessing the parallel speed-ups of different Canny edge detection parallelization strategies on the Tile64, a tiled multicore architecture developed by the Tilera Corporation. Included in these strategies are different ways Canny edge detection can be parallelized, as well as differences in data management. The two parallelization strategies examined were loop-level parallelism and domain decomposition. Loop-level parallelism is achieved through the use of OpenMP,1 and it is capable of parallelization across the range of values over which a loop iterates. Domain decomposition is the process of breaking down an image into subimages, where each subimage is processed independently, in parallel. The results of the two strategies show that for the same number of threads, programmer implemented, domain decomposition exhibits higher speed-ups than the compiler managed, loop-level parallelism implemented with OpenMP.

Validation of a Turkish Version of the Profiles of Organizational Influence Strategies

ERIC Educational Resources Information Center

Cetin, Saadet Kuru; Cinkir, Sakir

2016-01-01

Influencing others is at the heart of the management process. Managers use the influencing process for the purposes of controlling workers, using limited sources, implementing organizational change, breaking down the resistance of workers to this change, and enhancing the performance of workers of different from the managers' backgrounds. This…

78 FR 30305 - The President's Management Advisory Board (PMAB); Public Advisory Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-22

... strategies for the implementation of best business practices to improve Federal Government management and... for 2013 which include Management Innovation and Optimizing Federal Real Estate. In addition, the PMAB... offices at GSA, Washington, DC 20006, on official business days between the hours of 10 a.m. and 5 p.m...

Middle School Teachers' Perceptions of Barriers of Managing Student Behavior

ERIC Educational Resources Information Center

Whitlock, Winifred Nicole

2012-01-01

Despite training and support, many middle school teachers struggle to create, implement, and enforce research-based strategies to manage students' behaviors. The purpose of this case study was to examine teachers' perceptions about the barriers of managing student behavior. The research questions investigated 9 teachers' perceived…

40 CFR 51.302 - Implementation control strategies for reasonably attributable visibility impairment.

Code of Federal Regulations, 2010 CFR

2010-07-01

... hearings to each affected Federal Land Manager, and other affected States, and must state where the public can inspect a summary prepared by the Federal Land Managers of their conclusions and recommendations... conducted in accordance with the procedures in § 51.103. (b) State and Federal Land Manager Coordination. (1...

Changing shape: workforce and the implementation of Aboriginal health policy.

PubMed

Lloyd, Jane E; Wise, Marilyn J; Weeramanthri, Tarun

2008-02-01

Thirty-five interviews were conducted in a case study on the implementation of the Northern Territory Preventable Chronic Disease Strategy (PCDS) to explore the role of the health workforce in the implementation of Aboriginal health policy. There was a tendency for the workforce to implement those aspects of the policy that drew on existing skills in treatment and management and to avoid or delay implementation that required the acquisition of new skills in primary prevention. Factors that facilitated the implementation of the PCDS included the addition of new resources, employment of additional staff, training, increased commitment from managers, and the creation of dedicated chronic disease positions. Factors impeding implementation included insufficient numbers of service providers, too little support for current Aboriginal Health Workers, and high staff turnover.

Developing a strategic human resources plan for the Urban Angel.

PubMed

Owen, Susan M

2011-01-01

In healthcare a significant portion of the budget is related to human resources. However, many healthcare organizations have yet to develop and implement a focused organizational strategy that ensures all human resources are managed in a way that best supports the successful achievement of corporate strategies. St. Michael's Hospital, in Toronto, Ontario, recognized the benefits of a strategic human resources management plan. During an eight-month planning process, St. Michael's Hospital undertook the planning for and development of a strategic human resources management plan. Key learnings are outlined in this paper.

Sustainability of Evidence-Based Acute Pain Management Practices for Hospitalized Older Adults.

PubMed

Shuman, Clayton J; Xie, Xian-Jin; Herr, Keela A; Titler, Marita G

2017-11-01

Little is known regarding sustainability of evidence-based practices (EBPs) following implementation. This article reports sustainability of evidence-based acute pain management practices in hospitalized older adults following testing of a multifaceted Translating Research Into Practice (TRIP) implementation intervention. A cluster randomized trial with follow-up period was conducted in 12 Midwest U.S. hospitals (six experimental, six comparison). Use of evidence-based acute pain management practices and mean pain intensity were analyzed using generalized estimating equations across two time points (following implementation and 18 months later) to determine sustainability of TRIP intervention effects. Summative Index scores and six of seven practices were sustained. Experimental and comparison group differences for mean pain intensity over 72 hours following admission were sustained. Results revealed most evidence-based acute pain management practices were sustained for 18 months following implementation. Further work is needed to identify factors affecting sustainability of EBPs to guide development and testing of sustainability strategies.

Modeling the leadership attributes of top management in green innovation implementation

NASA Astrophysics Data System (ADS)

Ishak, Noormaizatul Akmar; Ramli, Mohammad Fadzli

2015-05-01

The implementation of green innovation in the companies is the interest of the governments all over the world. This has been the main focus of the Copenhagen Protocol and Kyoto Protocol that require all governments to preserve the nature through green initiatives. This paper proposes a mathematical model on the leadership attributes of the top management in ensuring green innovation implementation in their companies' strategies to reduce operational cost. With green innovation implementation in the Government-Linked Companies (GLCs), we identify the leadership attributes are tied up to the leadership style of the top managers in the companies. Through this model we have proved that green type leadership always contributes better in cost saving, therefore it is a more efficient leadership attribute for the GLCs especially.

Knowledge-based system for flight information management. Thesis

NASA Technical Reports Server (NTRS)

Ricks, Wendell R.

1990-01-01

The use of knowledge-based system (KBS) architectures to manage information on the primary flight display (PFD) of commercial aircraft is described. The PFD information management strategy used tailored the information on the PFD to the tasks the pilot performed. The KBS design and implementation of the task-tailored PFD information management application is described. The knowledge acquisition and subsequent system design of a flight-phase-detection KBS is also described. The flight-phase output of this KBS was used as input to the task-tailored PFD information management KBS. The implementation and integration of this KBS with existing aircraft systems and the other KBS is described. The flight tests are examined of both KBS's, collectively called the Task-Tailored Flight Information Manager (TTFIM), which verified their implementation and integration, and validated the software engineering advantages of the KBS approach in an operational environment.

Strategies to facilitate implementation and sustainability of large system transformations: a case study of a national program for improving quality of care for elderly people.

PubMed

Nyström, Monica Elisabeth; Strehlenert, Helena; Hansson, Johan; Hasson, Henna

2014-09-18

Large-scale change initiatives stimulating change in several organizational systems in the health and social care sector are challenging both to lead and evaluate. There is a lack of systematic research that can enrich our understanding of strategies to facilitate large system transformations in this sector. The purpose of this study was to examine the characteristics of core activities and strategies to facilitate implementation and change of a national program aimed at improving life for the most ill elderly people in Sweden. The program outcomes were also addressed to assess the impact of these strategies. A longitudinal case study design with multiple data collection methods was applied. Archival data (n = 795), interviews with key stakeholders (n = 11) and non-participant observations (n = 23) were analysed using content analysis. Outcome data was obtained from national quality registries. This study presents an approach for implementing a large national change program that is characterized by initial flexibility and dynamism regarding content and facilitation strategies and a growing complexity over time requiring more structure and coordination. The description of activities and strategies show that the program management team engaged a variety of stakeholders and actor groups and accordingly used a palate of different strategies. The main strategies used to influence change in the target organisations were to use regional improvement coaches, regional strategic management teams, national quality registries, financial incentives and annually revised agreements. Interactive learning sessions, intense communication, monitor and measurements, and active involvement of different experts and stakeholders, including elderly people, complemented these strategies. Program outcomes showed steady progress in most of the five target areas, less so for the target of achieving coordinated care. There is no blue-print on how to approach the challenging task of leading large scale change programs in complex contexts, but our conclusion is that more attention has to be given to the multidimensional strategies that program management need to consider. This multidimensionality comprises different strategies depending on types of actors, system levels, contextual factors, program progress over time, program content, types of learning and change processes, and the conditions for sustainability.

Control Strategy Scenarios for the Alien Lionfish Pterois volitans in Chinchorro Bank (Mexican Caribbean): Based on Semi-Quantitative Loop Analysis

PubMed Central

Ortiz, Marco; Rodriguez-Zaragoza, Fabián; Hermosillo-Nuñez, Brenda; Jordán, Ferenc

2015-01-01

Ecological and eco-social network models were constructed with different levels of complexity in order to represent and evaluate management strategies for controlling the alien species Pterois volitans in Chinchorro bank (Mexican Caribbean). Levins´s loop analysis was used as a methodological framework for assessing the local stability (considered as a component of sustainability) of the modeled management interventions represented by various scenarios. The results provided by models of different complexity (models 1 through 4) showed that a reduction of coral species cover would drive the system to unstable states. In the absence of the alien lionfish, the simultaneous fishing of large benthic epifaunal species, adult herbivorous fish and adult carnivorous fish could be sustainable only if the coral species present high levels of cover (models 2 and 3). Once the lionfish is added to the simulations (models 4 and 5), the analysis suggests that although the exploitation or removal of lionfish from shallow waters may be locally stable, it remains necessary to implement additional and concurrent human interventions that increase the holistic sustainability of the control strategy. The supplementary interventions would require the implementation of programs for: (1) the restoration of corals for increasing their cover, (2) the exploitation or removal of lionfish from deeper waters (decreasing the chance of source/sink meta-population dynamics) and (3) the implementation of bans and re-stocking programs for carnivorous fishes (such as grouper) that increase the predation and competition pressure on lionfish (i.e. biological control). An effective control management for the alien lionfish at Chinchorro bank should not be optimized for a single action plan: instead, we should investigate the concurrent implementation of multiple strategies. PMID:26114745

Control Strategy Scenarios for the Alien Lionfish Pterois volitans in Chinchorro Bank (Mexican Caribbean): Based on Semi-Quantitative Loop Analysis.

PubMed

Ortiz, Marco; Rodriguez-Zaragoza, Fabián; Hermosillo-Nuñez, Brenda; Jordán, Ferenc

2015-01-01

Ecological and eco-social network models were constructed with different levels of complexity in order to represent and evaluate management strategies for controlling the alien species Pterois volitans in Chinchorro bank (Mexican Caribbean). Levins´s loop analysis was used as a methodological framework for assessing the local stability (considered as a component of sustainability) of the modeled management interventions represented by various scenarios. The results provided by models of different complexity (models 1 through 4) showed that a reduction of coral species cover would drive the system to unstable states. In the absence of the alien lionfish, the simultaneous fishing of large benthic epifaunal species, adult herbivorous fish and adult carnivorous fish could be sustainable only if the coral species present high levels of cover (models 2 and 3). Once the lionfish is added to the simulations (models 4 and 5), the analysis suggests that although the exploitation or removal of lionfish from shallow waters may be locally stable, it remains necessary to implement additional and concurrent human interventions that increase the holistic sustainability of the control strategy. The supplementary interventions would require the implementation of programs for: (1) the restoration of corals for increasing their cover, (2) the exploitation or removal of lionfish from deeper waters (decreasing the chance of source/sink meta-population dynamics) and (3) the implementation of bans and re-stocking programs for carnivorous fishes (such as grouper) that increase the predation and competition pressure on lionfish (i.e. biological control). An effective control management for the alien lionfish at Chinchorro bank should not be optimized for a single action plan: instead, we should investigate the concurrent implementation of multiple strategies.

Sustainable intensification by managing microbial communities and processes in agroecosystems

USDA-ARS?s Scientific Manuscript database

By focusing on soil biology and biochemistry, agroecosystem management strategies are implemented which include reduced soil disturbance, diverse and adaptable crop rotations, retention of residue, and incorporation of livestock, cover crops, or both This systems approach is required to sustainably ...

Total Quality Management Implementation Strategy: Directorate of Quality Assurance

DTIC Science & Technology

1989-05-01

Total Quality Control Harrington, H. James The Improvement Process Imai, Masaaki Kaizen Ishikawa , Kaoru What is Total Quality Control Ishikawa ... Kaoru Statistical Quality Control Juran, J. M. Managerial Breakthrough Juran, J. M. Quality Control Handbook Mizuno, Ed Managing for Quality Improvements

Coping with Multiple Innovations in Schools: An Exploratory Study.

ERIC Educational Resources Information Center

Wallace, Mike

1991-01-01

Reviews small-scale, exploratory research into British schools' management of concurrent educational reform innovations generated by government, local education authorities, and the schools themselves. Describes changing innovations patterns, key factors influencing their adoption and implementation, the central management strategies employed, and…

Strategic Human Resources Management of Employer Cooperative Education Programs.

ERIC Educational Resources Information Center

Nielsen, Richard P.; Porter, Ralph C.

1982-01-01

This article discusses effective strategic planning and management of employer cooperative education programs. It examines types of planning, the need for such programs, and implementation strategies. Several case studies are considered: Dayton-Hudson, IBM, AT&T, Delta Airlines, and Rockwell International. (CT)

A mixed methods pilot study with a cluster randomized control trial to evaluate the impact of a leadership intervention on guideline implementation in home care nursing.

PubMed

Gifford, Wendy A; Davies, Barbara; Graham, Ian D; Lefebre, Nancy; Tourangeau, Ann; Woodend, Kirsten

2008-12-10

Foot ulcers are a significant problem for people with diabetes. Comprehensive assessments of risk factors associated with diabetic foot ulcer are recommended in clinical guidelines to decrease complications such as prolonged healing, gangrene and amputations, and to promote effective management. However, the translation of clinical guidelines into nursing practice remains fragmented and inconsistent, and a recent homecare chart audit showed less than half the recommended risk factors for diabetic foot ulcers were assessed, and peripheral neuropathy (the most significant predictor of complications) was not assessed at all. Strong leadership is consistently described as significant to successfully transfer guidelines into practice. Limited research exists however regarding which leadership behaviours facilitate and support implementation in nursing. The purpose of this pilot study is to evaluate the impact of a leadership intervention in community nursing on implementing recommendations from a clinical guideline on the nursing assessment and management of diabetic foot ulcers. Two phase mixed methods design is proposed (ISRCTN 12345678). Phase I: Descriptive qualitative to understand barriers to implementing the guideline recommendations, and to inform the intervention. Phase II: Matched pair cluster randomized controlled trial (n = 4 centers) will evaluate differences in outcomes between two implementation strategies. Nursing assessments of client risk factors, a composite score of 8 items based on Diabetes/Foot Ulcer guideline recommendations. In addition to the organization's 'usual' implementation strategy, a 12 week leadership strategy will be offered to managerial and clinical leaders consisting of: a) printed materials, b) one day interactive workshop to develop a leadership action plan tailored to barriers to support implementation; c) three post-workshop teleconferences. This study will provide vital information on which leadership strategies are well received to facilitate and support guideline implementation. The anticipated outcomes will provide information to assist with effective management of foot ulcers for people with diabetes. By tracking clinical outcomes associated with guideline implementation, health care administrators will be better informed to influence organizational and policy decision-making to support evidence-based quality care. Findings will be useful to inform the design of future multi-centered trials on various clinical topics to enhance knowledge translation for positive outcomes.

Child Sexual Abuse in Zimbabwe.

PubMed

Mantula, Fennie; Saloojee, Haroon

2016-01-01

Although child sexual abuse is a significant public health problem globally, its incidence, prevention, and management is less well described in resource-poor settings. In poorer settings prevention initiatives assume even more importance since resources for managing abused children are severely limited. This article examines the current status of policy and practice related to the prevention of child sexual abuse in Zimbabwe. It identifies implementation challenges and highlights opportunities that could be embraced to reduce CSA in Zimbabwe, based on evidence synthesized from recent work. Although Zimbabwe has a well-established legal and regulatory framework to protect children from child sexual abuse, implementation of existing policies is weak. Financial, human, and material resource constraints are frequently cited to explain limited prevention activity. Effective strategies for the prevention of child sexual abuse should focus on implementing existing legislation, targeting schoolchildren, and getting community involvement. A dedicated budget would help entrench these strategies, but gains can be achieved even in the absence of this.

Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015

PubMed Central

Dvorak, Jiri; Baume, Norbert; Botré, Francesco; Broséus, Julian; Budgett, Richard; Frey, Walter O; Geyer, Hans; Harcourt, Peter Rex; Ho, Dave; Howman, David; Isola, Victor; Lundby, Carsten; Marclay, François; Peytavin, Annie; Pipe, Andrew; Pitsiladis, Yannis P; Reichel, Christian; Robinson, Neil; Rodchenkov, Grigory; Saugy, Martial; Sayegh, Souheil; Segura, Jordi; Thevis, Mario; Vernec, Alan; Viret, Marjolaine; Vouillamoz, Marc; Zorzoli, Mario

2014-01-01

A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward. PMID:24764550

Time for change: a roadmap to guide the implementation of the World Anti-Doping Code 2015.

PubMed

Dvorak, Jiri; Baume, Norbert; Botré, Francesco; Broséus, Julian; Budgett, Richard; Frey, Walter O; Geyer, Hans; Harcourt, Peter Rex; Ho, Dave; Howman, David; Isola, Victor; Lundby, Carsten; Marclay, François; Peytavin, Annie; Pipe, Andrew; Pitsiladis, Yannis P; Reichel, Christian; Robinson, Neil; Rodchenkov, Grigory; Saugy, Martial; Sayegh, Souheil; Segura, Jordi; Thevis, Mario; Vernec, Alan; Viret, Marjolaine; Vouillamoz, Marc; Zorzoli, Mario

2014-05-01

A medical and scientific multidisciplinary consensus meeting was held from 29 to 30 November 2013 on Anti-Doping in Sport at the Home of FIFA in Zurich, Switzerland, to create a roadmap for the implementation of the 2015 World Anti-Doping Code. The consensus statement and accompanying papers set out the priorities for the antidoping community in research, science and medicine. The participants achieved consensus on a strategy for the implementation of the 2015 World Anti-Doping Code. Key components of this strategy include: (1) sport-specific risk assessment, (2) prevalence measurement, (3) sport-specific test distribution plans, (4) storage and reanalysis, (5) analytical challenges, (6) forensic intelligence, (7) psychological approach to optimise the most deterrent effect, (8) the Athlete Biological Passport (ABP) and confounding factors, (9) data management system (Anti-Doping Administration & Management System (ADAMS), (10) education, (11) research needs and necessary advances, (12) inadvertent doping and (13) management and ethics: biological data. True implementation of the 2015 World Anti-Doping Code will depend largely on the ability to align thinking around these core concepts and strategies. FIFA, jointly with all other engaged International Federations of sports (Ifs), the International Olympic Committee (IOC) and World Anti-Doping Agency (WADA), are ideally placed to lead transformational change with the unwavering support of the wider antidoping community. The outcome of the consensus meeting was the creation of the ad hoc Working Group charged with the responsibility of moving this agenda forward.

Focusing management in implementing a smoking ban in a university hospital in Sweden.

PubMed

Ullén, H; Höijer, Y; Ainetdin, T; Tillgren, P

2002-04-01

To explore the impact of various steps when introducing a smoking ban at the Karolinska Hospital (1000 beds; 6000 employees) in Stockholm, Sweden, a multiple evaluation strategy was performed over 5 years. All heads of clinical departments (N = 41) and a random sample of employees (n = 517) and a convenience sample of hospital labour managers (n = 17) were separately addressed through questionnaire surveys at different time intervals after the introduction of the ban in 1992. An observational and interview study completed the follow-up. The implementation process was supplemented by a comprehensive information strategy over 5 years. The two most important steps during implementation were management support and focus on environmental tobacco. The ban was well known at introduction. Heads of clinical departments reported a third of staff to be satisfied with the restrictions. In contrast, the staff survey revealed 62% to be positive. A shift in favour of a radical tobacco-free hospital was perceived during follow-up. Co-operation between hospital board, heads of clinical departments and local labour managers proved successful. The consecutive evaluations served as tools in labour management and contributed to staff compliance. A total ban, including the selling of tobacco and smoking in the hospital grounds is still to be achieved.

The Ontario Osteoporosis Strategy: implementation of a population-based osteoporosis action plan in Canada

PubMed Central

Hawker, G.; Cameron, C.; Canavan, J.; Beaton, D.; Bogoch, E.; Jain, R.; Papaioannou, A.

2016-01-01

In the last decade, there have been a number of action plans published to highlight the importance of preventing osteoporosis and related fractures. In the province of Ontario Canada, the Ministry of Health provided funding for the Ontario Osteoporosis Strategy. The goal is to reduce morbidity, mortality, and costs from osteoporosis and related fractures through an integrated and comprehensive approach aimed at health promotion and disease management. This paper describes the components of the Ontario Osteoporosis Strategy and progress on implementation efforts as of March 2009. There are five main components: health promotion; bone mineral density testing, access, and quality; postfracture care; professional education; and research and evaluation. Responsibility for implementation of the initiatives within the components is shared across a number of professional and patient organizations and academic teaching hospitals with osteoporosis researchers. The lessons learned from each phase of the development, implementation, and evaluation of the Ontario Osteoporosis Strategy provides a tremendous opportunity to inform other jurisdictions embarking on implementing similar large-scale bone health initiatives. PMID:20309525

Language-learning disabilities: Paradigms for the nineties.

PubMed

Wiig, E H

1991-01-01

We are beginning a decade, during which many traditional paradigms in education, special education, and speech-language pathology will undergo change. Among paradigms considered promising for speech-language pathology in the schools are collaborative language intervention and strategy training for language and communication. This presentation introduces management models for developing a collaborative language intervention process, among them the Deming Management Method for Total Quality (TQ) (Deming 1986). Implementation models for language assessment and IEP planning and multicultural issues are also introduced (Damico and Nye 1990; Secord and Wiig in press). While attention to processes involved in developing and implementing collaborative language intervention is paramount, content should not be neglected. To this end, strategy training for language and communication is introduced as a viable paradigm. Macro- and micro-level process models for strategy training are featured and general issues are discussed (Ellis, Deshler, and Schumaker 1989; Swanson 1989; Wiig 1989).

The Proposal Concept of Development and Implementation in Strategy of Sustainable Corporate Social Responsibility in the Context of the HCS Model 3E

NASA Astrophysics Data System (ADS)

Sakál, Peter; Hrdinová, Gabriela

2016-06-01

This article is the result of a conceptual design methodology for the development of a sustainable strategy of sustainable corporate social responsibility (SCSR) in the context of the HCS model 3E formed, as a co-author within the stated grants and dissertation. On the basis of the use of propositional logic, the SCSR procedure is proposed for incorporation into the corporate strategy of sustainable development and the integrated management system (IMS) of the industrial enterprise. The aim of this article is the proposal of the concept of development and implementation strategy of SCSR in the context of the HCS model 3E.

Air quality management in Portugal: example of needs and available tools.

PubMed

Borrego, C; Miranda, A I; Coutinho, M; Ferreira, J; Carvalho, A C

2002-01-01

The Framework Directive (FWD) and the proposed Daughter Directives are the newest legislative instruments concerning a new political strategy and air quality management approach for Europe. Additionally, the member countries of the United Nations Economic Commission for Europe have included the concepts of critical load and level for planning air pollution abatement strategies and as a base of international agreements concerning limitation of the emissions of air pollutants. These concepts imply an accurate knowledge about pollutants deposition fluxes. The paper describes the main needs and the tools available to define a strategy of air quality management in Portugal. Two study cases are presented: (1) extensive monitoring plan to assess the impact of an urban incinerator plant; and (2) contribution to a methodology to estimate critical levels for a coastal region in Portugal. These different approaches allowed illustrating the complexity of the implementation of an air pollution management strategy.

Single-entry models (SEMs) for scheduled services: Towards a roadmap for the implementation of recommended practices.

PubMed

Lopatina, Elena; Damani, Zaheed; Bohm, Eric; Noseworthy, Tom W; Conner-Spady, Barbara; MacKean, Gail; Simpson, Chris S; Marshall, Deborah A

2017-09-01

Long waiting times for elective services continue to be a challenging issue. Single-entry models (SEMs) are used to increase access to and flow through the healthcare system. This paper provides a roadmap for healthcare decision-makers, managers, physicians, and researchers to guide implementation and management of successful and sustainable SEMs. The roadmap was informed by an inductive qualitative synthesis of the findings from a deliberative process (a symposium on SEMs, with clinicians, researchers, senior policy-makers, healthcare managers, and patient representatives) and focus groups with the symposium participants. SEMs are a promising strategy to improve the management of referrals and represent one approach to reduce waiting times. The SEMs roadmap outlines current knowledge about SEMs and critical success factors for SEMs' implementation and management. This SEM roadmap is intended to help clinicians, decision-makers, managers, and researchers interested in developing new or strengthening existing SEMs. We consider this roadmap to be a living document that will continue to evolve as we learn more about implementing and managing sustainable SEMs. Copyright © 2017 Elsevier B.V. All rights reserved.

Teaching the Balanced Scorecard through Simulation

ERIC Educational Resources Information Center

Capelo, Carlos; Lopes, Ana Isabel; Mata, Ana

2012-01-01

Kaplan and Norton introduced the Balanced Scorecard (BSC) which is based on a systems perspective of the business strategy and performance measurement. Many organizations around the world are using the BSC to define, implement and manage strategy. Nevertheless there exist studies that identify problems and limitations associated with the…

Clinical Practice Guideline Implementation Strategy Patterns in Veterans Affairs Primary Care Clinics

PubMed Central

Hysong, Sylvia J; Best, Richard G; Pugh, Jacqueline A

2007-01-01

Background The Department of Veterans Affairs (VA) mandated the system-wide implementation of clinical practice guidelines (CPGs) in the mid-1990s, arming all facilities with basic resources to facilitate implementation; despite this resource allocation, significant variability still exists across VA facilities in implementation success. Objective This study compares CPG implementation strategy patterns used by high and low performing primary care clinics in the VA. Research Design Descriptive, cross-sectional study of a purposeful sample of six Veterans Affairs Medical Centers (VAMCs) with high and low performance on six CPGs. Subjects One hundred and two employees (management, quality improvement, clinic personnel) involved with guideline implementation at each VAMC primary care clinic. Measures Participants reported specific strategies used by their facility to implement guidelines in 1-hour semi-structured interviews. Facilities were classified as high or low performers based on their guideline adherence scores calculated through independently conducted chart reviews. Findings High performing facilities (HPFs) (a) invested significantly in the implementation of the electronic medical record and locally adapting it to provider needs, (b) invested dedicated resources to guideline-related initiatives, and (c) exhibited a clear direction in their strategy choices. Low performing facilities exhibited (a) earlier stages of development for their electronic medical record, (b) reliance on preexisting resources for guideline implementation, with little local adaptation, and (c) no clear direction in their strategy choices. Conclusion A multifaceted, yet targeted, strategic approach to guideline implementation emphasizing dedicated resources and local adaptation may result in more successful implementation and higher guideline adherence than relying on standardized resources and taxing preexisting channels. PMID:17355583

Power inequalities in the assessment of nursing competency within the workplace: implications for nursing management.

PubMed

Cusack, Lynette; Smith, Morgan

2010-09-01

This article explores the power implications of implementing competency-based assessments within the nursing work environment from a manager's perspective. It discusses how the implementation of competency-based assessments for continuing education may affect workplace culture, in particular, the use of power, within the nursing team. The term "managers" for the purpose of this article is defined as "nurses in senior administrative and educational positions within a health care facility." This article adds to the discourse on competency-based models by emphasizing the effect of the nursing work environment on the competency-based assessment process. It concludes by identifying strategies that can be used by nursing management when designing and implementing an effective and fair competency-based assessment for the nursing workplace. Copyright 2010, SLACK Incorporated.

Global Access Programs: A Collaborative Approach for Effective Implementation and Management.

PubMed

Ainge, Debra; Aitken, Suzanne; Corbett, Mark; De-Keyzer, David

Global access programs (GAPs) provide access to medicinal products for patients with serious medical conditions and no commercially available treatment options. Providing early access to medicines can be challenging for a pharmaceutical company. The demand for a GAP often occurs at a time when other activities are the prime focus, such as delivery of pivotal clinical trials or gaining of marketing authorization. Furthermore, the skills, experience, and infrastructure necessary to implement and manage a successful GAP vary significantly from those required for regular clinical trial execution, and the regulatory environment presents its own challenges, with regulations often poorly defined and with considerable inter-country variation. This article considers the triggers for early access requests and examines the need for companies to develop a global strategy for GAPs in order to respond appropriately to requests for early access. It also provides a comprehensive overview of the processes for GAP set-up, implementation, management, and closure, along with the considerations affecting the type and scope of GAP, such as demand, regulatory feasibility, license status of the product, drug pricing structure, company strategy, costs, and product supply. Also discussed is the need for appropriate personnel to implement and manage the GAP, and when to consider collaboration with an external GAP provider. In summary, GAPs require careful and efficient planning and management, from set-up to closure. Well-run GAPs provide an ethical and regulatory-compliant pathway for access of new treatments to patients with serious conditions and an unmet medical need.

Instructional and behavior management practices implemented by elementary general education teachers.

PubMed

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

2013-12-01

This investigation examined 317 general education kindergarten through fifth-grade teachers' use of instructional and behavioral management strategies as measured by the Classroom Strategy Scale (CSS)-Observer Form, a multidimensional tool for assessing classroom practices. The CSS generates frequency of strategy use and discrepancy scores reflecting the difference between recommended and actual frequencies of strategy use. Hierarchical linear models (HLMs) suggested that teachers' grade-level assignment was related to their frequency of using instructional and behavioral management strategies: Lower grade teachers utilized more clear 1 to 2 step commands, praise statements, and behavioral corrective feedback strategies than upper grade teachers, whereas upper grade teachers utilized more academic monitoring and feedback strategies, content/concept summaries, student focused learning and engagement, and student thinking strategies than lower grade teachers. Except for the use of praise statements, teachers' usage of instructional and behavioral management strategies was not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. HLMs suggested that teachers' grade level was related to their discrepancy scores of some instructional and behavioral management strategies: Upper grade teachers had higher discrepancy scores in academic performance feedback, behavioral feedback, and praise than lower grade teachers. Teachers' discrepancy scores of instructional and behavioral management strategies were not found to be related to years of teaching experience or to the interaction of years of teaching experience and grade-level assignment. Implications of results for school psychology practice are outlined. © 2013.

The development of a strategy for the implementation of automation in a bioanalytical laboratory.

PubMed

Mole, D; Mason, R J; McDowall, R D

1993-03-01

Laboratory automation is equipment, instrumentation, software and techniques that are classified into four groups: instrument automation; communications; data to information conversion; and information management. This new definition is necessary to understand the role that automation can play in achieving the aims and objectives of a laboratory within its organization. To undertake automation projects effectively, a laboratory automation strategy is outlined which requires an intimate knowledge of an organization and the target environment to implement individual automation projects.

Strategies and recommendations for addressing forest health issues in the Blue Mountains of Oregon and Washington.

Treesearch

J.A. Tanaka; G.L. Starr; T.M. Quigley

1995-01-01

The Blue Mountains Natural Resources Institute held three types of meetings to obtain public and scientific input into the development of strategies and recommendations for addressing forest health issues in the Blue Mountains of Oregon and Washington. Seven strategies are proposed: (1) plan and implement management activities on a landscape level; (2) enhance training...

Management Strategies for Positive Mental Health Outcomes: What Early Childhood Administrators Need to Know

ERIC Educational Resources Information Center

Green, Beth; Everhart, Maria C.; Gordon, Lynwood; Friesen, Barbara

2004-01-01

The focus of this training is on understanding ways to design and implement an overall mental health strategy in your program. The authors are not going to talk about specific intervention strategies, such as how to deal with challenging behavior in the classroom, or how to identify and screen children with possible mental health issues. Instead,…

Value for money in changing clinical practice: should decisions about guidelines and implementation strategies be made sequentially or simultaneously?

PubMed

Hoomans, Ties; Severens, Johan L; Evers, Silvia M A A; Ament, Andre J H A

2009-01-01

Decisions about clinical practice change, that is, which guidelines to adopt and how to implement them, can be made sequentially or simultaneously. Decision makers adopting a sequential approach first compare the costs and effects of alternative guidelines to select the best set of guideline recommendations for patient management and subsequently examine the implementation costs and effects to choose the best strategy to implement the selected guideline. In an integral approach, decision makers simultaneously decide about the guideline and the implementation strategy on the basis of the overall value for money in changing clinical practice. This article demonstrates that the decision to use a sequential v. an integral approach affects the need for detailed information and the complexity of the decision analytic process. More importantly, it may lead to different choices of guidelines and implementation strategies for clinical practice change. The differences in decision making and decision analysis between the alternative approaches are comprehensively illustrated using 2 hypothetical examples. We argue that, in most cases, an integral approach to deciding about change in clinical practice is preferred, as this provides more efficient use of scarce health-care resources.

Dispatch Strategy Development for Grid-tied Household Energy Systems

NASA Astrophysics Data System (ADS)

Cardwell, Joseph

The prevalence of renewable generation will increase in the next several decades and offset conventional generation more and more. Yet this increase is not coming without challenges. Solar, wind, and even some water resources are intermittent and unpredictable, and thereby create scheduling challenges due to their inherent "uncontrolled" nature. To effectively manage these distributed renewable assets, new control algorithms must be developed for applications including energy management, bridge power, and system stability. This can be completed through a centralized control center though efforts are being made to parallel the control architecture with the organization of the renewable assets themselves--namely, distributed controls. Building energy management systems are being employed to control localized energy generation, storage, and use to reduce disruption on the net utility load. One such example is VOLTTRONTM, an agent-based platform for building energy control in real time. In this thesis, algorithms developed in VOLTTRON simulate a home energy management system that consists of a solar PV array, a lithium-ion battery bank, and the grid. Dispatch strategies are implemented to reduce energy charges from overall consumption (/kWh) and demand charges (/kW). Dispatch strategies for implementing storage devices are tuned on a month-to-month basis to provide a meaningful economic advantage under simulated scenarios to explore algorithm sensitivity to changing external factors. VOLTTRON agents provide automated real-time optimization of dispatch strategies to efficiently manage energy supply and demand, lower consumer costs associated with energy usage, and reduce load on the utility grid.

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

DTIC Science & Technology

1989-09-01

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

Interpretation and Nonformal Environmental Education in Natural Resources Management.

ERIC Educational Resources Information Center

Olson, E. C.; And Others

1984-01-01

A visitor education strategy was developed, implemented, and tested for its effectiveness in raising levels of knowledge and attitudes toward state nature preserve management. Visitor sociodemographic and site-specific data were also collected and analyzed. Methodology, results, conclusions, and implications are reported. (Author/JN)

Managing for Results Through Teams.

ERIC Educational Resources Information Center

Chand, Sunil; Holm, Maudie L.

1998-01-01

Using examples from Cuyahoga Community College, this article examines the nature of teams, how they are suited to community college management, and how they can increase the effectiveness of community colleges. Presents tangible implementation strategies and unique applications for community colleges, including the use of faculty as team…

Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study.

PubMed

Ben Oumlil, A; Rao, C P

1992-01-01

Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.

Implementation of a Project Management Office (PMO)--experiences from year 1.

PubMed

Isola, Miriam; Polikaitis, Audrius; Laureto, Rose Ann

2006-01-01

Recognized as an early leader in clinical information systems, the University of Illinois Medical Center was challenged to meet the ever-increasing demand for information systems. Interviews with key stakeholders revealed unfavorable attitudes toward the Information Services department. Reasons given were that projects often are not aligned with business strategy, projects are delayed, IS itself is a barrier to progress, and a lack of proactive planning precipitates crises. Under the leadership of a new CIO, IS began developing a Project Management Office, or PMO, to better meet medical center business objectives and to more effectively manage technology projects. Successes during the first year included comprehensive IT strategic planning. Collaborative relationships were established with departmental leaders for planning, prioritizing, budgeting, and executing projects. A formal Web-based process for requesting IS projects was implemented, project management training was provided, and elements of standard project management methodology were implemented. While a framework for effective project management was created, significant effort is still required to firmly root these new processes within the organizational culture. Project management office goals for the second year include implementing a project portfolio management tool, refining the benefits methodology, and continuing the advancement of the project management methodology.

Database Objects vs Files: Evaluation of alternative strategies for managing large remote sensing data

NASA Astrophysics Data System (ADS)

Baru, Chaitan; Nandigam, Viswanath; Krishnan, Sriram

2010-05-01

Increasingly, the geoscience user community expects modern IT capabilities to be available in service of their research and education activities, including the ability to easily access and process large remote sensing datasets via online portals such as GEON (www.geongrid.org) and OpenTopography (opentopography.org). However, serving such datasets via online data portals presents a number of challenges. In this talk, we will evaluate the pros and cons of alternative storage strategies for management and processing of such datasets using binary large object implementations (BLOBs) in database systems versus implementation in Hadoop files using the Hadoop Distributed File System (HDFS). The storage and I/O requirements for providing online access to large datasets dictate the need for declustering data across multiple disks, for capacity as well as bandwidth and response time performance. This requires partitioning larger files into a set of smaller files, and is accompanied by the concomitant requirement for managing large numbers of file. Storing these sub-files as blobs in a shared-nothing database implemented across a cluster provides the advantage that all the distributed storage management is done by the DBMS. Furthermore, subsetting and processing routines can be implemented as user-defined functions (UDFs) on these blobs and would run in parallel across the set of nodes in the cluster. On the other hand, there are both storage overheads and constraints, and software licensing dependencies created by such an implementation. Another approach is to store the files in an external filesystem with pointers to them from within database tables. The filesystem may be a regular UNIX filesystem, a parallel filesystem, or HDFS. In the HDFS case, HDFS would provide the file management capability, while the subsetting and processing routines would be implemented as Hadoop programs using the MapReduce model. Hadoop and its related software libraries are freely available. Another consideration is the strategy used for partitioning large data collections, and large datasets within collections, using round-robin vs hash partitioning vs range partitioning methods. Each has different characteristics in terms of spatial locality of data and resultant degree of declustering of the computations on the data. Furthermore, we have observed that, in practice, there can be large variations in the frequency of access to different parts of a large data collection and/or dataset, thereby creating "hotspots" in the data. We will evaluate the ability of different approaches for dealing effectively with such hotspots and alternative strategies for dealing with hotspots.

Exploring information technology adoption by family physicians: survey instrument valuation.

PubMed Central

Dixon, D. R.; Stewart, M.

2000-01-01

As the information needs of family physicians become more complex, there will be a greater need to successfully implement the technologies needed to manage that information. The ability to stratify primary care physicians can enable the implementation process to be more efficient. This research tested a new instrument on 101 family physicians, and was able to stratify physicians into high, intermediate, and low information technology (IT) usage groups. It is expected that this stratification would allow managers of IT implementation to target specific adoption strategies for each group. The instrument is available from ddixon@julian.uwo.ca. PMID:11079870

Paranal maintenance and CMMS experience

NASA Astrophysics Data System (ADS)

Montano, Nelson

2004-10-01

During the last four years of operations, low technical downtime has been one of the relevant records of the Paranal Observatory. From the beginning of the Very Large Telescope (VLT) project, European Southern Observatory (ESO) has considered the implementation of a proper maintenance strategy a fundamental point in order to ensure low technical down time and preserve the Observatory's assets. The implementation of the maintenance strategy was based on the following aspects: - Strong maintenance sense during the design stage. Line Replacement Unit (LRU) concept, standardization and modularity of the Observatory equipment - Creation of a dedicated team for Maintenance - The implementation of a Computerized Maintenance Management System After four operational years, the result of these aspects has exceeded the expectations; the Observatory has been operating with high availability under a sustainable strategy. The strengths of the maintenance strategy have been based on modern maintenance concepts applied by regular production companies, where any minute of down time involves high cost. The operation of the actual Paranal Maintenance System is based mainly on proactive activities, such as regular inspections, preventive maintenance (PM) and predictive maintenance (PdM) plans. Nevertheless, it has been necessary to implement a strong plan for corrective maintenance (CM). The Spare Parts Strategy has also been an important point linked to the Maintenance Strategy and CMMS implementation. At present, almost 4,000 items related to the Observatory spare parts are loaded into the CMMS database. Currently, we are studying the implementation of a Reliability Centered Maintenance (RCM) project in one of our critical systems The following document presents the actual status of the Paranal Maintenance Strategy and which have been the motivations to implement the established strategy.

Mitigating the Impact of Nurse Manager Large Spans of Control.

PubMed

Simpson, Brenda Baird; Dearmon, Valorie; Graves, Rebecca

Nurse managers are instrumental in achievement of organizational and unit performance goals. Greater spans of control for managers are associated with decreased satisfaction and performance. An interprofessional team measured one organization's nurse manager span of control, providing administrative assistant support and transformational leadership development to nurse managers with the largest spans of control. Nurse manager satisfaction and transformational leadership competency significantly improved following the implementation of large span of control mitigation strategies.

Using Positive Behavior Support to Design Effective Classrooms

ERIC Educational Resources Information Center

Anderson, Cynthia M.; Spaulding, Scott A.

2007-01-01

A number of evidence-based classroom management approaches, procedures, and programs have been developed and presented over the years. In this article the authors synthesize recommendations from various sources, focusing on evidence-based strategies that can be implemented in a systematic manner. They focus specifically on universal strategies,…

Managerial Solutions: An Exercise in Developing Successful Communication Strategies.

ERIC Educational Resources Information Center

Hufman, Melody

Noting that every business person needs good communication skills, whether managers and employees, superordinates and subordinates, this paper outlines an exercise to teach students to set objectives, develop criteria, analyze perspectives, and implement successful communication strategies. The total time for the exercise is 2 hours and the number…

Reviews of Research: Childhood Stress.

ERIC Educational Resources Information Center

Jewett, Jan

1997-01-01

Reviews research on how stress affects young children and how it can be managed. Provides information on internal and external sources of stress, symptoms of stress in children, the four stages of stress experienced by children (alarm, appraisal, search for a coping strategy, and implementation of the strategy), and stress prevention and…

Use of Coaching and Behavior Support Planning for Students with Disruptive Behavior within a Universal Classroom Management Program

ERIC Educational Resources Information Center

Reinke, Wendy M.; Stormont, Melissa; Herman, Keith C.; Wang, Ze; Newcomer, Lori; King, Kathleen

2014-01-01

Even with the use of effective universal classroom management practices, some students will need additional behavioral supports. However, to translate implementation of new strategies into the classroom, professional development programs need to be adaptive to the complexities teachers face in providing instruction and managing classroom behaviors…

Collaboratively managing sudden oak death using tangible geospatial modeling

Treesearch

Ross K. Meentemeyer; Francesco Tonini; Douglas Shoemaker; Richard C. Cobb; Brendan A. Harmon; Vaclav Petras; Anna Petrasova; Helena Mitasova

2017-01-01

Failure to build consensus amongst stakeholders has been a primary obstacle barring progress in developing and implementing strategies to manage sudden oak death (SOD). Consensus as to the goals of in situ management of SOD has rarely been reached, because stakeholders’ visions of success vary widely and often compete with each other...

The role of social science in sucessfully implementing watershed management strategies

Treesearch

Kristin Floress; Kofi Akamani; Kathleen E. Halvorsen; Andrew T. Kozich; Mae Davenport

2015-01-01

Successful watershed management and changes in water quality conditions are dependent upon changes in human behaviors. Those tasked with managing watersheds and other natural resources often assume that people are not acting to protect or restore their resources because they lack the necessary knowledge and understanding. However, individual behaviors are impacted by a...

Alberta's systems approach to chronic disease management and prevention utilizing the expanded chronic care model.

PubMed

Delon, Sandra; Mackinnon, Blair

2009-01-01

Alberta's integrated approach to chronic disease management programming embraces client-centred care, supports self-management and facilitates care across the continuum. This paper presents strategies implemented through collaboration with primary care to improve care of individuals with chronic conditions, evaluation evidence supporting success and lessons learned from the Alberta perspective.

Enhancing Classroom Management Using the Classroom Check-up Consultation Model with In-Vivo Coaching and Goal Setting Components

ERIC Educational Resources Information Center

Kleinert, Whitney L.; Silva, Meghan R.; Codding, Robin S.; Feinberg, Adam B.; St. James, Paula S.

2017-01-01

Classroom management is essential to promote learning in schools, and as such it is imperative that teachers receive adequate support to maximize their competence implementing effective classroom management strategies. One way to improve teachers' classroom managerial competence is through consultation. The Classroom Check-Up (CCU) is a structured…

76 FR 46718 - Fisheries of the Caribbean, Gulf of Mexico, and South Atlantic; Snapper-Grouper Fishery Off the...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-03

... sector using the March 11, 2011, date as part of a management strategy. Control dates are intended to... the South Atlantic. If changes to the management regime are developed and implemented under the Magnuson-Stevens Fishery Conservation and Management Act (Magnuson-Stevens Act), a control date could be...

Consequence Management - Ready or Not?

DTIC Science & Technology

2003-04-07

Defense will have sufficient capability and be ready to respond to a Weapons of Mass Destruction/ Effects attack. An effective consequence management...Defense adopts the National Military Strategy and its consequence management approach, it must identify Weapons of Mass Destruction/ Effects threats...that the Department of Defense: develop Weapons of Mass Destruction/ Effects performance standards for response assets; implement a consequence

Nurse manager succession planning: A cost-benefit analysis.

PubMed

Phillips, Tracy; Evans, Jennifer L; Tooley, Stephanie; Shirey, Maria R

2018-03-01

This commentary presents a cost-benefit analysis to advocate for the use of succession planning to mitigate the problems ensuing from nurse manager turnover. An estimated 75% of nurse managers will leave the workforce by 2020. Many benefits are associated with proactively identifying and developing internal candidates. Fewer than 7% of health care organisations have implemented formal leadership succession planning programmes. A cost-benefit analysis of a formal succession-planning programme from one hospital illustrates the benefits of the programme in their organisation and can be replicated easily. Assumptions of nursing manager succession planning cost-benefit analysis are identified and discussed. The succession planning exemplar demonstrates the integration of cost-benefit analysis principles. Comparing the costs of a formal nurse manager succession planning strategy with the status quo results in a positive cost-benefit ratio. The implementation of a formal nurse manager succession planning programme effectively reduces replacement costs and time to transition into the new role. This programme provides an internal pipeline of future leaders who will be more successful than external candidates. Using an actual cost-benefit analysis equips nurse managers with valuable evidence depicting succession planning as a viable business strategy. © 2017 John Wiley & Sons Ltd.

Best strategies to implement clinical pathways in an emergency department setting: study protocol for a cluster randomized controlled trial

PubMed Central

2013-01-01

Background The clinical pathway is a tool that operationalizes best evidence recommendations and clinical practice guidelines in an accessible format for ‘point of care’ management by multidisciplinary health teams in hospital settings. While high-quality, expert-developed clinical pathways have many potential benefits, their impact has been limited by variable implementation strategies and suboptimal research designs. Best strategies for implementing pathways into hospital settings remain unknown. This study will seek to develop and comprehensively evaluate best strategies for effective local implementation of externally developed expert clinical pathways. Design/methods We will develop a theory-based and knowledge user-informed intervention strategy to implement two pediatric clinical pathways: asthma and gastroenteritis. Using a balanced incomplete block design, we will randomize 16 community emergency departments to receive the intervention for one clinical pathway and serve as control for the alternate clinical pathway, thus conducting two cluster randomized controlled trials to evaluate this implementation intervention. A minimization procedure will be used to randomize sites. Intervention sites will receive a tailored strategy to support full clinical pathway implementation. We will evaluate implementation strategy effectiveness through measurement of relevant process and clinical outcomes. The primary process outcome will be the presence of an appropriately completed clinical pathway on the chart for relevant patients. Primary clinical outcomes for each clinical pathway include the following: Asthma—the proportion of asthmatic patients treated appropriately with corticosteroids in the emergency department and at discharge; and Gastroenteritis—the proportion of relevant patients appropriately treated with oral rehydration therapy. Data sources include chart audits, administrative databases, environmental scans, and qualitative interviews. We will also conduct an overall process evaluation to assess the implementation strategy and an economic analysis to evaluate implementation costs and benefits. Discussion This study will contribute to the body of evidence supporting effective strategies for clinical pathway implementation, and ultimately reducing the research to practice gaps by operationalizing best evidence care recommendations through effective use of clinical pathways. Trial registration ClinicalTrials.gov: NCT01815710 PMID:23692634

Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial.

PubMed

Keurhorst, M; Anderson, P; Heinen, M; Bendtsen, Preben; Baena, Begoña; Brzózka, Krzysztof; Colom, Joan; Deluca, Paolo; Drummond, Colin; Kaner, Eileen; Kłoda, Karolina; Mierzecki, Artur; Newbury-Birch, Dorothy; Okulicz-Kozaryn, Katarzyna; Palacio-Vieira, Jorge; Parkinson, Kathryn; Reynolds, Jillian; Ronda, Gaby; Segura, Lidia; Słodownik, Luiza; Spak, Fredrik; van Steenkiste, Ben; Wallace, Paul; Wolstenholme, Amy; Wojnar, Marcin; Gual, Antoni; Laurant, M; Wensing, M

2016-07-16

Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation. In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design. Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups. The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science. ClinicalTrials.gov: NCT01501552.

Reduced prevalence and severity of wounds following implementation of the Champions for Skin Integrity model to facilitate uptake of evidence-based practice in aged care.

PubMed

Edwards, Helen E; Chang, Anne M; Gibb, Michelle; Finlayson, Kathleen J; Parker, Christina; O'Reilly, Maria; McDowell, Jan; Shuter, Patricia

2017-12-01

To evaluate the implementation of the Champions for Skin Integrity model on facilitating uptake of evidence-based wound management and improving skin integrity in residents of aged care facilities. The incidence of skin tears, pressure injuries and leg ulcers increases with age, and such wounds can be a serious issue in aged care facilities. Older adults are not only at higher risk for wounds related to chronic disease but also injuries related to falls and manual handling requirements. A longitudinal, pre-post design. The Champions for Skin Integrity model was developed using evidence-based strategies for transfer of evidence into practice. Data were collected before and six months after implementation of the model. Data on wound management and skin integrity were obtained from two random samples of residents (n = 200 pre; n = 201 post) from seven aged care facilities. A staff survey was also undertaken (n = 126 pre; n = 143 post) of experience, knowledge and evidence-based wound management. Descriptive statistics were calculated for all variables. Where relevant, chi-square for independence or t-tests were used to identify differences between the pre-/postdata. There was a significant decrease in the number of residents with a wound of any type (54% pre vs 43% post, χ 2 4·2, p = 0·041), as well as a significant reduction in specific wound types, for example pressure injuries (24% pre vs 10% post, χ 2 14·1, p < 0·001), following implementation of the model. An increase in implementation of evidence-based wound management and prevention strategies was observed in the postimplementation sample in comparison with the preimplementation sample. This included use of limb protectors and/or protective clothing 6% pre vs 20% post (χ 2 17·0, p < 0·001) and use of an emollient or soap alternative for bathing residents (50% pre vs 74% post, χ 2 13·9, p = 0·001). Implementation of the model in this sample fostered an increase in implementation of evidence-based wound management and prevention strategies, which was associated with a decrease in the prevalence and severity of wounds. This study suggests the Champions for Skin Integrity model has the potential to improve uptake of evidence-based wound management and improve skin integrity for older adults. © 2017 John Wiley & Sons Ltd.

Implementation of Integrated Service Networks under the Quebec Mental Health Reform: Facilitators and Barriers associated with Different Territorial Profiles.

PubMed

Fleury, Marie-Josée; Grenier, Guy; Vallée, Catherine; Aubé, Denise; Farand, Lambert

2017-03-10

This study evaluates implementation of the Quebec Mental Health Reform (2005-2015), which promoted the development of integrated service networks, in 11 local service networks organized into four territorial groups according to socio-demographic characteristics and mental health services offered. Data were collected from documents concerning networks; structured questionnaires completed by 90 managers and by 16 respondent-psychiatrists; and semi-structured interviews with 102 network stakeholders. Factors associated with implementation and integration were organized according to: 1) reform characteristics; 2) implementation context; 3) organizational characteristics; and 4) integration strategies. While local networks were in a process of development and expansion, none were fully integrated at the time of the study. Facilitators and barriers to implementation and integration were primarily associated with organizational characteristics. Integration was best achieved in larger networks including a general hospital with a psychiatric department, followed by networks with a psychiatric hospital. Formalized integration strategies such as service agreements, liaison officers, and joint training reduced some barriers to implementation in networks experiencing less favourable conditions. Strategies for the implementation of healthcare reform and integrated service networks should include sustained support and training in best-practices, adequate performance indicators and resources, formalized integration strategies to improve network coordination and suitable initiatives to promote staff retention.

Six steps to a successful dose-reduction strategy

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

Bennett, M.

1995-03-01

The increased importance of demonstrating achievement of the ALARA principle has helped produce a proliferation of dose-reduction ideas. Across a company there may be many dose-reduction items being pursued in a variety of areas. However, companies have a limited amount of resource and, therefore, to ensure funding is directed to those items which will produce the most benefit and that all areas apply a common policy, requires the presence of a dose-reduction strategy. Six steps were identified in formulating the dose-reduction strategy for Rolls-Royce and Associates (RRA): (1) collating the ideas; (2) quantitatively evaluating them on a common basis; (3)more » prioritizing the ideas in terms of cost benefit, (4) implementation of the highest priority items; (5) monitoring their success; (6) periodically reviewing the strategy. Inherent in producing the dose-reduction strategy has been a comprehensive dose database and the RRA-developed dose management computer code DOMAIN, which allows prediction of dose rates and dose. The database enabled high task dose items to be identified, assisted in evaluating dose benefits, and monitored dose trends once items had been implemented. The DOMAIN code was used both in quantifying some of the project dose benefits and its results, such as dose contours, used in some of the dose-reduction items themselves. In all, over fifty dose-reduction items were evaluated in the strategy process and the items which will give greatest benefit are being implemented. The strategy has been successful in giving renewed impetus and direction to dose-reduction management.« less

Business continuity management in international organisations.

PubMed

Adamou, Christel

2014-01-01

In the area of business continuity management, a preliminary review of the literature reveals extensive knowledge, expertise and experience concerning organisations in the private and public sectors. It is interesting to note, however, that there is little literature about business continuity management in international organisations, although these entities are complex and particularly prone to threats. This apparent absence of literature suggests that business continuity management has not yet hit the agenda of international organisations. In recent years, member states have encouraged senior management to design and implement business continuity strategies to minimise the mishandling of an internal crisis and build organisational resilience, but very few of them have actually been able to design and implement comprehensive business continuity programmes. Based on actual experience working in international organisations, this paper outlines some of the challenges faced by international organisations in developing and implementing business continuity activities and attempts to make suggestions for further improvement.

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

PubMed

de Wit, Niek J

2012-01-01

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

Community implementation dynamics: nutrient management in the New York City and Chesapeake Bay watersheds

USDA-ARS?s Scientific Manuscript database

Conservation of natural resources has implications for international, national, and local citizens. The creation of natural resource management and conservation strategies can be affected by engagement with local citizens and competing interests between agencies and stakeholders at the varying leve...

Managing Mentoring Programs.

ERIC Educational Resources Information Center

IUME Briefs, 1992

1992-01-01

Some programs for helping at-risk youth achieve excellent results, while others do not. One reason for program success can be proper management. Mentoring is a promising strategy for helping at-risk youth. Planners who want to create effective mentoring programs should look at the implementation experiences of other youth programs. Evaluations…

Strategic planning features of subsurface management in Kemerovo Oblast

NASA Astrophysics Data System (ADS)

Romanyuk, V.; Grinkevich, A.; Akhmadeev, K.; Pozdeeva, G.

2016-09-01

The article discusses the strategic planning features of regional development based on the production and subsurface management in Kemerovo Oblast. The modern approach - SWOT analysis was applied to assess the regional development strategy. The estimation of regional development plan implementation was given for the foreseeable future.

EVALUATION OF THE IMPLEMENTATION OF ASBESTOS OPERATIONS AND MAINTENANCE PROGRAMS IN NEW JERSEY SCHOOLS

EPA Science Inventory

Removal of asbestos-containing materials (ACM) was encouraged over alternative approaches of asbestos management in the past. However, in-place management and operstions nd maintenance programs are currently viewed by the EPA as the most appropriate overall strategy for managemen...

Management Matters: Planning Goals and Time

ERIC Educational Resources Information Center

Pappas, Marjorie L.

2004-01-01

This article discusses the importance of setting and implementing goals that can help change and improve a library media program over time--goals that go beyond merely keeping the library media center running. Suggestions for developing an action plan and strategies for effective time management are also presented.

Study protocol of an economic evaluation of an extended implementation strategy for the treatment of low back pain in general practice: a cluster randomised controlled trial.

PubMed

Jensen, Cathrine Elgaard; Riis, Allan; Pedersen, Kjeld Møller; Jensen, Martin Bach; Petersen, Karin Dam

2014-10-08

In Denmark, guidelines on low back pain management are currently being implemented; in association with this, a clinical trial is conducted. A health economic evaluation is carried out alongside the clinical trial to assess the cost-effectiveness of an extended implementation strategy to increase the general practitioners' adherence to the guidelines. In addition to usual dissemination, the extended implementation strategy is composed of visits from a guideline facilitator, stratification tools, and feedback on guideline adherence. The aim of this paper is to provide the considerations on the design of the health economic evaluation. The economic evaluation is carried out alongside a cluster randomised controlled trial consisting of 60 general practices in the North Denmark Region. An expected 1,200 patients between the age of 18 and 65 years with a low back pain diagnosis will be enrolled. The economic evaluation comprises both a cost-effectiveness analyses and a cost-utility analysis. Effectiveness measures include referral to secondary care, health-related quality of life measured by EQ-5D-5L, and disability measured by the Roland Morris disability questionnaire. Cost measures include all relevant additional costs of the extended implementation strategy compared to usual implementation. The economic evaluation will be performed from both a societal perspective and a health sector perspective with a 12-month time horizon. It is expected that the extended implementation strategy will reduce the number of patients referred to secondary care. It is hypothesised that the additional upfront cost of extended implementation will be counterbalanced by improvements in clinical practice and patient-related outcomes, thereby rendering the extended implementation strategy cost-effective. ClinicalTrials.gov: NCT01699256.

The status of marine and coastal EBM among a large sample of U.S. federal programs: a social network approach

NASA Astrophysics Data System (ADS)

Dell'Apa, A.; Fullerton, A.; Schwing, F. B.; Brady, M.

2016-12-01

Ecosystem-based management (EBM) is an integrated management approach that considers the entire ecosystem, including humans, across multiple sectors, with the goal to collectively manage natural resources, habitat, and species in a sustainable manner while maintaining ecosystem services to humans on the long-term. In the United States, the National Ocean Council (NOC) established a federal interagency subgroup (National Ocean Policy EBM-Subgroup) to provide policy advice on EBM strategies and technical representation from the federal agencies that are part of the NOC. As part of the NOP EBM-Subgroup effort, this study summarizes the status of EBM for several federal programs within the NOC agencies that implement or support marine and coastal EBM activities. Our objective was to provide an overview of the current state of practice among the many and varied U.S. federal programs employing EBM approaches in the ocean, coastal zone, and the Great Lakes. We used social network analysis techniques to explore similarities among programs in different topic areas (e.g., type of audience, partners, training, EBM best management practices and principles). Results highlight substantial differences in perceived and effective performances across programs, with Management programs showing a higher level of integration of EBM approaches than Non-Management programs. The use of EBM best management practices and principles among programs is unbalanced, with some key elements of EBM strategies less commonly employed in the management planning. This analysis identified gaps in the implementation of EBM strategies that can inform natural resource managers and planners

End-to-end modeling as part of an integrated research program in the Bering Sea

NASA Astrophysics Data System (ADS)

Punt, André E.; Ortiz, Ivonne; Aydin, Kerim Y.; Hunt, George L.; Wiese, Francis K.

2016-12-01

Traditionally, the advice provided to fishery managers has focused on the trade-offs between short- and long-term yields, and between future resource size and expected future catches. The harvest control rules that are used to provide management advice consequently relate catches to stock biomass levels expressed relative to reference biomass levels. There are, however, additional trade-offs. Ecosystem-based fisheries management (EBFM) aims to consider fish and fisheries in their ecological context, taking into account physical, biological, economic, and social factors. However, making EBFM operational remains challenging. It is generally recognized that end-to-end modeling should be a key part of implementing EBFM, along with harvest control rules that use information in addition to estimates of stock biomass to provide recommendations for management actions. Here we outline the process for selecting among alternative management strategies in an ecosystem context and summarize a Field-integrated End-To-End modeling program, or FETE, intended to implement this process as part of the Bering Sea Project. A key aspect of this project was that, from the start, the FETE included a management strategy evaluation component to compare management strategies. Effective use of end-to-end modeling requires that the models developed for a system are indeed integrated across climate drivers, lower trophic levels, fish population dynamics, and fisheries and their management. We summarize the steps taken by the program managers to promote integration of modeling efforts by multiple investigators and highlight the lessons learned during the project that can be used to guide future use and design of end-to-end models.

The status of marine and coastal EBM among a large sample of U.S. federal programs: a social network approach

NASA Astrophysics Data System (ADS)

Dell'Apa, A.; Fullerton, A.; Schwing, F. B.; Brady, M.

2016-02-01

Ecosystem-based management (EBM) is an integrated management approach that considers the entire ecosystem, including humans, across multiple sectors, with the goal to collectively manage natural resources, habitat, and species in a sustainable manner while maintaining ecosystem services to humans on the long-term. In the United States, the National Ocean Council (NOC) established a federal interagency subgroup (National Ocean Policy EBM-Subgroup) to provide policy advice on EBM strategies and technical representation from the federal agencies that are part of the NOC. As part of the NOP EBM-Subgroup effort, this study summarizes the status of EBM for several federal programs within the NOC agencies that implement or support marine and coastal EBM activities. Our objective was to provide an overview of the current state of practice among the many and varied U.S. federal programs employing EBM approaches in the ocean, coastal zone, and the Great Lakes. We used social network analysis techniques to explore similarities among programs in different topic areas (e.g., type of audience, partners, training, EBM best management practices and principles). Results highlight substantial differences in perceived and effective performances across programs, with Management programs showing a higher level of integration of EBM approaches than Non-Management programs. The use of EBM best management practices and principles among programs is unbalanced, with some key elements of EBM strategies less commonly employed in the management planning. This analysis identified gaps in the implementation of EBM strategies that can inform natural resource managers and planners

Anthropological perspectives on money management: considerations for the design and implementation of interventions for substance abuse.

PubMed

Carpenter-Song, Elizabeth

2012-01-01

There remains a long-standing argument regarding the need for money management strategies to control poor spending habits among people with substance use disorders. The objective was to review issues relevant to the design and implementation of money-management-based interventions for substance abuse. Using a comparative, cross-cultural framework of anthropology, this manuscript examines three challenges for the design and implementation of money management interventions for substance abuse: (i) clients may not trust mental health centers to manage their money, (ii) clients may have different economic perspectives from clinicians and researchers, and (iii) clients may obtain substances through informal networks of exchange. This article clarifies the inherently complex symbolic and social dimensions of money and addiction and illustrates the need for researchers and clinicians to be mindful of the cultural assumptions that underlie money management interventions for substance abuse. Using an anthropological approach toward understanding the issues surrounding money management for individuals struggling with addiction and mental illness has the potential to strengthen the design and implementation of money-management-based interventions in a manner that is acceptable and meaningful for this target population.

Barriers to the implementation of the SAFE strategy to combat hyperendemic trachoma in Australia.

PubMed

Wright, Heathcote R; Keeffe, Jill E; Taylor, Hugh R

2010-12-01

Australia is the only developed country in the world that still has endemic levels of blinding trachoma. The SAFE (Surgery, Antibiotics, Facial cleanliness, Environmental improvement) strategy is an effective public health intervention that has been successfully used to eliminate blinding trachoma in some of the poorest countries of the world. Yet the SAFE strategy has not been systematically implemented in Australia. We undertook semi-structured interviews to identify some of barriers to the implementation of the SAFE strategy within remote indigenous communities of Australia. Health care professionals who were responsible for delivering trachoma control programs throughout the Northern Territory were asked to participate in a semi-structured interview. Quantitative analysis was performed using an existing strategic management framework. Fourteen individuals were interviewed. Responses were grouped into 19 categories; 12 from the existing strategic management framework and 7 additional categories that were created for ideas unique to the trachoma control program in Australia. A number of key themes emerged from the interview and are presented in a literary style. From these key themes critical success factors for the implementation of a sustainable trachoma control program were identified. With the election of the Rudd government there has been a renewed interest in "closing the gap" between the health of indigenous and non-indigenous Australians. A federal government funding package of $58 million over four years has just been announced to tackle trachoma. It is hoped that the findings of this research can assist in making sure that money achieves its goal.

Implementation of a guideline for low back pain management in primary care: a cost-effectiveness analysis.

PubMed

Becker, Annette; Held, Heiko; Redaelli, Marcus; Chenot, Jean F; Leonhardt, Corinna; Keller, Stefan; Baum, Erika; Pfingsten, Michael; Hildebrandt, Jan; Basler, Heinz-Dieter; Kochen, Michael M; Donner-Banzhoff, Norbert; Strauch, Konstantin

2012-04-15

Cost-effectiveness analysis alongside a cluster randomized controlled trial. To study the cost-effectiveness of 2 low back pain guideline implementation (GI) strategies. Several evidence-based guidelines on management of low back pain have been published. However, there is still no consensus on the effective implementation strategy. Especially studies on the economic impact of different implementation strategies are lacking. This analysis was performed alongside a cluster randomized controlled trial on the effectiveness of 2 GI strategies (physician education alone [GI] or physician education in combination with motivational counseling [MC] by practice nurses)--both compared with the postal dissemination of the guideline (control group, C). Sociodemographic data, pain characteristics, and cost data were collected by interview at baseline and after 6 and 12 months. low back pain-related health care costs were valued for 2004 from the societal perspective. For the cost analysis, 1322 patients from 126 general practices were included. Both interventions showed lower direct and indirect costs as well as better patient outcomes during follow-up compared with controls. In addition, both intervention arms showed superiority of cost-effectiveness to C. The effects attenuated when adjusting for differences of health care utilization prior to patient recruitment and for clustering of data. Trends in cost-effectiveness are visible but need to be confirmed in future studies. Researchers performing cost-evaluation studies should test for baseline imbalances of health care utilization data instead of judging on the randomization success by reviewing non-cost parameters like clinical data alone.

Polish country study to address climate change: Strategies of the GHG`s emission reduction and adaptation of the Polish economy to the changed climate. Final report

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

NONE

1996-01-01

The Polish Country Study Project was initiated in 1992 as a result of the US Country Study Initiative whose objective was to grant the countries -- signatories of the United Nations` Framework Convention on Climate Change -- assistance that will allow them to fulfill their obligations in terms of greenhouse gases (GHG`s) inventory, preparation of strategies for the reduction of their emission, and adapting their economies to the changed climatic conditions. In February 1993, in reply to the offer from the United States Government, the Polish Government expressed interest in participation in this program. The Study proposal, prepared by themore » Ministry of Environmental Protection, Natural Resources and Forestry was presented to the US partner. The program proposal assumed implementation of sixteen elements of the study, encompassing elaboration of scenarios for the strategy of mission reduction in energy sector, industry, municipal management, road transport, forestry, and agriculture, as well as adaptations to be introduced in agriculture, forestry, water management, and coastal management. The entire concept was incorporated in macroeconomic strategy scenarios. A complementary element was the elaboration of a proposal for economic and legal instruments to implement the proposed strategies. An additional element was proposed, namely the preparation of a scenario of adapting the society to the expected climate changes.« less

Pharmaceutical management in ProCare Health Limited.

PubMed

Malcolm, L; Barry, M; MacLean, I

2001-06-22

To review pharmaceutical budget holding and management in ProCare Health Limited by; describing budget holding strategies implemented in 1995/6, identifying prescribing savings achieved, analysing variation in prescribing behaviour and comparing the findings with experience elsewhere. With 340 members, ProCare is one of the largest and most progressive of New Zealand's independent practitioner associations (IPAs). Data were obtained for the three years 1994 to 1996 to determine pharmaceutical expenditure against budget and against national trends, by member and general medical services (GMS) consultations. ProCare has established a classical, quality focussed pharmaceutical management strategy. Savings against the agreed budget was 9.5% comparing 1996 with 1995 but 5.7% compared, with national trends. Wide variation in per capita and per consultation costs was not reduced and was entirely explained by prescribing volumes not drug prices. The most important finding is that general practitioners (GPs), working collaboratively, can establish a strategy of clinical and corporate governance which may be exerting a wide ranging influence over clinical behaviour. Although there may be doubts about the actual levels of saving these appeared to be well in excess of the financial investment in the strategy. Greater savings appear possible with a focus on addressing the large and apparently inappropriate per capita prescribing volume variation between practices. Understanding and successfully addressing this variation will be one of the key issues facing the implementation of the government's primary health care strategy.

Determinants of quality management systems implementation in hospitals.

PubMed

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

2009-03-01

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

Impact of 68Ga-PSMA-11 PET/CT on the Management of Prostate Cancer Patients with Biochemical Recurrence.

PubMed

Calais, Jeremie; Fendler, Wolfgang P; Eiber, Matthias; Gartmann, Jeannine; Chu, Fang-I; Nickols, Nicholas G; Reiter, Robert E; Rettig, Matthew B; Marks, Leonard S; Ahlering, Thomas E; Huynh, Linda M; Slavik, Roger; Gupta, Pawan; Quon, Andrew; Allen-Auerbach, Martin S; Czernin, Johannes; Herrmann, Ken

2018-03-01

In this prospective survey of referring physicians, we investigated whether and how 68 Ga-labeled prostate-specific membrane antigen 11 ( 68 Ga-PSMA-11) PET/CT affects the implemented management of prostate cancer patients with biochemical recurrence (BCR). Methods: We conducted a prospective survey of physicians (NCT02940262) who referred 161 patients with prostate cancer BCR (median prostate-specific antigen value, 1.7 ng/mL; range, 0.05-202 ng/mL). Referring physicians completed one questionnaire before the scan to indicate the treatment plan without 68 Ga-PSMA-11 PET/CT information (Q1; n = 101), one immediately after the scan to denote intended management changes (Q2; n = 101), and one 3-6 mo later to document the final implemented management (Q3; n = 56). The implemented management was also obtained via electronic chart review or patient contact ( n = 45). Results: A complete documented management strategy (Q1 + Q2 + implemented management) was available for 101 of 161 patients (63%). Seventy-six of these (75%) had a positive 68 Ga-PSMA-11 PET/CT result. The implemented management differed from the prescan intended management (Q1) in 54 of 101 patients (53%). The postscan intended management (Q2) differed from the prescan intended management (Q1) in 62 of 101 patients (61%); however, these intended changes were not implemented in 29 of 62 patients (47%). Pelvic nodal and extrapelvic metastatic disease on 68 Ga-PSMA-11 PET/CT (PSMA T0N1M0 and PSMA T0N1M1 patterns) was significantly associated with implemented management changes ( P = 0.001 and 0.05). Conclusion: Information from 68 Ga-PSMA-11 PET/CT brings about management changes in more than 50% of prostate cancer patients with BCR (54/101; 53%). However, intended management changes early after 68 Ga-PSMA-11 PET/CT frequently differ from implemented management changes. © 2018 by the Society of Nuclear Medicine and Molecular Imaging.

Air quality management in Mexico.

PubMed

Fernández-Bremauntz, Adrián

2008-01-01

Several significant program and policy measures have been implemented in Mexico over the past 15 yr to improve air quality. This article provides an overview of air quality management strategies in Mexico, including (1) policy initiatives such as vehicle use restrictions, air quality standards, vehicle emissions, and fuel quality standards, and (2) supporting programs including establishment of a national emission inventory, an air pollution episodes program, and the implementation of exposure and health effects studies. Trends in air pollution episodes and ambient air pollutant concentrations are described.

Information Resource Management for Naval Shore Activities: Concepts and Implementation Strategy.

DTIC Science & Technology

1984-09-01

with accurate inorl atn, at the right time and a the lowest cost. (Ref. 21: p. 15) *" managing the i0formation resource essentially means gathering...US Lf eczcJu 21 =guZ~wuLU Essential in the implementation of Information -" ]Resource anagement, is a clear understanding of the rela- tionships...of determins.ng the needs of the user of a structure anu then d9signing to meet those needs as effectively as possIble within ecnomic and

The design of a real-time formative evaluation of the implementation process of lifestyle interventions at two worksites using a 7-step strategy (BRAVO@Work).

PubMed

Wierenga, Debbie; Engbers, Luuk H; van Empelen, Pepijn; Hildebrandt, Vincent H; van Mechelen, Willem

2012-08-07

Worksite health promotion programs (WHPPs) offer an attractive opportunity to improve the lifestyle of employees. Nevertheless, broad scale and successful implementation of WHPPs in daily practice often fails. In the present study, called BRAVO@Work, a 7-step implementation strategy was used to develop, implement and embed a WHPP in two different worksites with a focus on multiple lifestyle interventions.This article describes the design and framework for the formative evaluation of this 7-step strategy under real-time conditions by an embedded scientist with the purpose to gain insight into whether this this 7-step strategy is a useful and effective implementation strategy. Furthermore, we aim to gain insight into factors that either facilitate or hamper the implementation process, the quality of the implemented lifestyle interventions and the degree of adoption, implementation and continuation of these interventions. This study is a formative evaluation within two different worksites with an embedded scientist on site to continuously monitor the implementation process. Each worksite (i.e. a University of Applied Sciences and an Academic Hospital) will assign a participating faculty or a department, to implement a WHPP focusing on lifestyle interventions using the 7-step strategy. The primary focus will be to describe the natural course of development, implementation and maintenance of a WHPP by studying [a] the use and adherence to the 7-step strategy, [b] barriers and facilitators that influence the natural course of adoption, implementation and maintenance, and [c] the implementation process of the lifestyle interventions. All data will be collected using qualitative (i.e. real-time monitoring and semi-structured interviews) and quantitative methods (i.e. process evaluation questionnaires) applying data triangulation. Except for the real-time monitoring, the data collection will take place at baseline and after 6, 12 and 18 months. This is one of the few studies to extensively and continuously monitor the natural course of the implementation process of a WHPP by a formative evaluation using a mix of quantitative and qualitative methods on different organizational levels (i.e. management, project group, employees) with an embedded scientist on site. NTR2861.

Business continuity and disaster management within the public service in relation to a national development plan.

PubMed

Ferguson, Cliff

2018-01-01

Within South Africa, few public service departments understand the concepts of business continuity management (BCM) and what it takes to implement a well-constructed business continuity plan. Likewise, few of these entities understand the purpose of designing and maintaining resilient systems that are immune to incidents. This paper discusses the integration of the South African Disaster Management Act 2002, the Disaster Management Framework and the National Development Plan, linking these to BCM, through a resilience period model, as a means for the implementation of resilience strategies. The goals of the National Development Plan are outlined with a view to how resilience can be achieved in each. A resilience period model has been advocated for the implementation of projects within the public sector in order to provide continuity and sustainability.

Integrated management of childhood illness: a summary of first experiences.

PubMed Central

Lambrechts, T.; Bryce, J.; Orinda, V.

1999-01-01

The strategy of Integrated Management of Childhood Illness (IMCI) aims to reduce child mortality and morbidity in developing countries by combining improved management of common childhood illnesses with proper nutrition and immunization. The strategy includes interventions to improve the skills of health workers, the health system, and family and community practices. This article describes the experience of the first countries to adopt and implement the IMCI interventions, the clinical guidelines dealing with the major causes of morbidity and mortality in children, and the training package on these guidelines for health workers in first-level health facilities. The most relevant lessons learned and how these lessons have served as a basis for developing a broader IMCI strategy are described. PMID:10444882

Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems

PubMed Central

2013-01-01

Background Given the importance of influence networks in the implementation of evidence-based practices and interventions, it is unclear whether such networks continue to operate as sources of information and advice when they are segmented and disrupted by randomization to different implementation strategy conditions. The present study examines the linkages across implementation strategy conditions of social influence networks of leaders of youth-serving systems in 12 California counties participating in a randomized controlled trial of community development teams (CDTs) to scale up use of an evidence-based practice. Methods Semi-structured interviews were conducted with 38 directors, assistant directors, and program managers of county probation, mental health, and child welfare departments. A web-based survey collected additional quantitative data on information and advice networks of study participants. A mixed-methods approach to data analysis was used to create a sociometric data set (n = 176) to examine linkages between treatment and standard conditions. Results Of those network members who were affiliated with a county (n = 137), only 6 (4.4%) were directly connected to a member of the opposite implementation strategy condition; 19 (13.9%) were connected by two steps or fewer to a member of the opposite implementation strategy condition; 64 (46.7%) were connected by three or fewer steps to a member of the opposite implementation strategy condition. Most of the indirect steps between individuals who were in different implementation strategy conditions were connections involving a third non-county organizational entity that had an important role in the trial in keeping the implementation strategy conditions separate. When these entities were excluded, the CDT network exhibited fewer components and significantly higher betweenness centralization than did the standard condition network. Conclusion Although the integrity of the RCT in this instance was not compromised by study participant influence networks, RCT designs should consider how influence networks may extend beyond boundaries established by the randomization process in implementation studies. Trial registration NCT00880126 PMID:24229373

Beyond the Reagan tax proposal: hospital capital management strategies.

PubMed

Harris, J P

1985-11-01

If Reagan's tax proposal is implemented, low-cost tax-exempt revenue bonds, advance refunding, and the investment tax credit would be eliminated. Such possibilities could cause a serious blow to the hospital industry--the cost of capital could rise significantly, the hospital's ability to manage debt could decrease, and joint ventures could become less attractive. However, in light of the known elements in Reagan's proposal, certain financing strategies can be adopted immediately that will help offset these possibilities and help ensure long-term survival.

Science for the changing Great Basin

USGS Publications Warehouse

Beever, Erik; Pyke, David A.

2004-01-01

The U.S. Geological Survey (USGS), with its multidisciplinary structure and role as a federal science organization, is well suited to provide integrated science in the Great Basin of the western United States. A research strategy developed by the USGS and collaborating partners addresses critical management issues in the basin, including invasive species, status and trends of wildlife populations and communities, wildfire, global climate change, and riparian and wetland habitats. Information obtained through implementation of this strategy will be important for decision-making by natural-resource managers.

A Different Approach to the Generation of Patient Management Problems from a Knowledge-Based System

PubMed Central

Barriga, Rosa Maria

1988-01-01

Several strategies are proposed to approach the generation of Patient Management Problems from a Knowledge Base and avoid inconsistencies in the results. These strategies are based on a different Knowledge Base structure and in the use of case introductions that describe the patient attributes which are not disease-dependent. This methodology has proven effective in a recent pilot test and it is on its way to implementation as part of an educational program at CWRU, School of Medicine.

Charleston Harbor, SC, Regional Sediment Management Study; Beneficial Use of Dredged Material through Nearshore Placement

DTIC Science & Technology

2017-05-01

Project 454632, “Charleston Harbor, SC, Regional Sediment Management Study” Project . The HQUSACE RSM Program Manager was Ms. Linda S. Lillycrop, U.S. Army...objective of the U.S. Army Corps of Engineers (USACE) RSM Program is to improve the management of sediments across multiple projects , manage sediments as a...optimize use of sediments and streamline projects . The adaptive management strategies are developed and implemented through application of the best

Charleston Harbor, SC, Regional Sediment Management Study: Beneficial Use of Dredged Material through Nearshore Placement

DTIC Science & Technology

2017-05-01

Project 454632, “Charleston Harbor, SC, Regional Sediment Management Study” Project . The HQUSACE RSM Program Manager was Ms. Linda S. Lillycrop, U.S. Army...objective of the U.S. Army Corps of Engineers (USACE) RSM Program is to improve the management of sediments across multiple projects , manage sediments as a...optimize use of sediments and streamline projects . The adaptive management strategies are developed and implemented through application of the best

The Immuno-Dynamics of Conflict Intervention in Social Systems

PubMed Central

Krakauer, David C.; Page, Karen; Flack, Jessica

2011-01-01

We present statistical evidence and dynamical models for the management of conflict and a division of labor (task specialization) in a primate society. Two broad intervention strategy classes are observed– a dyadic strategy – pacifying interventions, and a triadic strategy –policing interventions. These strategies, their respective degrees of specialization, and their consequences for conflict dynamics can be captured through empirically-grounded mathematical models inspired by immuno-dynamics. The spread of aggression, analogous to the proliferation of pathogens, is an epidemiological problem. We show analytically and computationally that policing is an efficient strategy as it requires only a small proportion of a population to police to reduce conflict contagion. Policing, but not pacifying, is capable of effectively eliminating conflict. These results suggest that despite implementation differences there might be universal features of conflict management mechanisms for reducing contagion-like dynamics that apply across biological and social levels. Our analyses further suggest that it can be profitable to conceive of conflict management strategies at the behavioral level as mechanisms of social immunity. PMID:21887221

The immuno-dynamics of conflict intervention in social systems.

PubMed

Krakauer, David C; Page, Karen; Flack, Jessica

2011-01-01

We present statistical evidence and dynamical models for the management of conflict and a division of labor (task specialization) in a primate society. Two broad intervention strategy classes are observed--a dyadic strategy--pacifying interventions, and a triadic strategy--policing interventions. These strategies, their respective degrees of specialization, and their consequences for conflict dynamics can be captured through empirically-grounded mathematical models inspired by immuno-dynamics. The spread of aggression, analogous to the proliferation of pathogens, is an epidemiological problem. We show analytically and computationally that policing is an efficient strategy as it requires only a small proportion of a population to police to reduce conflict contagion. Policing, but not pacifying, is capable of effectively eliminating conflict. These results suggest that despite implementation differences there might be universal features of conflict management mechanisms for reducing contagion-like dynamics that apply across biological and social levels. Our analyses further suggest that it can be profitable to conceive of conflict management strategies at the behavioral level as mechanisms of social immunity.

A systematic review of implementation strategies to deliver guidelines on obstetric care practice in low- and middle-income countries.

PubMed

Imamura, Mari; Kanguru, Lovney; Penfold, Suzanne; Stokes, Tim; Camosso-Stefinovic, Janette; Shaw, Beth; Hussein, Julia

2017-01-01

Healthcare measures to prevent maternal deaths are well known. However, effective implementation of this knowledge to change practice remains a challenge. To assess whether strategies to promote the use of guidelines can improve obstetric practices in low- and middle-income countries (LMICs). Electronic databases were searched up to February 7, 2014, using relevant terms for implementation strategies (e.g. "audit," "education," "reminder"), and maternal mortality. Randomized and non-randomized studies of implementation strategies targeting healthcare professionals within the formal health services in LMICs were included. Cochrane methodological guidance was followed. Because of heterogeneity in the interventions, a narrative synthesis was completed. Nine studies met the inclusion criteria. Moderate-to-low-quality evidence was found to show improvement in the areas of doctor-patient communication (one study), analgesic provision (one study), the management of emergencies (two studies) and maternal and late neonatal mortality (one study each). Intervention effects were not consistent across studies. Implementation strategies targeting health professionals could lead to improvement in obstetric care in LMICs. Future research should explore what feature of an intervention is effective in one context and how this could be translated into another context. CRD42014010310. © 2016 International Federation of Gynecology and Obstetrics.

What Board Members Need to Know About: Enrollment Management

ERIC Educational Resources Information Center

Hundrieser, Jim

2015-01-01

Contemporary strategic enrollment management entails planning, implementing, and developing administrative structures to develop and support strategies and tactics to regulate patterns of students entering the institution and through to graduation. It must do so in a way that is both predictable and consistent with the institution's mission and…

Human Performance Technology and Knowledge Management: A Case Study

ERIC Educational Resources Information Center

Massey, Anne P.; Montoya-Weiss, Mitzi M.; O'Driscoll, Tony M.

2005-01-01

As organizations respond to competitive environments and strive to enhance performance, knowledge management (KM) has increasingly become a strategic activity. A KM strategy entails consciously helping people share and put knowledge into action. A key challenge is how to develop and implement KM solutions that provide performance support to…

Effective Management and Operation of Graduate Programs in Colleges of Pharmacy

ERIC Educational Resources Information Center

Farnsworth, Norman R.

1977-01-01

Management strategy and policy adapted at the University of Illinois at the Medical Center are described in terms of: faculty teaching vs. research time; faculty effectiveness and productivity; committee meetings; morale; departmental funds for research; expectations from graduate students; student recruitment; and program implementation. (LBH)

Effectiveness of an Afterschool-Based Aggression Management Program for Elementary Students

ERIC Educational Resources Information Center

Staecker, Emma; Puett, Eli; Afrassiab, Shayda; Ketcherside, Miranda; Azim, Sabiya; Rhodes, Darson; Wang, Anna

2016-01-01

A school-community partnership team implemented an aggression management curriculum in an afterschool program as an early-intervention strategy at the upper elementary level. Although statistically significant differences in physical or psychological aggression were not found, the partnership team gained a better understanding of evidence-based…

Implementing Integrated Multicultural Instructional Design in Management Education

ERIC Educational Resources Information Center

Schultz, Jennifer L.; Higbee, Jeanne L.

2011-01-01

This purpose of this paper is to summarize the principles of integrated multicultural instructional design (IMID; Higbee, Goff, & Schultz, in press; Higbee, Schultz, & Goff, 2010) and present specific strategies for incorporating IMID in management education. The primary goal of IMID is to promote the integration of multicultural content…

Sheila Hayter | NREL

Science.gov Websites

Hayter Photo of Sheila Hayter Sheila Hayter Group Manager - Strategy, Policy, & Implementation Group Sheila.Hayter@nrel.gov | 303-384-7519 Sheila has been with NREL for more than 25 years and is presently a group manager within the Integrated Application Center (IAC) leading a team of technical and

Improving Financial Awareness among College Students: Assessment of a Financial Management Project

ERIC Educational Resources Information Center

Palmer, Lance; Bliss, Donna L.; Goetz, Joseph W.; Moorman, Diann

2010-01-01

The effect of a financial management intervention on college students' financial behavior was examined. The intervention strategy, a form of expenditure tracking, focused on consciousness-raising and was implemented among 170 undergraduate students. Qualitative analysis of participants' self-reflection papers revealed that awareness of spending…

Implementing evidence-based practice during an economic downturn.

PubMed

Beck, Mary S; Staffileno, Beth A

2012-01-01

Building a sustainable evidence-based practice (EBP) infrastructure during times of financial constraints poses challenges for nurse leaders. To be successful, plans need to be creative and adaptive, while mindful of limited resources. This commentary describes change management strategies used to implement an EBP infrastructure at a hospital after organizational restructuring occurred.

Strategies for Implementation: The El Camino TQM Story.

ERIC Educational Resources Information Center

Schauerman, Sam; Peachy, Burt

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

Implementing Positive Behavior Support in Preschools: An Exploratory Study of CW-FIT Tier 1

ERIC Educational Resources Information Center

Jolstead, Krystine A.; Caldarella, Paul; Hansen, Blake; Korth, Byran B.; Williams, Leslie; Kamps, Debra

2017-01-01

Challenging behavior in preschool is a serious concern for teachers. Positive behavior interventions and supports (PBIS) have been shown to be effective in reducing such behaviors. Class-Wide Function-Related Intervention Teams (CW-FIT) is a specific multi-tiered intervention for implementing effective classroom management strategies using PBIS…

Implementing Positive Behavior Support in Preschools: An Exploratory Study of CW-FIT Tier 1

ERIC Educational Resources Information Center

Jolstead, Krystine A.; Caldarella, Paul; Hansen, Blake D.; Korth, Byran B.; Williams, Leslie; Kamps, Debra M.

2017-01-01

Challenging behavior in preschool is a serious concern for teachers. Positive behavior interventions and supports (PBIS) has been shown to be effective in reducing such behaviors. Class-Wide Function-Related Intervention Teams (CW-FIT) is a specific multi-tiered intervention for implementing effective classroom management strategies using PBIS…

The Successful Implementation of Electronic Health Records at Small Rural Hospitals

ERIC Educational Resources Information Center

Richardson, Daniel

2016-01-01

Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement…

A case study of polypharmacy management in nine European countries: Implications for change management and implementation.

PubMed

McIntosh, Jennifer; Alonso, Albert; MacLure, Katie; Stewart, Derek; Kempen, Thomas; Mair, Alpana; Castel-Branco, Margarida; Codina, Carles; Fernandez-Llimos, Fernando; Fleming, Glenda; Gennimata, Dimitra; Gillespie, Ulrika; Harrison, Cathy; Illario, Maddalena; Junius-Walker, Ulrike; Kampolis, Christos F; Kardas, Przemyslaw; Lewek, Pawel; Malva, João; Menditto, Enrica; Scullin, Claire; Wiese, Birgitt

2018-01-01

Multimorbidity and its associated polypharmacy contribute to an increase in adverse drug events, hospitalizations, and healthcare spending. This study aimed to address: what exists regarding polypharmacy management in the European Union (EU); why programs were, or were not, developed; and, how identified initiatives were developed, implemented, and sustained. Change management principles (Kotter) and normalization process theory (NPT) informed data collection and analysis. Nine case studies were conducted in eight EU countries: Germany (Lower Saxony), Greece, Italy (Campania), Poland, Portugal, Spain (Catalonia), Sweden (Uppsala), and the United Kingdom (Northern Ireland and Scotland). The workflow included a review of country/region specific polypharmacy policies, key informant interviews with stakeholders involved in policy development and implementation and, focus groups of clinicians and managers. Data were analyzed using thematic analysis of individual cases and framework analysis across cases. Polypharmacy initiatives were identified in five regions (Catalonia, Lower Saxony, Northern Ireland, Scotland, and Uppsala) and included all care settings. There was agreement, even in cases without initiatives, that polypharmacy is a significant issue to address. Common themes regarding the development and implementation of polypharmacy management initiatives were: locally adapted solutions, organizational culture supporting innovation and teamwork, adequate workforce training, multidisciplinary teams, changes in workflow, redefinition of roles and responsibilities of professionals, policies and legislation supporting the initiative, and data management and information and communication systems to assist development and implementation. Depending on the setting, these were considered either facilitators or barriers to implementation. Within the studied EU countries, polypharmacy management was not widely addressed. These results highlight the importance of change management and theory-based implementation strategies, and provide examples of polypharmacy management initiatives that can assist managers and policymakers in developing new programs or scaling up existing ones, particularly in places currently lacking such initiatives.

The Role of Human Resource Management in Today's Organizations: The Case of Cyprus in Comparison with the European Union.

ERIC Educational Resources Information Center

Stavrou-Costea, Eleni

2002-01-01

A survey of 91 Cypriot human resource managers identified strategies, training and development practices, and use of flexible work arrangements. Compared with European Union nations, the role of human resource management in many Cypriot organizations is not strategic, and flexible practices are not yet implemented to the same extent as elsewhere.…

A Climate Change Adaptation Strategy for Management of ...

EPA Pesticide Factsheets

Sea level rise is causing shoreline erosion, increased coastal flooding, and marsh vulnerability to the impact of storms. Coastal marshes provide flood abatement, carbon and nutrient sequestration, water quality maintenance, and habitat for fish, shellfish, and wildlife, including species of concern, such as the saltmarsh sparrow (Ammodramus caudacutus). We present a climate change adaptation strategy (CCAS) adopted by scientific, management, and policy stakeholders for managing coastal marshes and enhancing system resiliency. A common adaptive management approach previously used for restoration projects was modified to identify climate-related vulnerabilities and plan climate change adaptive actions. As an example of implementation of the CCAS, we describe the stakeholder plans and management actions the US Fish and Wildlife Service and partners developed to build coastal resiliency in the Narrow River Estuary, RI, in the aftermath of Superstorm Sandy. When possible, an experimental BACI (before-after, control-impact) design, described as pre- and post-sampling at the impact site and one or more control sites, was incorporated into the climate change adaptation and implementation plans. Specific climate change adaptive actions and monitoring plans are described and include shoreline stabilization, restoring marsh drainage, increasing marsh elevation, and enabling upland marsh migration. The CCAS provides a framework and methodology for successfully managing coa

Adoption of Soil Health Improvement Strategies by Australian Farmers: II. Impediments and Incentives

ERIC Educational Resources Information Center

Bennett, J. McL.; Cattle, S. R.

2014-01-01

Purpose: Many farmers remain hesitant to implement structured management plans and strategies tailored to address soil health, irrespective of mounting scientific evidence for the credibility of certain soil health indicators, an increase in the reporting of program benefits and progress in communicating these benefits. Hence, the purpose of this…

Distance Learning: A Strategy for Improving Incontinence Care in Nursing Homes

ERIC Educational Resources Information Center

Rahman, Anna N.; Schnelle, John F.; Yamashita, Takashi; Patry, Gail; Prasauskas, Ruta

2010-01-01

Purpose: This article describes a distance learning model designed to help nursing homes implement incontinence management best practices. A basic premise is that translating research into practice requires both a feasible intervention and a dissemination strategy responsive to the target audience's needs. Design and Methods: Over 8 months, nurse…

Implementing Innovation in Primary EFL: A Case Study in Greece

ERIC Educational Resources Information Center

Karavas, Evdokia

2014-01-01

The purpose of this article is to highlight and discuss the strategies used to diffuse and manage a primary ELT innovation in Greece, strategies that proved essential for developing stakeholders' acceptance and ownership of the innovation, thereby facilitating its further development and sustainability. The PEAP Programme, launched in 2010,…

Investigating the Usability of Classroom Management Strategies among Elementary Schoolteachers

ERIC Educational Resources Information Center

Briesch, Amy M.; Briesch, Jacquelyn M.; Chafouleas, Sandra M.

2015-01-01

Although teachers are often asked to implement classroom interventions to address student behavior, little is known about their perceived usability of many evidence-based strategies. One thousand five elementary schoolteachers completed the Usage Rating Profile-Intervention-Revised (URP-IR) with regard to the use of one of five evidence-based…

Portfolio Management

NASA Technical Reports Server (NTRS)

Duncan, Sharon L.

2011-01-01

Enterprise Business Information Services Division (EBIS) supports the Laboratory and its functions through the implementation and support of business information systems on behalf of its business community. EBIS Five Strategic Focus Areas: (1) Improve project estimating, planning and delivery capability (2) Improve maintainability and sustainability of EBIS Application Portfolio (3) Leap forward in IT Leadership (4) Comprehensive Talent Management (5) Continuous IT Security Program. Portfolio Management is a strategy in which software applications are managed as assets

[Design, implementation and evaluation of a management model of patient safety in hospitals in Catalonia, Spain].

PubMed

Saura, Rosa Maria; Moreno, Pilar; Vallejo, Paula; Oliva, Glòria; Alava, Fernando; Esquerra, Miquel; Davins, Josep; Vallès, Roser; Bañeres, Joaquim

2014-07-01

Since its inception in 2006, the Alliance for Patient Safety in Catalonia has played a major role in promoting and shaping a series of projects related to the strategy of the Ministry of Health, Social Services and Equality, for improving patient safety. One such project was the creation of functional units or committees of safety in hospitals in order to facilitate the management of patient safety. The strategy has been implemented in hospitals in Catalonia which were selected based on criteria of representativeness. The intervention was based on two lines of action, one to develop the model framework and the other for its development. Firstly the strategy for safety management based on EFQM (European Foundation for Quality Management) was defined with the development of standards, targets and indicators to implement security while the second part involved the introduction of tools, methodologies and knowledge to the management support of patient safety and risk prevention. The project was developed in four hospital areas considered higher risk, each assuming six goals for safety management. Some of these targets such as the security control panel or system of adverse event reporting were shared. 23 hospitals joined the project in Catalonia. Despite the different situations in each centre, high compliance was achieved in the development of the objectives. In each of the participating areas the security control panel was developed. Stable structures for safety management were established or strengthened. Training in patient safety played and important role, 1415 professionals participated. Through these kind of projects not only have been introduced programs of proven effectiveness in reducing risks, but they also provide to the facilities a work system that allows autonomy in diagnosis and analysis of the different risk situations or centre specific safety issues. Copyright © 2014. Published by Elsevier Espana.

Clinically led performance management in secondary healthcare: evaluating the attitudes of medical and non-clinical managers.

PubMed

Trebble, Timothy M; Paul, Maureen; Hockey, Peter M; Heyworth, Nicola; Humphrey, Rachael; Powell, Timothy; Clarke, Nicholas

2015-03-01

Improving the quality and activity of clinicians' practice improves patient care. Performance-related human resource management (HRM) is an established approach to improving individual practice but with limited use among clinicians. A framework for performance-related HRM was developed from successful practice in non-healthcare organisations centred on distributive leadership and locally provided, validated and interpreted performance measurement. This study evaluated the response of medical and non-clinical managers to its implementation into a large secondary healthcare organisation. A semistructured qualitative questionnaire was developed from themes identified during framework implementation and included attitudes to previous approaches to measuring doctors' performance, and the structure and response to implementation of the performance-related HRM framework. Responses were analysed through a process of data summarising and categorising. A total of 29, from an invited cohort of 31, medical and non-clinical managers from departmental to executive level were interviewed. Three themes were identified: (1) previous systems of managing clinical performance were considered to be ineffective due to insufficient empowerment of medical managers and poor quality of available performance data; (2) the implemented framework was considered to address these needs and was positively received by medical and non-clinical managers; (3) introduction of performance-related HRM required the involvement of the whole organisation to executive level and inclusion within organisational strategy, structure and training. This study suggests that a performance-related HRM framework may facilitate the management of clinical performance in secondary healthcare, but is dependent on the design and methods of application used. Such approaches contrast with those currently proposed for clinicians in secondary healthcare in the UK and suggest that alternative strategies should be considered. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

How to successfully select and implement electronic health records (EHR) in small ambulatory practice settings.

PubMed

Lorenzi, Nancy M; Kouroubali, Angelina; Detmer, Don E; Bloomrosen, Meryl

2009-02-23

Adoption of EHRs by U.S. ambulatory practices has been slow despite the perceived benefits of their use. Most evaluations of EHR implementations in the literature apply to large practice settings. While there are similarities relating to EHR implementation in large and small practice settings, the authors argue that scale is an important differentiator. Focusing on small ambulatory practices, this paper outlines the benefits and barriers to EHR use in this setting, and provides a "field guide" for these practices to facilitate successful EHR implementation. The benefits of EHRs in ambulatory practices include improved patient care and office efficiency, and potential financial benefits. Barriers to EHRs include costs; lack of standardization of EHR products and the design of vendor systems for large practice environments; resistance to change; initial difficulty of system use leading to productivity reduction; and perceived accrual of benefits to society and payers rather than providers. The authors stress the need for developing a flexible change management strategy when introducing EHRs that is relevant to the small practice environment; the strategy should acknowledge the importance of relationship management and the role of individual staff members in helping the entire staff to manage change. Practice staff must create an actionable vision outlining realistic goals for the implementation, and all staff must buy into the project. The authors detail the process of implementing EHRs through several stages: decision, selection, pre-implementation, implementation, and post-implementation. They stress the importance of identifying a champion to serve as an advocate of the value of EHRs and provide direction and encouragement for the project. Other key activities include assessing and redesigning workflow; understanding financial issues; conducting training that is well-timed and meets the needs of practice staff; and evaluating the implementation process. The EHR implementation experience depends on a variety of factors including the technology, training, leadership, the change management process, and the individual character of each ambulatory practice environment. Sound processes must support both technical and personnel-related organizational components. Additional research is needed to further refine recommendations for the small physician practice and the nuances of specific medical specialties.

Determining climate change management priorities: A case study from Wisconsin

USGS Publications Warehouse

LeDee, Olivia E.; Ribic, Christine

2015-01-01

A burgeoning dialogue exists regarding how to allocate resources to maximize the likelihood of long-term biodiversity conservation within the context of climate change. To make effective decisions in natural resource management, an iterative, collaborative, and learning-based decision process may be more successful than a strictly consultative approach. One important, early step in a decision process is to identify priority species or systems. Although this promotes the conservation of select species or systems, it may inadvertently alter the future of non-target species and systems. We describe a process to screen terrestrial wildlife for potential sensitivity to climate change and then use the results to engage natural resource professionals in a process of identifying priorities for monitoring, research, and adaptation strategy implementation. We demonstrate this approach using a case study from Wisconsin. In Wisconsin, experts identified 23 out of 353 species with sufficient empirical research and management understanding to inform targeted action. Habitat management and management of hydrological conditions were the common strategies for targeted action. Although there may be an interest in adaptation strategy implementation for many species and systems, experts considered existing information inadequate to inform targeted action. According to experts, 40% of the vertebrate species in Wisconsin will require near-term intervention for climate adaptation. These results will inform state-wide conservation planning as well as regional efforts.

Guideline attribute and implementation preferences among physicians in multiple health systems.

PubMed

Stone, Tamara T; Schweikhart, Sharon B; Mantese, Annamarie; Sonnad, Seema S

2005-01-01

Although practice guidelines are effective in assisting providers with clinical decision making, ineffective implementation strategies often prevent their use in practice. This study aimed to understand physician preferences for guideline format, placement, content, evidence, and learning strategies in different clinical environments. Semistructured telephone interviews were conducted with 500 randomly selected physicians from 4 major US health systems who were involved in the treatment of patients with acute myocardial infarction or pediatric asthma. Paired sample t tests and Tukey's method of comparisons determined the relative ranking of physicians' guideline implementation preferences. Physicians preferred guidelines located on the front of the patient chart, in palm pilots, or in progress notes and presented as flow charts/flow diagrams, algorithms, or preprinted orders that contain strategies to minimize readmits/encourage self-management and immediate treatment flows. Discussions with colleagues and continuing medical education are the most effective strategies for encouraging guideline use, and randomized controlled trials remain the most persuasive medical evidence. Health care organizations must align guideline implementation efforts with physician preferences to encourage utilization. The results of this study reveal systematic physician preferences for guideline implementation that can be applied to clinical settings to encourage guideline use by physicians.

Social customer relationship management: taking advantage of Web 2.0 and Big Data technologies.

PubMed

Orenga-Roglá, Sergio; Chalmeta, Ricardo

2016-01-01

The emergence of Web 2.0 and Big Data technologies has allowed a new customer relationship strategy based on interactivity and collaboration called Social Customer Relationship Management (Social CRM) to be created. This enhances customer engagement and satisfaction. The implementation of Social CRM is a complex task that involves different organisational, human and technological aspects. However, there is a lack of methodologies to assist companies in these processes. This paper shows a novel methodology that helps companies to implement Social CRM, taking into account different aspects such as social customer strategy, the Social CRM performance measurement system, the Social CRM business processes, or the Social CRM computer system. The methodology was applied to one company in order to validate and refine it.

Strengthening public health pesticide management in countries endemic with malaria or other major vector-borne diseases: an evaluation of three strategies.

PubMed

van den Berg, Henk; Yadav, Rajpal S; Zaim, Morteza

2014-09-18

Public health pesticides has been the mainstay control of vectors of malaria and other diseases, and public health pests, but there is increasing concern over how these pesticides are being managed. Poor pesticide management could lead to risks to human health and the environment, or diminish the effectiveness of interventions. Strategies for strengthening the management of public health pesticides, from manufacture to disposal, should be evaluated to propose future directions. The process and outcomes of three strategies were studied in five regions of the WHO (African Region, Eastern Mediterranean Region, South-East Asia Region, Western Pacific Region, and American Region) and 13 selected countries. These strategies are: regional policy development, in-depth country support and thematic support across countries. Consensus, frameworks and action plans on public health pesticide management were developed at regional level. Country support for situation analysis and national action planning highlighted weaknesses over the entire spectrum of pesticide management practices, mainly related to malaria control. The thematic support on pesticide quality control contributed to structural improvements on a priority issue for malaria control across countries. The three strategies showed promising and complementary results, but guidelines and tools for implementation of the strategies should be further improved. Increased national and international priority should be given to support the development of policy, legislation and capacity that are necessary for sound management of public health pesticides.

Implementing Key Strategies for Successful Network Integration in the Quebec Substance-Use Disorders Programme

PubMed Central

Perreault, Michel; Grenier, Guy; Imboua, Armelle; Brochu, Serge

2016-01-01

Background: Fragmentation and lack of coordination often occur among organisations offering treatment for individuals with substance-use disorders. Better integration from a system perspective within a network of organisations offering substance-use disorder services can be developed using various integration strategies at the administrative and clinical levels. This study aims to identify integration strategies implemented in Quebec substance-use disorder networks and to assess their strengths and limitations. Methods: A total of 105 stakeholders representing two regions and four local substance-use disorder networks participated in focus groups or individual interviews. Thematic qualitative and descriptive quantitative analyses were conducted. Results: Six types of service integration strategies have been implemented to varying degrees in substance-use disorder networks. They are: 1) coordination activities-governance, 2) primary-care consolidation models, 3) information and monitoring management tools, 4) service coordination strategies, 5) clinical evaluation tools and 6) training activities. Conclusion: Important investments have been made in Quebec for the training and assessment of individuals with substance-use disorders, particularly in terms of support for emergency room liaison teams and the introduction of standardised clinical evaluation tools. However, the development of integration strategies was insufficient to ensure the implementation of successful networks. Planning, consolidation of primary care for substance-use disorders and systematic implementation of various clinical and administrative integration strategies are needed in order to ensure a better continuum of care for individuals with substance-use disorders. PMID:27616951

Population Health Management for Inflammatory Bowel Disease.

PubMed

Dulai, Parambir S; Singh, Siddharth; Ohno-Machado, Lucilla; Sandborn, William J

2018-01-01

Inflammatory bowel diseases (IBDs) are chronic and impose significant, multidimensional burdens on patients and health care systems. The increasing prevalence of IBD will only worsen this problem globally-population health management (PHM) strategies are needed to increase quality of care and population health outcomes while reducing health care costs. We discuss the key components of PHM in IBD. Effective implementation of PHM strategies requires accurate identification of at-risk patients and key areas of variability in care. Improving outcomes of the at-risk population requires implementation of a multicomponent chronic care model designed to shift delivery of ambulatory care from acute, episodic, and reactive encounters, to proactive, planned, long-term care. This is achieved through team care of an activated patient with the help of remote monitoring, clinical information systems, and integrated decision support, with accompanying changes in delivery systems. Performance measurement is integral to any PHM strategy. This involves developing and implementing meaningful metrics of different phases of quality of IBD care and measuring them efficiently using modern clinical information systems. Such an integrated framework of PHM in IBD will facilitate the delivery of high-value care to patients. Copyright © 2018 AGA Institute. Published by Elsevier Inc. All rights reserved.

Post-Closure Strategy for Use-Restricted Sites on the Nevada National Security Site, Nevada Test and Training Range, and Tonopah Test Range, Nevada

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

Silvas, A. J.

The purpose of this Post-Closure Strategy is to provide a consistent methodology for continual evaluation of post-closure requirements for use-restricted areas on the Nevada National Security Site (NNSS), Nevada Test and Training Range (NTTR), and Tonopah Test Range (TTR) to consolidate, modify, or streamline the program. In addition, this document stipulates the creation of a single consolidated Post-Closure Plan that will detail the current post-closure requirements for all active use restrictions (URs) and outlines its implementation and subsequent revision. This strategy will ensure effective management and control of the post-closure sites. There are currently over 200 URs located on themore » NNSS, NTTR, and TTR. Post-closure requirements were initially established in the Closure Report for each site. In some cases, changes to the post-closure requirements have been implemented through addenda, errata sheets, records of technical change, or letters. Post-closure requirements have been collected from these multiple sources and consolidated into several formats, such as summaries and databases. This structure increases the possibility of inconsistencies and uncertainty. As more URs are established and the post-closure program is expanded, the need for a comprehensive approach for managing the program will increase. Not only should the current requirements be obtainable from a single source that supersedes all previous requirements, but the strategy for modifying the requirements should be standardized. This will enable more effective management of the program into the future. This strategy document and the subsequent comprehensive plan are to be implemented under the assumption that the NNSS and outlying sites will be under the purview of the U.S. Department of Energy, National Nuclear Security Administration for the foreseeable future. This strategy was also developed assuming that regulatory control of the sites remains static. The comprehensive plan is not intended to be a permanent long-term stewardship plan. However, it is intended to clarify requirements and identify components to effectively manage the sites until regulatory requirements are met or management of the site changes. The Environmental Management Program is required to manage these sites until the NNSS Environmental Restoration program is completed, currently planned for 2030. Prior to completion of the Environmental Restoration program, additional planning will be conducted to ensure that long-term stewardship of the sites is maintained. A comprehensive post-closure plan can be transitioned effectively into any future site-wide long-term stewardship program that may be developed. Therefore, the post-closure plan will include current aspects of the post-closure program that are also important aspects of long-term stewardship, including the following: • Management of physical and engineering controls such as fences, signs, and soil covers • Management of institutional and administrative controls such as use restrictions and real estate systems • Management of monitoring and maintenance programs • Management of information related to the sites such as geographic information system data and related documentation The strategy will also allow for periodic review and modification of any aspect of the program to ensure continued effectiveness.« less

Factors that influence producer decisions to implement management strategies.

PubMed

Field, Thomas G

2014-12-01

Cow-calf enterprises in the USA are widely divergent in size, locale, resource availability, management skill, and market focus. Furthermore, variation exists in dependence on the cow-calf enterprise as a primary source of income, perception about the utility of a particular management practice or technology, and assessment of cost: benefit resulting from implementation impact decisions. Enterprises with larger cow inventories, greater dependence on income from the cattle enterprise, and that retain ownership further into the supply chain beyond the cow-calf operation are more likely to institute management protocols such as vaccination programs, defined calving seasons, and reproductive technologies. Successful cow-calf managers place the highest priority on herd nutrition, pasture and range management, herd health, financial management marketing, production management, and genetics. Management practices are more likely to be adopted when they align with a manager's perception of the utility, labor availability, favorable cost: benefit outcomes and profit motivation.

The challenge of transferring an implementation strategy from academia to the field: a process evaluation of local quality improvement collaboratives in Dutch primary care using the normalization process theory.

PubMed

Trietsch, Jasper; van Steenkiste, Ben; Hobma, Sjoerd; Frericks, Arnoud; Grol, Richard; Metsemakers, Job; van der Weijden, Trudy

2014-12-01

A quality improvement strategy consisting of comparative feedback and peer review embedded in available local quality improvement collaboratives proved to be effective in changing the test-ordering behaviour of general practitioners. However, implementing this strategy was problematic. We aimed for large-scale implementation of an adapted strategy covering both test ordering and prescribing performance. Because we failed to achieve large-scale implementation, the aim of this study was to describe and analyse the challenges of the transferring process. In a qualitative study 19 regional health officers, pharmacists, laboratory specialists and general practitioners were interviewed within 6 months after the transfer period. The interviews were audiotaped, transcribed and independently coded by two of the authors. The codes were matched to the dimensions of the normalization process theory. The general idea of the strategy was widely supported, but generating the feedback was more complex than expected and the need for external support after transfer of the strategy remained high because participants did not assume responsibility for the work and the distribution of resources that came with it. Evidence on effectiveness, a national infrastructure for these collaboratives and a general positive attitude were not sufficient for normalization. Thinking about managing large databases, responsibility for tasks and distribution of resources should start as early as possible when planning complex quality improvement strategies. Merely exploring the barriers and facilitators experienced in a preceding trial is not sufficient. Although multifaceted implementation strategies to change professional behaviour are attractive, their inherent complexity is also a pitfall for large-scale implementation. © 2014 John Wiley & Sons, Ltd.

Strengthening health disaster risk management in Africa: multi-sectoral and people-centred approaches are required in the post-Hyogo Framework of Action era.

PubMed

Olu, Olushayo; Usman, Abdulmumini; Manga, Lucien; Anyangwe, Stella; Kalambay, Kalula; Nsenga, Ngoy; Woldetsadik, Solomon; Hampton, Craig; Nguessan, Francois; Benson, Angela

2016-08-02

In November 2012, the 62nd session of the Regional Committee for Africa adopted a comprehensive 10-year regional strategy for health disaster risk management (DRM). This was intended to operationalize the World Health Organization's core commitments to health DRM and the Hyogo Framework for Action 2005-2015 in the health sectors of the 47 African member states. This study reported the formative evaluation of the strategy, including evaluation of the progress in achieving nine targets (expected to be achieved incrementally by 2014, 2017, and 2022). We proposed recommendations for accelerating the strategy's implementation within the Sendai Framework for Disaster Risk Reduction. This study used a mixed methods design. A cross-sectional quantitative survey was conducted along with a review of available reports and information on the implementation of the strategy. A review meeting to discuss and finalize the study findings was also conducted. In total, 58 % of the countries assessed had established DRM coordination units within their Ministry of Health (MOH). Most had dedicated MOH DRM staff (88 %) and national-level DRM committees (71 %). Only 14 (58 %) of the countries had health DRM subcommittees using a multi-sectoral disaster risk reduction platform. Less than 40 % had conducted surveys such as disaster risk analysis, hospital safety index, and mapping of health resources availability. Key challenges in implementing the strategy were inadequate political will and commitment resulting in poor funding for health DRM, weak health systems, and a dearth of scientific evidence on mainstreaming DRM and disaster risk reduction in longer-term health system development programs. Implementation of the strategy was behind anticipated targets despite some positive outcomes, such as an increase in the number of countries with health DRM incorporated in their national health legislation, MOH DRM units, and functional health sub-committees within national DRM committees. Health system-based, multi-sectoral, and people-centred approaches are proposed to accelerate implementation of the strategy in the post-Hyogo Framework of Action era.

Urban gray vs. urban green vs. soil protection — Development of a systemic solution to soil sealing management on the example of Germany

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

Artmann, Martina, E-mail: m.artmann@ioer.de

Managing urban soil sealing is a difficult venture due to its spatial heterogeneity and embedding in a socio-ecological system. A systemic solution is needed to tackle its spatial, ecological and social sub-systems. This study develops a guideline for urban actors to find a systemic solution to soil sealing management based on two case studies in Germany: Munich and Leipzig. Legal-planning, informal-planning, economic-fiscal, co-operative and informational responses were evaluated by indicators to proof which strategy considers the spatial complexity of urban soil sealing (systemic spatial efficiency) and, while considering spatial complexity, to assess what the key management areas for action aremore » to reduce the ecological impacts by urban soil sealing (ecological impact efficiency) and to support an efficient implementation by urban actors (social implementation efficiency). Results suggest framing the systemic solution to soil sealing management through a cross-scale, legal-planning development strategy embedded in higher European policies. Within the socio-ecological system, the key management area for action should focus on the protection of green infrastructure being of high value for actors from the European to local scales. Further efforts are necessary to establish a systemic monitoring concept to optimize socio-ecological benefits and avoid trade-offs such as between urban infill development and urban green protection. This place-based study can be regarded as a stepping stone on how to develop systemic strategies by considering different spatial sub-targets and socio-ecological systems. - Highlights: • Urban soil sealing management is spatially complex. • The legal-planning strategy supports a systemic sealing management. • Urban green infrastructure protection should be in the management focus. • Soil protection requires policies from higher levels of government. • A systemic urban soil sealing monitoring concept is needed.« less

Using action research to plan a violence prevention program for emergency departments.

PubMed

Gates, Donna; Gillespie, Gordon; Smith, Carolyn; Rode, Jennifer; Kowalenko, Terry; Smith, Barbara

2011-01-01

Although there are numerous studies that show that emergency department (ED) violence is a prevalent and serious problem for healthcare workers, there is a lack of published evaluations of interventions aimed at reducing this alarming trend. Using an action research model, the authors partnered with six hospitals to plan, implement and evaluate a violence prevention and management intervention. Phase one of this project involved gathering information from employees, managers and patients using focus groups. Ninety-seven persons participated in one of twelve focus groups. The Haddon matrix was used to develop focus group questions aimed at gathering data about the pre-assault, during assault, and post-assault time frames and to compare these findings to planned strategies. Analysis consisted of identification of themes related to intervention strategies for patients/visitors, employees, managers, and the work environment. Thematic analysis results supported the relevance, feasibility, and saliency of the planned intervention strategies. With the exception of a few items, employees and managers from the different occupational groups agreed on the interventions needed to prevent and manage violence against ED workers. Patients focused on improved staff communication and comfort measures. Results support that violence in the emergency department is increasing, that violence is a major concern for those who work in and visit emergency departments, and that interventions are needed to reduce workplace violence. The Haddon matrix along with an action research method was useful to identify intervention strategies most likely to be successfully implemented and sustained by the emergency departments. Copyright © 2011 Emergency Nurses Association. Published by Mosby, Inc. All rights reserved.

Adaptive Management as an Effective Strategy: Interdisciplinary Perceptions for Natural Resources Management

NASA Astrophysics Data System (ADS)

Dreiss, Lindsay M.; Hessenauer, Jan-Michael; Nathan, Lucas R.; O'Connor, Kelly M.; Liberati, Marjorie R.; Kloster, Danielle P.; Barclay, Janet R.; Vokoun, Jason C.; Morzillo, Anita T.

2017-02-01

Adaptive management is a well-established approach to managing natural resources, but there is little evidence demonstrating effectiveness of adaptive management over traditional management techniques. Peer-reviewed literature attempts to draw conclusions about adaptive management effectiveness using social perceptions, but those studies are largely restricted to employees of US federal organizations. To gain a more comprehensive insight into perceived adaptive management effectiveness, this study aimed to broaden the suite of disciplines, professional affiliations, and geographic backgrounds represented by both practitioners and scholars. A questionnaire contained a series of questions concerning factors that lead to or inhibit effective management, followed by another set of questions focused on adaptive management. Using a continuum representing strategies of both adaptive management and traditional management, respondents selected those strategies that they perceived as being effective. Overall, characteristics (i.e., strategies, stakeholders, and barriers) identified by respondents as contributing to effective management closely aligned with adaptive management. Responses were correlated to the type of adaptive management experience rather than an individual's discipline, occupational, or regional affiliation. In particular, perceptions of characteristics contributing to adaptive management effectiveness varied between respondents who identified as adaptive management scholars (i.e., no implementation experience) and adaptive management practitioners. Together, these results supported two concepts that make adaptive management effective: practitioners emphasized adaptive management's value as a long-term approach and scholars noted the importance of stakeholder involvement. Even so, more communication between practitioners and scholars regarding adaptive management effectiveness could promote interdisciplinary learning and problem solving for improved resources management.

Adaptive Management as an Effective Strategy: Interdisciplinary Perceptions for Natural Resources Management.

PubMed

Dreiss, Lindsay M; Hessenauer, Jan-Michael; Nathan, Lucas R; O'Connor, Kelly M; Liberati, Marjorie R; Kloster, Danielle P; Barclay, Janet R; Vokoun, Jason C; Morzillo, Anita T

2017-02-01

Adaptive management is a well-established approach to managing natural resources, but there is little evidence demonstrating effectiveness of adaptive management over traditional management techniques. Peer-reviewed literature attempts to draw conclusions about adaptive management effectiveness using social perceptions, but those studies are largely restricted to employees of US federal organizations. To gain a more comprehensive insight into perceived adaptive management effectiveness, this study aimed to broaden the suite of disciplines, professional affiliations, and geographic backgrounds represented by both practitioners and scholars. A questionnaire contained a series of questions concerning factors that lead to or inhibit effective management, followed by another set of questions focused on adaptive management. Using a continuum representing strategies of both adaptive management and traditional management, respondents selected those strategies that they perceived as being effective. Overall, characteristics (i.e., strategies, stakeholders, and barriers) identified by respondents as contributing to effective management closely aligned with adaptive management. Responses were correlated to the type of adaptive management experience rather than an individual's discipline, occupational, or regional affiliation. In particular, perceptions of characteristics contributing to adaptive management effectiveness varied between respondents who identified as adaptive management scholars (i.e., no implementation experience) and adaptive management practitioners. Together, these results supported two concepts that make adaptive management effective: practitioners emphasized adaptive management's value as a long-term approach and scholars noted the importance of stakeholder involvement. Even so, more communication between practitioners and scholars regarding adaptive management effectiveness could promote interdisciplinary learning and problem solving for improved resources management.

Current and future directions in Medi-Cal chronic disease care management: a view from the top.

PubMed

Goldman, L Elizabeth; Handley, Margaret; Rundall, Thomas G; Schillinger, Dean

2007-05-01

To determine the extent to which Medicaid managed care (MMC) organizations are engaged in chronic disease care management (CDCM), tailor CDCM for diverse populations, or plan to expand CDCM. Web-based survey of 23 eligible California MMC health plan executives in fall 2005. Frequency distributions of survey responses. Nineteen (83%) of 23 executives responded, representing 2.5 million beneficiaries. Eighteen (95%) MMC plans reported implementing 1 or more elements of CDCM. Although plans used a wide range of CDCM strategies to reach performance goals, most implemented provider awareness activities such as offering guidelines or disease-specific feedback to physician groups. More than half of the plans reported interest in expanding CDCM to include more active interventions such as disease registries, pay for performance, telephone counseling to patients, and other self-management support programs. Few plans reported tailoring their CDCM to vulnerable member populations such as those with limited literacy or limited English proficiency. Executives reported that insufficient financial resources at the plan level, lack of organizational leadership and commitment in physician organizations, and limited information technology in physician offices were barriers to CDCM expansion. California MMC health plans reported substantial interest in CDCM and a desire to increase CDCM. Representatives reported intentions to expand to strategies that more directly engage providers and patients. To ensure that the growing number of vulnerable enrollees with chronic disease receive high-quality care, policy efforts should focus on enabling MMC health plans to more consistently implement and target population-based strategies such as CDCM.

[Implementation of a Clinical Practice Guidelines for the Management of Adults With Schizophrenia in Colombia].

PubMed

Sánchez Díaz, Natalia; Duarte Osorio, Andrés; Gómez Restrepo, Carlos; Bohórquez Peñaranda, Adriana Patricia

2016-01-01

To present overall strategies and activities for the implementation process of the recommendations contained in the clinical practice guideline for the management of adults with schizophrenia (GPC_E) published by the Colombian Ministry of Health and Welfare (MSPS). Prioritize the proposed recommendations, identify barriers and solving strategies to implement the GPC_E, and develop a monitoring and evaluation system for the key recommendations. The Guideline Developer Group (GDG) included professionals with primary dedication to implementation issues that accompanied the entire process. During the GDG meetings implementation topics were identified and discussed, and later complemented by literature reviews concerning the experience of mental health guidelines implementation at national and international level. Additionally, feedback from the discussions raised during the socialization meetings, and joint meetings with the MSPS and the Institute of Technology Assessment in Health (IETS) were included. The prioritization of recommendations was made in conjunction with the GDG, following the proposed steps in the methodological guide for the development of Clinical Practice Guidelines with Economic Evaluation in the General System of Social Security in Colombian Health (GMEGPC) using the tools 13 and 14. the conclusions and final adjustments were discussed with the GPC_E leaders. The implementation chapter includes a description of the potential barriers, solution strategies, facilitators and monitoring indicators. The identified barriers were categorized in the following 3 groups: Cultural context, health system and proposed interventions. The issues related to solving strategies and facilitating education programs include community mental health, mental health training for health workers in primary care, decentralization and integration of mental health services at the primary care level, use of technologies information and communication and telemedicine. To monitor and evaluate o the implementation process, five (5) indicators were designed one (1) structure, two (2) process and two (2)outcome indicators. The GPC_E implementation within the Colombian General health System of Social Security (SGSSSC) poses multiple challenges. Potential barriers, enabling strategies and indicators for monitoring and evaluation described in this article, can provide efficient support to ensure the success of this process in the institutions that will adopt the guideline. Copyright © 2014 Asociación Colombiana de Psiquiatría. Publicado por Elsevier España. All rights reserved.

An integrative review of absenteeism in newly graduated nurses.

PubMed

Craft, Judy; Christensen, Martin; Wirihana, Lisa; Bakon, Shannon; Barr, Jennie; Tsai, Lily

2017-10-30

Managing sickness and absenteeism in the workplace is challenging, and nurse managers must consider their various causes so they can implement effective management strategies. It is also vital to consider the factors that influence absenteeism and turnover among newly graduated registered nurses (RNs), whose retention can help to address staff shortages. This article describes a literature review that aimed to identify the potential causes of sickness absence in newly graduated RNs. It also discusses strategies that nurse managers can use to retain and maintain their workforce. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

[Women-and Child-Friendly Institutional Strategies with an integral approach in Colombia].

PubMed

Farías-Jiménez, Patricia; Arocha-Zuluaga, Gina Paola; Trujillo-Ramírez, Kenny Margarita; Botero-Uribe, Inés

2014-01-01

It is uncommon to implement and document a maternal and child healthcare strategy on a territorial and institutional level is infrequent. Therefore, we aimed to describe the experience of a consulting team composed of two physicians, two nurses and two nutritionists, whose purpose was to support the introduction of the Women- and Child-Friendly Institutional Strategy with an integral approach in 25 healthcare institutions in three Colombian departments (Cauca, Huila and Nariño), according to unmet basic needs. The Women- and Child-Friendly Institutional Strategy, considered a senior management strategy, promotes a specific method that allows monitoring of institutions during the implementation of a health and nutritional care strategy for women and children, and offers them the possibility of voluntarily becoming accredited as a Women- and Child-Friendly Institutions. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Implementing an anti-smoking program in rural-remote communities: challenges and strategies.

PubMed

Tall, Julie A; Brew, Bronwyn K; Saurman, Emily; Jones, Therese C

2015-01-01

Rural-remote communities report higher smoking rates and poorer health outcomes than that of metropolitan areas. While anti-smoking programs are an important measure for addressing smoking and improving health, little is known of the challenges faced by primary healthcare staff implementing those programs in the rural-remote setting. The aim of this study was to explore the challenges and strategies of implementing an anti-smoking program by primary healthcare staff in rural-remote Australia. Guided by a phenomenological approach, semi-structured interviews and focus groups were conducted with health service managers, case managers and general practitioners involved in program implementation in Australian rural-remote communities between 2008 and 2010. Program implementation was reported to be challenged by limited primary and mental healthcare resources and client access to services; limited collaboration between health services; the difficulty of accessing staff training; high levels of community distress and disadvantage; the normalisation of smoking and its deleterious impact on smoking abstinence among program clients; and low morale among health staff. Strategies identified to overcome challenges included appointing tobacco-dedicated staff; improving health service collaboration, access and flexibility; providing subsidised pharmacotherapies and boosting staff morale. Findings may assist health services to better tailor anti-smoking programs for the rural-remote setting, where smoking rates are particularly high. Catering for the unique challenges of the rural-remote setting is necessary if anti-smoking programs are to be efficacious, cost-effective and capable of improving rural-remote health outcomes.

Collecting, Integrating, and Disseminating Patient-Reported Outcomes for Research in a Learning Healthcare System

PubMed Central

Harle, Christopher A.; Lipori, Gloria; Hurley, Robert W.

2016-01-01

Introduction: Advances in health policy, research, and information technology have converged to increase the electronic collection and use of patient-reported outcomes (PROs). Therefore, it is important to share lessons learned in implementing PROs in research information systems. Case Description: The purpose of this case study is to describe a novel information system for electronic PROs and lessons learned in implementing that system to support research in an academic health center. The system incorporates freely available and commercial software and involves clinical and research workflows that support the collection, transformation, and research use of PRO data. The software and processes that comprise the system serve three main functions, (i) collecting electronic PROs in clinical care, (ii) integrating PRO data with non-patient generated clinical data, and (iii) disseminating data to researchers through the institution’s research informatics infrastructure, including the i2b2 (Informatics for Integrating Biology and the Bedside) system. Strategies: Our successful design and implementation was driven by three overarching strategies. First, we selected and implemented multiple interfaced technologies to support PRO collection, management, and research use. Second, we aimed to use standardized approaches to measuring PROs, sending PROs between systems, and disseminating PROs. Finally, we focused on using technologies and processes that aligned with existing clinical research information management strategies within our organization. Conclusion: These experiences and lessons may help future implementers and researchers enhance the scale and sustainable use of systems for research use of PROs. PMID:27563683

The place of knowledge management in influencing lasting health change in Africa: an analysis of AMREF's progress

PubMed Central

Shoo, Rumishael; Matuku, Willy; Ireri, Jane; Nyagero, Josephat; Gatonga, Patrick

2012-01-01

Introduction AMREF (African Medical and Research Foundation) developed a Knowledge Management Strategy that focused on creating, capturing and applying health knowledge to close the gap between communities and health systems in Africa. There was need to identify AMREF's current Knowledge Management implementation status, problems and constraints encountered after two years of enforcement of the strategy and suggest the way forward. Methods This study was conducted between October 2011 and February 2012. Quantitative data on number and foci of AMREF research publications were collected using a questionnaire. Focus group discussions and in-depth interviews were used to gather data on explanations for the trend of publications and the status of the implementation of the 2010-2014 Knowledge Management Strategy. Quantitative data was analysed using SPSS computer software whereas content analysis of themes was employed on qualitative data. Results Between 1960 and 2011, AMREF produced 257 peer reviewed publications, 158 books and manuals and about 1,188 technical publications including evaluations, guidelines and technical reports. However, the numbers of publications declined from around the year 2000. Large quantities of unpublished and unclassified materials are also in the custody of Heritage. Barriers to Knowledge Management included: lack of incentives for documentation and dissemination; limited documentation and use of good practices in programming; and superficial attention to results or use of evidence. Conclusion Alternative ways of reorganizing Knowledge Management will enable AMREF to use evidence-based knowledge to advocate for appropriate changes in African health policies and practices. PMID:23467647

The place of knowledge management in influencing lasting health change in Africa: an analysis of AMREF's progress.

PubMed

Shoo, Rumishael; Matuku, Willy; Ireri, Jane; Nyagero, Josephat; Gatonga, Patrick

2012-01-01

AMREF (African Medical and Research Foundation) developed a Knowledge Management Strategy that focused on creating, capturing and applying health knowledge to close the gap between communities and health systems in Africa. There was need to identify AMREF's current Knowledge Management implementation status, problems and constraints encountered after two years of enforcement of the strategy and suggest the way forward. This study was conducted between October 2011 and February 2012. Quantitative data on number and foci of AMREF research publications were collected using a questionnaire. Focus group discussions and in-depth interviews were used to gather data on explanations for the trend of publications and the status of the implementation of the 2010-2014 Knowledge Management Strategy. Quantitative data was analysed using SPSS computer software whereas content analysis of themes was employed on qualitative data. Between 1960 and 2011, AMREF produced 257 peer reviewed publications, 158 books and manuals and about 1,188 technical publications including evaluations, guidelines and technical reports. However, the numbers of publications declined from around the year 2000. Large quantities of unpublished and unclassified materials are also in the custody of Heritage. Barriers to Knowledge Management included: lack of incentives for documentation and dissemination; limited documentation and use of good practices in programming; and superficial attention to results or use of evidence. Alternative ways of reorganizing Knowledge Management will enable AMREF to use evidence-based knowledge to advocate for appropriate changes in African health policies and practices.

Enablers and barriers for implementing high-quality hypertension care in a rural primary care setting in Nigeria: perspectives of primary care staff and health insurance managers.

PubMed

Odusola, Aina O; Stronks, Karien; Hendriks, Marleen E; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A

2016-01-01

Hypertension is a highly prevalent risk factor for cardiovascular diseases in sub-Saharan Africa (SSA) that can be modified through timely and long-term treatment in primary care. We explored perspectives of primary care staff and health insurance managers on enablers and barriers for implementing high-quality hypertension care, in the context of a community-based health insurance programme in rural Nigeria. Qualitative study using semi-structured individual interviews with primary care staff (n = 11) and health insurance managers (n=4). Data were analysed using standard qualitative techniques. Both stakeholder groups perceived health insurance as an important facilitator for implementing high-quality hypertension care because it covered costs of care for patients and provided essential resources and incentives to clinics: guidelines, staff training, medications, and diagnostic equipment. Perceived inhibitors included the following: high staff workload; administrative challenges at facilities; discordance between healthcare provider and insurer on how health insurance and provider payment methods work; and insufficient fit between some guideline recommendations and tools for patient education and characteristics/needs of the local patient population. Perceived strategies to address inhibitors included the following: task-shifting; adequate provider payment benchmarking; good provider-insurer relationships; automated administration systems; and tailoring guidelines/patient education. By providing insights into perspectives of primary care providers and health insurance managers, this study offers information on potential strategies for implementing high-quality hypertension care for insured patients in SSA.

Causes and remedies for the dominant risk factors in Enterprise System implementation projects: the consultants' perspective.

PubMed

Lech, Przemysław

2016-01-01

The purpose of this research was to investigate the causes of the dominant risk factors, affecting Enterprise System implementation projects and propose remedies for those risk factors from the perspective of implementation consultants. The study used a qualitative research strategy, based on e-mail interviews, semi-structured personal interviews with consultants and participant observation during implementation projects. The main contribution of this paper is that it offers viable indications of how to mitigate the dominant risk factors. These indications were grouped into the following categories: stable project scope, smooth communication supported by the project management, dedicated, competent and decision-making client team, competent and engaged consultant project manager, schedule and budget consistent with the project scope, use of methodology and procedures, enforced and enabled by the project managers, competent and dedicated consultants. A detailed description is provided for each category.

Using Benchmarking To Influence Tuition and Fee Decisions.

ERIC Educational Resources Information Center

Hubbell, Loren W. Loomis; Massa, Robert J.; Lapovsky, Lucie

2002-01-01

Discusses the use of benchmarking in managing enrollment. Using a case study, illustrates how benchmarking can help administrators develop strategies for planning and implementing admissions and pricing practices. (EV)

Information Technology in Complex Health Services

PubMed Central

Southon, Frank Charles Gray; Sauer, Chris; Dampney, Christopher Noel Grant (Kit)

1997-01-01

Abstract Objective: To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. Design: A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. Measurements: Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. Results: Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. Conclusion: The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case. PMID:9067877

Information technology in complex health services: organizational impediments to successful technology transfer and diffusion.

PubMed

Southon, F C; Sauer, C; Grant, C N

1997-01-01

To identify impediments to the successful transfer and implementation of packaged information systems through large, divisionalized health services. A case analysis of the failure of an implementation of a critical application in the Public Health System of the State of New South Wales, Australia, was carried out. This application had been proven in the United States environment. Interviews involving over 60 staff at all levels of the service were undertaken by a team of three. The interviews were recorded and analyzed for key themes, and the results were shared and compared to enable a continuing critical assessment. Two components of the transfer of the system were considered: the transfer from a different environment, and the diffusion throughout a large, divisionalized organization. The analyses were based on the Scott-Morton organizational fit framework. In relation to the first, it was found that there was a lack of fit in the business environments and strategies, organizational structures and strategy-structure pairing as well as the management process-roles pairing. The diffusion process experienced problems because of the lack of fit in the strategy-structure, strategy-structure-management processes, and strategy-structure-role relationships. The large-scale developments of integrated health services present great challenges to the efficient and reliable implementation of information technology, especially in large, divisionalized organizations. There is a need to take a more sophisticated approach to understanding the complexities of organizational factors than has traditionally been the case.

Modifying physician behavior to improve cost-efficiency in safety-net ambulatory settings.

PubMed

Borkowski, Nancy; Gumus, Gulcin; Deckard, Gloria J

2013-01-01

Change interventions in one form or another are viewed as important tools to reduce variation in medical services, reduce costs, and improve quality of care. With the current focus on efficient resource use, the successful design and implementation of change strategies are of utmost importance for health care managers. We present a case study in which macro and micro level change strategies were used to modify primary care physicians' practice patterns of prescribing diagnostic services in a safety-net's ambulatory clinics. The findings suggest that health care managers using evidence-based strategies can create a practice environment that reduces barriers and facilitates change.

Provider Adherence to Implementation of Clinical Practice Guidelines for Neurogenic Bowel in Adults With Spinal Cord Injury

PubMed Central

Goetz, Lance L; Nelson, Audrey L; Guihan, Marylou; Bosshart, Helen T; Harrow, Jeffrey J; Gerhart, Kevin D; Krasnicka, Barbara; Burns, Stephen P

2005-01-01

Background/Objectives: Clinical Practice Guidelines (CPGs) have been published on a number of topics in spinal cord injury (SCI) medicine. Research in the general medical literature shows that the distribution of CPGs has a minimal effect on physician practice without targeted implementation strategies. The purpose of this study was to determine (a) whether dissemination of an SCI CPG improved the likelihood that patients would receive CPG recommended care and (b) whether adherence to CPG recommendations could be improved through a targeted implementation strategy. Specifically, this study addressed the “Neurogenic Bowel Management in Adults with Spinal Cord Injury” Clinical Practice Guideline published in March 1998 by the Consortium for Spinal Cord Medicine Methods: CPG adherence was determined from medical record review at 6 Veterans Affairs SCI centers for 3 time periods: before guideline publication (T1), after guideline publication but before CPG implementation (T2), and after targeted CPG implementation (T3). Specific implementation strategies to enhance guideline adherence were chosen to address the barriers identified by SCI providers in focus groups before the intervention. Results: Overall adherence to recommendations related to neurogenic bowel did not change between T1 and T2 (P = not significant) but increased significantly between T2 and T3 (P < 0.001) for 3 of 6 guideline recommendations. For the other 3 guideline recommendations, adherence rates were noted to be high at T1. Conclusions: While publication of the CPG alone did not alter rates of provider adherence, the use of a targeted implementation plan resulted in increases in adherence rates with some (3 of 6) CPG recommendations for neurogenic bowel management. PMID:16869086

Evaluating Niger's experience in strengthening supervision, improving availability of child survival drugs through cost recovery, and initiating training for Integrated Management of Childhood Illness (IMCI)

PubMed Central

Tawfik, Youssef M; Legros, Stephane; Geslin, Colette

2001-01-01

Background WHO and UNICEF have recently developed the "Integrated Management of Childhood Illness" (IMCI) as an efficient strategy to assist developing countries reduce childhood mortality. Early experience with IMCI implementation suggests that clinical training is essential but not sufficient for the success of the strategy. Attention needs to be given to strengthening health systems, such as supervision and drug supply. Results This paper presents results of evaluating an innovative approach for implementing IMCI in Niger. It starts with strengthening district level supervision and improving the availability of child survival drugs through cost recovery well before the beginning of IMCI clinical training. The evaluation documented the effectiveness of the initial IMCI clinical training and referral. Conclusions Strengthening supervision and assuring the availability of essential drugs need to precede the initiation of IMCI Clinical training. Longer term follow up is necessary to confirm the impact of the approach on IMCI preparation and implementation. PMID:11504567

Wait time management strategies for total joint replacement surgery: sustainability and unintended consequences.

PubMed

Pomey, Marie-Pascale; Clavel, Nathalie; Amar, Claudia; Sabogale-Olarte, Juan Carlos; Sanmartin, Claudia; De Coster, Carolyn; Noseworthy, Tom

2017-09-07

In Canada, long waiting times for core specialized services have consistently been identified as a key barrier to access. Governments and organizations have responded with strategies for better access management, notably for total joint replacement (TJR) of the hip and knee. While wait time management strategies (WTMS) are promising, the factors which influence their sustainable implementation at the organizational level are understudied. Consequently, this study examined organizational and systemic factors that made it possible to sustain waiting times for TJR within federally established limits and for at least 18 months or more. The research design is a multiple case study of WTMS implementation. Five cases were selected across five Canadian provinces. Three success levels were pre-defined: 1) the WTMS maintained compliance with requirements for more than 18 months; 2) the WTMS met requirements for 18 months but could not sustain the level thereafter; 3) the WTMS never met requirements. For each case, we collected documents and interviewed key informants. We analyzed systemic and organizational factors, with particular attention to governance and leadership, culture, resources, methods, and tools. We found that successful organizations had specific characteristics: 1) management of the whole care continuum, 2) strong clinical leadership; 3) dedicated committees to coordinate and sustain strategy; 4) a culture based on trust and innovation. All strategies led to relatively similar unintended consequences. The main negative consequence was an initial increase in waiting times for TJR and the main positive consequence was operational enhancement of other areas of specialization based on the TJR model. This study highlights important differences in factors which help to achieve and sustain waiting times. To be sustainable, a WTMS needs to generate greater synergies between contextual-level strategy (provincial or regional) and organizational objectives and constraints. Managers at the organizational level should be vigilant with regard to unintended consequences that a WTMS in one area can have for other areas of care. A more systemic approach to sustainability can help avoid or mitigate undesirable unintended consequences.

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda

PubMed Central

2014-01-01

Background Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. Methods In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. Discussion EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. Trial registration PACTR201311000681314 PMID:24690284

Expanded Quality Management Using Information Power (EQUIP): protocol for a quasi-experimental study to improve maternal and newborn health in Tanzania and Uganda.

PubMed

Hanson, Claudia; Waiswa, Peter; Marchant, Tanya; Marx, Michael; Manzi, Fatuma; Mbaruku, Godfrey; Rowe, Alex; Tomson, Göran; Schellenberg, Joanna; Peterson, Stefan

2014-04-02

Maternal and newborn mortality remain unacceptably high in sub-Saharan Africa. Tanzania and Uganda are committed to reduce maternal and newborn mortality, but progress has been limited and many essential interventions are unavailable in primary and referral facilities. Quality management has the potential to overcome low implementation levels by assisting teams of health workers and others finding local solutions to problems in delivering quality care and the underutilization of health services by the community. Existing evidence of the effect of quality management on health worker performance in these contexts has important limitations, and the feasibility of expanding quality management to the community level is unknown. We aim to assess quality management at the district, facility, and community levels, supported by information from high-quality, continuous surveys, and report effects of the quality management intervention on the utilization and quality of services in Tanzania and Uganda. In Uganda and Tanzania, the Expanded Quality Management Using Information Power (EQUIP) intervention is implemented in one intervention district and evaluated using a plausibility design with one non-randomly selected comparison district. The quality management approach is based on the collaborative model for improvement, in which groups of quality improvement teams test new implementation strategies (change ideas) and periodically meet to share results and identify the best strategies. The teams use locally-generated community and health facility data to monitor improvements. In addition, data from continuous health facility and household surveys are used to guide prioritization and decision making by quality improvement teams as well as for evaluation of the intervention. These data include input, process, output, coverage, implementation practice, and client satisfaction indicators in both intervention and comparison districts. Thus, intervention districts receive quality management and continuous surveys, and comparison districts-only continuous surveys. EQUIP is a district-scale, proof-of-concept study that evaluates a quality management approach for maternal and newborn health including communities, health facilities, and district health managers, supported by high-quality data from independent continuous household and health facility surveys. The study will generate robust evidence about the effectiveness of quality management and will inform future nationwide implementation approaches for health system strengthening in low-resource settings. PACTR201311000681314.

Patient Blood Management: An International Perspective.

PubMed

Eichbaum, Quentin; Murphy, Michael; Liu, Yu; Kajja, Isaac; Hajjar, Ludhmila Abrahao; Smit Sibinga, Cees Th; Shan, Hua

2016-12-01

This article describes practices in patient blood management (PBM) in 4 countries on different continents that may provide insights for anesthesiologists and other physicians working in global settings. The article has its foundation in the proceedings of a session at the 2014 AABB annual meeting during which international experts from England, Uganda, China, and Brazil presented the programs and implementation strategies in PBM developed in their respective countries. To systematize the review and enhance the comparability between these countries on different continents, authors were requested to respond to the same set of 6 key questions with respect to their country's PBM program(s). Considerable variation exists between these country regions that is driven both by differences in health contexts and by disparities in resources. Comparing PBM strategies from low-, middle-, and high-income countries, as described in this article, allows them to learn bidirectionally from one another and to work toward implementing innovative and preferably evidence-based strategies for improvement. Sharing and distributing knowledge from such programs will ultimately also improve transfusion outcomes and patient safety.

The Climaware project: Impacts of climate change on water resources management - regional strategies and European view

NASA Astrophysics Data System (ADS)

Thirel, Guillaume; D'Agostino, Daniela; Démerliac, Stéphane; Dorchies, David; Flörke, Martina; Jay-Allemand, Maxime; Jost, Claudine; Kehr, Katrin; Perrin, Charles; Scardigno, Alessandra; Schneider, Christof; Theobald, Stephan; Träbing, Klaus

2014-05-01

Climate projections produced with CMIP5 and applied by the Intergovernmental Panel on Climate Change (IPCC) in its fifth assessment report indicate that changes in precipitation and temperature are expected to occur throughout Europe in the 21th century, with a likely decrease of water availability in many regions. Besides, water demand is also expected to increase, in link with these expected climate modifications, but also due to socio-economic and demographic changes. In this respect, the use of future freshwater resources may not be sustainable from the current water management perspective. Therefore adaptation strategies will most likely be needed to cope with these evolutions. In this context, the main objective of the ClimAware project (2010-2013 - www.uni-kassel.de/fb14/wasserbau/CLIMAWARE/, a project implemented within the IWRM-NET Funding Initiative) was to analyse the impacts of climate change (CC) on freshwater resources at the continental and regional scales and to identify efficient adaptation strategies to improve water management for various socio-economic sectors. This should contribute to a more effective implementation of the Water Framework Directive (WFD) and its instruments (river basin management plans, programmes of measures). The project developed integrated measures for improved freshwater management under CC constraints. More specifically, the objectives of the ClimAware project were to: • elaborate quantitative projections of changes in river flows and consequences such as flood frequency, drought occurrence and sectorial water uses. • analyse the effect of CC on the hydromorphological reference conditions of rivers and therefore the definition of "good status". • define management rules/strategies concerning dam management and irrigation practices on different time perspectives. • investigate uncertainties in climate model - scenario combinations. The research approach considered both European and regional perspectives, to get an integrated analysis across different spatial scales. To fulfil the objectives of the ClimAware project, the following modelling methodology was implemented. Starting from a European modelling approach of water availability and use based on the WaterGAP3 model, the changes in the hydrologic regimes and water use of different sectors were analysed. Subsequently three case studies were used to investigate the impacts of CC at a regional scale. Regional models from three different countries and focusing on three types of water management issues were developed: • Hydromorphology (Eder basin, Germany): By using different scenarios, the influence of CC on the hydromorphological characteristics of the River Weser according to the WFD was evaluated and proposals for implementation were given. The objective was to examine, on typical river sections, how the WFD objectives can be implemented under CC constraints. • Dam management (Seine basin, France): Water management on the River Seine for water supply and flood alleviation is partly based on the management of artificial reservoirs. The case study developed scenarios linking the impact of CC on water resources and the expected change on the uses and on the management of the system. • Agricultural water use (Apulia region, Italy): In this region, economic and demographic changes cause an increase in the demand for good-quality municipal and industrial water. Besides, changes in the agricultural practices increase the demand for water in the agricultural sector. Since water is scarce in this region, the study focuses on the agricultural sector, which has the largest water saving potential. The final assessment comprises a cross-scale integration between the European and regional modelling frameworks in order to facilitate knowledge transfer and to help establishing sustainable and integrated water resources management plans.

Implementation of Health Information Technology in Routine Care for Fibromyalgia: Pilot Study.

PubMed

Sparks, Toni; Kawi, Jennifer; Menzel, Nancy Nivison; Hartley, Kendall

2016-02-01

Fibromyalgia management remains complicated and challenging. Health information technology is an evidence-based, nonpharmacological self and symptom management strategy, but few studies have evaluated its feasibility for managing fibromyalgia patients in clinical practice. FibroGuide is an example of an evidence-based, interactive, and computer-based program comprised of 10 educational modules on fibromyalgia. Study aims were to: (1) develop a process for implementing FibroGuide into the routine care of patients with fibromyalgia, (2) evaluate the overall impact on fibromyalgia before and after a 12-week implementation, and (3) assess patient perspectives on using FibroGuide health information technology to assist in self-management. In this pilot study, 35 participants with fibromyalgia were recruited from an Advanced Practice Registered Nurse's outpatient clinic. Using a descriptive design, quantitative data analysis was employed to address study aims. Based on data collection pre- and post-intervention using paired samples testing, a statistically significant change (p = .017) was observed in overall fibromyalgia impact (improved symptom severity, activity, and function). Majority felt that FibroGuide was helpful as part of their routine care, and nearly half reported that it assisted in their self-management. Although 65% noted that technology was an effective and efficient way to receive education for fibromyalgia management, 57% preferred talking to healthcare providers. Larger longitudinal studies are needed on the use of health information technology in fibromyalgia, evaluating both statistical and clinical significance, while decreasing barriers to participant use for this promising adjunct to clinical management. Providers need to be well educated on supporting self-management strategies and health information technology. Copyright © 2016 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.

A review of climate-change adaptation strategies for wildlife management and biodiversity conservation.

PubMed

Mawdsley, Jonathan R; O'Malley, Robin; Ojima, Dennis S

2009-10-01

The scientific literature contains numerous descriptions of observed and potential effects of global climate change on species and ecosystems. In response to anticipated effects of climate change, conservation organizations and government agencies are developing "adaptation strategies" to facilitate the adjustment of human society and ecological systems to altered climate regimes. We reviewed the literature and climate-change adaptation plans that have been developed in United States, Canada, England, México, and South Africa and found 16 general adaptation strategies that relate directly to the conservation of biological diversity. These strategies can be grouped into four broad categories: land and water protection and management; direct species management; monitoring and planning; and law and policy. Tools for implementing these strategies are similar or identical to those already in use by conservationists worldwide (land and water conservation, ecological restoration, agrienvironment schemes, species translocation, captive propagation, monitoring, natural resource planning, and legislation/regulation). Although our review indicates natural resource managers already have many tools that can be used to address climate-change effects, managers will likely need to apply these tools in novel and innovative ways to meet the unprecedented challenges posed by climate change.

Ecology of Fungus Gnats (Bradysia spp.) in Greenhouse Production Systems Associated with Disease-Interactions and Alternative Management Strategies.

PubMed

Cloyd, Raymond A

2015-04-09

Fungus gnats (Bradysia spp.) are major insect pests of greenhouse-grown horticultural crops mainly due to the direct feeding damage caused by the larvae, and the ability of larvae to transmit certain soil-borne plant pathogens. Currently, insecticides and biological control agents are being used successively to deal with fungus gnat populations in greenhouse production systems. However, these strategies may only be effective as long as greenhouse producers also implement alternative management strategies such as cultural, physical, and sanitation. This includes elimination of algae, and plant and growing medium debris; placing physical barriers onto the growing medium surface; and using materials that repel fungus gnat adults. This article describes the disease-interactions associated with fungus gnats and foliar and soil-borne diseases, and the alternative management strategies that should be considered by greenhouse producers in order to alleviate problems with fungus gnats in greenhouse production systems.

Ecology of Fungus Gnats (Bradysia spp.) in Greenhouse Production Systems Associated with Disease-Interactions and Alternative Management Strategies

PubMed Central

Cloyd, Raymond A.

2015-01-01

Fungus gnats (Bradysia spp.) are major insect pests of greenhouse-grown horticultural crops mainly due to the direct feeding damage caused by the larvae, and the ability of larvae to transmit certain soil-borne plant pathogens. Currently, insecticides and biological control agents are being used successively to deal with fungus gnat populations in greenhouse production systems. However, these strategies may only be effective as long as greenhouse producers also implement alternative management strategies such as cultural, physical, and sanitation. This includes elimination of algae, and plant and growing medium debris; placing physical barriers onto the growing medium surface; and using materials that repel fungus gnat adults. This article describes the disease-interactions associated with fungus gnats and foliar and soil-borne diseases, and the alternative management strategies that should be considered by greenhouse producers in order to alleviate problems with fungus gnats in greenhouse production systems. PMID:26463188