Planning Guide for Implementing a Quality Youth Apprenticeship Program in Georgia.

ERIC Educational Resources Information Center

Smith, Clifton L.

This planning guide begins with an overview of school-to-work transition. Section 1 also provides an overview of federal and Georgia state legislation and describes current school-to-work transition efforts, such as tech prep education, youth apprenticeship, cooperative education, entrepreneurial ventures and school-based enterprises,…

Implementing SCANS. Highlight Zone: Research @ Work.

ERIC Educational Resources Information Center

Packer, Arnold C.; Brainard, Scott

Foremost among efforts over the last decade to improve the work-related skills required of all young people to meet the demands of American's workplaces was the Secretary's Commission on Achieving Necessary Skills Commission (SCANS). Integral to SCANS were its three-part foundation (basic skills, thinking skills, and personal qualities) and these…

Evaluating a nursing care delivery model using a quality improvement design.

PubMed

Nardone, P L; Markie, J W; Tolle, S

1995-10-01

The goal to develop and implement a new model of nursing care delivery grew out of administrative and shared governance initiatives to improve the quality of nursing care. This evaluative study used both quantitative and qualitative methods. Seven principles related to quality were identified and became the driving force behind the changes. Aspects of these changes in care delivery were piloted on a neurological unit and included implementation of collaborative rounds, a modular structure, role changes, and work redesign. Frequency distribution, questionnaire, focus group, and financial data indicated that there had been improvement in the delivery of care in addition to financial benefits. A considerable amount of the data provided evidence that supported continuing the changes.

Predicting the visual quality impacts of development: a simulation of alternative policies for implementing the Massachusetts Scenic and Recreational Rivers Act

Treesearch

Carl Steinitz

1979-01-01

An implementation work program has been de-veloped by the Massachusetts Department of Environmental Management (MASS D.E.M.) for the Massachusetts Scenic and Recreational Rivers Act, and the North River has been chosen as the pilot project area. The question which has been posed by MASS D.E.M. is: "What will be the impacts of eleven alternative implementation...

43 CFR 45.73 - How will the bureau analyze a proposed alternative and formulate its modified condition or...

Code of Federal Regulations, 2010 CFR

2010-10-01

..., distribution, cost, and use; (2) Flood control; (3) Navigation; (4) Water supply; (5) Air quality; and (6..., including: (1) Any evidence on the implementation costs or operational impacts for electricity production of...) Cost significantly less to implement; or (ii) Result in improved operation of the project works for...

Implementing resilience engineering for healthcare quality improvement using the CARE model: a feasibility study protocol.

PubMed

Anderson, J E; Ross, A J; Back, J; Duncan, M; Snell, P; Walsh, K; Jaye, P

2016-01-01

Resilience engineering (RE) is an emerging perspective on safety in complex adaptive systems that emphasises how outcomes emerge from the complexity of the clinical environment. Complexity creates the need for flexible adaptation to achieve outcomes. RE focuses on understanding the nature of adaptations, learning from success and increasing adaptive capacity. Although the philosophy is clear, progress in applying the ideas to quality improvement has been slow. The aim of this study is to test the feasibility of translating RE concepts into practical methods to improve quality by designing, implementing and evaluating interventions based on RE theory. The CARE model operationalises the key concepts and their relationships to guide the empirical investigation. The settings are the Emergency Department and the Older Person's Unit in a large London teaching hospital. Phases 1 and 2 of our work, leading to the development of interventions to improve the quality of care, are described in this paper. Ethical approval has been granted for these phases. Phase 1 will use ethnographic methods, including observation of work practices and interviews with staff, to understand adaptations and outcomes. The findings will be used to collaboratively design, with clinical staff in interactive design workshops, interventions to improve the quality of care. The evaluation phase will be designed and submitted for ethical approval when the outcomes of phases 1 and 2 are known. Study outcomes will be knowledge about the feasibility of applying RE to improve quality, the development of RE theory and a validated model of resilience in clinical work which can be used to guide other applications. Tools, methods and practical guidance for practitioners will also be produced, as well as specific knowledge of the potential effectiveness of the implemented interventions in emergency and older people's care. Further studies to test the application of RE at a larger scale will be required, including studies of other healthcare settings, organisational contexts and different interventions.

What is needed to implement a web-based audit and feedback intervention with outreach visits to improve care quality: A concept mapping study among cardiac rehabilitation teams.

PubMed

van Engen-Verheul, Mariëtte M; Peek, Niels; Haafkens, Joke A; Joukes, Erik; Vromen, Tom; Jaspers, Monique W M; de Keizer, Nicolette F

2017-01-01

Evidence on successful quality improvement (QI) in health care requires quantitative information from randomized clinical trials (RCTs) on the effectiveness of QI interventions, but also qualitative information from professionals to understand factors influencing QI implementation. Using a structured qualitative approach, concept mapping, this study determines factors identified by cardiac rehabilitation (CR) teams on what is needed to successfully implement a web-based audit and feedback (A&F) intervention with outreach visits to improve the quality of CR care. Participants included 49 CR professionals from 18 Dutch CR centres who had worked with the A&F system during a RCT. In three focus group sessions participants formulated statements on factors needed to implement QI successfully. Subsequently, participants rated all statements for importance and feasibility and grouped them thematically. Multi dimensional scaling was used to produce a final concept map. Forty-two unique statements were formulated and grouped into five thematic clusters in the concept map. The cluster with the highest importance was QI team commitment, followed by organisational readiness, presence of an adequate A&F system, access to an external quality assessor, and future use and functionalities of the A&F system. Concept mapping appeared efficient and useful to understand contextual factors influencing QI implementation as perceived by healthcare teams. While presence of a web-based A&F system and external quality assessor were seen as instrumental for gaining insight into performance and formulating QI actions, QI team commitment and organisational readiness were perceived as essential to actually implement and carry out these actions. These two sociotechnical factors should be taken into account when implementing and evaluating the success of QI implementations in future research. Copyright © 2016. Published by Elsevier Ireland Ltd.

Quality work in long-term care: the role of first-line leaders.

PubMed

Kjøs, Bente Ødegård; Botten, Grete; Gjevjon, Edith Roth; Romøren, Tor Inge

2010-10-01

To explore the first-line leaders' role in quality work in long-term care in Norway, in order to determine how that work is related to such success characteristics as leadership, staff, patients, performance, information and information technology. Cross-sectional telephone survey. The text was analysed using content analysis. Thirty-two Norwegian municipalities stratified according to region and population size. Sixty-four first-line leaders in nursing homes and home-based care. Main outcome measure The clinical microsystem approach is used as a framework by defining and designing measureable variables. Thirty-six leaders described how they initiated and motivated employees to be active in quality work; the remaining leaders indicated that they played a passive role. The first-line leaders played a key role in implementing national quality policies and regulations. The quantity of other success characteristics was low. The municipalities delegated the responsibility of implanting national policies to the first-line leaders. Missing were key quality success criteria such as macro- and meso-perspectives for the municipality as a whole and co-operation with other leaders in the organization and fostering of relevant learning. Quality work was fragmented rather than comprehensive and systematic.

The introduction of DRG funding and hospital nurses' changing perceptions of their practice environment, quality of care and satisfaction: comparison of cross-sectional surveys over a 10-year period.

PubMed

Zander, Britta; Dobler, Lydia; Busse, Reinhard

2013-02-01

As other countries which have introduced diagnosis-related groups (DRGs) to pay their hospitals Germany initially expected that quality of care could deteriorate. Less discussed were potential implications for nurses, who might feel the efficiency-increasing effects of DRGs on their daily work, which in turn may lead to an actual worsening of care quality. To analyze whether the DRG implementation in German acute hospitals (as well as other changes over the 10-year period) had measurable effects on (1) the nurse work environment (including e.g. an adequate number of nursing staff to provide quality patient care), (2) quality of patient care and safety (incl. confidence into patients' ability to manage care when discharged), and (3) whether the effects from (1) and (2)--if any--impacted on the nurses themselves (satisfaction with their current job and their choice of profession as well as emotional exhaustion). Two rounds of nurse surveys with the Practice Environment Scale of the Nursing Work Index (PES-NWI), five years before DRG implementation (i.e. in 1998/1999; n=2681 from 29 hospitals) and five years after (i.e. in 2009/2010; n=1511 from 49 hospitals). The analysis utilized 15 indicators as outcomes for (1) practice environment, (2) quality of patient care and safety, as well as (3) nurses' satisfaction and emotional exhaustion. Multivariate analyses were performed for all three sets of outcomes using SPSS version 20. Aspects of the practice environment (especially adequate staffing and supportive management) worsened within the examined time span of 10 years, which as a consequence had significant negative impact on the nurse-perceived quality of care (except for patient safety, which improved). Both the aspects of the practice environment and the quality aspects impacted substantially on satisfaction and emotional exhaustion among nurses. The DRG implementation in Germany has apparently had measurable negative effects on nurses and nurse-perceived patient outcomes, however, not as distinct as often assumed. Copyright © 2012 Elsevier Ltd. All rights reserved.

Safety culture in the gynecology robotics operating room.

PubMed

Zullo, Melissa D; McCarroll, Michele L; Mendise, Thomas M; Ferris, Edward F; Roulette, G D; Zolton, Jessica; Andrews, Stephen J; von Gruenigen, Vivian E

2014-01-01

To measure the safety culture in the robotics surgery operating room before and after implementation of the Robotic Operating Room Computerized Checklist (RORCC). Prospective study. Gynecology surgical staff (n = 32). An urban community hospital. The Safety Attitudes Questionnaire domains examined were teamwork, safety, job satisfaction, stress recognition, perceptions of management, and working conditions. Questions and domains were described using percent agreement and the Cronbach alpha. Paired t-tests were used to describe differences before and after implementation of the checklist. Mean (SD) staff age was 46.7 (9.5) years, and most were women (78%) and worked full-time (97%). Twenty respondents (83% of nurses, 80% of surgeons, 66% of surgical technicians, and 33% of certified registered nurse anesthetists) completed the Safety Attitudes Questionnaire; 6 were excluded because of non-matching identifiers. Before RORCC implementation, the highest quality of communication and collaboration was reported by surgeons and surgical technicians (100%). Certified registered nurse anesthetists reported only adequate levels of communication and collaboration with other positions. Most staff reported positive responses for teamwork (48%; α = 0.81), safety (47%; α = 0.75), working conditions (37%; α = 0.55), stress recognition (26%; α = 0.71), and perceptions of management (32%; α = 0.52). No differences were observed after RORCC implementation. Quality of communication and collaboration in the gynecology robotics operating room is high between most positions; however, safety attitude responses are low overall. No differences after RORCC implementation and low response rates may highlight lack of staff support. Copyright © 2014. Published by Elsevier Inc.

Quality-assurance plan for water-resources activities of the U.S. Geological Survey in Idaho

USGS Publications Warehouse

Packard, F.A.

1996-01-01

To ensure continued confidence in its products, the Water Resources Division of the U.S. Geological Survey implemented a policy that all its scientific work be performed in accordance with a centrally managed quality-assurance program. This report establishes and documents a formal policy for current (1995) quality assurance within the Idaho District of the U.S. Geological Survey. Quality assurance is formalized by describing district organization and operational responsibilities, documenting the district quality-assurance policies, and describing district functions. The districts conducts its work through offices in Boise, Idaho Falls, Twin Falls, Sandpoint, and at the Idaho National Engineering Laboratory. Data-collection programs and interpretive studies are conducted by two operating units, and operational and technical assistance is provided by three support units: (1) Administrative Services advisors provide guidance on various personnel issues and budget functions, (2) computer and reports advisors provide guidance in their fields, and (3) discipline specialists provide technical advice and assistance to the district and to chiefs of various projects. The district's quality-assurance plan is based on an overall policy that provides a framework for defining the precision and accuracy of collected data. The plan is supported by a series of quality-assurance policy statements that describe responsibilities for specific operations in the district's program. The operations are program planning; project planning; project implementation; review and remediation; data collection; equipment calibration and maintenance; data processing and storage; data analysis, synthesis, and interpretation; report preparation and processing; and training. Activities of the district are systematically conducted under a hierarchy of supervision an management that is designed to ensure conformance with Water Resources Division goals quality assurance. The district quality-assurance plan does not describe detailed technical activities that are commonly termed "quality-control procedures." Instead, it focuses on current policies, operations, and responsibilities that are implemented at the management level. Contents of the plan will be reviewed annually and updated as programs and operations change.

The European Working Time Directive and training in cardiothoracic surgery in the United Kingdom.

PubMed

West, D; Codispoti, M; Graham, T

2007-04-01

The European Working Time Directive (EWTD) limited average working hours for junior doctors to 58 per week in 2004. The Cardiothoracic Specialty Advisory Board conducted postal and email surveys of cardiothoracic trainees' work patterns and attitudes in 2003 and 2005-6. The results reveal an increase in shift-based working from 15% to 58% of respondents. One hundred per cent of respondents felt that the EWTD had had a negative impact on training, and only 30% were satisfied with their training to date. Satisfied trainees were more likely to work in larger units as assessed by ITU beds (20.6 vs. 8.9, p < 0.001) and cardiac cases/year (1586.2 vs. 828.4, p < 0.001). They had performed more cardiac cases than their peers (72.7 vs. 26.7, p = 0.005). Fifty-two per cent thought that their quality of life improved after EWTD implementation. The EWTD is unpopular amongst cardiothoracic trainees, who perceive it as harming training. Overall trainee satisfaction is low. Larger units and increased personal operative experience are associated with trainee satisfaction. Training programmes must act vigorously to safeguard training quality before implementation of the 48-hour limit in 2009.

Kathleen Mears Memorial Lecture: personal accountability: your key to survival in health care reform.

PubMed

Galloway, Sabrina G

2014-09-01

Over the past thirty years the rising cost of healthcare has produced changes in reimbursement strategies. Continually, pressures are placed on the practitioners to reduce the length of the patient hospital stay and provide services in a high quality, risk free, cost effective manner. Following the implementation of diagnostic related groups (DRGs) in the 1980s and Managed Care in the 1990s we are now faced with embracing and surviving the Affordable Health Care Act-H.R.3590 (HHS 2013) that is linking reimbursement to quality outcomes. In short, financial constraints in the funding of health care will once more alter the patterns of delivery and challenge the practitioners to maintain superior care. As Neurodiagnostic Professionals this new reform offers another opportunity to review our process of care and the Neurodiagnostic labs role in the delivery of healthcare. For success, close examination of routine workflows, recognizing and solving existing delivery limitations, developing team care coordination, and increasing the neurodiagnostic professionals profile within the work environment will be required. Embracing your role in this overall process will most likely demand more paperwork, changing protocols, learning and implementing new policies, accepting new work schedules, implementing new quality standards, and pursuing additional education or credentials. Unlike never before more emphasis will be placed on measuring and reporting on the quality of the care we deliver in our labs, intensive care units, and operating rooms.

Consensus guidelines for implementation of quality processes to prevent invasive fungal disease and enhanced surveillance measures during hospital building works, 2014.

PubMed

Chang, C C; Ananda-Rajah, M; Belcastro, A; McMullan, B; Reid, A; Dempsey, K; Athan, E; Cheng, A C; Slavin, M A

2014-12-01

Healthcare-associated fungal outbreaks impose a substantial economic burden on the health system and typically result in high patient morbidity and mortality, particularly in the immunocompromised host. As the population at risk of invasive fungal infection continues to grow due to the increased burden of cancer and related factors, the need for hospitals to employ preventative measures has become increasingly important. These guidelines outline the standard quality processes hospitals need to accommodate into everyday practice and at times of healthcare-associated outbreak, including the role of antifungal stewardship programmes and best practice environmental sampling. Specific recommendations are also provided to help guide the planning and implementation of quality processes and enhanced surveillance before, during and after high-risk activities, such as hospital building works. Areas in which information is still lacking and further research is required are also highlighted. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Template for success: using a resident-designed sign-out template in the handover of patient care.

PubMed

Clark, Clancy J; Sindell, Sarah L; Koehler, Richard P

2011-01-01

Report our implementation of a standardized handover process in a general surgery residency program. The standardized handover process, sign-out template, method of implementation, and continuous quality improvement process were designed by general surgery residents with support of faculty and senior hospital administration using standard work principles and business models of the Virginia Mason Production System and the Toyota Production System. Nonprofit, tertiary referral teaching hospital. General surgery residents, residency faculty, patient care providers, and hospital administration. After instruction in quality improvement initiatives, a team of general surgery residents designed a sign-out process using an electronic template and standard procedures. The initial implementation phase resulted in 73% compliance. Using resident-driven continuous quality improvement processes, real-time feedback enabled residents to modify and improve this process, eventually attaining 100% compliance and acceptance by residents. The creation of a standardized template and protocol for patient handovers might eliminate communication failures. Encouraging residents to participate in this process can establish the groundwork for successful implementation of a standardized handover process. Integrating a continuous quality-improvement process into such an initiative can promote active participation of busy general surgery residents and lead to successful implementation of standard procedures. Copyright © 2011 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study.

PubMed

Hopkins, Jammie M; Glenn, Beth A; Cole, Brian L; McCarthy, William; Yancey, Antronette

2012-06-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations' full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite's intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60-70 worksites in Los Angeles County.

Implementing organizational physical activity and healthy eating strategies on paid time: process evaluation of the UCLA WORKING pilot study

PubMed Central

Hopkins, Jammie M.; Glenn, Beth A.; Cole, Brian L.; McCarthy, William; Yancey, Antronette

2012-01-01

Integrating organizationally targeted wellness strategies into the routine conduct of business has shown promise in engaging captive audiences at highest risk of obesity and obesity-related health consequences. This paper presents a process evaluation of the implementation of the University of California, Los Angeles, Working Out Regularly Keeps Individuals Nurtured and Going (WORKING) pilot study. WORKING focuses on integrating physical activity and nutrition practices into workplace routine during non-discretionary paid work time. The purpose of the evaluation was to assess the quality of implementation and to understand factors that facilitated or hindered organizations’ full uptake of the intervention. Fifteen worksites were randomly assigned to an intervention condition. Qualitative data were gathered through routine site visits and informant interviews conducted throughout each worksite’s intervention period. Worksites were classified into one of four implementation success categories based on their level of adoption and maintenance of core intervention strategies. Six key factors emerged that were related to implementation success: site layout and social climate, wellness infrastructure, number and influence of Program Champions, leadership involvement, site innovation and creativity. This pilot study has informed the conduct of WORKING II; a cluster randomized controlled trial aimed at enrolling 60–70 worksites in Los Angeles County. PMID:22323279

77 FR 4826 - Notice of the Joint Colorado Resource Advisory Council Meeting

Federal Register 2010, 2011, 2012, 2013, 2014

2012-01-31

... meeting may include working group reports, the National Landscape Conservation System strategy implementation, vegetation management, BLM internet, air quality and the General Land Office anniversary. These...

Implementation of a multi-professional standardized care plan in electronic health records for the care of stroke patients.

PubMed

Pöder, Ulrika; Fogelberg-Dahm, Marie; Wadensten, Barbro

2011-09-01

To compare staff opinions about standardized care plans and self-reported habits with regard to documentation, and their perceived knowledge about the evidence-based guidelines in stroke care before and after implementation of an evidence-based-standardized care plan (EB-SCP) and quality standard for stroke care. The aim was also to describe staff opinions about, and their use of, the implemented EB-SCP. To facilitate evidence-based practice (EBP), a multi-professional EB-SCP and quality standard for stroke care was implemented in the electronic health record (EHR). Quantitative, descriptive and comparative, based on questionnaires completed before and after implementation. Perceived knowledge about evidence-based guidelines in stroke care increased after implementation of the EB-SCP. The majority agreed that the EB-SCP is useful and facilitates their work. There was no change between before and after implementation with regard to opinions about standardized care plans, self-reported documentation habits or time spent on documentation. An evidence-based SCP seems to be useful in patient care and improves perceived knowledge about evidence-based guidelines in stroke care. For nursing managers, introduction of evidence-based SCP in the EHR may improve the prerequisites for promoting high-quality EBP in multi-professional care. 2011 Blackwell Publishing Ltd.

Electronic health records implementation: an evaluation of information system impact and contingency factors.

PubMed

Nguyen, Lemai; Bellucci, Emilia; Nguyen, Linh Thuy

2014-11-01

This paper provides a review of EHR (electronic health record) implementations around the world and reports on findings including benefits and issues associated with EHR implementation. A systematic literature review was conducted from peer-reviewed scholarly journal publications from the last 10 years (2001-2011). The search was conducted using various publication collections including: Scopus, Embase, Informit, Medline, Proquest Health and Medical Complete. This paper reports on our analysis of previous empirical studies of EHR implementations. We analysed data based on an extension of DeLone and McLean's information system (IS) evaluation framework. The extended framework integrates DeLone and McLean's dimensions, including information quality, system quality, service quality, intention of use and usage, user satisfaction and net benefits, together with contingent dimensions, including systems development, implementation attributes and organisational aspects, as identified by Van der Meijden and colleagues. A mix of evidence-based positive and negative impacts of EHR was found across different evaluation dimensions. In addition, a number of contingent factors were found to contribute to successful implementation of EHR. This review does not include white papers or industry surveys, non-English papers, or those published outside the review time period. This review confirms the potential of this technology to aid patient care and clinical documentation; for example, in improved documentation quality, increased administration efficiency, as well as better quality, safety and coordination of care. Common negative impacts include changes to workflow and work disruption. Mixed observations were found on EHR quality, adoption and satisfaction. The review warns future implementers of EHR to carefully undertake the technology implementation exercise. The review also informs healthcare providers of contingent factors that potentially affect EHR development and implementation in an organisational setting. Our findings suggest a lack of socio-technical connectives between the clinician, the patient and the technology in developing and implementing EHR and future developments in patient-accessible EHR. In addition, a synthesis of DeLone and McLean's framework and Van der Meijden and colleagues' contingent factors has been found useful in comprehensively understanding and evaluating EHR implementations. Crown Copyright © 2014. Published by Elsevier Ireland Ltd. All rights reserved.

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

PubMed Central

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

2017-01-01

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

The development, implementation and evaluation of clinical pathways for chronic obstructive pulmonary disease (COPD) in Saskatchewan: protocol for an interrupted times series evaluation.

PubMed

Rotter, Thomas; Plishka, Christopher; Hansia, Mohammed Rashaad; Goodridge, Donna; Penz, Erika; Kinsman, Leigh; Lawal, Adegboyega; O'Quinn, Sheryl; Buchan, Nancy; Comfort, Patricia; Patel, Prakesh; Anderson, Sheila; Winkel, Tanya; Lang, Rae Lynn; Marciniuk, Darcy D

2017-11-28

Chronic obstructive pulmonary disease (COPD) has substantial economic and human costs; it is expected to be the third leading cause of death worldwide by 2030. To minimize these costs high quality guidelines have been developed. However, guidelines alone rarely result in meaningful change. One method of integrating guidelines into practice is the use of clinical pathways (CPWs). CPWs bring available evidence to a range of healthcare professionals by detailing the essential steps in care and adapting guidelines to the local context. We are working with local stakeholders to develop CPWs for COPD with the aims of improving care while reducing utilization. The CPWs will employ several steps including: standardizing diagnostic training, unifying components of chronic disease care, coordinating education and reconditioning programs, and ensuring care uses best practices. Further, we have worked to identify evidence-informed implementation strategies which will be tailored to the local context. We will conduct a three-year research project using an interrupted time series (ITS) design in the form of a multiple baseline approach with control groups. The CPW will be implemented in two health regions (experimental groups) and two health regions will act as controls (control groups). The experimental and control groups will each contain an urban and rural health region. Primary outcomes for the study will be quality of care operationalized using hospital readmission rates and emergency department (ED) presentation rates. Secondary outcomes will be healthcare utilization and guideline adherence, operationalized using hospital admission rates, hospital length of stay and general practitioner (GP) visits. Results will be analyzed using segmented regression analysis. Funding has been procured from multiple stakeholders. The project has been deemed exempt from ethics review as it is a quality improvement project. Intervention implementation is expected to begin in summer of 2017. This project is expected to improve quality of care and reduce healthcare utilization. In addition it will provide evidence on the effects of CPWs in both urban and rural settings. If the CPWs are found effective we will work with all stakeholders to implement similar CPWs in surrounding health regions. Clinicaltrials.gov ( NCT03075709 ). Registered 8 March 2017.

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

PubMed

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

2006-01-01

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

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

PubMed Central

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

2006-01-01

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

AMSCO Culture Survey: Base Data for Quality and Productivity Programs. Training and Development Research Center Project Number Twenty-Four.

ERIC Educational Resources Information Center

Swanson, Richard A.; Sleezer, Catherine M.

The AMSCO culture survey instrument was developed to obtain specific information about the changing employee values resulting from the implementation of the new quality programs at AMSCO, Rice Lake, Wisconsin. The culture dimensions measured in the survey included job evaluation/job satisfaction, work efficiency, training and development,…

Evolving an empowering approach to continuous quality improvement in home care.

PubMed

McWilliam, C L; Desai, K L; Sweetland, D

1995-01-01

Theory suggests that in an "empowering" organization all individuals assume genuine decision-making roles and control over their work. Unfortunately, many organizations actually stifle empowerment through creating new bureaucratic barriers as they implement structures to deploy quality management principles. The Oxford County Home Care Program describes how it redesigned its organizational structure to facilitate empowerment.

Development of the High-Order Decoupled Direct Method in Three Dimensions for Particulate Matter: Enabling Advanced Sensitivity Analysis in Air Quality Models

EPA Science Inventory

The high-order decoupled direct method in three dimensions for particular matter (HDDM-3D/PM) has been implemented in the Community Multiscale Air Quality (CMAQ) model to enable advanced sensitivity analysis. The major effort of this work is to develop high-order DDM sensitivity...

Family Quality of Life: Moving from Measurement to Application

ERIC Educational Resources Information Center

Zuna, Nina I.; Turnbull, Ann; Summers, Jean Ann

2009-01-01

Noting the absence of sound theoretical underpinnings for family quality of life (FQoL) research and work, the authors note that, to guide FQoL practice, research findings must be schematically organized so as to enable practitioners to implement empirical findings effectively. One way to meet this goal is to introduce a theoretical model that…

Portuguese food composition database quality management system.

PubMed

Oliveira, L M; Castanheira, I P; Dantas, M A; Porto, A A; Calhau, M A

2010-11-01

The harmonisation of food composition databases (FCDB) has been a recognised need among users, producers and stakeholders of food composition data (FCD). To reach harmonisation of FCDBs among the national compiler partners, the European Food Information Resource (EuroFIR) Network of Excellence set up a series of guidelines and quality requirements, together with recommendations to implement quality management systems (QMS) in FCDBs. The Portuguese National Institute of Health (INSA) is the national FCDB compiler in Portugal and is also a EuroFIR partner. INSA's QMS complies with ISO/IEC (International Organization for Standardisation/International Electrotechnical Commission) 17025 requirements. The purpose of this work is to report on the strategy used and progress made for extending INSA's QMS to the Portuguese FCDB in alignment with EuroFIR guidelines. A stepwise approach was used to extend INSA's QMS to the Portuguese FCDB. The approach included selection of reference standards and guides and the collection of relevant quality documents directly or indirectly related to the compilation process; selection of the adequate quality requirements; assessment of adequacy and level of requirement implementation in the current INSA's QMS; implementation of the selected requirements; and EuroFIR's preassessment 'pilot' auditing. The strategy used to design and implement the extension of INSA's QMS to the Portuguese FCDB is reported in this paper. The QMS elements have been established by consensus. ISO/IEC 17025 management requirements (except 4.5) and 5.2 technical requirements, as well as all EuroFIR requirements (including technical guidelines, FCD compilation flowchart and standard operating procedures), have been selected for implementation. The results indicate that the quality management requirements of ISO/IEC 17025 in place in INSA fit the needs for document control, audits, contract review, non-conformity work and corrective actions, and users' (customers') comments, complaints and satisfaction, with minor adaptation. Implementation of the FCDB QMS proved to be a way of reducing the subjectivity of the compilation process and fully documenting it, and also facilitates training of new compilers. Furthermore, it has strengthened cooperation and trust among FCDB actors, as all of them were called to be involved in the process. On the basis of our practical results, we can conclude that ISO/IEC 17025 management requirements are an adequate reference for the implementation of INSA's FCDB QMS with the advantages of being well known to all members of staff and also being a common quality language among laboratories producing FCD. Combining quality systems and food composition activities endows the FCDB compilation process with flexibility, consistency and transparency, and facilitates its monitoring and assessment, providing the basis for strengthening confidence among users, data producers and compilers.

[Implementation of a new electronic patient record in surgery].

PubMed

Eggli, S; Holm, J

2001-12-01

The increasing amount of clinical data, intensified interest of patients in medical information, medical quality management and the recent cost explosion in health care systems have forced medical institutions to improve their strategy in handling medical data. In the orthopedic department (3,600 surgeries, 75 beds, 14,000 consultations) software application for comprehensive patient data management has been developed. When implementing the electronic patient history following criteria were evaluated: 1. software evaluation, 2. implementation, 3. work flow, 4. data security/system stability. In the first phase the functional character was defined. Implementation required 3 months after parametrization. The expense amounted to 130,000 DM (30 clients). The training requirements were one afternoon for the secretaries and a 2-h session for the residents. The access speed on medically relevant data averaged under 3 s. The average saving in working hours was approximately 5 h/week for the secretaries and 4 h/week for the residents. The saving in paper amounted to 36,000 sheets/year. In 3 operational years there were 3 server breakdowns. Evaluation of the saving on working hours showed that such a system can amortize within a year. The latest improvements in hardware and software technology made the electronic medical record with integrated quality-control practicable without massive expenditure. The system supplies an extensive platform of information for patient treatment and an instrument to evaluate the efficiency of therapy strategies independent of the clinical field.

Improving the Communication Environment for Children with Severe Handicaps through Manual Sign Inservice Training.

ERIC Educational Resources Information Center

Lloyd, Lyle L.; And Others

A "working party" (a decision-making group similar to the quality circles concept) comprised of public elementary school personnel (administrator, regular and special education staff), and parents, university special education faculty and graduate students worked cooperatively to develop and implement a manual sign inservice training package to…

High Performance Work Systems for Online Education

ERIC Educational Resources Information Center

Contacos-Sawyer, Jonna; Revels, Mark; Ciampa, Mark

2010-01-01

The purpose of this paper is to identify the key elements of a High Performance Work System (HPWS) and explore the possibility of implementation in an online institution of higher learning. With the projected rapid growth of the demand for online education and its importance in post-secondary education, providing high quality curriculum, excellent…

A Review of the Implementation of the "Better Behaviour-Better Learning" Report

ERIC Educational Resources Information Center

Her Majesty's Inspectorate of Education, 2005

2005-01-01

The promotion of pupils' self-discipline has been clearly highlighted as one of the National Priorities for Scottish education. This reflects the key role that establishing positive working relationships between pupils and staff is known to play in ensuring effective learning. Equally, this relationship also works in reverse. The quality of…

Expanded Medical Home Model Works for Children in Foster Care

ERIC Educational Resources Information Center

Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

2012-01-01

The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

Extending systematic reviews to include evidence on implementation: methodological work on a review of community-based initiatives to prevent injuries.

PubMed

Roen, Katrina; Arai, Lisa; Roberts, Helen; Popay, Jennie

2006-08-01

Unintentional injury is a leading cause of mortality and disability among young and old. While evidence about the effectiveness of interventions in reducing injuries is accumulating, reviews of this evidence frequently fail to include details of implementation processes. Our research, of which the work reported here formed a part, had two main objectives: (1) to identify evidence about the implementation of interventions aimed at reducing unintentional injuries amongst children and young people; and (2) to explore methods for systematically reviewing evidence on implementation. Existing systematic reviews of the effectiveness of interventions aiming to reduce unintentional injuries in children and young people formed the starting point for the work reported here. In summary, many of the published papers we identified contained little information on implementation processes and, even when these were discussed, the extent to which authors' claims were based on research evidence was unclear. On the basis of the studies we reviewed implementation data were insufficiently strong to provide a sound evidence base for practitioners and policymakers. Notwithstanding this, we identified valuable data about the context in which such initiatives are implemented and the type of factors that might impinge on implementation. This work has implications in three areas: (1) researchers with an interest in evidence-based public health could be encouraged to consider implementation issues in the design of intervention studies; (2) funding bodies could be encouraged to prioritise intervention studies using mixed methods that will enable researchers to consider effectiveness and implementation; (3) journal editors could work towards increasing the quality of reporting on implementation issues through the development of guidelines.

[RehaFuturReal®: Evaluation of Implementation in Organizational Structure and in Counseling Process - An Overview of Results].

PubMed

Arling, V; Knispel, J; Spijkers, W

2016-08-01

Due to prevailing future challenges in vocational rehabilitation, development process RehaFutur (BMAS) was initiated. In this context, recommendations were made to secure a future-oriented, innovative vocational rehabilitation in Germany. Deutsche Rentenversicherung (DRV) Westfalen transferred these recommendations into a new and applicable counseling concept RehaFutuReal(®). Rehabilitation managers (RM) are central protagonists in counseling process. Therefore, RehaFuturReal(®) focused on optimization of counseling performance. To achieve this aim, rehabilitation managers were taught to work with a case management (CM) based approach. RWTH Aachen supported RehaFuturReal(®) from an academic point of view and conducted a formative and summative evaluation. Primary aim of RWTH Aachen was to support DRV Westfalen during implementation of RehaFuturReal(®) into their organizational structure. Additionally, RWTH Aachen controlled whether transfer of RehaFutuReal(®) in counseling process was successful. From 04-01-13 until 12-31-14, RehaFuturReal(®) was tested by DRV Westfalen in the intervention district Dortmund with 10 RM. There were 3 selection criteria for the overall sample of N=320 insurants: participants were required to have an active employment status, suffered from integration issues and were in need of support to achieve vocational integration. Evaluation of RehaFuturReal(®) was realized summative (pre-post-comparison) and formative (process-orientated). Evaluative judgment regarding implementation in organizational structure and counseling process was performed by using three-stage-concept of Donabedian (quality of structure, process and results). Thereby, feedback of RM, insurants and employers was taken into account. Analysis of evaluation results revealed a positive overall impression. Implementation into organizational structure was successful on all 3 quality stages: concept of project and CM-training were an adequate basis and appropriately put into practice by fulfilling prescribed objectives, topics and schedule (quality of structure). Rehabilitation managers identified themselves with the implementation process into DRV Westfalen (grading of CM training: M=1,67; SD=0,65; quality of process). Analogous, consultants reported a high level of satisfaction during implementation of new counseling process (possible span: 1-4; M=3,11; SD=0,33; quality of results). Regarding implementation of counseling process, sample fitted into 3 selection criteria wherefore the correct insurants were picked in RehaFuturReal(®) (quality of structure). CM-orientated counseling approach was properly implemented into everyday work of RM by using CM-instruments for documentation (quality of process). RM were highly satisfied (possible span: 1-4) with counseling performance (M=3,43; SD=0,77). Employers also rated counseling performance positively (M=3,38; SD=0,85). By contrast, surveying insurants revealed a heterogeneous impression of satisfaction (M=2,97; SD=1,03) (quality of results). © Georg Thieme Verlag KG Stuttgart · New York.

Promoting Afterschool Quality and Positive Youth Development: Cluster Randomized Trial of the Pax Good Behavior Game.

PubMed

Smith, Emilie Phillips; Osgood, D Wayne; Oh, Yoonkyung; Caldwell, Linda C

2018-02-01

This randomized trial tested a strategy originally developed for school settings, the Pax Good Behavior Game (PAX GBG), in the new context of afterschool programs. We examined this approach in afterschool since 70% of all juvenile crime occurs between the hours of 3-6 pm, making afterschool an important setting for prevention and promotion. Dual-career and working families need monitoring and supervision for their children in quality settings that are safe and appropriately structured. While substantial work has identified important features of afterschool programs, increasing attention is being given to how to foster quality. PAX GBG, with its focus on shared norms, cooperative teams, contingent activity rewards, and liberal praise, could potentially enhance not only appropriate structure and supportive relationships, but also youth self-regulation, co-regulation, and socio-emotional development. This study examined the PAX GBG among 76 afterschool programs, serving 811 youth ages 5-12, who were diverse in race-ethnicity, socio-economic status, and geographic locale. Demographically matched pairs of afterschool programs were randomized to PAX GBG or treatment-as-usual. Independent observers conducted ratings of implementation fidelity and program quality across time; along with surveys of children's problem and prosocial behavior. Interaction effects were found using hierarchical linear models such that experimental programs evidencing higher implementation fidelity demonstrated better program quality than controls, (i.e., less harshness, increased appropriate structure, support, and engagement), as well as reduced child-reported hyperactivity and intent-to-treat effects on prosocial behavior. This study demonstrates that best practices fostered by PAX GBG and implemented with fidelity in afterschool result in higher quality contexts for positive youth development.

Teachers' Perceptions of School Organizational Climate as Predictors of Dosage and Quality of Implementation of a Social-Emotional and Character Development Program.

PubMed

Malloy, Margaret; Acock, Alan; DuBois, David L; Vuchinich, Samuel; Silverthorn, Naida; Ji, Peter; Flay, Brian R

2015-11-01

Organizational climate has been proposed as a factor that might influence a school's readiness to successfully implement school-wide prevention programs. The aim of this study was to evaluate the influence of teachers' perceptions of three dimensions of school organizational climate on the dosage and quality of teacher implementation of Positive Action, a social-emotional and character development (SECD) program. The dimensions measured were teachers' perceptions of (a) the school's openness to innovation, (b) the extent to which schools utilize participatory decision-making practices, and (c) the existence of supportive relationships among teachers (teacher-teacher affiliation). Data from 46 teachers in seven schools enrolled in the treatment arm of a longitudinal, cluster-randomized, controlled trial were analyzed. Teacher perceptions of a school's tendency to be innovative was associated with a greater number of lessons taught and self-reported quality of delivery, and teacher-teacher affiliation was associated with a higher use of supplementary activities. The findings suggest that perceptions of a school's organizational climate impact teachers' implementation of SECD programs and have implications for school administrators and technical assistance providers as they work to implement and sustain prevention programs in schools.

Active Residents in Care Homes (ARCH): study protocol to investigate the implementation and outcomes of a whole-systems activity programme in residential care homes for older people.

PubMed

Koskela, Sian A; Jones, Fiona; Clarke, Natasha; Anderson, Liezl; Kennedy, Bernadette; Grant, Robert; Gage, Heather; Hurley, Michael V

2017-03-01

To evaluate the effectiveness, acceptability and costs of Active Residents in Care Homes, ARCH - a programme aiming to increase opportunities for activity in older care home residents. Feasibility study. Residential care homes for older people. 10-15 residents, staff and family members will be recruited in each of the three participating care homes. ARCH is a 12-month 'whole-systems' programme implemented by occupational therapists and physiotherapists. They will conduct a comprehensive assessment of each care home, considering the physical environment, working practices and organisation structure as well as residents' individual needs, and recommend ways to address barriers and increase residents' activity levels. The therapists will then work with staff to improve understanding of the issues, instigate training, environmental, organisational and working practice changes as necessary. Residents' activity levels, health and quality of life will be tested using several measures to see which are practicable and appropriate for this population in this context. This includes: Assessment of Physical Activity in Frail Older People; Pool Activity Level Checklist; Dementia Care Mapping observations; and EQ-5D-5L. Residents will be assessed prior to programme implementation then 4- and 12-months post-implementation. Semi-structured interviews will explore the experiences of residents, staff, family members and therapists. Providing evidence of effectiveness and acceptability of ARCH, and documenting factors that impede/facilitate implementation will help us identify ways to enhance the care and quality of life of older people in residential care, and our understanding of how to implement them. ISRCTN24000891. Copyright © 2015 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

42 CFR 3.10 - Purpose.

Code of Federal Regulations, 2011 CFR

2011-10-01

... AND PATIENT SAFETY WORK PRODUCT General Provisions § 3.10 Purpose. The purpose of this part is to implement the Patient Safety and Quality Improvement Act of 2005 (Pub. L. 109-41), which amended Title IX of...

33 CFR 236.6 - Other agencies EQ measures.

Code of Federal Regulations, 2014 CFR

2014-07-01

... ENVIRONMENTAL QUALITY § 236.6 Other agencies EQ measures. The selected plan may include EQ measures not proposed..., implementation of such measures will not be required as local cooperation for the works proposed for Corps...

42 CFR 3.10 - Purpose.

Code of Federal Regulations, 2014 CFR

2014-10-01

... AND PATIENT SAFETY WORK PRODUCT General Provisions § 3.10 Purpose. The purpose of this part is to implement the Patient Safety and Quality Improvement Act of 2005 (Pub. L. 109-41), which amended Title IX of...

42 CFR 3.10 - Purpose.

Code of Federal Regulations, 2010 CFR

2010-10-01

... AND PATIENT SAFETY WORK PRODUCT General Provisions § 3.10 Purpose. The purpose of this part is to implement the Patient Safety and Quality Improvement Act of 2005 (Pub. L. 109-41), which amended Title IX of...

Transparency in a Pediatric Quality Improvement Collaborative: A Passionate Journey by NPC-QIC Clinicians and Parents.

PubMed

Lihn, Stacey L; Kugler, John D; Peterson, Laura E; Lannon, Carole M; Pickles, Diane; Beekman, Robert H

2015-01-01

Transparency-sharing data or information about outcomes, processes, protocols, and practices-may be the most powerful driver of health care improvement. In this special article, the development and growth of transparency within the National Pediatric Cardiology Quality Improvement Collaborative is described. The National Pediatric Cardiology Quality Improvement Collaborative transparency journey is guided by equal numbers of clinicians and parents of children with congenital heart disease working together in a Transparency Work Group. Activities are organized around four interrelated levels of transparency (individual, organizational, collaborative, and system), each with a specified purpose and aim. A number of Transparency Work Group recommendations have been operationalized. Aggregate collaborative performance is now reported on the public-facing web site. Specific information that the Transparency Work Group recommends centers provide to parents has been developed and published. Almost half of National Pediatric Cardiology Quality Improvement Collaborative centers participated in a pilot of transparently sharing their outcomes achieved with one another. Individual centers have also begun successfully implementing recommended transparency activities. Despite progress, barriers to full transparency persist, including health care organization concerns about potential negative effects of disclosure on reputation and finances, and lack of reliable definitions, data, and reporting standards for fair comparisons of centers. The National Pediatric Cardiology Quality Improvement Collaborative's transparency efforts have been a journey that continues, not a single goal or destination. Balanced participation of clinicians and parents has been a critical element of the collaborative's success on this issue. Plans are in place to guide implementation of additional transparency recommendations across all four levels, including extension of the activities beyond the collaborative to support transparency efforts in national cardiology and cardiac surgery societies. © 2015 Wiley Periodicals, Inc.

Education Quality and the Kenyan 8-4-4 Curriculum: Secondary School Learners' Experiences

ERIC Educational Resources Information Center

Milligan, Lizzi O.

2017-01-01

This article explores the implementation of Kenyan secondary education in rural Western Kenya, focusing on learners' experiences. One of the key challenges to educational quality is shown to be the size and breadth of the secondary education curriculum. Learners are in school 12 hours a day with those approaching their final exams working three to…

Sociological Perspectives on Ethnic Minority Teachers in China: A Review of the Research Literature

ERIC Educational Resources Information Center

Lee, MaryJo Benton

2016-01-01

Improving the quality of education has been a central goal of the People's Republic of China since its founding in 1949. Particular concern has been focused on ethnic minority areas where educational quality lags behind that of other regions. Since 1986 the State Education Commission has been working toward the implementation of nine years of…

$1.2 Billion Investment Needed in 2017 to Implement CCDBG Reauthorization

ERIC Educational Resources Information Center

Center for Law and Social Policy, Inc. (CLASP), 2016

2016-01-01

The Child Care and Development Block Grant (CCDBG) is the primary source of federal funding for child care subsidies for low-income families and to improve child care quality for all children. Quality child care enables parents to work or go to school while providing children with safe and enriching environments where they can learn and thrive.…

Outcomes for implementation science: an enhanced systematic review of instruments using evidence-based rating criteria.

PubMed

Lewis, Cara C; Fischer, Sarah; Weiner, Bryan J; Stanick, Cameo; Kim, Mimi; Martinez, Ruben G

2015-11-04

High-quality measurement is critical to advancing knowledge in any field. New fields, such as implementation science, are often beset with measurement gaps and poor quality instruments, a weakness that can be more easily addressed in light of systematic review findings. Although several reviews of quantitative instruments used in implementation science have been published, no studies have focused on instruments that measure implementation outcomes. Proctor and colleagues established a core set of implementation outcomes including: acceptability, adoption, appropriateness, cost, feasibility, fidelity, penetration, sustainability (Adm Policy Ment Health Ment Health Serv Res 36:24-34, 2009). The Society for Implementation Research Collaboration (SIRC) Instrument Review Project employed an enhanced systematic review methodology (Implement Sci 2: 2015) to identify quantitative instruments of implementation outcomes relevant to mental or behavioral health settings. Full details of the enhanced systematic review methodology are available (Implement Sci 2: 2015). To increase the feasibility of the review, and consistent with the scope of SIRC, only instruments that were applicable to mental or behavioral health were included. The review, synthesis, and evaluation included the following: (1) a search protocol for the literature review of constructs; (2) the literature review of instruments using Web of Science and PsycINFO; and (3) data extraction and instrument quality ratings to inform knowledge synthesis. Our evidence-based assessment rating criteria quantified fundamental psychometric properties as well as a crude measure of usability. Two independent raters applied the evidence-based assessment rating criteria to each instrument to generate a quality profile. We identified 104 instruments across eight constructs, with nearly half (n = 50) assessing acceptability and 19 identified for adoption, with all other implementation outcomes revealing fewer than 10 instruments. Only one instrument demonstrated at least minimal evidence for psychometric strength on all six of the evidence-based assessment criteria. The majority of instruments had no information regarding responsiveness or predictive validity. Implementation outcomes instrumentation is underdeveloped with respect to both the sheer number of available instruments and the psychometric quality of existing instruments. Until psychometric strength is established, the field will struggle to identify which implementation strategies work best, for which organizations, and under what conditions.

National Ignition Facility quality assurance program plan revision 2

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

Wolfe, C R

1998-06-01

NIF Project activities will be conducted in a manner consistent with the guidance and direction of the DOE Order on Quality Assurance (414.1), the LLNL QA Program, and the Laser Directorate QA Plan. Quality assurance criteria will be applied in a graded manner to achieve a balance between the rigor of application of QA measures and the scale, cost, and complexity of the work involved. Accountability for quality is everyone's, extending from the Project Manager through established lines of authority to all Project personnel, who are responsible for the requisite quality of their own work. The NLF QA Program willmore » be implemented by personnel conducting their activities to meet requirements and expectations, according to established plans and procedures that reflect the way business is to be conducted on the Project.« less

Framework for Quality Professional Development for Practitioners Working with Adult English Language Learners. Revised

ERIC Educational Resources Information Center

Center for Adult English Language Acquisition, 2010

2010-01-01

The Center for Adult English Language Acquisition (CAELA) Network, under contract with the Office of Vocational and Adult Education (OVAE), has created a framework that can be used to plan, implement, and evaluate professional development for practitioners working with adult English language learners at the state, regional, and program levels. The…

The National Health Educator Competencies Update Project: Celebrating a Milestone and Recommending next Steps to the Profession

ERIC Educational Resources Information Center

Airhihenbuwa, Collins O.; Cottrell, Randall R.; Adeyanju, Matthew; Auld, M. Elaine; Lysoby, Linda; Smith, Becky J.

2005-01-01

For more than 60 years, the health education profession has worked to develop, implement, and refine guidelines for preparing and training health educators. Among the seminal works documenting this dedication to, and quest for, quality assurance in professional preparation and practice are guidelines for professional education of health educators…

Classroom Assessment in Mathematics: Views from a National Science Foundation Working Conference (Greensboro, North Carolina, May 16-18, 1997).

ERIC Educational Resources Information Center

Bright, George W., Ed.; Joyner, Jeane M., Ed.

This document presents papers from a National Science Foundation (NSF) working conference to identify research issues and implementation strategies that support quality classroom assessment. Papers include: (1) "Understanding and Improving Classroom Assessment: Summary of Issues Raised" (George W. Bright and Jeane M. Joyner); (2) "Recommendations…

Developing clinical indicators for the secondary health system in India.

PubMed

Thakur, Harshad; Chavhan, S; Jotkar, Raju; Mukherjee, Kanchan

2008-08-01

One of the prime goals of any health system is to deliver good and competent quality of healthcare. Through World Bank-assisted Maharashtra Health Systems Development Project, Government of Maharashtra in India developed and implemented clinical indicators to improve quality. During this, clinical areas eligible for monitoring quality of care and roles of health staff working at various levels were identified. Brainstorming discussion sessions were conducted to refine list of potential clinical indicators and to identify implementation problems. It was implemented in four stages. (a) Self-explanatory tool of record, standard operating procedures and training manual were prepared during tools preparation stage. (b) Pilot implementation was done to monitor the usefulness of indicators, document the experiences and standardize the system accordingly. (c) The final selection of indicators was done taking into consideration points like data reliability, indicator usefulness etc. For final implementation, 15 indicators for district and 6 indicators for rural hospitals were selected. (d) Transfer of skills was done through training of various hospital functionaries. Selection and prioritization of clinical indicators is the most crucial part. Active participation of local employees is essential for sustainability of the scheme. It is also important to ensure that data recorded/reported is both reliable and valid, to conduct monthly review of the scheme at various levels and to link it with the quality improvement programme.

Improved quality and more attractive work by applying EBM in disability evaluations: a qualitative survey.

PubMed

Hoving, Jan L; Kok, Rob; Ketelaar, Sarah M; Smits, Paul B A; van Dijk, Frank J H; Verbeek, Jos H

2016-02-29

The uptake of evidence in practice by physicians, even if they are trained in the systematic method of evidence-based medicine (EBM), remains difficult to improve. The aim of this study was to explore perceptions and experiences of physicians doing disability evaluations regarding motivators and preconditions for the implementation of EBM in daily practice. This qualitative study was nested in a cluster randomized controlled trial (Trial registration NTR1767; 20-apr-2009) evaluating the effects of training in EBM. The 45 physicians that participated received a comprehensive 6-months training program in EBM of which the last course day included audio-recorded interviews in groups. During these interviews participating physicians discussed perceptions and experiences regarding EBM application in daily practice. In an iterative process we searched for common motivators or preconditions for the implementation of EBM. Three main concepts or themes emerged after analyzing the transcriptions of the discussions: 1) improved quality of physicians' actions, such as clients benefiting from the application of EBM; 2) improved work attractiveness of physicians; and 3) preconditions that have to be met in order to work in an evidence-based manner including professional competence, facilitating material conditions and organizational support and demands. Physicians trained in EBM are motivated to use EBM because they perceive it as a factor improving the quality of their work and making their work more attractive. In addition to personal investments and gains, organizational support should further facilitate the uptake of evidence in practice.

Implementation of quality improvement techniques for management and technical processes in the ACRV project

NASA Technical Reports Server (NTRS)

Raiman, Laura B.

1992-01-01

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Implementation of quality improvement techniques for management and technical processes in the ACRV project

NASA Astrophysics Data System (ADS)

Raiman, Laura B.

1992-12-01

Total Quality Management (TQM) is a cooperative form of doing business that relies on the talents of everyone in an organization to continually improve quality and productivity, using teams and an assortment of statistical and measurement tools. The objective of the activities described in this paper was to implement effective improvement tools and techniques in order to build work processes which support good management and technical decisions and actions which are crucial to the success of the ACRV project. The objectives were met by applications in both the technical and management areas. The management applications involved initiating focused continuous improvement projects with widespread team membership. The technical applications involved applying proven statistical tools and techniques to the technical issues associated with the ACRV Project. Specific activities related to the objective included working with a support contractor team to improve support processes, examining processes involved in international activities, a series of tutorials presented to the New Initiatives Office and support contractors, a briefing to NIO managers, and work with the NIO Q+ Team. On the technical side, work included analyzing data from the large-scale W.A.T.E.R. test, landing mode trade analyses, and targeting probability calculations. The results of these efforts will help to develop a disciplined, ongoing process for producing fundamental decisions and actions that shape and guide the ACRV organization .

Optimization of the choice of unmanned aerial vehicles used to monitor the implementation of selected construction projects

NASA Astrophysics Data System (ADS)

Skorupka, Dariusz; Duchaczek, Artur; Waniewska, Agnieszka; Kowacka, Magdalena

2017-07-01

Due to their properties unmanned aerial vehicles have huge number of possibilities for application in construction engineering. The nature and extent of construction works performedmakes the decision to purchase the right equipment significant for the possibility for its further use while monitoring the implementation of these works. Technical factors, such as the accuracy and quality of the applied measurement instruments are especially important when monitoring the realization of construction projects. The paper presents the optimization of the choice of unmanned aerial vehicles using the Bellinger method. The decision-making analysis takes into account criteria that are particularly crucial by virtue of the range of monitoring of ongoing construction works.

[The influence of quality management on job satisfaction and work load--exemplary study in a German hospital].

PubMed

Hein, Sandra; Lauterbach, Karl W; Plamper, Evelyn; Gerber, Andreas

2009-01-01

Surveys among employees are getting more and more relevant in hospital settings since an increase in both (1) efficiency and (2) quality in connection with (3) enhanced patient orientation will only be achieved, if at the same time the employees' health status and satisfaction are taken into account. Thus, the objective of this study was to compare the satisfaction of employees in a single hospital enquired in 2002 with that of 2005. Particular consideration was given to their view of quality management. Is there a correlation between employees' satisfaction, their degree of information on quality management, and their assessment of quality management? In the survey of 2005 employees were more satisfied with their work and their working conditions than in the previous inquiry conducted in 2002. They felt less mental stress, despite the declining length of hospitalisation combined with a higher turnover of in-hospital cases and with lower numbers of full-time staff. The employees' satisfaction, however, differed widely among the three departments with regard to the items "involvement with decisions" and "support by the superiors". The overall assessment of quality management is positive. Specific items such as the assessment of the management's commitment to quality management were strongly influenced by the employees' degree of information on quality management, which varies between departments. In the department with the lowest work satisfaction quality management was attributed a high potential for change and improvement. After quality management will have been implemented throughout the hospital, a new survey should be undertaken to evaluate whether quality management affects the employees' satisfaction with their work.

Providing a healthy work environment for nurses: the influence on retention.

PubMed

Cohen, Jayne; Stuenkel, Diane; Nguyen, Quyen

2009-01-01

Differences in registered nurses' (RNs) perceptions of their work environment were measured with the Insel and Moos' Work Environment Scale to identify factors in the work environment that may influence retention. Statistically significant differences for perceptions of supervisor support and innovation were found between those RNs who left their unit or hospital during a 24-month period and those who stayed. Implementing strategies to promote retention of RNs to ensure safe, quality patient care is essential.

Needs assessment and implementation of an employee assistance program: promoting a healthier work force.

PubMed

Monfils, M K

1995-05-01

1. The functions of a continuous quality improvement tool used by Deming--the Plan, Do, Check, Act Cycle--can be applied to the assessment, implementation, and ongoing evaluation of an Employee Assistance Program (EAP). 2. Various methods are available to assess the need for an EAP. As much data as possible should be collected to qualify and quantify the need so that management can make an informed decision and develop measures to determine program effectiveness. 3. Once an EAP is implemented, it should be monitored continually against the effectiveness measures initially developed. Using a continuous quality improvement process, the occupational health nurse and the EAP provider can establish a dynamic relationship that allows for growth beyond the original design and increased effectiveness of service to employees.

Exposing the Science in Citizen Science: Fitness to Purpose and Intentional Design.

PubMed

Parrish, Julia K; Burgess, Hillary; Weltzin, Jake F; Fortson, Lucy; Wiggins, Andrea; Simmons, Brooke

2018-05-21

Citizen science is a growing phenomenon. With millions of people involved and billions of in-kind dollars contributed annually, this broad extent, fine grain approach to data collection should be garnering enthusiastic support in the mainstream science and higher education communities. However, many academic researchers demonstrate distinct biases against the use of citizen science as a source of rigorous information. To engage the public in scientific research, and the research community in the practice of citizen science, a mutual understanding is needed of accepted quality standards in science, and the corresponding specifics of project design and implementation when working with a broad public base. We define a science-based typology focused on the degree to which projects deliver the type(s) and quality of data/work needed to produce valid scientific outcomes directly useful in science and natural resource management. Where project intent includes direct contribution to science and the public is actively involved either virtually or hands-on, we examine the measures of quality assurance (methods to increase data quality during the design and implementation phases of a project) and quality control (post hoc methods to increase the quality of scientific outcomes). We suggest that high quality science can be produced with massive, largely one-off, participation if data collection is simple and quality control includes algorithm voting, statistical pruning and/or computational modeling. Small to mid-scale projects engaging participants in repeated, often complex, sampling can advance quality through expert-led training and well-designed materials, and through independent verification. Both approaches - simplification at scale and complexity with care - generate more robust science outcomes.

The potential contribution of the Queensland wet tropics region natural resource plan to river improvement and water quality.

PubMed

McDonald, G; Weston, N; Dorrington, B

2003-01-01

This paper reports on work in progress on the new Wet Tropics Regional Natural Resource Management Plan and its potential to deliver river management and water quality outcomes. The plan is being prepared in accordance with the guidelines of the Nation Action Plan for Salinity and Water Quality/Natural Heritage Trust (NAP/NHT2). In particular the paper discusses the technical basis for priorities, target setting and implementation and the most effective instruments for achieving river improvement and water quality outcomes in the region.

Oregon Department of Transportation research leader : fall 2008.

DOT National Transportation Integrated Search

2008-01-01

The newsletter includes: : 1) To ensure safe travel through construction work zones, Traffic Control Plans (TCPs) are developed to communicate required traffic control measures to the construction team. The quality of the design and implementation of...

Implementation of Evidence-Based Employment Services in Specialty Mental Health

PubMed Central

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

2013-01-01

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

Near-infrared Spectroscopy in the Brewing Industry.

PubMed

Sileoni, Valeria; Marconi, Ombretta; Perretti, Giuseppe

2015-01-01

This article offers an exhaustive description of the use of Near-Infrared (NIR) Spectroscopy in the brewing industry. This technique is widely used for quality control testing of raw materials, intermediates, and finished products, as well as process monitoring during malting and brewing. In particular, most of the reviewed works focus on the assessment of barley properties, aimed at quickly selecting the best barley varieties in order to produce a high-quality malt leading to high-quality beer. Various works concerning the use of NIR in the evaluation of raw materials, such as barley, malt, hop, and yeast, are also summarized here. The implementation of NIR sensors for the control of malting and brewing processes is also highlighted, as well as the use of NIR for quality assessment of the final product.

Improving the Quality of Care for Patients Diagnosed With Glioma During the Perioperative Period

PubMed Central

Riblet, Natalie B.V.; Schlosser, Evelyn M.; Homa, Karen; Snide, Jennifer A.; Jarvis, Lesley A.; Simmons, Nathan E.; Sargent, David H.; Mason, Linda P.; Cooney, Tobi J.; Kennedy, Nancy L.; Fadul, Camilo E.

2014-01-01

Purpose: Although there is agreement on the oncologic management of patients with glioma, few guidelines exist to standardize other aspects of care, including supportive care. Methods: A quality improvement (QI) project was chartered to improve the care provided to patients with glioma. A multidisciplinary team was convened and identified 10 best-practice measures. Using a plan-do-study-act framework, the team brainstormed and implemented various improvement interventions between June 2011 and October 2012. Statistical process control charts were used to evaluate progress. A dashboard of quality measures was generated to allow for ongoing measurement and reporting. Results: The retrospective assessment phase consisted of 43 patients with diagnosis of glioma. A manual medical record review for these patients showed that compliance with 10 best-practice measures ranged from 23% to 100%. Several factors contributed to less-than-ideal process performance, including poor communication among disciplines and lack of familiarity with the larger system of care. After implementing improvement interventions, performance was measured in 96 consecutive patients with glioma. The proportion of patients who met criteria for 10 practice measures significantly improved (pre-QI work, 63%; post-QI work, 85%; P = .003). The largest improvement was observed in the measure assessing for preoperative notification of the neuro-oncology program (pre-QI work, 39%; post-QI work, 97%; P < .001). Conclusion: QI principles were used by a multidisciplinary team to improve the quality of care for patients with glioma during the perioperative period. Leadership involvement, ongoing dialogue across departments, and reporting of system performance were important for sustaining process improvements. PMID:25294392

Radiation protection program for early detection of breast cancer in a mammography facility

NASA Astrophysics Data System (ADS)

Villagomez Casimiro, Mariana; Ruiz Trejo, Cesar; Espejo Fonseca, Ruby

2014-11-01

Mammography is the best tool for early detection of Breast Cancer. In this diagnostic radiology modality it is necessary to establish the criteria to ensure the proper use and operation of the equipment used to obtain mammographic images in order to contribute to the safe use of ionizing radiation. The aim of the work was to implement at FUCAM-AC the radiation protection program which must be established for patients and radiation workers according to Mexican standards [1-4]. To achieve this goal, radiation protection and quality control manuals were elaborated [5]. Furthermore, a quality control program (QCP) in the mammography systems (analog/digital), darkroom included, has been implemented. Daily sensitometry, non-variability of the image quality, visualizing artifacts, revision of the equipment mechanical stability, compression force and analysis of repetition studies are some of the QCP routine tests that must be performed by radiological technicians of this institution as a set of actions to ensure the protection of patients. Image quality and patients dose assessment were performed on 4 analog equipment installed in 2 mobile units. In relation to dose assessment, all equipment passed the acceptance criteria (<3 mGy per projection). The image quality test showed that most images (70%)- presented artifacts. A brief summary of the results of quality control tests applied to the equipment and film processor are presented. To maintain an adequate level of quality and safety at FUCAM-AC is necessary that the proposed radiation protection program in this work is applied.

[Does implementation of benchmarking in quality circles improve the quality of care of patients with asthma and reduce drug interaction?].

PubMed

Kaufmann-Kolle, Petra; Szecsenyi, Joachim; Broge, Björn; Haefeli, Walter Emil; Schneider, Antonius

2011-01-01

The purpose of this cluster-randomised controlled trial was to evaluate the efficacy of quality circles (QCs) working either with general data-based feedback or with an open benchmark within the field of asthma care and drug-drug interactions. Twelve QCs, involving 96 general practitioners from 85 practices, were randomised. Six QCs worked with traditional anonymous feedback and six with an open benchmark. Two QC meetings supported with feedback reports were held covering the topics "drug-drug interactions" and "asthma"; in both cases discussions were guided by a trained moderator. Outcome measures included health-related quality of life and patient satisfaction with treatment, asthma severity and number of potentially inappropriate drug combinations as well as the general practitioners' satisfaction in relation to the performance of the QC. A significant improvement in the treatment of asthma was observed in both trial arms. However, there was only a slight improvement regarding inappropriate drug combinations. There were no relevant differences between the group with open benchmark (B-QC) and traditional quality circles (T-QC). The physicians' satisfaction with the QC performance was significantly higher in the T-QCs. General practitioners seem to take a critical perspective about open benchmarking in quality circles. Caution should be used when implementing benchmarking in a quality circle as it did not improve healthcare when compared to the traditional procedure with anonymised comparisons. Copyright © 2011. Published by Elsevier GmbH.

Are work organization interventions effective in preventing or reducing work-related musculoskeletal disorders? A systematic review of the literature.

PubMed

Stock, Susan R; Nicolakakis, Nektaria; Vézina, Nicole; Vézina, Michel; Gilbert, Louis; Turcot, Alice; Sultan-Taïeb, Hélène; Sinden, Kathryn; Denis, Marie-Agnès; Delga, Céline; Beaucage, Clément

2018-03-01

Objectives We sought to determine whether interventions that target work organization or the psychosocial work environment are effective in preventing or reducing work-related musculoskeletal disorders (WMSD) compared to usual work. Methods We systematically reviewed the 2000-2015 English- and French-language scientific literature, including studies evaluating the effectiveness of an organizational or psychosocial work intervention on incidence, prevalence or intensity of work-related musculoskeletal pain or disorders in the neck, shoulders, upper limbs and/or back or of work absence due to such problems, among non-sick-listed workers. We excluded rehabilitation and individual-level behavioral interventions and studies with >50% attrition. We analyzed medium- and high-quality studies and synthesized the evidence using the Grading of Recommendations Assessment, Development & Evaluation (GRADE) approach. An analysis of key workplace intervention elements supplemented the interpretation of results. Results We identified 884 articles; 28 met selection criteria, yielding 2 high-quality, 10 medium-quality and 16 low-quality studies. There was moderate evidence that supplementary breaks, compared to conventional break schedules, are effective in reducing symptom intensity in various body regions. Evidence was low-to-very-low quality for other interventions, primarily due to risk of bias related to study design, high attrition rates, co-interventions, and insensitive indicators. Most interventions lacked key intervention elements, such as work activity analysis and ergonomist guidance during implementation, but the relation of these elements to intervention effectiveness or ineffectiveness remains to be demonstrated. Conclusions Targeting work-rest cycles may reduce WMSD. Better quality studies are needed to allow definitive conclusions to be drawn on the effectiveness of other work organizational or psychosocial interventions to prevent or reduce WMSD.

An Overview of the Quality Function Deployment (QFD) Technique

NASA Technical Reports Server (NTRS)

Sherif, Josef S.; Tran, Tuyet-Lan

1995-01-01

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

The radiation metrology network related to the field of mammography: implementation and uncertainty analysis of the calibration system

NASA Astrophysics Data System (ADS)

Peixoto, J. G. P.; de Almeida, C. E.

2001-09-01

It is recognized by the international guidelines that it is necessary to offer calibration services for mammography beams in order to improve the quality of clinical diagnosis. Major efforts have been made by several laboratories in order to establish an appropriate and traceable calibration infrastructure and to provide the basis for a quality control programme in mammography. The contribution of the radiation metrology network to the users of mammography is reviewed in this work. Also steps required for the implementation of a mammography calibration system using a constant potential x-ray and a clinical mammography x-ray machine are presented. The various qualities of mammography radiation discussed in this work are in accordance with the IEC 61674 and the AAPM recommendations. They are at present available at several primary standard dosimetry laboratories (PSDLs), namely the PTB, NIST and BEV and a few secondary standard dosimetry laboratories (SSDLs) such as at the University of Wisconsin and at the IAEA's SSDL. We discuss the uncertainties involved in all steps of the calibration chain in accord with the ISO recommendations.

Using implementation tools to design and conduct quality improvement projects for faster and more effective improvement.

PubMed

Ovretveit, John; Mittman, Brian; Rubenstein, Lisa; Ganz, David A

2017-10-09

Purpose The purpose of this paper is to enable improvers to use recent knowledge from implementation science to carry out improvement changes more effectively. It also highlights the importance of converting research findings into practical tools and guidance for improvers so as to make research easier to apply in practice. Design/methodology/approach This study provides an illustration of how a quality improvement (QI) team project can make use of recent findings from implementation research so as to make their improvement changes more effective and sustainable. The guidance is based on a review and synthesis of improvement and implementation methods. Findings The paper illustrates how research can help a quality project team in the phases of problem definition and preparation, in design and planning, in implementation, and in sustaining and spreading a QI. Examples of the use of different ideas and methods are cited where they exist. Research limitations/implications The example is illustrative and there is little limited experimental evidence of whether using all the steps and tools in the one approach proposed do enable a quality team to be more effective. Evidence supporting individual guidance proposals is cited where it exists. Practical implications If the steps proposed and illustrated in the paper were followed, it is possible that quality projects could avoid waste by ensuring the conditions they need for success are in place, and sustain and spread improvement changes more effectively. Social implications More patients could benefit more quickly from more effective implementation of proven interventions. Originality/value The paper is the first to describe how improvement and implementation science can be combined in a tangible way that practical improvers can use in their projects. It shows how QI project teams can take advantage of recent advances in improvement and implementation science to make their work more effective and sustainable.

Stormwater management impacts on urban stream water quality and quantity during and after development in Clarksburg, MD

NASA Astrophysics Data System (ADS)

Loperfido, J. V.; Noe, G. B.; Jarnagin, S.; Mohamoud, Y. M.; Van Ness, K.; Hogan, D. M.

2012-12-01

Urbanization and urban land use leads to degradation of local stream habitat and 'urban stream syndrome.' Best Management Practices (BMPs) are often used in an attempt to mitigate the impact of urban land use on stream water quality and quantity. Traditional development has employed stormwater BMPs that were placed in a centralized manner located either in the stream channel or near the riparian zone to treat stormwater runoff from large drainage areas; however, urban streams have largely remained impaired. Recently, distributed placement of BMPs throughout the landscape has been implemented in an attempt to detain, treat, and infiltrate stormwater runoff from smaller drainage areas near its source. Despite increasing implementation of distributed BMPs, little has been reported on the catchment-scale (1-10 km^2) performance of distributed BMPs and how they compare to centralized BMPs. The Clarksburg Special Protection Area (CSPA), located in the Washington, DC exurbs within the larger Chesapeake Bay watershed, is undergoing rapid urbanization and employs distributed BMPs on the landscape that treat small drainage areas with the goal of preserving high-quality stream resources in the area. In addition, the presence of a nearby traditionally developed (centralized BMPs) catchment and an undeveloped forested catchment makes the CSPA an ideal setting to understand how the best available stormwater management technology implemented during and after development affects stream water quality and quantity through a comparative watershed analysis. The Clarksburg Integrated Monitoring Partnership is a consortium of local and federal agencies and universities that conducts research in the CSPA including: monitoring of stream water quality, geomorphology, and biology; analysis of stream hydrological and water quality data; and GIS mapping and analysis of land cover, elevation change and BMP implementation data. Here, the impacts of urbanization on stream water quantity, geomorphology, and biology during development while implementing advanced sediment and erosion control BMPs are discussed. Also, effects of centralized versus distributed stormwater BMPs and land cover on stream water quantity and quality following suburban development are presented. This includes stream response to precipitation events, baseflow and stormflow export of water, and water chemistry data. Results from this work have informed land use planning at the local level and are being incorporated through adaptive management to maintain the high-quality stream resources in the CSPA. More generally, results from this work could inform urban development stakeholders on effective strategies to curtail urban stream syndrome.

Organisational readiness and Lean Thinking implementation: findings from three emergency department case studies in New Zealand.

PubMed

Rees, Gareth H

2014-01-01

This paper describes and contrasts the implementation of Lean Thinking – a quality methodology that emphasises waste reduction and performing at higher levels of productivity with the same or less resources – into New Zealand's healthcare system. As the field is relatively new, three literature-based exemplar cases were developed to provide an analysis framework to analyse the three New Zealand research sites, which had activities, teamwork, leadership and sustainability as its core themes. Each research site's case was developed from primary data gathered through interviews, augmented by secondary data from project reports, District Health Board websites and media stories. The results highlight the benefits of a supportive quality-focussed organisational culture, executive management involvement and cross-functional teams as enablers. Further, work intensification and workplace resistance were also evident in varying levels within the sites. The study, while reiterating the problems of introducing quality methods from other domains into healthcare, presents the New Zealand context and reinforces that organisational preparedness as a significant factor which contributes to implementation success. This study goes beyond investigations of the use of Lean tools, changing improvement metrics and descriptive statistics to identify the contexts and variables which surround quality and process improvement implementations. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Continuous quality improvement: a shared governance model that maximizes agent-specific knowledge.

PubMed

Burkoski, Vanessa; Yoon, Jennifer

2013-01-01

Motivate, Innovate, Celebrate: an innovative shared governance model through the establishment of continuous quality improvement (CQI) councils was implemented across the London Health Sciences Centre (LHSC). The model leverages agent-specific knowledge at the point of care and provides a structure aimed at building human resources capacity and sustaining enhancements to quality and safe care delivery. Interprofessional and cross-functional teams work through the CQI councils to identify, formulate, execute and evaluate CQI initiatives. In addition to a structure that facilitates collaboration, accountability and ownership, a corporate CQI Steering Committee provides the forum for scaling up and spreading this model. Point-of-care staff, clinical management and educators were trained in LEAN methodology and patient experience-based design to ensure sufficient knowledge and resources to support the implementation.

Considering context in quality improvement interventions and implementation: concepts, frameworks, and application.

PubMed

McDonald, Kathryn M

2013-01-01

Growing consensus within the health care field suggests that context matters and needs more concerted study for helping those who implement and conduct research on quality improvement interventions. Health care delivery system decision makers require information about whether an intervention tested in one context will work in another with some differences from the original site. We aimed to define key terms, enumerate candidate domains for the study of context, provide examples from the pediatric quality improvement literature, and identify potential measures for selected contexts. Key sources include the organizational literature, broad evaluation frameworks, and a recent project in the patient safety area on context sensitivity. The article concludes with limitations and next steps for developments in this area. Copyright © 2013 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.

Potential of integrated continuous surveys and quality management to support monitoring, evaluation, and the scale-up of health interventions in developing countries.

PubMed

Rowe, Alexander K

2009-06-01

Well-funded initiatives are challenging developing countries to increase health intervention coverage and show impact. Despite substantial resources, however, major obstacles include weak health systems, a lack of reasonably accurate monitoring data, and inadequate use of data for managing programs. This report discusses how integrated continuous surveys and quality management (I-Q), which are well-recognized approaches in wealthy countries, could support intervention scale-up, monitoring and evaluation, quality control for commodities, capacity building, and implementation research in low-resource settings. Integrated continuous surveys are similar to existing national cross-sectional surveys of households and health facilities, except data are collected over several years by permanent teams, and most results are reported monthly at the national, province, and district levels. Quality management involves conceptualizing work as processes, involving all workers in quality improvement, monitoring quality, and teams that improve quality with "plan-do-study-act" cycles. Implementing and evaluating I-Q in a low-income country would provide critical information on the value of this approach.

Using quality control to limit bismuth in copper cathodes

NASA Astrophysics Data System (ADS)

Serrano, John R.; Berger, Dennis; Bridges, Bill

1994-10-01

This article describes quality-control work at Phelps Dodge, undertaken as part of ISO 9003 certification, to better identify and prevent the contamination of copper cathodes by bismuth. It also overviews the implementation of a production control system as well as associated training designed to minimize the possibility of bismuth-contaminated copper progressing beyond the cathode stage to other areas of manufacturing or distribution.

Occupational safety and health objectives of Healthy People 2010: a systematic approach for occupational health nurses--Part II.

PubMed

Olszewski, Kimberly; Parks, Carol; Chikotas, Noreen E

2007-03-01

Occupational safety and health objectives 20.6 through 20.11 focus on reducing work-related assaults, lead exposure, skin diseases and disorders, needlestick injuries, and work-related, noise-induced hearing loss and promoting worksite stress reduction programs. Using the intervention strategies provided, occupational health nurses can play a key role in reducing workplace-related injury, disease, disability, and death. variety of resources pertaining to occupational health and safety from the federal, national, health care, nursing, and environmental realms can assist occupational health nurses in developing and implementing programs appropriate for their workplaces. Through the Healthy People 2010 occupational health and safety objectives, occupational health nurses have the opportunity to develop and implement workplace policies and programs promoting not only a safe and healthy work environment but also improved health and disease prevention. Occupational health nurses can implement strategies to increase quality and years of life and eliminate health disparities in the American work force.

Computerised Order Entry Systems and Pathology Services - A Synthesis of the Evidence

PubMed Central

Georgiou, Andrew; Westbrook, Johanna I

2006-01-01

Computerised Physician Order Entry (CPOE) systems have been promoted in Australia and internationally for their potential to improve the quality of care. The existing research of the effect of CPOE on pathology laboratories has been variable, pointing to the potential to increase efficiency and effectiveness and contribute to enhancing the quality of patient care on the one hand, while leading to significant disruptions in work organisation with a negative impact on departmental relations on the other hand. In this paper we provide an overview of the research evidence about the impact of CPOE on four areas associated with pathology services; a) efficiency of the ordering process, e.g. test turnaround times, b) effectiveness as measured by test ordering volumes and test order appropriateness, c) quality of care, particularly its effects on patient care and d) work organisation patterns, which can be severely disrupted by CPOE. We discuss the possible ramifications of CPOE and offer three broad, but important recommendations for pathology laboratories, based on our own research experience investigating CPOE implementations over three years. Firstly, pathology laboratories need to be active participants in planning the implementation of CPOE. Secondly, the importance of building a firm organisational foundation for the introduction of the new system that includes openness and responsiveness to feedback. And thirdly, the implementation process needs to be underpinned by a strong commitment to a multi-method evaluation at every stage of the process to be able to measure the impact of the system on work practices and outcomes. PMID:17077878

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

DTIC Science & Technology

1990-12-12

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

[THE EVALUATION OF THE EFFECTIVENESS OF THE IMPLEMENTATION OF INFORMATION SYSTEM 1C: ENTERPRISE IN THE HOSPITAL].

PubMed

Baimagambetova, A; Kulov, D; Tsay, A; Kairbekova, K; Sakenova, M

2017-03-01

The aim of research was to assess the impact of the introduction of information system 1C: Enterprise on the work of medical staff. It was evaluated staff satisfaction in terms of quality and speed of their duties, as well as sociological changes after the introduction in the work the information system 1C: Enterprise from 2010. The research involved 138 employees of the hospital, including 48 doctors and 90 nurses with experience of at least 5 years. The average age of respondents was 45 years. The study was conducted through questionnaires, including questions relating to life expectancy, changing the speed and quality of execution of tasks, also attended to questions about the change in the frequency of conflict situations and wages. Separately, it was included open-ended question about the change in the level of motivation before and after the implementation of the information system. Respondents gave the evaluation and describe the specific changes they have noticed. Objective assessment of the effectiveness was evaluated according to the official statistics on the number of people served, the time spent on one patient, the level of qualification of medical personnel. 76% of employees have noted positive changes in the work after the implementation of the information system 1C: Enterprise in the work, there is a change of diagnosis rate, the quality of treatment, 72.3% of physicians and 48% of nurses have noted a decrease in time spent on paperwork. 13.6% of physicians and 23.0% of nurses did not notice any difference. Other members expressed dissatisfaction, because of the necessity of learning of a computer program. After the number of the served population program of work increased by 6.8%, decreased the number of days of hospitalization by 12%. The use of modern information systems increases the level of health services and health workers, increasing productivity.

A multi-method study on the quality of the nurse work environment in acute-care hospitals: positioning Switzerland in the Magnet hospital research.

PubMed

Desmedt, M; De Geest, S; Schubert, M; Schwendimann, R; Ausserhofer, D

2012-12-21

Magnet hospitals share nurse work environment characteristics associated with superior patient, nurse and financial outcomes. In Switzerland, however, it is uncertain how nurses appraise their work environments. To describe the quality of the nurse work environment in 35 Swiss acute care hospitals and to benchmark findings based on international Magnet hospital research. This study used two data sources: (1) the Swiss arm of the RN4CAST study; and (2) a structured literature review. Hospitals were categorised based on Magnet and non-Magnet data. Our outcome variable of interest was the quality of nurse work environment measured with the Practice Environment Scale of the Nurse Work Index (PES-NWI). We reviewed 13 American, Canadian, and Australian studies of acute-care hospitals. Three provided Magnet hospitals' nurse work environment data, and all included non-Magnet hospitals' data. Swiss hospitals' evaluations on nurse work environment quality varied widely, but 25% achieved scores indicating "Magnet nurse work environments". Swiss hospitals' average "Nursing manager ability" subscale scores fulfilled Magnet hospital criteria, although "Nurse participation in hospital affairs" and "Nursing staffing and resource adequacy" scores neared non-Magnet levels. On average, our results indicated high quality nurse work environments in Swiss hospitals. Implementing Magnet model organisational principles might be a valuable approach for Swiss acute-care hospitals to both improve mixed and unfavourable nurse work environments and to improve nurse and patient outcomes. National benchmarking of nurse work environments and other nurse-sensitive indicators may facilitate evaluating the impact of current developments in Swiss healthcare.

Conformance testing strategies for DICOM protocols in a heterogenous communications system

NASA Astrophysics Data System (ADS)

Meyer, Ralph; Hewett, Andrew J.; Cordonnier, Emmanuel; Piqueras, Joachim; Jensch, Peter F.

1995-05-01

The goal of the DICOM standard is to define a standard network interface and data model for imaging devices from various vendors. It shall facilitate the development and integration of information systems and picture archiving and communication systems (PACS) in a networked environment. Current activities in Oldenburg, Germany include projects to establish cooperative work applications for radiological purposes, comprising (joined) text, data, signal and image communications, based on narrowband ISDN and ATM communication for regional and Pan European applications. In such a growing and constantly changing environment it is vital to have a solid and implementable plan to bring standards in operation. A communication standard alone cannot ensure interoperability between different vendor implementations. Even DICOM does not specify implementation-specific requirements nor does it specify a testing procedure to assess an implementation's conformance to the standard. The conformance statements defined in the DICOM standard only allow a user to determine which optional components are supported by the implementation. The goal of our work is to build a conformance test suite for DICOM. Conformance testing can aid to simplify and solve problems with multivendor systems. It will check a vendor's implementation against the DICOM standard and state the found subset of functionality. The test suite will be built in respect to the ISO 9646 Standard (OSI-Conformance Testing Methodology and Framework) which is a standard devoted to the subject of conformance testing implementations of Open Systems Interconnection (OSI) standards. For our heterogeneous communication environments we must also consider ISO 9000 - 9004 (quality management and quality assurance) to give the users the confidence in evolving applications.

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2014 CFR

2014-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2013 CFR

2013-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2012 CFR

2012-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

40 CFR 49.154 - Permit application requirements.

Code of Federal Regulations, 2011 CFR

2011-07-01

..., production rates and operating schedules. (vii) Identification and description of any existing air pollution... pollution prevention techniques, air pollution control devices, design standards, equipment standards, work... ASSISTANCE INDIAN COUNTRY: AIR QUALITY PLANNING AND MANAGEMENT General Federal Implementation Plan Provisions...

Embankment quality and assessment of moisture control implementation : tech transfer summary.

DOT National Transportation Integrated Search

2016-02-01

The motivation for this project was based on work by : Iowa State University (ISU) researchers at a few recent : grading projects that demonstrated embankments were : being constructed outside moisture control limits, even : though the contractor QC ...

Effects of a performance and quality improvement intervention on the work environment in HIV-related care: a quasi-experimental evaluation in Zambia.

PubMed

Bazant, Eva; Sarkar, Supriya; Banda, Joseph; Kanjipite, Webby; Reinhardt, Stephanie; Shasulwe, Hildah; Mulilo, Joyce Monica Chongo; Kim, Young Mi

2014-12-20

Human resource shortages and reforms in HIV-related care make it challenging for frontline health care providers in southern Africa to deliver high-quality services. At health facilities of the Zambian Defence Forces, a performance and quality improvement approach was implemented to improve HIV-related care and was evaluated in 2010/2011. Changes in providers' work environment and perceived quality of HIV-related care were assessed to complement data of provider performance. The intervention involved on-site training, supportive supervision, and action planning focusing on detailed service delivery standards. The quasi-experimental evaluation collected pre- and post-intervention data from eight intervention and comparison facilities matched on defence force branch and baseline client volume. Overall, 101 providers responded to a 24-item questionnaire on the work environment, covering topics of drugs, supplies, and equipment; training, feedback, and supervision; compensation; staffing; safety; fulfilment; and HIV services quality. In bivariate analysis and multivariate analyses, we assessed changes within each study group and between the two groups. In the bivariate analysis, the intervention group providers reported improvements in the work environment on adequacy of equipment, feeling safe from harm, confidence in clinical skills, and reduced isolation, while the comparison group reported worsening of the work environment on supplies, training, safety, and departmental morale.In the multivariate analysis, the intervention group's improvement and the comparison group's decline were significant on perceived adequacy of drugs, supplies, and equipment; constructive feedback received from supervisor and co-workers; and feeling safe from physical harm (all P <0.01, except P <0.04 for equipment). Further, the item "provider lacks confidence in some clinical skills" declined in the intervention group but increased in the comparison group (P = -0.005). In multivariate analysis, changes in perceived quality of HIV care did not differ between study groups. Provider perceptions were congruent with observations of preparing drugs, supplies, equipment, and in service delivery of prevention of mother-to-child transmission of HIV and antiretroviral therapy follow-up care. The performance and quality improvement intervention implemented at Zambian Defence Forces' health facilities was associated with improvements in providers' perceptions of work environment consistent with the intervention's focus on commodities, skills acquisition, and receipt of constructive feedback.

A Formal Integrity Framework with Application to a Secure Information ATM (SIATM)

DTIC Science & Technology

2012-10-01

work on Integrity and resultant implementations seems to have focussed more on a matters related to source authentication and transmission assurance...to have focussed more on a matters related to source authentication and transmission assurance. However, the quality of data aspect is becoming more...implementations seems to have focussed more on matters related to source authentication and transmission assur- ance, for which there is a

Answering the call to accessible quality health care for all using a new model of local community not-for-profit charity clinics: A return to Christ-centered care of the past

PubMed Central

Cuellar De la Cruz, Yuri

2017-01-01

This article uses studies and organizational trends to understand available solutions to the lack of quality health care access, especially for the poor and needy of local U.S. communities. The U.S. healthcare system seems to be moving toward the World Health Organization's recommendation for universal health coverage for healthcare sustainability. Healthcare trends and offered solutions are varied. Christian healthcare traditionally implements works of mercy guided by a Christian ethos embracing the teachings of human dignity, solidarity, the common good, and subsidiarity. Culture of Life Ministries is one of many new sustainable U.S. healthcare models which implements Christ-centered health care to meet the need of quality and accessible health care for the local community. Culture of Life Ministries employs a model of charity care through volunteerism. Volunteer workers not only improve but also transform the local healthcare system into a personal healing ministry of the highest quality for every person. Summary: The lack of access to quality health care is a common problem in the U.S. despite various solutions offered through legislative and socioeconomic works: universal healthcare models, insurance models, and other business models. U.S. health care would be best transformed by returning to the implementation of a traditional system founded on the Christian principles of human dignity, solidarity, subsidiarity, and the common good. Culture of Life Ministries is an example of such a local ministry in Texas, which has found success in practically applying these Christ-centered, healthcare principles into an emerging not-for-profit, economically sustainable, healthcare model. PMID:28392598

Identifying knowledge gaps between practice and research for implementation components of sustainable interventions to improve the working environment - A rapid review.

PubMed

Rasmussen, Charlotte Diana Nørregaard; Højberg, Helene; Bengtsen, Elizabeth; Jørgensen, Marie Birk

2018-02-01

In a recent study, we involved all relevant stakeholders to identify practice-based implementation components for successful implementation and sustainability in work environment interventions. To understand possible knowledge gaps between evidence and practice, the aim of this paper is to investigate if effectiveness studies of the 11 practice-based implementation components can be identified in existing scientific literature. PubMed/MEDLINE, PsycINFO, and Web of Science were searched for relevant studies. After screening, 38 articles met the inclusion criteria. Since some of the studies describe more than one practice-based implementation concept a total of 125 quality criteria assessments were made. The overall result is that 10 of the 11 practice-based implementation components can be found in the scientific literature, but the evaluation of them is poor. From this review it is clear that there are knowledge gaps between evidence and practice with respect to the effectiveness of implementation concepts. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effect assessment in work environment interventions: a methodological reflection.

PubMed

Neumann, W P; Eklund, J; Hansson, B; Lindbeck, L

2010-01-01

This paper addresses a number of issues for work environment intervention (WEI) researchers in light of the mixed results reported in the literature. If researchers emphasise study quality over intervention quality, reviews that exclude case studies with high quality and multifactorial interventions may be vulnerable to 'quality criteria selection bias'. Learning from 'failed' interventions is inhibited by both publication bias and reporting lengths that limit information on relevant contextual and implementation factors. The authors argue for the need to develop evaluation approaches consistent with the complexity of multifactorial WEIs that: a) are owned by and aimed at the whole organisation; and b) include intervention in early design stages where potential impact is highest. Context variety, complexity and instability in and around organisations suggest that attention might usefully shift from generalisable 'proof of effectiveness' to a more nuanced identification of intervention elements and the situations in which they are more likely to work as intended. STATEMENT OF RELEVANCE: This paper considers ergonomics interventions from perspectives of what constitutes quality and 'proof". It points to limitations of traditional experimental intervention designs and argues that the complexity of organisational change, and the need for multifactorial interventions that reach deep into work processes for greater impact, should be recognised.

Staff experiences within the implementation of computer-based nursing records in residential aged care facilities: a systematic review and synthesis of qualitative research.

PubMed

Meißner, Anne; Schnepp, Wilfried

2014-06-20

Since the introduction of electronic nursing documentation systems, its implementation in recent years has increased rapidly in Germany. The objectives of such systems are to save time, to improve information handling and to improve quality. To integrate IT in the daily working processes, the employee is the pivotal element. Therefore it is important to understand nurses' experience with IT implementation. At present the literature shows a lack of understanding exploring staff experiences within the implementation process. A systematic review and meta-ethnographic synthesis of primary studies using qualitative methods was conducted in PubMed, CINAHL, and Cochrane. It adheres to the principles of the PRISMA statement. The studies were original, peer-reviewed articles from 2000 to 2013, focusing on computer-based nursing documentation in Residential Aged Care Facilities. The use of IT requires a different form of information processing. Some experience this new form of information processing as a benefit while others do not. The latter find it more difficult to enter data and this result in poor clinical documentation. Improvement in the quality of residents' records leads to an overall improvement in the quality of care. However, if the quality of those records is poor, some residents do not receive the necessary care. Furthermore, the length of time necessary to complete the documentation is a prominent theme within that process. Those who are more efficient with the electronic documentation demonstrate improved time management. For those who are less efficient with electronic documentation the information processing is perceived as time consuming. Normally, it is possible to experience benefits when using IT, but this depends on either promoting or hindering factors, e.g. ease of use and ability to use it, equipment availability and technical functionality, as well as attitude. In summary, the findings showed that members of staff experience IT as a benefit when it simplifies their daily working routines and as a burden when it complicates their working processes. Whether IT complicates or simplifies their routines depends on influencing factors. The line between benefit and burden is semipermeable. The experiences differ according to duties and responsibilities.

Pharmacy Dashboard: An Innovative Process for Pharmacy Workload and Productivity.

PubMed

Kinney, Ashley; Bui, Quyen; Hodding, Jane; Le, Jennifer

2017-03-01

Background: Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective: To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods: Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results: The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion: A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work.

Pharmacy Dashboard: An Innovative Process for Pharmacy Workload and Productivity

PubMed Central

Bui, Quyen; Hodding, Jane; Le, Jennifer

2017-01-01

Background: Innovative approaches, including LEAN systems and dashboards, to enhance pharmacy production continue to evolve in a cost and safety conscious health care environment. Furthermore, implementing and evaluating the effectiveness of these novel methods continues to be challenging for pharmacies. Objective: To describe a comprehensive, real-time pharmacy dashboard that incorporated LEAN methodologies and evaluate its utilization in an inpatient Central Intravenous Additives Services (CIVAS) pharmacy. Methods: Long Beach Memorial Hospital (462 adult beds) and Miller Children's and Women's Hospital of Long Beach (combined 324 beds) are tertiary not-for-profit, community-based hospitals that are served by one CIVAS pharmacy. Metrics to evaluate the effectiveness of CIVAS were developed and implemented on a dashboard in real-time from March 2013 to March 2014. Results: The metrics that were designed and implemented to evaluate the effectiveness of CIVAS were quality and value, financial resilience, and the department's people and culture. Using a dashboard that integrated these metrics, the accuracy of manufacturing defect-free products was ≥99.9%, indicating excellent quality and value of CIVAS. The metric for financial resilience demonstrated a cost savings of $78,000 annually within pharmacy by eliminating the outsourcing of products. People and value metrics on the dashboard focused on standard work, with an overall 94.6% compliance to the workflow. Conclusion: A unique dashboard that incorporated metrics to monitor 3 important areas was successfully implemented to improve the effectiveness of CIVAS pharmacy. These metrics helped pharmacy to monitor progress in real-time, allowing attainment of production goals and fostering continuous quality improvement through LEAN work. PMID:28439134

Quality improvement on chemistry practicum courses through implementation of 5E learning cycle

NASA Astrophysics Data System (ADS)

Merdekawati, Krisna

2017-03-01

Two of bachelor of chemical education's competences are having practical skills and mastering chemistry material. Practicum courses are organized to support the competency achievement. Based on observation and evaluation, many problems were found in the implementation of practicum courses. Preliminary study indicated that 5E Learning Cycle can be used as an alternative solution in order to improve the quality of chemistry practicum course. The 5E Learning Cycle can provide positive influence on the achievement of the competence, laboratory skills, and students' understanding. The aim of the research was to describe the feasibility of implementation of 5E Learning Cycle on chemistry practicum courses. The research was based on phenomenology method in qualitative approach. The participants of the research were 5 person of chemistry laboratory manager (lecturers at chemistry and chemistry education department). They concluded that the 5E Learning Cycle could be implemented to improve the quality of the chemistry practicum courses. Practicum guides and assistant competences were organized to support the implementation of 5E Learning Cycle. It needed training for assistants to understand and implement in the stages of 5E Learning Cycle. Preparation of practical guidelines referred to the stages of 5E Learning Cycle, started with the introduction of contextual and applicable materials, then followed with work procedures that accommodate the stage of engagement, exploration, explanation, extension, and evaluation

An Annotated Reading List for Concurrent Engineering

DTIC Science & Technology

1989-07-01

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

A Screening Assessment of the Potential Impacts of Climate Change on the Costs of Implementing Water Quality-Based Effluent Limits at Publicly-Owned Treatment Works (Potws) in the Great Lakes Region (External Review Draft)

EPA Science Inventory

EPA has released this draft document solely for the purpose of pre-dissemination peer review under applicable information quality guidelines. This document has not been formally disseminated by EPA. It does not represent and should not be construed to represent any Agency policy ...

Air quality impacts of implementing emission reduction strategies at southern California airports

NASA Astrophysics Data System (ADS)

Benosa, Guillem; Zhu, Shupeng; Kinnon, Michael Mac; Dabdub, Donald

2018-07-01

Reducing aviation emissions will be a major concern in the coming years, as the relative contribution of aviation to overall emissions is projected to increase in the future. The South Coast Air Basin of California (SoCAB) is an extreme nonattainment area with many airports located upwind of the most polluted regions in the basin. Techniques to reduce aviation emissions have been studied in the past, and strategies that can be implemented at airports include taxi-out times reduction, ground support equipment electrification and aviation biofuel implementation. These strategies have been analyzed only at the national scale, their effectiveness to improve air quality within the SoCAB given the local meteorology and chemical regimes is unclear. This work studies how the adoption of the techniques at commercial SoCAB airports affect ozone (O3) and fine particulate matter (PM2.5) concentrations. In addition, potential impacts on public exposure to PM2.5 and O3 resulting from changes in the concentration of these pollutants are estimated. In addition, the work calculates aviation emissions for each scenario and simulate the transport and atmospheric chemistry of the pollutants using the Community Multiscale Air Quality (CMAQ) model. The simultaneous application of all reduction strategies is projected to reduce the aviation-attributable population weighted ground-level PM2.5 by 36% in summer and 32% in winter. On the other hand, O3 increases by 16% in winter. Occurring mostly in densely populated areas, the decrease in ground-level PM2.5 would have a positive health impact and help the region achieve attainment of national ambient air quality standards.

The 1999 ICSI/IHI colloquium on clinical quality improvement--"quality: settling the frontier".

PubMed

Palmersheim, T M

1999-12-01

A Colloquium on Clinical Quality Improvement, "Quality: Setting the Frontier," held in May 1999, covered methods and programs in clinical quality improvement. Leadership and organizational behavior were the main themes of the breakout sessions; specific topics included implementing guidelines, applying continuous quality improvement (CQI) methods in preventive services and primary care, and using systems thinking to improve clinical outcomes. Three keynote addresses were presented. James L. Reinertsen, MD (CareGroup, Boston), characterized the financial challenges faced by many health care organizations as a "clarion call" for leadership on quality. "The leadership imperative is to establish an environment in which quality can thrive, despite unprecedented, severe economic pressures on our health systems." How do we make improvement more effective? G. Ross Baker, PhD (University of Toronto), reviewed what organizational literature says about making teams more effective, understanding the organizational context to enable improvement work, and augmenting existing methods for creating sustainable improvement. For example, he noted the increasing interest among may organizations in rapid-cycle improvement but cautioned that such efforts may work best where problems can be addressed by existing clinical teams (not cross-functional work groups) and where there are available solutions that have worked in other settings. Mark Chassin, MD (Mount Sinai School of Medicine, New York), stated that critical tasks for improving quality include increasing public awareness, engaging clinicians in improvement, increasing the investment in producing measures and improvement tools, and reinventing health care delivery, clinical education and training, and QI.

Good reasons to implement quality assurance in nationwide breast cancer screening programs in Croatia and Serbia: results from a pilot study.

PubMed

Ciraj-Bjelac, Olivera; Faj, Dario; Stimac, Damir; Kosutic, Dusko; Arandjic, Danijela; Brkic, Hrvoje

2011-04-01

The purpose of this study is to investigate the need for and the possible achievements of a comprehensive QA programme and to look at effects of simple corrective actions on image quality in Croatia and in Serbia. The paper focuses on activities related to the technical and radiological aspects of QA. The methodology consisted of two phases. The aim of the first phase was the initial assessment of mammography practice in terms of image quality, patient dose and equipment performance in selected number of mammography units in Croatia and Serbia. Subsequently, corrective actions were suggested and implemented. Then the same parameters were re-assessed. Most of the suggested corrective actions were simple, low-cost and possible to implement immediately, as these were related to working habits in mammography units, such as film processing and darkroom conditions. It has been demonstrated how simple quantitative assessment of image quality can be used for optimisation purposes. Analysis of image quality parameters as OD, gradient and contrast demonstrated general similarities between mammography practices in Croatia and Serbia. The applied methodology should be expanded to larger number of hospitals and applied on a regular basis. Copyright © 2009 Elsevier Ireland Ltd. All rights reserved.

Chemical reactivity testing for the National Spent Nuclear Fuel Program. Revision 2

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

Koester, L.W.

This quality assurance project plan (QAPjP) summarizes requirements used by Lockheed Martin Energy Systems, Incorporated (LMES) Development Division at Y-12 for conducting chemical reactivity testing of Department of Energy (DOE) owned spent nuclear fuel, sponsored by the National Spent Nuclear Fuel Program (NSNFP). The requirements are based on the NSNFP Statement of work PRO-007 (Statement of Work for Laboratory Determination of Uranium Hydride Oxidation Reaction Kinetics.) This QAPjP will utilize the quality assurance program at Y-12, Y60-101PD, Quality Program Description, and existing implementing procedures for the most part in meeting the NSNFP Statement of Work PRO-007 requirements, exceptions will bemore » noted. The project consists of conducting three separate series of related experiments, ''Passivation of Uranium Hydride Powder With Oxygen and Water'', '''Passivation of Uranium Hydride Powder with Surface Characterization'', and ''Electrochemical Measure of Uranium Hydride Corrosion Rate''.« less

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

PubMed

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

2016-11-01

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

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

PubMed

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

2013-07-01

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

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England

PubMed Central

Osaro, Erhabor; Chima, Njemanze

2014-01-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the “engine room” of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness. PMID:25182941

Challenges of a negative work load and implications on morale, productivity and quality of service delivered in NHS laboratories in England.

PubMed

Osaro, Erhabor; Chima, Njemanze

2014-06-01

The National Health Service (NHS) is a term used to describe the publicly funded healthcare delivery system providing quality healthcare services in the United Kingdom. There are several challenges militating against the effective laboratory service delivery in the NHS in England. Biomedical scientists work in healthcare to diagnose disease and evaluate the effectiveness of treatment through the analysis of body fluids and tissue samples from patients. They provide the "engine room" of modern medicine with 70% of diagnosis based on the laboratory results generated by them. This review involved the search of literature for information on working condition of biomedical scientist in the NHS in England. Laboratory service delivery in the NHS in England faces numerous daunting challenges; staffing levels in the last few years have become dangerously low, less remunerated, relatively less experienced and predominantly band 5's, multidisciplinary rather than specialty based, associated with working more unsocial hours without adequate recovery time, de-banding of staff, high staff turnaround, profit and cost driven rather than quality. These factors has resulted in burn out, low morale, high sickness absences, increased error rate, poor team spirit, diminished productivity and suboptimal laboratory service delivery. There is the urgent need to retract our steps on unpopular policies to ensure that patient care is not compromised by ensuring adequate staffing level and mix, ensuring adequate remuneration of laboratory staff, implementing evidenced-based specialty oriented service, determining the root cause/s for the high staff turnover and implementing corrective action, identifying other potential sources of waste in the system rather than pruning the already dangerously low staffing levels and promoting a quality delivery side by side cost effectiveness.

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

PubMed

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

2013-01-01

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

Effects of work hour reduction on residents' lives: a systematic review.

PubMed

Fletcher, Kathlyn E; Underwood, Willie; Davis, Steven Q; Mangrulkar, Rajesh S; McMahon, Laurence F; Saint, Sanjay

2005-09-07

The Accreditation Council for Graduate Medical Education implemented mandatory work hour limitations in July 2003, partly out of concern for residents' well-being in the setting of sleep deprivation. These limitations are likely to also have an impact on other aspects of the lives of residents. To summarize the literature regarding the effect of interventions to reduce resident work hours on residents' education and quality of life. We searched the English-language literature about resident work hours from 1966 through April 2005 using MEDLINE, EMBASE, and Current Contents, supplemented with hand-search of additional journals, reference list review, and review of abstracts from national meetings. Studies were included that assessed a system change designed to counteract the effects of resident work hours, fatigue, or sleep deprivation; included an outcome directly related to residents; and were conducted in the United States. For each included study, 2 investigators independently abstracted data related to study quality, subjects, interventions, and findings using a standard data abstraction form. Fifty-four articles met inclusion criteria. The interventions used to decrease resident work hours varied but included night and day float teams, extra cross-coverage, and physician extenders. Outcomes included measures of resident education (operative experience, test scores, satisfaction) and quality of residents' lives (amount of sleep, well-being). Interventions to reduce resident work hours resulted in mixed effects on both operative experience and on perceived educational quality but generally improved residents' quality of life. Many studies had major limitations in their design or conduct. Past interventions suggest that residents' quality of life may improve with work hour limitations, but interpretation of the outcomes of these studies is hampered by suboptimal study design and the use of nonvalidated instruments. The long-term impact of reducing resident work hours on education remains unknown. Current and future interventions should be evaluated with more rigorous methods and should investigate links between residents' quality of life and quality of patient care.

Radiation protection program for early detection of breast cancer in a mammography facility

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

Mariana, Villagomez Casimiro, E-mail: marjim10-66@ciencias.unam.mx, E-mail: cesar@fisica.unam.mx; Cesar, Ruiz Trejo, E-mail: marjim10-66@ciencias.unam.mx, E-mail: cesar@fisica.unam.mx; Ruby, Espejo Fonseca

Mammography is the best tool for early detection of Breast Cancer. In this diagnostic radiology modality it is necessary to establish the criteria to ensure the proper use and operation of the equipment used to obtain mammographic images in order to contribute to the safe use of ionizing radiation. The aim of the work was to implement at FUCAM-AC the radiation protection program which must be established for patients and radiation workers according to Mexican standards [1–4]. To achieve this goal, radiation protection and quality control manuals were elaborated [5]. Furthermore, a quality control program (QCP) in the mammography systemsmore » (analog/digital), darkroom included, has been implemented. Daily sensitometry, non-variability of the image quality, visualizing artifacts, revision of the equipment mechanical stability, compression force and analysis of repetition studies are some of the QCP routine tests that must be performed by radiological technicians of this institution as a set of actions to ensure the protection of patients. Image quality and patients dose assessment were performed on 4 analog equipment installed in 2 mobile units. In relation to dose assessment, all equipment passed the acceptance criteria (<3 mGy per projection). The image quality test showed that most images (70%)– presented artifacts. A brief summary of the results of quality control tests applied to the equipment and film processor are presented. To maintain an adequate level of quality and safety at FUCAM-AC is necessary that the proposed radiation protection program in this work is applied.« less

[Health insurance dentists' subjective perceptions of quality when implementing quality management in practice - results from a nationwide survey].

PubMed

Kettler, Nele; Chenot, Regine; Jordan, A Rainer

2015-01-01

Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems. As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis. When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented" by 82.3 %, 80.2 % and 79.9 % of respondents, respectively. There appeared to be a disconnect between the respondents' subjective perceptions of quality and the benefits of QM as part of day-to-day practice management, with QM systems failing to reflect the respondents' subjective views on quality. The perceptions of QM among German statutory health insurance dentists are generally positive but marked by a disconnect between aspects of quality currently measured by QM systems and the dentists' views on what is required in order to assess quality standards in relation to the dimensions "patient", "quality of treatment" and "staff". A targeted review of the tools offered by QM systems may lead to improved ease of implementation. If QM is to form an integral part of clinical practice, all future developments need to consider the dentists' subjective perceptions of quality and their attitudes towards QM. Copyright © 2015. Published by Elsevier GmbH.

Accountability to Public Stakeholders in Watershed-Based Restoration

EPA Science Inventory

There is an increasing push at the federal, state, and local levels for watershed-based conservation projects. These projects work to address water quality issues in degraded waterways through the implementation of a suite of best management practices on land throughout a watersh...

Implementation of QoSS (Quality-of-Security Service) for NoC-Based SoC Protection

NASA Astrophysics Data System (ADS)

Sepúlveda, Johanna; Pires, Ricardo; Strum, Marius; Chau, Wang Jiang

Many of the current electronic systems embedded in a SoC (System-on-Chip) are used to capture, store, manipulate and access critical data, as well as to perform other key functions. In such a scenario, security is considered as an important issue. The Network-on-chip (NoC), as the foreseen communication structure of next-generation SoC devices, can be used to efficiently incorporate security. Our work proposes the implementation of QoSS (Quality of Security Service) to overcome present SoC vulnerabilities. QoSS is a novel concept for data protection that introduces security as a dimension of QoS. In this paper, we present the implementation of two security services (access control and authentication), that may be configured to assume one from several possible levels, the implementation of a technique to avoid denial-of-service (DoS) attacks, evaluate their effectiveness and estimate their impact on NoC performance.

[Is It Time to Implement a 12-Hour Shift for Nurses in Taiwan?

PubMed

Lin, Yi-Fung; Chang, Shiow-Ru; Wang, Li-Ting

2017-04-01

The twelve-hour shift system, first introduced in the U.S. in 1967 to address a nursing shortage, is now the main system of shift rotation used in numerous countries. In recent years, several hospitals in Taiwan have implemented the 12-hour shift model as one initiative to improve the problems of overtime and high turnover rate among nursing staff. Under this model, nurses work only three to four days per week for 12-hour shifts per day. Despite the increase in numbers of days off, there is growing concern that long shift hours may harm both the safety of patients and the well being of the nurses. The aim of the present article is to explain the application of the 12-hour shift system and to review the potential impacts of this model. Benefits of the 12-hour shift system include improving quality of life for nursing staff, reducing the turnover rate, and increasing job satisfaction. Primary concerns regarding this system include patient safety, nurse fatigue, and the potential negative effects on the sleep quality of nurses. These findings may be referenced by policymakers considering the development / implementation of flexible work schedules in Taiwan. The government must set a ceiling on work hours allowed per week and impose limits on overtime in order to prevent burnout in nursing staff.

Mechanisation and automation technologies development in work at construction sites

NASA Astrophysics Data System (ADS)

Sobotka, A.; Pacewicz, K.

2017-10-01

Implementing construction work that creates buildings is a very complicated and laborious task and requires the use of various types of machines and equipment. For years there has been a desire for designers and technologists to introduce devices that replace people’s work on machine construction, automation and even robots. Technologies for building construction are still being developed and implemented to limit people’s hard work and improve work efficiency and quality in innovative architectonical and construction solutions. New opportunities for improving work on the construction site include computerisation of technological processes and construction management for projects and processes. The aim of the paper was to analyse the development of mechanisation, automation and computerisation of construction processes and selected building technologies, with special attention paid to 3D printing technology. The state of mechanisation of construction works in Poland and trends in its development in construction technologies are presented. These studies were conducted on the basis of the available literature and a survey of Polish construction companies.

Effect of the new contract on GPs' working lives and perceptions of quality of care: a longitudinal survey.

PubMed

Whalley, Diane; Gravelle, Hugh; Sibbald, Bonnie

2008-01-01

An ambitious pay-for-performance system was implemented in UK general practice in 2004 amid doubts that it could improve both the working lives of doctors and quality of care. To evaluate doctors' perceptions of their working lives and quality of care before and after the new contract. Longitudinal questionnaire survey. England, UK. A longitudinal postal survey of English GPs in February 2004 and September 2005. Measures included reported job satisfaction (7-point scale), hours worked, income, and impact of the contract. Responses were available from 2105 doctors in 2004 and 1349 in 2005. Mean overall job satisfaction increased from 4.58 out of 7 in 2004 to 5.17 in 2005. The greatest improvements in satisfaction were with remuneration and hours of work. Mean reported hours worked fell from 44.5 to 40.8. Mean income increased from an estimated 73,400 pounds in 2004 to 92,600 pounds in 2005. Most GPs reported that the new contract had increased their income (88%), but decreased their professional autonomy (71%), and increased their administrative (94%) and clinical (86%) workloads. After the introduction of the contract doctors were more positive than they had anticipated about its impact on quality of care. GPs' job satisfaction increased after the introduction of the new contract, despite perceptions of negative consequences for workload and autonomy. GPs reported working fewer hours with a higher income, and their expectations regarding the impact of the contract on quality of care had been exceeded.

Successful factors to prevent pressure ulcers - an interview study.

PubMed

Hommel, Ami; Gunningberg, Lena; Idvall, Ewa; Bååth, Carina

2017-01-01

To explore successful factors to prevent pressure ulcers in hospital settings. Pressure ulcer prevalence has been recognised as a quality indicator for both patient safety and quality of care in hospital and community settings. Most pressure ulcer can be prevented if effective measures are implemented and evaluated. The Swedish Association of Local Authorities and Regions initiated nationwide pressure ulcer prevalence studies in 2011. In 2014, after four years of measurement, the prevalence was still unacceptably high on a national level. The mean prevalence of pressure ulcer in the spring of 2014 was 14% in hospital settings with a range from 2·7-36·4%. Qualitative semistructured interviews were conducted. A qualitative content analysis, in addition to Promoting Action on Research Implementation in Health Services frameworks, was used in the analysis of the data text. Individual interviews and focus groups were used to create opportunities for both individual responses and group interactions. The study was conducted at six hospitals during the fall of 2014. Three main categories were identified as successful factors to prevent pressure ulcer in hospitals: creating a good organisation, maintaining persistent awareness and realising the benefits for patients. The goal for all healthcare personnel must be delivering high-quality, sustainable care to patients. Prevention of pressure ulcer is crucial in this work. It seems to be easier for small hospitals (with a low number of units/beds) to develop and sustain an effective organisation in prevention work. The nurse managers' attitude and engagement are crucial to enable the personnel to work actively with pressure ulcer prevention. Strategies are proposed to advance clinical leadership, knowledge, skills and abilities for the crucial implementation of pressure ulcer prevention. © 2016 John Wiley & Sons Ltd.

Introduction: the Interdisciplinary Nursing Quality Research Initiative.

PubMed

Naylor, Mary D; Lustig, Adam; Kelley, Heather J; Volpe, Ellen M; Melichar, Lori; Pauly, Mark V

2013-04-01

The Robert Wood Johnson Foundation launched the Interdisciplinary Nursing Quality Research Initiative (INQRI) program in 2005 to generate, disseminate, and translate research to understand how nurses contribute to and can improve patient care quality. This special edition of Medical Care provides an overview of the program's strategy, goals, and impact, highlighting cross-cutting issues addressed by the initiative. INQRI's leadership and select grantees discuss the implications of a collection of studies on the following: advances in the science of nursing's contribution to quality, measurement of quality, interdisciplinary collaboration, implementation methodology, dissemination and translation of findings, and the business case for nursing. A comprehensive review of the scholarly literature published in 2004 and 2009 found that the evidence linking nursing to quality of care has grown. The second paper discusses INQRI's work on measurement of quality of care, revealing the need for additional comprehensive measures. The third paper examines INQRI's focus on interdisciplinary collaboration, finding that it can enhance methodological approaches and result in substantive changes in health delivery systems. The fourth paper presents methodological challenges faced in health care implementation, emphasizing the need for standardized terms and research designs. The fifth paper addresses INQRI's commitment to translating research into practice, illustrating dissemination strategies and lessons learned. The final paper discusses how the INQRI program has contributed to the current evidence regarding the business case for nursing. This supplement describes the accomplishments of the INQRI program, discusses current issues in research design and implementation, and places INQRI research within the larger context regarding advances in nursing science.

Writing standard operating procedures (SOPs) for cryostorage protocols: using shoot meristem cryopreservation as an example.

PubMed

Harding, Keith; Benson, Erica E

2015-01-01

Standard operating procedures are a systematic way of making sure that biopreservation processes, tasks, protocols, and operations are correctly and consistently performed. They are the basic documents of biorepository quality management systems and are used in quality assurance, control, and improvement. Methodologies for constructing workflows and writing standard operating procedures and work instructions are described using a plant cryopreservation protocol as an example. This chapter is pertinent to other biopreservation sectors because how methods are written, interpreted, and implemented can affect the quality of storage outcomes.

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.

Quality assurance practices in Europe: a survey of molecular genetic testing laboratories

PubMed Central

Berwouts, Sarah; Fanning, Katrina; Morris, Michael A; Barton, David E; Dequeker, Elisabeth

2012-01-01

In the 2000s, a number of initiatives were taken internationally to improve quality in genetic testing services. To contribute to and update the limited literature available related to this topic, we surveyed 910 human molecular genetic testing laboratories, of which 291 (32%) from 29 European countries responded. The majority of laboratories were in the public sector (81%), affiliated with a university hospital (60%). Only a minority of laboratories was accredited (23%), and 26% was certified. A total of 22% of laboratories did not participate in external quality assessment (EQA) and 28% did not use reference materials (RMs). The main motivations given for accreditation were to improve laboratory profile (85%) and national recognition (84%). Nearly all respondents (95%) would prefer working in an accredited laboratory. In accredited laboratories, participation in EQA (P<0.0001), use of RMs (P=0.0014) and availability of continuous education (CE) on medical/scientific subjects (P=0.023), specific tasks (P=0.0018), and quality assurance (P<0.0001) were significantly higher than in non-accredited laboratories. Non-accredited laboratories expect higher restriction of development of new techniques (P=0.023) and improvement of work satisfaction (P=0.0002) than accredited laboratories. By using a quality implementation score (QIS), we showed that accredited laboratories (average score 92) comply better than certified laboratories (average score 69, P<0.001), and certified laboratories better than other laboratories (average score 44, P<0.001), with regard to the implementation of quality indicators. We conclude that quality practices vary widely in European genetic testing laboratories. This leads to a potentially dangerous situation in which the quality of genetic testing is not consistently assured. PMID:22739339

Self-directed work teams in marketing organizations.

PubMed

Gilbertson, T F

1999-01-01

As marketing organizations move toward the 21st century they are becoming concerned with the development of self-directed work teams. Marketing organizations that have informed, motivated, skilled, trained, and committed employees will out perform organizations which operate in the traditional manner. Many self-directed work teams have grown out of the quality circles. The goal of these teams is to increase employee involvement in decisions of the organization to the greatest extent that employees' knowledge and training allow. In fact, today's marketing organizations need to be able to respond quickly to change driven by internal and external customers. The winning organizations will be able to produce more product with better quality in less time by staying lean, flexible, and implementing self-directed work teams. Marketing organizations that can commit to self-directed work teams will benefit by having customer and employee satisfaction, money saved, and excessive bureaucracy eliminated.

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

PubMed

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

2006-09-20

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

Development of a multihospital pharmacy quality assurance program.

PubMed

Hoffmann, R P; Ravin, R; Colaluca, D M; Gifford, R; Grimes, D; Grzegorczyk, R; Keown, F; Kuhr, F; McKay, R; Peyser, J; Ryan, R; Zalewski, C

1980-07-01

Seven community hospitals have worked cooperatively for 18 months to develop an initial hospital pharmacy quality assurance program. Auditing criteria were developed for nine service areas corresponding to the model program developed by the American Society of Hospital Pharmacists. Current plans are to implement and modify this program as required at each participating hospital. Follow-up programs will also be essential to a functional, ongoing program, and these will be developed in the future.

Effective Evaluation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief OPRE 2011-11a

ERIC Educational Resources Information Center

Zellman, Gail L.; Brandon, Richard N.; Boller, Kimberly; Kreader, J. Lee

2011-01-01

It is important to evaluate Quality Rating and Improvement Systems (QRISs) so that policy makers and stakeholders can learn how well they are working and how they might be improved. Well-designed QRIS evaluations go beyond a "pass/fail" judgment to identify implementation successes and problems and assess what needs to be done to improve…

Focus on Customer Service. Service Management: How to Plan for it Rather Than Hope for It [and] Learning to Say "Yes": A Customer Service Program for Library Staff [and] Maintaining Momentum in a Quality Improvement Process.

ERIC Educational Resources Information Center

Brewer, Julie; And Others

1995-01-01

Presents three articles that discuss customer service in libraries, with a focus on planning for service management, a customer service program for library staff, and a quality improvement process. Highlights include developing and implementing service strategies, dealing with requests, redefining work relationships, coworkers as customers,…

Developing and implementing a heart failure data mart for research and quality improvement.

PubMed

Abu-Rish Blakeney, Erin; Wolpin, Seth; Lavallee, Danielle C; Dardas, Todd; Cheng, Richard; Zierler, Brenda

2018-04-19

The purpose of this project was to build and formatively evaluate a near-real time heart failure (HF) data mart. Heart Failure (HF) is a leading cause of hospital readmissions. Increased efforts to use data meaningfully may enable healthcare organizations to better evaluate effectiveness of care pathways and quality improvements, and to prospectively identify risk among HF patients. We followed a modified version of the Systems Development Life Cycle: 1) Conceptualization, 2) Requirements Analysis, 3) Iterative Development, and 4) Application Release. This foundational work reflects the first of a two-phase project. Phase two (in process) involves the implementation and evaluation of predictive analytics for clinical decision support. We engaged stakeholders to build working definitions and established automated processes for creating an HF data mart containing actionable information for diverse audiences. As of December 2017, the data mart contains information from over 175,000 distinct patients and >100 variables from each of their nearly 300,000 visits. The HF data mart will be used to enhance care, assist in clinical decision-making, and improve overall quality of care. This model holds the potential to be scaled and generalized beyond the initial focus and setting.

Health-related Quality of Life and Related Factors in Full-time and Part-time Workers.

PubMed

Kim, Byungsung; Kim, Wonjoon; Choi, Hyunrim; Won, Changwon; Kim, Youngshin

2012-07-01

There has been a rapid increase in the number of part-time workers in Korea with little information available on associated changes in quality of life. This study was designed to compare part-time and full-time workers in terms of the quality of life and related factors. Data were extracted from the 4th Korea National Health and Nutrition Examination Survey, conducted in 2008. Of the 1,284 participants selected, 942 were females (range, 20 to 64 years). Based on the information provided by self-administered questionnaire, subjects were categorized according to the working pattern (full-time and part-time) and working hours (<30 and ≥30 hours). Differences in socio-demographic characteristics, health-related behaviors, and job characteristics were assessed by t-test and chi-square test. EuroQol-five dimensions (EQ-5D) index was implemented in order to measure the quality of life. Differences in the EQ-5D index scores between the groups were compared by t-test, stepwise multivariate logistic regression analyses. Quality of life did not differ by work patterns. In males, the Organization for Economic Cooperation and Development part-time group was associated with poorer quality of life (odds ratio [OR], 0.49; P = 0.028). For both sexes, the non-stress group was linked with superior quality of life in comparison to the stress group (OR, 2.64; P = 0.002; OR, 2.17; P < 0.001). Female employees engaged in non-manual labor had superior quality of life than those engaged in manual labor (OR, 1.40; P = 0.027). This study concludes that working less than 30 hours per week is related to lower quality of life in comparison to working 30 hours or more in male employees in Korea.

Development, implementation, and evaluation of the Apollo model of pediatric rehabilitation service delivery.

PubMed

Camden, Chantal; Swaine, Bonnie; Tétreault, Sylvie; Bergeron, Sophie; Lambert, Carole

2013-05-01

This article presents the experience of a rehabilitation program that undertook the challenge to reorganize its services to address accessibility issues and improve service quality. The context in which the reorganization process occurred, along with the relevant literature justifying the need for a new service delivery model, and an historical perspective on the planning; implementation; and evaluation phases of the process are described. In the planning phase, the constitution of the working committee, the data collected, and the information found in the literature are presented. Apollo, the new service delivery model, is then described along with each of its components (e.g., community, group, and individual interventions). Actions and lessons learnt during the implementation of each component are presented. We hope by sharing our experiences that we can help others make informed decisions about service reorganization to improve the quality of services provided to children with disabilities, their families, and their communities.

In-service evaluation of major urban arterials with landscaped medians : phase III.

DOT National Transportation Integrated Search

2013-06-01

Several cities have implemented redevelopment plans that include the re-design of major regional arterials in order to raise the quality of life of those living, working, and shopping along, or near the arterial. Many of these redevelopment efforts i...

40 CFR 130.11 - Program management.

Code of Federal Regulations, 2011 CFR

2011-07-01

... quality standards (WQS), development of alternative approaches to control pollution, implementation and... primarily to manage the wastewater treatment works construction grants program pursuant to the provisions of 40 CFR part 35, subpart J. A State may also use part of the 205(g) funds to administer approved...

Cardiac surgical outcomes improvement led by a physician champion working with a nurse clinical coordinator.

PubMed

Stanford, John R; Swaney-Berghoff, Laurie; Recht, Kimberly

2012-01-01

Cardiac surgical outcomes improvement in a community hospital was driven by a physician champion working with a nurse clinical coordinator. Specific system improvements implemented were (1) nurse checklists of vital signs, cardiovascular function parameters, and life support appliance operation; (2) use of the EuroSCORE system of preoperative patient risk assessment; (3) monthly morbidity and mortality conferences; and (4) daily patient progress tracking. The hospital received 1 star (bottom 12% of hospitals for quality outcomes) from the Society of Thoracic Surgeons Adult Cardiac Database in 2006 prior to program inception, 2 stars (middle 76% of hospitals for quality outcomes) in 2007 and 2008, and 3 stars (top 12% of hospitals) in 2009. The physician and nurse together combined a strategy for clinical improvement with the cultural practices at the hospital to ensure that system improvements approved at the strategic level were implemented at the point of care. Both strategy and culture must be addressed to ensure patient outcomes improvement.

Innovative Information Systems in the Intensive Care Unit, King Saud Medical City in Saudi Arabia.

PubMed

Al Saleem, Nouf; Al Harthy, Abdulrahman

2015-01-01

The purpose of this paper is to discuss the experience of implementing innovative information technology to improve the quality of services in one of the largest Intensive Care Units in Saudi Arabia. The Intensive Care Units in King Saud Medical City (ICU-KSMC) is the main ICU in the kingdom that represents the Ministry of Health. KSMC's ICU is also considered one of the largest ICU in the world as it consists of six units with 129 beds. Leaders in KSMC's ICU have introduced and integrated three information technologies to produce powerful, accurate, and timely information systems to overcome the challenges of the ICU nature and improve the quality of service to ensure patients' safety. By 2015, ICU in KSMC has noticed a remarkable improvement in: beds' occupation and utilization, staff communication, reduced medical errors, and improved departmental work flow, which created a healthy professional work environment. Yet, ICU in KSMC has ongoing improvement projects that include future plans for more innovative information technologies' implementation in the department.

Health Sector Reform in the Kurdistan Region - Iraq: Financing Reform, Primary Care, and Patient Safety.

PubMed

Anthony, C Ross; Moore, Melinda; Hilborne, Lee H; Mulcahy, Andrew W

2014-12-30

In 2010, the Kurdistan Regional Government asked the RAND Corporation to help guide reform of the health care system in the Kurdistan Region of Iraq. The overarching goal of reform was to help establish a health system that would provide high-quality services efficiently to everyone to prevent, treat, and manage physical and mental illnesses and injuries. This article summarizes the second phase of RAND's work, when researchers analyzed three distinct but intertwined health policy issue areas: development of financing policy, implementation of early primary care recommendations, and evaluation of quality and patient safety. For health financing, the researchers reviewed the relevant literature, explored the issue in discussions with key stakeholders, developed and assessed various policy options, and developed plans or approaches to overcome barriers and achieve stated policy objectives. In the area of primary care, they developed and helped to implement a new management information system. In the area of quality and patient safety, they reviewed relevant literature, discussed issues and options with health leaders, and recommended an approach toward incremental implementation.

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.

ISO 9001 in a neonatal intensive care unit (NICU).

PubMed

Vitner, Gad; Nadir, Erez; Feldman, Michael; Yurman, Shmuel

2011-01-01

The aim of this paper is to present the process for approving and certifying a neonatal intensive care unit to ISO 9001 standards. The process started with the department head's decision to improve services quality before deciding to achieve ISO 9001 certification. Department processes were mapped and quality management mechanisms were developed. Process control and performance measurements were defined and implemented to monitor the daily work. A service satisfaction review was conducted to get feedback from families. In total, 28 processes and related work instructions were defined. Process yields showed service improvements. Family satisfaction improved. The paper is based on preparing only one neonatal intensive care unit to the ISO 9001 standard. The case study should act as an incentive for hospital managers aiming to improve service quality based on the ISO 9001 standard. ISO 9001 is becoming a recommended tool to improve clinical service quality.

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

PubMed

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

2004-01-01

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

Integration of Engineering Education by High School Teachers to Meet Standards in the Physics Classroom

NASA Astrophysics Data System (ADS)

Kersten, Jennifer Anna

In recent years there has been increasing interest in engineering education at the K-12 level, which has resulted in states adopting engineering standards as a part of their academic science standards. From a national perspective, the basis for research into engineering education at the K-12 level is the belief that it is of benefit to student learning, including to "improve student learning and achievement in science and mathematics; increase awareness of engineering and the work of engineers; boost youth interest in pursuing engineering as a career; and increase the technological literacy of all students" (National Research Council, 2009a, p. 1). The above has led to a need to understand how teachers are currently implementing engineering education in their classrooms. High school physics teachers have a history of implementing engineering design projects in their classrooms, thus providing an appropriate setting to look for evidence of quality engineering education at the high school level. Understanding the characteristics of quality engineering integration can inform curricular and professional development efforts for teachers asked to implement engineering in their classrooms. Thus, the question that guided this study is: How, and to what extent, do physics teachers represent quality engineering in a physics unit focused on engineering? A case study research design was implemented for this project. Three high school physics teachers were participants in this study focused on the integration of engineering education into the physics classroom. The data collected included observations, interviews, and classroom documents that were analyzed using the Framework for Quality K-12 Engineering Education (Moore, Glancy et al., 2013). The results provided information about the areas of the K-12 engineering framework addressed during these engineering design projects, and detailed the quality of these lesson components. The results indicate that all of the design projects contained components of the indicators central to engineering education, although with varied degrees of success. In addition, each design project contained aspects important to the development of students' understanding of engineering and that promote important professional skills used by engineers. The implications of this work are discussed at the teacher, school, professional development, and policy levels.

Standard Review Plan for Environmental Restoration Program Quality Management Plans. Revision 2

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

Not Available

1993-12-01

The Department of Energy, Richland Operations Office (RL) Manual Environmental Restoration Program Quality System Requirements (QSR) for the Hanford Site, defines all quality requirements governing Hanford Environmental Restoration (ER) Program activities. The QSR requires that ER Program participants develop Quality Management Plans (QMPs) that describe how the QSR requirements will be implemented for their assigned scopes of work. This standard review plan (SRP) describes the ER program participant responsibilities for submittal of QMPs to the RL Environmental Restoration Division for review and the RL methodology for performing the reviews of participant QMPS. The SRP serves the following functions: acts asmore » a guide in the development or revision of QMPs to assure that the content is complete and adequate; acts as a checklist to be used by the RL staff in their review of participant QMPs; acts as an index or matrix between the requirements of the QSR and implementing methodologies described in the QMPs; decreases the time and subjectivity of document reviews; and provides a formal, documented method for describing exceptions, modifications, or waivers to established ER Program quality requirements.« less

Global quality imaging: improvement actions.

PubMed

Lau, Lawrence S; Pérez, Maria R; Applegate, Kimberly E; Rehani, Madan M; Ringertz, Hans G; George, Robert

2011-05-01

Workforce shortage, workload increase, workplace changes, and budget challenges are emerging issues around the world, which could place quality imaging at risk. It is important for imaging stakeholders to collaborate, ensure patient safety, improve the quality of care, and address these issues. There is no single panacea. A range of improvement measures, strategies, and actions are required. Examples of improvement actions supporting the 3 quality measures are described under 5 strategies: conducting research, promoting awareness, providing education and training, strengthening infrastructure, and implementing policies. The challenge is to develop long-term, cost-effective, system-based improvement actions that will bring better outcomes and underpin a sustainable future for quality imaging. In an imaging practice, these actions will result in selecting the right procedure (justification), using the right dose (optimization), and preventing errors along the patient journey. To realize this vision and implement these improvement actions, a range of expertise and adequate resources are required. Stakeholders should collaborate and work together. In today's globalized environment, collaboration is strength and provides synergy to achieve better outcomes and greater success. Copyright © 2011 American College of Radiology. Published by Elsevier Inc. All rights reserved.

The Role of the Clinical and Translational Science Awards Program in Improving the Quality and Efficiency of Clinical Research

PubMed Central

Rosenblum, Daniel

2011-01-01

Recognizing the need to increase the efficiency and quality of translating basic discovery into treatment and prevention strategies for patients and the public, the National Institutes of Health (NIH) announced the Clinical and Translational Science Awards (CTSAs) in 2006. Academic health centers that competed successfully for these awards agreed to work as a consortium and in cooperation with the NIH to improve the translation process by training the next generation of investigators to work in interdisciplinary teams, developing public-private partnerships in the movement of basic discovery to preclinical and clinical studies and trials, improving clinical research management, and engaging with communities to ensure their involvement in shaping research questions and in implementing research results. The CTSAs have addressed the crucial need to improve the quality and efficiency of clinical research by (1) providing training for clinical investigators and for bench researchers to facilitate their participation in the clinical and translational research environment, (2) developing more systematic approaches to clinical research management, and (3) engaging communities as active participants in the design and conduct of clinical research studies and trials and as leaders in implementing health advances that are of high importance to them. We provide an overview of the CTSA activities with attention to these three areas, which are essential to developing efficient clinical research efforts and effective implementation of research results on a national level. PMID:21896519

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

PubMed

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

2017-07-01

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

Statistical auditing of toxicology reports.

PubMed

Deaton, R R; Obenchain, R L

1994-06-01

Statistical auditing is a new report review process used by the quality assurance unit at Eli Lilly and Co. Statistical auditing allows the auditor to review the process by which the report was generated, as opposed to the process by which the data was generated. We have the flexibility to use different sampling techniques and still obtain thorough coverage of the report data. By properly implementing our auditing process, we can work smarter rather than harder and continue to help our customers increase the quality of their products (reports). Statistical auditing is helping our quality assurance unit meet our customers' need, while maintaining or increasing the quality of our regulatory obligations.

Recommendations and Ongoing Efforts within the NASA Data Quality Working Group

NASA Astrophysics Data System (ADS)

Moroni, D. F.; Ramapriyan, H.; Bagwell, R.; Downs, R. R.

2015-12-01

Since its inception in March 2014, the NASA Data Quality Working Group (DQWG) has procured a set of 12 high level recommendations which had been sifted from and aggregated from a prioritized subset of nearly 100 unique recommendations spanning four unique data quality management phases and distributed between two actionable categories. The four data quality management phases as identified by the DQWG are: 1. Capturing (i.e., deriving, collecting and organizing the information), 2. Describing (i.e., documenting and procuring the information for public consumption), 3. Facilitating Discovery (i.e., publishing and providing access to the information), and 4. Enabling Use (i.e., enhancing the utility of the information). Mapping each of our recommendations to one or more of the above management phases is intended to enable improved assessment of cost, feasibility, and relevancy to the entities responsible for implementing such recommendations. The DQWG further defined two distinct actionable categories: 1) Data Systems and 2) Science. The purpose of these actionable categories is to define specifically who is responsible for the implementation and adherence toward these recommendations; we refer to the responsible entities as the "actionees". Here we will summarize each of the high level recommendations along with their corresponding management phases and actionees. We will present what has recently been identified as our set of "low-hanging fruit" recommendations, which are intended for near-term implementation. Finally, we will present the status and motivation for continuing and future planned activities, which include but are not limited to: engaging inter-agency and international communities, more direct feedback from Earth observation missions, and mapping of "low-hanging fruit" recommendations to existing solutions.

IMPORTANCE OF INTEGRATED MANAGEMENT SYSTEM APPLIED IN HEALTH ESTABLISHMENTS IN ORDER TO RAISE TREATMENT QUALITY.

PubMed

Dodić, Biljana; Miljković, Tatjana; Bjelobrk, Marija; Cemerlic Ađić, Nada; Ađić, Filip; Dodić, Slobodan

2016-01-01

The term "management" is best characterized as "managing" economic or social processes to achieve objectives through a rational use of material and immaterial resources by applying the principles, functions, and management methods. This study has been aimed at evaluating the value of an integrated quality management system implemented at the Institute of Cardiovascular Diseases of Vojvodina to improve the quality of treatment. In the period from 2008 to 2010 about 40 employees from the Institute of Cardiovascular Diseases of Vojvodina attended various courses given by the lecturers of the Faculty of Technical Sciences, where the function and significance of the "International Standards Organization" were explained, after which standards of interest were implemented at the Institute of Cardiovascular Diseases of Vojvodina. The Department of Cardiology has introduced 11 cardiac procedures with 5 special instructions, 14 general procedures, and 7 specific procedures with 2 instructions. The Department of Cardiac Surgery has introduced 7 procedures to be implemented. The "Vojvodina score" model was put into practice for the perioperative evaluation of cardiac surgery risk. During 2014, the Institute of Cardiovascular Diseases ofVojvodina obtained accreditation for the period of 7 years. The integrated quality management system must be applied in order to achieve a high level of health care in the shortest possible time and with the least possible consumption of material and human resources. The application of this system in practice gives a realistic insight into the working processes and facilitates their functioning. It demands and requires constant monitoring of the system efficiency along with continuous changes and improvements of all elements of the working processes and functional units.

A case study of a team-based, quality-focused compensation model for primary care providers.

PubMed

Greene, Jessica; Hibbard, Judith H; Overton, Valerie

2014-06-01

In 2011, Fairview Health Services began replacing their fee-for-service compensation model for primary care providers (PCPs), which included an annual pay-for-performance bonus, with a team-based model designed to improve quality of care, patient experience, and (eventually) cost containment. In-depth interviews and an online survey of PCPs early after implementation of the new model suggest that it quickly changed the way many PCPs practiced. Most PCPs reported a shift in orientation toward quality of care, working more collaboratively with their colleagues and focusing on their full panel of patients. The majority reported that their quality of care had improved because of the model and that their colleagues' quality had to. The comprehensive change did, however, result in lower fee-for-service billing and reductions in PCP satisfaction. While Fairview's compensation model is still a work in progress, their early experiences can provide lessons for other delivery systems seeking to reform PCP compensation.

The cost risk implementation on design-build project of integrated public spaces child friendly in capital of Jakarta

NASA Astrophysics Data System (ADS)

Mardiaman, Mubarok, Abdul

2017-11-01

Jakarta area of 662.33 km2 with a population of 10,075,030 inhabitants and green open spaces 9.98%. The Jakarta government built a child-friendly integrated open space as facilities for playing. Providing of facilities was hoped suitable with time, cost, quality, accountability and proper financial governance. Based on the PU ministerial regulation number 19/PRT/M/2015 on the standards and guidelines for procurement the design and construction work on the integrated build and the PU ministerial regulation No. 07/PRT/M/2011 on standards and guidelines for procurement of construction works and consulting services of public works and the ministry of housing. RPTRA development at 123 locations in Jakarta was implemented base on the contract of design and build. The design study was influenced by the cost elements; the main strength (expert), skilled personnel, support personnel, major equipment and support. The construction fee relies on; expert implementation, hardware implementation, preparation work, land, buildings, courtyards, fences, complementary and governance capabilities for human resources in completing the construction activities to minimize the cost risk. Montecarlo simulations was conducted to determine the average unit price, model and analyze systems. In the cost contract, the percentage of design work stipulated 2.5%, build 97.5%. Base on regulation the minister of public work for design work cost 2.72%, build 97.28%. Then, actual cost for design 2.67% and build 97.33%. From the three reference was shown that there are differentiation one another. The acceleration of planning able to make the cost and time more efficient that impact on the implementation margin.

A pilot project of European Working Time Directive compliant rosters in a university teaching hospital.

PubMed

Garvin, J T; McLaughlin, R; Kerin, M J

2008-04-01

In response to the requirements of the European Working Time Directive (EWTD), a national implementation group was formed to liaise with local implementation groups at nine different pilot sites. As part of this process, a pilot EWTD compliant rota was run for six weeks amongst general surgical SHOs in University Hospital Galway. A rota was devised for nine general surgical SHOs, the aim being to achieve EWTD compliance. SHOs were asked to complete questionnaires to assess the effectiveness of the pilot. During the pilot SHOs were rostered for an average of 53.6 hours. Actual hours worked were 58.1 hours. Fifty-two point five per cent of working weeks were non-compliant with the provisions of the EWTD. Seventy per cent of the time SHOs felt that continuity of care was not achieved. Eighty-one per cent felt that patient care deteriorated during the pilot. SHOs spent an average of 2.5 days per week engaged in sessional commitments with their consultant. Fifty percent of SHOs missed elective operating sessions or outpatient clinics. SHOs attended an average of 1.3 emergency operations per week (range 0-8) and 5.5 elective procedures per week (range 0-12). All SHOs reported a deterioration in quantity or quality of training. However, 69% reported an improvement in their quality of life during the pilot. With this tightly defined shift system, hours worked were in breach of the provisions of the EWTD. Sixty-nine per cent of SHOs reported an improvement in quality of life, but all reported a deterioration in training and 81% felt that patient care suffered.

Quality management in Irish health care.

PubMed

Ennis, K; Harrington, D

1999-01-01

This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.

EduXs: Multilayer Educational Services Platforms

ERIC Educational Resources Information Center

Chang, Li-Jie; Yang, Jie-Chi; Deng, Yi-Chan; Chan, Tak-Wai

2003-01-01

How to use the online social learning communities to improve quality and quantity of interactions in physical social learning communities is an important issue. This work describes the design and implementation of multilayer educational services platforms that enable learners to establish their own online social learning communities and integrate…

75 FR 60471 - Statement of Organization, Functions, and Delegations of Authority

Federal Register 2010, 2011, 2012, 2013, 2014

2010-09-30

... support for working families and improving the quality of child care to promote healthy development... child care programs authorized under the Child Care and Development Block Grant (CCDBG) Act and section...; identifies and implements operational planning objectives and initiatives related to child care; provides...

Taking Steps toward PK-3 Success

ERIC Educational Resources Information Center

Eubanks, Shyrelle

2007-01-01

This tandem brief examines state policies and practices regarding critical PK-3 working conditions and identifies strategies to influence teacher job quality through collective bargaining and other collaborative processes. The document is designed to support efforts to change or implement policies that will improve the teaching and learning…

One size does not fit all: a qualitative content analysis of the importance of existing quality improvement capacity in the implementation of Releasing Time to Care: the Productive Ward™ in Saskatchewan, Canada.

PubMed

Hamilton, Jessica; Verrall, Tanya; Maben, Jill; Griffiths, Peter; Avis, Kyla; Baker, G Ross; Teare, Gary

2014-12-19

Releasing Time to Care: The Productive Ward™ (RTC) is a method for conducting continuous quality improvement (QI). The Saskatchewan Ministry of Health mandated its implementation in Saskatchewan, Canada between 2008 and 2012. Subsequently, a research team was developed to evaluate its impact on the nursing unit environment. We sought to explore the influence of the unit's existing QI capacity on their ability to engage with RTC as a program for continuous QI. We conducted interviews with staff from 8 nursing units and asked them to speak about their experience doing RTC. Using qualitative content analysis, and guided by the Organizing for Quality framework, we describe the existing QI capacity and impact of RTC on the unit environment. The results focus on 2 units chosen to highlight extreme variation in existing QI capacity. Unit B was characterized by a strong existing environment. RTC was implemented in an environment with a motivated manager and collaborative culture. Aided by the structural support provided by the organization, the QI capacity on this unit was strengthened through RTC. Staff recognized the potential of using the RTC processes to support QI work. Staff on unit E did not have the same experience with RTC. Like unit B, they had similar structural supports provided by their organization but they did not have the same existing cultural or political environment to facilitate the implementation of RTC. They did not have internal motivation and felt they were only doing RTC because they had to. Though they had some success with RTC activities, the staff did not have the same understanding of the methods that RTC could provide for continuous QI work. RTC has the potential to be a strong tool for engaging units to do QI. This occurs best when RTC is implemented in a supporting environment. One size does not fit all and administrative bodies must consider the unique context of each environment prior to implementing large-scale QI projects. Use of an established framework, like Organizing for Quality, could highlight the distinctive supports needed in particular care environments to increase the likelihood of successful engagement.

[Standard operating procedures in ethic committees].

PubMed

Czarkowski, Marek

2006-02-01

Polish ethic committees should have to work together in order to maintain and develop high quality standards in the protection of human subjects. Exchanging knowledge, know-how and information polish ethic committees should have to implement standard operating procedures. Procedures should improve quality and proficiency of all types of ethic committee's activities. Standard operating procedures should cover as important problems as conflict of interest, trial's insurance or elections of ethic committees. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. Governmental initiatives and creation of forum for polish ethic committees are essential in the effective standardisation, coordination and implementation of procedures in regional ethic committees. These projects need support via public funding from our authorities.

Recent National Transonic Facility Test Process Improvements (Invited)

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

Recent National Transonic Facility Test Process Improvements (Invited)

NASA Technical Reports Server (NTRS)

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

2001-01-01

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

Pressure ulcer prevention program: a journey.

PubMed

Delmore, Barbara; Lebovits, Sarah; Baldock, Philip; Suggs, Barbara; Ayello, Elizabeth A

2011-01-01

The Centers for Medicare & Medicaid Services' regulations regarding nonpayment for hospital-acquired conditions such as pressure ulcers have prompted a marked increase in focus on preventive care. Our hospital also used this change in payment policy as an opportunity to strengthen our pressure ulcer prevention practices. We used an 8-spoke prevention wheel to develop and implement practice changes that reduced pressure ulcer incidence from 7.3% to 1.3% in 3 years. Because it is about the journey, we will describe the mechanisms we designed and implemented, and identify strategies that worked or did not work as we promulgated a quality improvement process for pressure ulcer prevention in our large urban hospital center.

An introduction to implementation science for the non-specialist.

PubMed

Bauer, Mark S; Damschroder, Laura; Hagedorn, Hildi; Smith, Jeffrey; Kilbourne, Amy M

2015-09-16

The movement of evidence-based practices (EBPs) into routine clinical usage is not spontaneous, but requires focused efforts. The field of implementation science has developed to facilitate the spread of EBPs, including both psychosocial and medical interventions for mental and physical health concerns. The authors aim to introduce implementation science principles to non-specialist investigators, administrators, and policymakers seeking to become familiar with this emerging field. This introduction is based on published literature and the authors' experience as researchers in the field, as well as extensive service as implementation science grant reviewers. Implementation science is "the scientific study of methods to promote the systematic uptake of research findings and other EBPs into routine practice, and, hence, to improve the quality and effectiveness of health services." Implementation science is distinct from, but shares characteristics with, both quality improvement and dissemination methods. Implementation studies can be either assess naturalistic variability or measure change in response to planned intervention. Implementation studies typically employ mixed quantitative-qualitative designs, identifying factors that impact uptake across multiple levels, including patient, provider, clinic, facility, organization, and often the broader community and policy environment. Accordingly, implementation science requires a solid grounding in theory and the involvement of trans-disciplinary research teams. The business case for implementation science is clear: As healthcare systems work under increasingly dynamic and resource-constrained conditions, evidence-based strategies are essential in order to ensure that research investments maximize healthcare value and improve public health. Implementation science plays a critical role in supporting these efforts.

UK doctors' views on the implementation of the European Working Time Directive as applied to medical practice: a qualitative analysis.

PubMed

Clarke, Rachel T; Pitcher, Alex; Lambert, Trevor W; Goldacre, Michael J

2014-02-06

To report on what doctors at very different levels of seniority wrote, in their own words, about their concerns about the European Working Time Directive (EWTD) and its implementation in the National Health Service (NHS). All medical school graduates from 1993, 2005 and 2009 were surveyed by post and email in 2010. The UK. Using qualitative methods, we analysed free-text responses made in 2010, towards the end of the first year of full EWTD implementation, of three cohorts of the UK medical graduates (graduates of 1993, 2005 and 2009), surveyed as part of the UK Medical Careers Research Group's schedule of multipurpose longitudinal surveys of doctors. Of 2459 respondents who gave free-text comments, 279 (11%) made unprompted reference to the EWTD; 270 of the 279 comments were broadly critical. Key themes to emerge included frequent dissociation between rotas and actual hours worked, adverse effects on training opportunities and quality, concerns about patient safety, lowering of morale and job satisfaction, and attempts reportedly made in some hospitals to persuade junior doctors to collude in the inaccurate reporting of compliance. Further work is needed to determine whether problems perceived with the EWTD, when they occur, are attributable to the EWTD itself, and shortened working hours, or to the way that it has been implemented in some hospitals.

UK doctors’ views on the implementation of the European Working Time Directive as applied to medical practice: a qualitative analysis

PubMed Central

Clarke, Rachel T; Pitcher, Alex; Lambert, Trevor W; Goldacre, Michael J

2014-01-01

Objectives To report on what doctors at very different levels of seniority wrote, in their own words, about their concerns about the European Working Time Directive (EWTD) and its implementation in the National Health Service (NHS). Design All medical school graduates from 1993, 2005 and 2009 were surveyed by post and email in 2010. Setting The UK. Methods Using qualitative methods, we analysed free-text responses made in 2010, towards the end of the first year of full EWTD implementation, of three cohorts of the UK medical graduates (graduates of 1993, 2005 and 2009), surveyed as part of the UK Medical Careers Research Group's schedule of multipurpose longitudinal surveys of doctors. Results Of 2459 respondents who gave free-text comments, 279 (11%) made unprompted reference to the EWTD; 270 of the 279 comments were broadly critical. Key themes to emerge included frequent dissociation between rotas and actual hours worked, adverse effects on training opportunities and quality, concerns about patient safety, lowering of morale and job satisfaction, and attempts reportedly made in some hospitals to persuade junior doctors to collude in the inaccurate reporting of compliance. Conclusions Further work is needed to determine whether problems perceived with the EWTD, when they occur, are attributable to the EWTD itself, and shortened working hours, or to the way that it has been implemented in some hospitals. PMID:24503304

Production and quality assurance automation in the Goddard Space Flight Center Flight Dynamics Facility

NASA Technical Reports Server (NTRS)

Chapman, K. B.; Cox, C. M.; Thomas, C. W.; Cuevas, O. O.; Beckman, R. M.

1994-01-01

The Flight Dynamics Facility (FDF) at the NASA Goddard Space Flight Center (GSFC) generates numerous products for NASA-supported spacecraft, including the Tracking and Data Relay Satellites (TDRS's), the Hubble Space Telescope (HST), the Extreme Ultraviolet Explorer (EUVE), and the space shuttle. These products include orbit determination data, acquisition data, event scheduling data, and attitude data. In most cases, product generation involves repetitive execution of many programs. The increasing number of missions supported by the FDF has necessitated the use of automated systems to schedule, execute, and quality assure these products. This automation allows the delivery of accurate products in a timely and cost-efficient manner. To be effective, these systems must automate as many repetitive operations as possible and must be flexible enough to meet changing support requirements. The FDF Orbit Determination Task (ODT) has implemented several systems that automate product generation and quality assurance (QA). These systems include the Orbit Production Automation System (OPAS), the New Enhanced Operations Log (NEOLOG), and the Quality Assurance Automation Software (QA Tool). Implementation of these systems has resulted in a significant reduction in required manpower, elimination of shift work and most weekend support, and improved support quality, while incurring minimal development cost. This paper will present an overview of the concepts used and experiences gained from the implementation of these automation systems.

Experience of plastic surgery registrars in a European Working Time Directive compliant rota.

PubMed

de Blacam, Catherine; Tierney, Sean; Shelley, Odhran

2017-08-01

Surgical training requires exposure to clinical decision-making and operative experience in a supervised environment. It is recognised that learning ability is compromised when fatigued. The European Working Time Directive requires a decrease in working hours, but compliance reduces trainees' clinical exposure, which has profound implications for plastic surgery training. The aim of this study was to evaluate plastic surgery registrars' experience of an EWTD-compliant rota, and to examine its impact on patient care, education, and logbook activity. An electronic survey was distributed to plastic surgery registrars in a university teaching hospital. Registrars were asked to rate 31 items on a five-point Likert scale, including statements on patient care, clinical and operative duties, training, and quality-of-life. Interquartile deviations explored consensus among responses. Operative caseload was objectively evaluated using eLogbook data to compare activity at equal time points before and after implementation of the EWTD rota. Highest levels of consensus among respondents were found in positive statements addressing alertness and preparation for theatre, as well as time to read and study for exams. Registrars agreed that EWTD compliance improved their quality-of-life. However, it was felt that continuity of patient care was compromised by work hours restriction. Registrars were concerned about their operative experience. eLogbook data confirmed a fall-off in mean caseload of 31.8% compared to activity prior to EWTD rota implementation. While EWTD compliant rotas promote trainee quality-of-life and satisfaction with training, attention needs to be paid to optimising operative opportunities.

A new impetus for guideline development and implementation: construction and evaluation of a toolbox.

PubMed

Hilbink, Mirrian A H W; Ouwens, Marielle M T J; Burgers, Jako S; Kool, Rudolf B

2014-03-19

In the last decade, guideline organizations faced a number of problems, including a lack of standardization in guideline development methods and suboptimal guideline implementation. To contribute to the solution of these problems, we produced a toolbox for guideline development, implementation, revision, and evaluation. All relevant guideline organizations in the Netherlands were approached to prioritize the topics. We sent out a questionnaire and discussed the results at an invitational conference. Based on consensus, twelve topics were selected for the development of new tools. Subsequently, working groups were composed for the development of the tools. After development of the tools, their draft versions were pilot tested in 40 guideline projects. Based on the results of the pilot tests, the tools were refined and their final versions were presented. The vast majority of organizations involved in pilot testing of the tools reported satisfaction with using the tools. Guideline experts involved in pilot testing of the tools proposed a variety of suggestions for the implementation of the tools. The tools are available in Dutch and in English at a web-based platform on guideline development and implementation (http://www.ha-ring.nl). A collaborative approach was used for the development and evaluation of a toolbox for development, implementation, revision, and evaluation of guidelines. This approach yielded a potentially powerful toolbox for improving the quality and implementation of Dutch clinical guidelines. Collaboration between guideline organizations within this project led to stronger linkages, which is useful for enhancing coordination of guideline development and implementation and preventing duplication of efforts. Use of the toolbox could improve quality standards in the Netherlands, and might facilitate the development of high-quality guidelines in other countries as well.

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

PubMed

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

2017-05-31

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

The past, present, and future of urgent matters: lessons learned from a decade of emergency department flow improvement.

PubMed

McClelland, Mark Stephen; Lazar, Danielle; Sears, Vickie; Wilson, Marcia; Siegel, Bruce; Pines, Jesse M

2011-12-01

Over the past decade, emergency departments (ED) have encountered major challenges due to increased crowding and a greater public focus on quality measurement and quality improvement. Responding to these challenges, many EDs have worked to improve their processes and develop new and innovative models of care delivery. Urgent Matters has contributed to ED quality and patient flow improvement by working with hospitals throughout the United States. Recognizing that EDs across the country are struggling with many of the same issues, Urgent Matters-a program funded by the Robert Wood Johnson Foundation (RWJF)-has sought to identify, develop, and disseminate innovative approaches, interventions, and models to improve ED flow and quality. Using a variety of techniques, such as learning networks (collaboratives), national conferences, e-newsletters, webinars, best practices toolkits, and social media, Urgent Matters has served as a thought leader and innovator in ED quality improvement initiatives. The Urgent Matters Seven Success Factors were drawn from the early work done by program participants and propose practical guidelines for implementing and sustaining ED improvement activities. This article chronicles the history, activities, lessons learned, and future of the Urgent Matters program. © 2011 by the Society for Academic Emergency Medicine.

Softcopy quality ruler method: implementation and validation

NASA Astrophysics Data System (ADS)

Jin, Elaine W.; Keelan, Brian W.; Chen, Junqing; Phillips, Jonathan B.; Chen, Ying

2009-01-01

A softcopy quality ruler method was implemented for the International Imaging Industry Association (I3A) Camera Phone Image Quality (CPIQ) Initiative. This work extends ISO 20462 Part 3 by virtue of creating reference digital images of known subjective image quality, complimenting the hardcopy Standard Reference Stimuli (SRS). The softcopy ruler method was developed using images from a Canon EOS 1Ds Mark II D-SLR digital still camera (DSC) and a Kodak P880 point-and-shoot DSC. Images were viewed on an Apple 30in Cinema Display at a viewing distance of 34 inches. Ruler images were made for 16 scenes. Thirty ruler images were generated for each scene, representing ISO 20462 Standard Quality Scale (SQS) values of approximately 2 to 31 at an increment of one just noticeable difference (JND) by adjusting the system modulation transfer function (MTF). A Matlab GUI was developed to display the ruler and test images side-by-side with a user-adjustable ruler level controlled by a slider. A validation study was performed at Kodak, Vista Point Technology, and Aptina Imaging in which all three companies set up a similar viewing lab to run the softcopy ruler method. The results show that the three sets of data are in reasonable agreement with each other, with the differences within the range expected from observer variability. Compared to previous implementations of the quality ruler, the slider-based user interface allows approximately 2x faster assessments with 21.6% better precision.

Implementation of Quality Management in Core Service Laboratories

PubMed Central

Creavalle, T.; Haque, K.; Raley, C.; Subleski, M.; Smith, M.W.; Hicks, B.

2010-01-01

CF-28 The Genetics and Genomics group of the Advanced Technology Program of SAIC-Frederick exists to bring innovative genomic expertise, tools and analysis to NCI and the scientific community. The Sequencing Facility (SF) provides next generation short read (Illumina) sequencing capacity to investigators using a streamlined production approach. The Laboratory of Molecular Technology (LMT) offers a wide range of genomics core services including microarray expression analysis, miRNA analysis, array comparative genome hybridization, long read (Roche) next generation sequencing, quantitative real time PCR, transgenic genotyping, Sanger sequencing, and clinical mutation detection services to investigators from across the NIH. As the technology supporting this genomic research becomes more complex, the need for basic quality processes within all aspects of the core service groups becomes critical. The Quality Management group works alongside members of these labs to establish or improve processes supporting operations control (equipment, reagent and materials management), process improvement (reengineering/optimization, automation, acceptance criteria for new technologies and tech transfer), and quality assurance and customer support (controlled documentation/SOPs, training, service deficiencies and continual improvement efforts). Implementation and expansion of quality programs within unregulated environments demonstrates SAIC-Frederick's dedication to providing the highest quality products and services to the NIH community.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

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

Best Practices in Hiring: Addressing Unconscious Bias

NASA Astrophysics Data System (ADS)

Simpson, Caroline E.

2012-01-01

Research has shown that implementing certain hiring practices will increase diversity in the workplace while enhancing academic quality. All of these practices rely on addressing the issue of 'unconscious bias.' A brief overview of unconscious bias--what it is, how it works, and simple measures to counter it--will be presented. Successful strategies, actions, and recommendations for implementing best recruiting and hiring practices, which have been proven to enhance academic excellence by ensuring a deep and diverse applicant pool, will also be presented.

Forensic entomology: implementing quality assurance for expertise work.

PubMed

Gaudry, Emmanuel; Dourel, Laurent

2013-09-01

The Department of Forensic Entomology (Institut de Recherche Criminelle de la Gendarmerie Nationale, France) was accredited by the French Committee of Accreditation (Cofrac's Healthcare section) in October 2007 on the basis of NF EN ISO/CEI 17025 standard. It was the first accreditation in this specific field of forensic sciences in France and in Europe. The present paper introduces the accreditation process in forensic entomology (FE) through the experience of the Department of Forensic Entomology. Based upon the identification of necrophagous insects and the study of their biology, FE must, as any other expertise work in forensic sciences, demonstrate integrity and good working practice to satisfy both the courts and the scientific community. FE does not, strictly speaking, follow an analytical method. This could explain why, to make up for a lack of appropriate quality reference, a specific documentation was drafted and written by the staff of the Department of Forensic Entomology in order to define working methods complying with quality standards (testing methods). A quality assurance system is laborious to set up and maintain and can be perceived as complex, time-consuming and never-ending. However, a survey performed in 2011 revealed that the accreditation process in the frame of expertise work has led to new well-defined working habits, based on an effort at transparency. It also requires constant questioning and a proactive approach, both profitable for customers (magistrates, investigators) and analysts (forensic entomologists).

Office Automation and Quality of Work Life: The Effects of Transition Variables on Employee Perceptions.

ERIC Educational Resources Information Center

Matherly, Donna

1983-01-01

The author presents survey findings on problems involved in the implementation of new technology. The results of questionnaires returned by 286 administrative systems operants are presented concerning interpersonal relations, career advancement, job security, personal comfort, job design, and job satisfaction. (CT)

Greenforce Initiative: Advancing Greener Careers

ERIC Educational Resources Information Center

Mwase, Gloria; Keniry, Julian

2011-01-01

With support from the Bank of America Charitable Foundation and the Charles Stewart Mott Foundation, the National Wildlife Federation (NWF) and Jobs for the Future (JFF) formed the Greenforce Initiative--a two-year venture that will work with community colleges across the nation to strengthen their capacity to implement or refine quality pathways…

How Leaders Cultivate Spirituality in the Workplace: What the Research Shows.

ERIC Educational Resources Information Center

Groen, Janet

2001-01-01

A study of five adult educators identified internal and external leadership qualities that support a spirituality-infused workplace, including a sense of vocation, a culture that encourages creativity and risk and balances work and home life, and leaders' willingness to express and implement an organization's values. (SK)

TQM--Will It Work in Your Library?

ERIC Educational Resources Information Center

Butcher, Karyle

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

Experiential Learning through Integrated Project Work: An Example from Soil Science.

ERIC Educational Resources Information Center

Mellor, Antony

1991-01-01

Describes the planning, implementation, and evaluation of an integrated student soil science project. Reports that the course was designed to develop student-centered approaches to learning and to develop transferable skills and personal qualities at the same time. Explains that the project included fieldwork, laboratory analysis, data…

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.

Implementation of Quality Assurance Systems at E.T.S. Ingenieros Agrónomos of Madrid in the Framework of E.H.E.

NASA Astrophysics Data System (ADS)

Arce, A.; Tarquis, A. M.; Cartagena, M. C.

2012-04-01

The Bologna Process is to improve the quality of education, mobility, diversity and the competitiveness and involves three fundamental changes: transform of the structure of titles, changing in methods of teaching and implementation of the systems of quality assurance. Once that titles structure given by the E.T.S. Agronomic Engineer (ETSIA) have been defined, and introduced new methods of learning, this work has focused in the third point: implementation of quality assurance systems as well as the new three titles planning that begins to impart at ETSIA, Madrid, during 2010-2011 course. The academic year 2010-2011 was the first year of implementation of the Bologna Process, this paper attempts to compare the academic results obtained by students in the three new degrees in the subject of Chemistry I and II compared with the results obtained in the same subject in the degree of Agronomic Engineer in the past four years. The academic results have been lower than expected and worse than in previous courses. The paper tries to account for these results based on the percentage of compliance with the guidance of teachers, and based on student participation and training prior to beginning the course. Finally, propose possible solutions to try to correct these results in future courses, with the aim of improving efficiency rates, success and absenteeism important in the first year since it will condition the dropout rate of these new degrees.

Implementation Science Supports Core Clinical Competencies: An Overview and Clinical Example.

PubMed

Kirchner, JoAnn E; Woodward, Eva N; Smith, Jeffrey L; Curran, Geoffrey M; Kilbourne, Amy M; Owen, Richard R; Bauer, Mark S

2016-12-08

Instead of asking clinicians to work faster or longer to improve quality of care, implementation science provides another option. Implementation science is an emerging interdisciplinary field dedicated to studying how evidence-based practice can be adopted into routine clinical care. This article summarizes principles and methods of implementation science, illustrates how they can be applied in a routine clinical setting, and highlights their importance to practicing clinicians as well as clinical trainees. A hypothetical clinical case scenario is presented that explains how implementation science improves clinical practice. The case scenario is also embedded within a real-world implementation study to improve metabolic monitoring for individuals prescribed antipsychotics. Context, recipient, and innovation (ie, the evidence-based practice) factors affected improvement of metabolic monitoring. To address these factors, an external facilitator and a local quality improvement team developed an implementation plan involving a multicomponent implementation strategy that included education, performance reports, and clinician follow-up. The clinic remained compliant with recommended metabolic monitoring at 1-year follow up. Implementation science improves clinical practice by addressing context, recipient, and innovation factors and uses this information to develop and utilize specific strategies that improve clinical practice. It also enriches clinical training, aligning with core competencies by the Accreditation Council for Graduate Medical Education and American Boards of Medical Specialties. By learning how to change clinical practice through implementation strategies, clinicians are more able to adapt in complex systems of practice. © Copyright 2016 Physicians Postgraduate Press, Inc.

Quality-assurance plan for water-resources activities of the U. S. Geological Survey in Montana--1991

USGS Publications Warehouse

Moreland, Joe A.

1991-01-01

As the Nation's principal earth-science information agency, the U.S. Geological Survey has developed a worldwide reputation for collecting accurate data and producing factual, impartial interpretive reports. To ensure continued confidence in the pro- ducts, the Water Resources Division of the U.S. Geological Survey has implemented a policy that all scientific work will be performed in accordance with a centrally managed quality-assurance program. The formal policy for quality assurance within the Montana District was established and documented in USGS Open-File Report 91-194. This report has been revised to reflect changes in personnel and organi- zational structure that have occurred since 1991. Quality assurance is formalized by describing organization and operational responsibilities, the quality-assurance policy, and the quality- assurance responsibilities for performing District functions. The District conducts its work through offices in Helena, Billings, Kalispell, and Fort Peck. Data-collection programs and interpretive studies are conducted by three operating sections and four support units. Discipline specialists provide technical advice and assistance. Management advisors provide guidance on various personnel issues and support functions.

Quality-assurance plan for water-resources activities of the U.S. Geological Survey in Montana--1995

USGS Publications Warehouse

Moreland, Joe A.

1995-01-01

As the Nation's principal earth-science information agency, the U.S. Geological Survey has developed a worldwide reputation for collecting accurate data and producing factual, impartial interpretive reports. To ensure continued confidence in the pro- ducts, the Water Resources Division of the U.S. Geological Survey has implemented a policy that all scientific work will be performed in accordance with a centrally managed quality-assurance program. The formal policy for quality assurance within the Montana District was established and documented in USGS Open-File Report 91-194. This report has been revised to reflect changes in personnel and organi- zational structure that have occurred since 1991. Quality assurance is formalized by describing organization and operational responsibilities, the quality-assurance policy, and the quality- assurance responsibilities for performing District functions. The District conducts its work through offices in Helena, Billings, Kalispell, and Fort Peck. Data-collection programs and interpretive studies are conducted by three operating sections and four support units. Discipline specialists provide technical advice and assistance. Management advisors provide guidance on various personnel issues and support functions.

Practical experience from the Office of Adolescent Health's large scale implementation of an evidence-based Teen Pregnancy Prevention Program.

PubMed

Margolis, Amy Lynn; Roper, Allison Yvonne

2014-03-01

After 3 years of experience overseeing the implementation and evaluation of evidence-based teen pregnancy prevention programs in a diversity of populations and settings across the country, the Office of Adolescent Health (OAH) has learned numerous lessons through practical application and new experiences. These lessons and experiences are applicable to those working to implement evidence-based programs on a large scale. The lessons described in this paper focus on what it means for a program to be implementation ready, the role of the program developer in replicating evidence-based programs, the importance of a planning period to ensure quality implementation, the need to define and measure fidelity, and the conditions necessary to support rigorous grantee-level evaluation. Published by Elsevier Inc.

Progressively implementation of the new degrees at E.T.S. of Agriculture Engineering and extinction of the earlier degrees

NASA Astrophysics Data System (ADS)

Arce, A.; Caniego, J.; Vazquez, J.; Serrano, A.; Tarquis, A. M.; Cartagena, M. C.

2012-04-01

The Bologna process is to improve the quality of education, mobility, diversity and the competitiveness and involves three fundamental changes: transform of the structure of titles, changing in methods of teaching and implementation of the systems of quality assurance. Once that the new degrees have been implemented with this structure, and began at E.T.S. of Agriculture Engineering (ETSIA) at Madrid from 2010-2011 course, the main aim of this work is to deeply study the changes in teaching methodology as well as progressively implementation of the educational planning of the three new degrees: Engineering and Agronomic Graduate, Food Industry Engineering Graduate and Agro-environmental Graduate. Each one of them presents 240 ECTS with a common first course and will have access to an official Master in Agronomic Engineering. As part as an educational innovation project awarded by the Technical University of Madrid (UPM) to improve educational quality, the second course has been designed with the main objective to continue the educative model implemented last course. This model identifies several teaching activities and represents a proper teaching style at ETSIA-UPM. At the same time, a monitoring and development coordination plans have been established. On the other hand, a procedure to extinguish the earlier plans of Agriculture Engineering was also defined. Other activities related to this Project were the information improvement of the grades, in particular at High Schools centers, improving the processes of reception, counseling and tutoring and mentoring. Likewise, cooperative working workshops and programs to support the teaching of English language were implemented. Satisfaction surveys and opinion polls were done to professors and students involved in first course in order to test several aspects of this project. The students surveys were analyzed taking in account the academic results and their participation in mentoring activities giving a highly satisfactory level. In general, the professors gave the same result although they pointed out certain discontent respect to some circumstances giving some solutions to correct these problems.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2013-06-11

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

Challenges for implementing water quality monitoring and analysis on a small Costa Rican catchment

NASA Astrophysics Data System (ADS)

Golcher, Christian; Cernesson, Flavie; Tournoud, Marie-George; Bonin, Muriel; Suarez, Andrea

2016-04-01

The Costa Rican water regulatory framework (WRF) (2007), expresses the national concern about the degradation of surface water quality observed in the country since several years. Given the urgency of preserving and restoring the surface water bodies, and facing the need of defining a monitoring tool to classify surface water pollution, the Costa-Rican WRF relies on two water quality indexes: the so-called "Dutch Index" (D.I) and the Biological Monitoring Working Party adapted to Costa Rica (BMWP'CR), allowing an "easy" physicochemical and biological appraisal of the water quality and the ecological integrity of water bodies. Herein, we intend to evaluate whether the compound of water quality indexes imposed by Costa Rican legislation, is suitable to assess rivers local and global anthropogenic pressure and environmental conditions. We monitor water quality for 7 points of Liberia River (northern pacific region - Costa Rica) from March 2013 to July 2015. Anthropogenic pressures are characterized by catchment land use and riparian conditions. Environmental conditions are built from rainfall daily series. Our results show (i) the difficulties to monitor new sites following the recent implementation of the WRF; (ii) the statistical characteristics of each index; and (iii) a modelling tentative of relationships between water quality indexes and explanatory factors (land-use, riparian characteristics and climate conditions).

Differences in Sociocognitive Beliefs between Involved and Noninvolved Employees during the Implementation of an Electronic Health Record System

PubMed Central

Stanczyk, Nicola Esther; Crutzen, Rik; Sewuster, Nikki; Schotanus, Elwin; Mulders, Merijn; Cremers, Henricus Paul

2017-01-01

Background Electronic health records (EHRs) can improve quality and efficiency in patient care. However, the intention to work with such a new system is often relatively low among employees because the work processes of the healthcare organization may change. Involving employees in an EHR implementation may increase their beliefs and perceived capabilities concerning the new system. The current study aimed to assess the role of involvement and its effects on sociocognitive beliefs regarding the implementation of a new EHR system. Methods The study was performed in June 2015 among all eligible employees of a hospital in the Netherlands. Both involved and noninvolved employees were invited to complete a paper-based questionnaire concerning their sociocognitive beliefs (i.e., attitude, social influence, self-efficacy, and intention) related to the EHR implementation. Independent sample t-tests were used to assess potential differences in sociocognitive beliefs between employees who were involved in the implementation process and those who were not. Effect sizes (Cohen's d) were calculated to indicate the standardized difference between the means. Results A total of 359 participants completed the paper-based questionnaire and were included in the analyses. Involved employees (n = 94) reported significantly higher levels of attitude (p < .001, d = .62), perceived self-efficacy (p = .01, d = .31), social support (p < .001, d = .68), and a higher intention to work with the new EHR system (p < .001, d = .60), compared with the group of employees who were not involved in the implementation process (n = 265). Conclusion Involving employees during an EHR implementation appears to enhance employees’ sociocognitive beliefs and increases their intention to work with the new system. PMID:28566986

Differences in Sociocognitive Beliefs between Involved and Noninvolved Employees during the Implementation of an Electronic Health Record System.

PubMed

Stanczyk, Nicola Esther; Crutzen, Rik; Sewuster, Nikki; Schotanus, Elwin; Mulders, Merijn; Cremers, Henricus Paul

2017-01-01

Electronic health records (EHRs) can improve quality and efficiency in patient care. However, the intention to work with such a new system is often relatively low among employees because the work processes of the healthcare organization may change. Involving employees in an EHR implementation may increase their beliefs and perceived capabilities concerning the new system. The current study aimed to assess the role of involvement and its effects on sociocognitive beliefs regarding the implementation of a new EHR system. The study was performed in June 2015 among all eligible employees of a hospital in the Netherlands. Both involved and noninvolved employees were invited to complete a paper-based questionnaire concerning their sociocognitive beliefs (i.e., attitude, social influence, self-efficacy, and intention) related to the EHR implementation. Independent sample t-tests were used to assess potential differences in sociocognitive beliefs between employees who were involved in the implementation process and those who were not. Effect sizes (Cohen's d ) were calculated to indicate the standardized difference between the means. A total of 359 participants completed the paper-based questionnaire and were included in the analyses. Involved employees ( n = 94) reported significantly higher levels of attitude ( p < .001, d = .62), perceived self-efficacy ( p = .01, d = .31), social support ( p < .001, d = .68), and a higher intention to work with the new EHR system ( p < .001, d = .60), compared with the group of employees who were not involved in the implementation process ( n = 265). Involving employees during an EHR implementation appears to enhance employees' sociocognitive beliefs and increases their intention to work with the new system.

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

PubMed Central

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

2006-01-01

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

Hospital culture--why create one?

PubMed

Sovie, M D

1993-01-01

Hospitals, to survive, must be transformed into responsive, participative organizations capable of new practices that produce improved results in both quality of care and service at reduced costs. Creating, managing, and changing the culture are critical leadership functions that will enable the hospital to succeed. Strategic planning and effective implementation of planned change will produce the desired culture. Work restructuring, a focus on quality management along with changes in clinical practices, as well as the care and support processes, are all a part of the necessary hospital cultural revolution.

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

PubMed

Pawa, Jasmine; Robson, John; Hull, Sally

2017-11-01

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

Long Working Hours in Korea: Based on the 2014 Korean Working Conditions Survey.

PubMed

Park, Jungsun; Kim, Yangho; Han, Boyoung

2017-12-01

Long working hours adversely affect worker safety and health. In 2004, Korea passed legislation that limited the work week to 40 hours, in an effort to improve quality-of-life and increase business competitiveness. This regulation was implemented in stages, first for large businesses and then for small businesses, from 2004 to 2011. We previously reported that average weekly working hours decreased from 2006 to 2010, based on the Korean Working Conditions Survey. In the present study, we examine whether average weekly working hours continued to decrease in 2014 based on the 2014 Korean Working Conditions Survey. The results show that average weekly working hours among all groups of workers decreased in 2014 relative to previous years; however, self-employed individuals and employers (who are not covered by the new legislation) in the specific service sectors worked > 60 h/wk in 2014. The Korean government should prohibit employees from working excessive hours and should also attempt to achieve social and public consensus regarding work time reduction to improve the safety, health, and quality-of-life of all citizens, including those who are employers and self-employed.

Assisting Social Security Disability Insurance beneficiaries with schizophrenia, bipolar disorder, or major depression in returning to work.

PubMed

Drake, Robert E; Frey, William; Bond, Gary R; Goldman, Howard H; Salkever, David; Miller, Alexander; Moore, Troy A; Riley, Jarnee; Karakus, Mustafa; Milfort, Roline

2013-12-01

People with psychiatric impairments (primarily schizophrenia or a mood disorder) are the largest and fastest-growing group of Social Security Disability Insurance (SSDI) beneficiaries. The authors investigated whether evidence-based supported employment and mental health treatments can improve vocational and mental health recovery for this population. Using a randomized controlled trial design, the authors tested a multifaceted intervention: team-based supported employment, systematic medication management, and other behavioral health services, along with elimination of barriers by providing complete health insurance coverage (with no out-of-pocket expenses) and suspending disability reviews. The control group received usual services. Paid employment was the primary outcome measure, and overall mental health and quality of life were secondary outcome measures. Overall, 2,059 SSDI beneficiaries with schizophrenia, bipolar disorder, or depression in 23 cities participated in the 2-year intervention. The teams implemented the intervention package with acceptable fidelity. The intervention group experienced more paid employment (60.3% compared with 40.2%) and reported better mental health and quality of life than the control group. Implementation of the complex intervention in routine mental health treatment settings was feasible, and the intervention was effective in assisting individuals disabled by schizophrenia or depression to return to work and improve their mental health and quality of life.

Learning from the design and implementation of large-scale programs to improve infant and young child feeding.

PubMed

Baker, Jean; Sanghvi, Tina; Hajeebhoy, Nemat; Abrha, Teweldebrhan Hailu

2013-09-01

Improving and sustaining infant and young child feeding (IYCF) practices requires multiple interventions reaching diverse target groups over a sustained period of time. These interventions, together with improved maternal nutrition, are the cornerstones for realizing a lifetime of benefitsfrom investing in nutrition during the 1000 day period. Summarize major lessons from Alive & Thrive's work to improve IYCF in three diverse settings--Bangladesh, Ethiopia, and Vietnam. Draw lessons from reports, studies, surveys, routine monitoring, and discussions on the drivers of successful design and implementation of lYCF strategies. Teaming up with carefully selected implementing partners with strong commitment is a critical first step. As programs move to implementation at scale, strategic systems strengthening is needed to avoid operational bottlenecks. Performance of adequate IYCF counseling takes more than training; it requires rational task allocation, substantial follow up, and recognition of frontline workers. Investing in community demand for IYCF services should be prioritized, specifically through social mobilization and relevant media for multiple audiences. Design of behavior change communication and its implementation must be flexible and responsive to shifts in society's use of media and other social changes. Private sector creative agencies and media companies are well equipped to market IYCF. Scaling up core IYCF interventions and maintaining quality are facilitated by national-level coordinating and information exchange mechanisms using evidence on quality and coverage. It is possible to deliver quality IYCF interventions at scale, while creating new knowledge, tools, and approaches that can be adapted by others

The newest miracle drug: quality circles in hospitals.

PubMed

McKinney, M M

1984-01-01

In recent years, a number of hospitals throughout the United States have been exploring the use of Japanese-style quality circles to reduce their operating expenses, improve productivity, and enhance the quality of work life for hospital employees. This article examines the organizational climate necessary for quality circles, methods used to implement quality circles, and management's role in guiding and responding to circle activities. Ideas for building and maintaining staff support are presented along with a cost/benefit analysis of quality circle programs. The author concludes that quality circles are most successful in hospitals where they are part of a larger organizational development effort. When administrators believe in their employees' ability to contribute to the institution and are willing to invest necessary time and resources in employee education and the measurement of quality circle achievements, quality circles can produce creative solutions to perplexing institutional problems.

Improving quality and safety in nursing homes and home care: the study protocol of a mixed-methods research design to implement a leadership intervention

PubMed Central

Wiig, Siri; Ree, Eline; Johannessen, Terese; Strømme, Torunn; Storm, Marianne; Aase, Ingunn; Ullebust, Berit; Holen-Rabbersvik, Elisabeth; Hurup Thomsen, Line; Sandvik Pedersen, Anne Torhild; van de Bovenkamp, Hester; Bal, Roland; Aase, Karina

2018-01-01

Introduction Nursing homes and home care face challenges across different countries as people are living longer, often with chronic conditions. There is a lack of knowledge regarding implementation and impact of quality and safety interventions as most research evidence so far is generated in hospitals. Additionally, there is a lack of effective leadership tools for quality and safety improvement work in this context. Methods and analysis The aim of the ‘Improving Quality and Safety in Primary Care—Implementing a Leadership Intervention in Nursing Homes and Homecare’ (SAFE-LEAD) study is to develop and evaluate a research-based leadership guide for managers to increase quality and safety competence. The project applies a mixed-methods design and explores the implications of the leadership guide on managers’ and staffs’ knowledge, attitudes and practices. Four nursing homes and four home care services from different Norwegian municipalities will participate in the intervention. Surveys, process evaluation (interviews, observations) and document analyses will be conducted to evaluate the implementation and impact of the leadership intervention. A comparative study of Norway and the Netherlands will establish knowledge of the context dependency of the intervention. Ethics and dissemination The study is approved by the Norwegian Centre for Research Data (2017/52324 and 54855). The results will be disseminated through scientific articles, two PhD dissertations, an anthology, presentations at national and international conferences, and in social media, newsletters and in the press. The results will generate knowledge to inform leadership practices in nursing homes and home care. Moreover, the study will build new theory on leadership interventions and the role of contextual factors in nursing homes and home care. PMID:29599394

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions

PubMed Central

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

Background: The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Methods: Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. Results: 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Conclusions: Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing. PMID:18718981

Reviewing evidence on complex social interventions: appraising implementation in systematic reviews of the health effects of organisational-level workplace interventions.

PubMed

Egan, M; Bambra, C; Petticrew, M; Whitehead, M

2009-01-01

The reporting of intervention implementation in studies included in systematic reviews of organisational-level workplace interventions was appraised. Implementation is taken to include such factors as intervention setting, resources, planning, collaborations, delivery and macro-level socioeconomic contexts. Understanding how implementation affects intervention outcomes may help prevent erroneous conclusions and misleading assumptions about generalisability, but implementation must be adequately reported if it is to be taken into account. Data on implementation were obtained from four systematic reviews of complex interventions in workplace settings. Implementation was appraised using a specially developed checklist and by means of an unstructured reading of the text. 103 studies were identified and appraised, evaluating four types of organisational-level workplace intervention (employee participation, changing job tasks, shift changes and compressed working weeks). Many studies referred to implementation, but reporting was generally poor and anecdotal in form. This poor quality of reporting did not vary greatly by type or date of publication. A minority of studies described how implementation may have influenced outcomes. These descriptions were more usefully explored through an unstructured reading of the text, rather than by means of the checklist. Evaluations of complex interventions should include more detailed reporting of implementation and consider how to measure quality of implementation. The checklist helped us explore the poor reporting of implementation in a more systematic fashion. In terms of interpreting study findings and their transferability, however, the more qualitative appraisals appeared to offer greater potential for exploring how implementation may influence the findings of specific evaluations. Implementation appraisal techniques for systematic reviews of complex interventions require further development and testing.

Organizational Climate, Stress, and Error in Primary Care: The MEMO Study

DTIC Science & Technology

2005-05-01

quality, and errors. This model was derived from our earlier work, the Physician Worklife Study14,15 as well as the pioneering work of Lazarus and... Worklife Study instrument,14, 15 and included our five-item global job satisfaction measure and a newly implemented four-item job stress measure.21...measures of practice emphasis with respect to issues such as work–home balance , professionalism, and diversity in office staff, as well as single

Hospital nurses' wellbeing at work: a theoretical model.

PubMed

Utriainen, Kati; Ala-Mursula, Leena; Kyngäs, Helvi

2015-09-01

To develop a theoretical model of hospital nurses' wellbeing at work. The concept of wellbeing at work is presented without an exact definition and without considering different contents. A model was developed in a deductive manner and empirical data collected from nurses (n = 233) working in a university hospital. Explorative factor analysis was used. The main concepts were: patients' experience of high-quality care; assistance and support among nurses; nurses' togetherness and cooperation; fluent practical organisation of work; challenging and meaningful work; freedom to express diverse feelings in the work community; well-conducted everyday nursing; status related to the work itself; fair and supportive leadership; opportunities for professional development; fluent communication with other professionals; and being together with other nurses in an informal way. Themes included: collegial relationships; enhancing high-quality patient care; supportive and fair leadership; challenging, meaningful and well organised work; and opportunities for professional development. Object-dependent wellbeing was supported. Managers should focus on strengthening the positive aspect of wellbeing at work, focusing on providing fluently organised work practices, fair and supportive leadership and togetherness while allowing nurses to implement their own ideas and promote the experience of meaningfulness. © 2014 John Wiley & Sons Ltd.

Empowering certified nurse's aides to improve quality of work life through a team communication program.

PubMed

Howe, Erin E

2014-01-01

The purpose of this pilot study was to explore the impact of a certified nurse's aide (CNA)-led interdisciplinary teamwork and communication intervention on perceived quality of work environment and six-month job intentions. CNAs are frequently excluded from team communication and decision-making, which often leads to job dissatisfaction with high levels of staff turnover. Using a mixed quantitative and qualitative approach with pre- post-program design, the intervention utilized the strategy of debriefing from the national patient safety initiative, TeamSTEPPS. Inherent in the program design, entitled Long Term Care (LTC) Team Talk, was the involvement of the CNAs in the development of the intervention as an empowering process on two wings of a transitional care unit in a long-term care facility in upstate NY. CNAs' perceptions of work environment quality were measured using a Quality of Work Life (QWL) instrument. Additionally, job turnover intent within six months was assessed. Results indicated improved scores on nearly all QWL subscales anticipated to be impacted, and enhanced perceived empowerment of the CNAs on each wing albeit through somewhat different experiential processes. The program is highly portable and can potentially be implemented in a variety of long-term care settings. Copyright © 2014 Mosby, Inc. All rights reserved.

A survey of quality assurance practices in biomedical open source software projects.

PubMed

Koru, Günes; El Emam, Khaled; Neisa, Angelica; Umarji, Medha

2007-05-07

Open source (OS) software is continuously gaining recognition and use in the biomedical domain, for example, in health informatics and bioinformatics. Given the mission critical nature of applications in this domain and their potential impact on patient safety, it is important to understand to what degree and how effectively biomedical OS developers perform standard quality assurance (QA) activities such as peer reviews and testing. This would allow the users of biomedical OS software to better understand the quality risks, if any, and the developers to identify process improvement opportunities to produce higher quality software. A survey of developers working on biomedical OS projects was conducted to examine the QA activities that are performed. We took a descriptive approach to summarize the implementation of QA activities and then examined some of the factors that may be related to the implementation of such practices. Our descriptive results show that 63% (95% CI, 54-72) of projects did not include peer reviews in their development process, while 82% (95% CI, 75-89) did include testing. Approximately 74% (95% CI, 67-81) of developers did not have a background in computing, 80% (95% CI, 74-87) were paid for their contributions to the project, and 52% (95% CI, 43-60) had PhDs. A multivariate logistic regression model to predict the implementation of peer reviews was not significant (likelihood ratio test = 16.86, 9 df, P = .051) and neither was a model to predict the implementation of testing (likelihood ratio test = 3.34, 9 df, P = .95). Less attention is paid to peer review than testing. However, the former is a complementary, and necessary, QA practice rather than an alternative. Therefore, one can argue that there are quality risks, at least at this point in time, in transitioning biomedical OS software into any critical settings that may have operational, financial, or safety implications. Developers of biomedical OS applications should invest more effort in implementing systemic peer review practices throughout the development and maintenance processes.

Ozone Control Strategies | Ground-level Ozone | New ...

EPA Pesticide Factsheets

2017-09-05

The Air Quality Planning Unit's primary goal is to protect your right to breathe clean air. Guided by the Clean Air Act, we work collaboratively with states, communities, and businesses to develop and implement strategies to reduce air pollution from a variety of sources that contribute to the ground-level ozone or smog problem.

Technology and Stress in the Workplace: The Role of the Consulting Psychologist.

ERIC Educational Resources Information Center

Cahill, Janet

Poorly planned implementation of microcomputers has been shown to increase stress symptoms. Concerns have also been raised about the impact of new technology on the quality of the work environment. Programming expertise alone is not sufficient to prevent these problems. This paper therefore describes the role that psychologists can play in…

Working with Family, Friend, and Neighbor Caregivers: Lessons from Four Diverse Communities

ERIC Educational Resources Information Center

Powell, Douglas R.

2011-01-01

This article is excerpted from "Who's Watching the Babies? Improving the Quality of Family, Friend, and Neighbor Care" by Douglas R. Powell ("ZERO TO THREE," 2008). The article explores questions about program development and implementation strategies for supporting Family, Friend, and Neighbor (FFN) caregivers: How do programs and their host…

76 FR 45705 - Approval and Promulgation of Air Quality Implementation Plans; Pennsylvania; Diesel-Powered Motor...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-01

... following methods: A. http://www.regulations.gov . Follow the on-line instructions for submitting comments... the equipment is in good working order, if necessary as part of the inspection; (6) idling of a... off school property during queuing for the sequential discharge or pickup of students where the...

An International Study in Competency Education: Postcards from Abroad. CompetencyWorks Issue Brief

ERIC Educational Resources Information Center

Bristow, Sara Frank; Patrick, Susan

2014-01-01

"An International Study in Competency Education: Postcards from Abroad" seeks to highlight components of competency education in international practice, to inform US policymakers and decision makers seeking to implement high-quality competency pathways at the state or local level. Other countries are studying our innovations, and we are…

Quality Care through Multi-Age Grouping of Children.

ERIC Educational Resources Information Center

Prendergast, Leo

2002-01-01

Asserts that multi-age grouping in early childhood settings can and does work. Addresses four main hurdles to successful implementation: (1) laws and regulations that act as barriers; (2) health concerns; (3) overcoming educational values that conflict with those of the age-grouped classroom; and (4) staff misunderstanding of multi-age grouping…

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

ERIC Educational Resources Information Center

Waldrop, Phillip S.; Scott, Thomas E.

2000-01-01

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

All over the Map: A Progress Report on the State Children's Health Insurance Program (CHIP).

ERIC Educational Resources Information Center

Edmunds, Margo; Teitelbaum, Martha; Gleason, Cassy

The State Children's Health Insurance Program (CHIP) was designed in 1997 to support working families by providing affordable, quality health coverage for their children in an efficient, effective, and coordinated way. This report examines the progress made in implementing CHIP nationwide. Information sources included the following: (1) federal…

Distributed sensor architecture for intelligent control that supports quality of control and quality of service.

PubMed

Poza-Lujan, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, José-Enrique; Simarro, Raúl; Benet, Ginés

2015-02-25

This paper is part of a study of intelligent architectures for distributed control and communications systems. The study focuses on optimizing control systems by evaluating the performance of middleware through quality of service (QoS) parameters and the optimization of control using Quality of Control (QoC) parameters. The main aim of this work is to study, design, develop, and evaluate a distributed control architecture based on the Data-Distribution Service for Real-Time Systems (DDS) communication standard as proposed by the Object Management Group (OMG). As a result of the study, an architecture called Frame-Sensor-Adapter to Control (FSACtrl) has been developed. FSACtrl provides a model to implement an intelligent distributed Event-Based Control (EBC) system with support to measure QoS and QoC parameters. The novelty consists of using, simultaneously, the measured QoS and QoC parameters to make decisions about the control action with a new method called Event Based Quality Integral Cycle. To validate the architecture, the first five Braitenberg vehicles have been implemented using the FSACtrl architecture. The experimental outcomes, demonstrate the convenience of using jointly QoS and QoC parameters in distributed control systems.

Distributed Sensor Architecture for Intelligent Control that Supports Quality of Control and Quality of Service

PubMed Central

Poza-Lujan, Jose-Luis; Posadas-Yagüe, Juan-Luis; Simó-Ten, José-Enrique; Simarro, Raúl; Benet, Ginés

2015-01-01

This paper is part of a study of intelligent architectures for distributed control and communications systems. The study focuses on optimizing control systems by evaluating the performance of middleware through quality of service (QoS) parameters and the optimization of control using Quality of Control (QoC) parameters. The main aim of this work is to study, design, develop, and evaluate a distributed control architecture based on the Data-Distribution Service for Real-Time Systems (DDS) communication standard as proposed by the Object Management Group (OMG). As a result of the study, an architecture called Frame-Sensor-Adapter to Control (FSACtrl) has been developed. FSACtrl provides a model to implement an intelligent distributed Event-Based Control (EBC) system with support to measure QoS and QoC parameters. The novelty consists of using, simultaneously, the measured QoS and QoC parameters to make decisions about the control action with a new method called Event Based Quality Integral Cycle. To validate the architecture, the first five Braitenberg vehicles have been implemented using the FSACtrl architecture. The experimental outcomes, demonstrate the convenience of using jointly QoS and QoC parameters in distributed control systems. PMID:25723145

Medical Image Processing Server applied to Quality Control of Nuclear Medicine.

NASA Astrophysics Data System (ADS)

Vergara, C.; Graffigna, J. P.; Marino, E.; Omati, S.; Holleywell, P.

2016-04-01

This paper is framed within the area of medical image processing and aims to present the process of installation, configuration and implementation of a processing server of medical images (MIPS) in the Fundación Escuela de Medicina Nuclear located in Mendoza, Argentina (FUESMEN). It has been developed in the Gabinete de Tecnologia Médica (GA.TE.ME), Facultad de Ingeniería-Universidad Nacional de San Juan. MIPS is a software that using the DICOM standard, can receive medical imaging studies of different modalities or viewing stations, then it executes algorithms and finally returns the results to other devices. To achieve the objectives previously mentioned, preliminary tests were conducted in the laboratory. More over, tools were remotely installed in clinical enviroment. The appropiate protocols for setting up and using them in different services were established once defined those suitable algorithms. Finally, it’s important to focus on the implementation and training that is provided in FUESMEN, using nuclear medicine quality control processes. Results on implementation are exposed in this work.

Quality management system in radiotherapy in the light of regulations applicable in Poland

PubMed Central

2012-01-01

The need to establish conditions for safe irradiation was noted in Poland back in 1986 in the Atomic Law, but for over 16 years no regulations regarding this aspect were passed. The radiological incident in Bialystok (Poland) in 2001 undeniably accelerated the implementation of new legal regulations. Nevertheless, in the absence of national guidelines until 2002, most health care institutions resorted to the quality management system (QMS) model proposed by the ISO norm 9001:2000. Eventually, practice proved the theory and the aforementioned model was also implemented into Polish acts of law defining basic requirements for QMS in radiotherapy. The aim of this work is to review current national regulations regarding QMS in radiotherapy, in particular those referring to standard procedures, the establishment of a commission for procedures and performance of external and internal clinical audits in oncological radiotherapy, as well as to present the process of their implementation into the practice of health care institutions. PMID:23788867

Improving ward environments and developing skills for discharge with the implementation of self-catering on a low secure forensic unit.

PubMed Central

O'Reilly, Alison

2016-01-01

The opportunities for service users to develop skills for more independent living and take control of their environments are limited in secure mental health units. This paper will outline a quality improvement project that changed how the catering services were delivered in a low secure unit in East London NHS Foundation Trust (ELFT). A Quality Improvement methodology was adopted incorporating the Plan, Do, Study, Act (PDSA) cycle which included the trial of service users preparing their own meals on a daily basis. The participation rates were measured and functional daily living skills were recorded. Following success of the trial, long-term implementation of self-catering was agreed, with service users being supported to prepare a shared evening meal every day on the ward with an average of 60% participation. Functional living skills indicated an improvement in the area of process skills. The project aligned with ELFT's aims of service users working in collaboration with staff to implement changes in service delivery. PMID:28090324

Improving ward environments and developing skills for discharge with the implementation of self-catering on a low secure forensic unit.

PubMed

O'Reilly, Alison

2016-01-01

The opportunities for service users to develop skills for more independent living and take control of their environments are limited in secure mental health units. This paper will outline a quality improvement project that changed how the catering services were delivered in a low secure unit in East London NHS Foundation Trust (ELFT). A Quality Improvement methodology was adopted incorporating the Plan, Do, Study, Act (PDSA) cycle which included the trial of service users preparing their own meals on a daily basis. The participation rates were measured and functional daily living skills were recorded. Following success of the trial, long-term implementation of self-catering was agreed, with service users being supported to prepare a shared evening meal every day on the ward with an average of 60% participation. Functional living skills indicated an improvement in the area of process skills. The project aligned with ELFT's aims of service users working in collaboration with staff to implement changes in service delivery.

Design of experiments (DoE) in pharmaceutical development.

PubMed

N Politis, Stavros; Colombo, Paolo; Colombo, Gaia; M Rekkas, Dimitrios

2017-06-01

At the beginning of the twentieth century, Sir Ronald Fisher introduced the concept of applying statistical analysis during the planning stages of research rather than at the end of experimentation. When statistical thinking is applied from the design phase, it enables to build quality into the product, by adopting Deming's profound knowledge approach, comprising system thinking, variation understanding, theory of knowledge, and psychology. The pharmaceutical industry was late in adopting these paradigms, compared to other sectors. It heavily focused on blockbuster drugs, while formulation development was mainly performed by One Factor At a Time (OFAT) studies, rather than implementing Quality by Design (QbD) and modern engineering-based manufacturing methodologies. Among various mathematical modeling approaches, Design of Experiments (DoE) is extensively used for the implementation of QbD in both research and industrial settings. In QbD, product and process understanding is the key enabler of assuring quality in the final product. Knowledge is achieved by establishing models correlating the inputs with the outputs of the process. The mathematical relationships of the Critical Process Parameters (CPPs) and Material Attributes (CMAs) with the Critical Quality Attributes (CQAs) define the design space. Consequently, process understanding is well assured and rationally leads to a final product meeting the Quality Target Product Profile (QTPP). This review illustrates the principles of quality theory through the work of major contributors, the evolution of the QbD approach and the statistical toolset for its implementation. As such, DoE is presented in detail since it represents the first choice for rational pharmaceutical development.

Measuring quality progress

NASA Astrophysics Data System (ADS)

Lambert, Larry D.

The study by the American Productivity & Quality Center (APQC) was commissioned by Loral Space Information Systems, Inc. and the National Aeronautics and Space Administration (NASA) to evaluate internal assessment systems. APQC benchmarked approaches to the internal assessment of quality management systems in three phases. The first phase included work conducted for the International Benchmarking Clearinghouse (IBC) and consisted of an in-depth analysis of the 1991 Malcolm Baldrige National Quality Award criteria. The second phase was also performed for the IBC and compared the 1991 award criteria among the following quality awards: Deming Prize, Malcolm Baldrige National Quality Award, The President's Award for Quality and Productivity Improvement, The NASA Excellence Award (The George M. Lowe Trophy) for Quality and Productivity Improvement and the Shigeo Shingo Award for Excellence in Manufacturing. The third phase compared the internal implementation approaches of 23 companies selected from American industry for their recognized, formal assessment systems.

Measuring quality progress

NASA Technical Reports Server (NTRS)

Lambert, Larry D.

1992-01-01

The study by the American Productivity & Quality Center (APQC) was commissioned by Loral Space Information Systems, Inc. and the National Aeronautics and Space Administration (NASA) to evaluate internal assessment systems. APQC benchmarked approaches to the internal assessment of quality management systems in three phases. The first phase included work conducted for the International Benchmarking Clearinghouse (IBC) and consisted of an in-depth analysis of the 1991 Malcolm Baldrige National Quality Award criteria. The second phase was also performed for the IBC and compared the 1991 award criteria among the following quality awards: Deming Prize, Malcolm Baldrige National Quality Award, The President's Award for Quality and Productivity Improvement, The NASA Excellence Award (The George M. Lowe Trophy) for Quality and Productivity Improvement and the Shigeo Shingo Award for Excellence in Manufacturing. The third phase compared the internal implementation approaches of 23 companies selected from American industry for their recognized, formal assessment systems.

Quality improvement and emerging global health priorities

PubMed Central

Mensah Abrampah, Nana; Syed, Shamsuzzoha Babar; Hirschhorn, Lisa R; Nambiar, Bejoy; Iqbal, Usman; Garcia-Elorrio, Ezequiel; Chattu, Vijay Kumar; Devnani, Mahesh; Kelley, Edward

2018-01-01

Abstract Quality improvement approaches can strengthen action on a range of global health priorities. Quality improvement efforts are uniquely placed to reorient care delivery systems towards integrated people-centred health services and strengthen health systems to achieve Universal Health Coverage (UHC). This article makes the case for addressing shortfalls of previous agendas by articulating the critical role of quality improvement in the Sustainable Development Goal era. Quality improvement can stimulate convergence between health security and health systems; address global health security priorities through participatory quality improvement approaches; and improve health outcomes at all levels of the health system. Entry points for action include the linkage with antimicrobial resistance and the contentious issue of the health of migrants. The work required includes focussed attention on the continuum of national quality policy formulation, implementation and learning; alongside strengthening the measurement-improvement linkage. Quality improvement plays a key role in strengthening health systems to achieve UHC. PMID:29873793

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

PubMed Central

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

2017-01-01

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

Rationale and Design of the Lung Cancer Screening Implementation. Evaluation of Patient-Centered Care Study.

PubMed

Miranda, Leah S; Datta, Santanu; Melzer, Anne C; Wiener, Renda Soylemez; Davis, James M; Tong, Betty C; Golden, Sara E; Slatore, Christopher G

2017-10-01

Screening for lung cancer using low-dose computed tomography has been demonstrated to reduce lung cancer-related mortality and is being widely implemented. Further research in this area is needed to assess the impact of screening on patient-centered outcomes. Here, we describe the design and rationale for a new study entitled Lung Cancer Screening Implementation: Evaluation of Patient-Centered Care. The protocol is composed of an interconnected series of studies evaluating patients and clinicians who are engaged in lung cancer screening in real-world settings. The primary goal of this study is to evaluate communication processes that are being used in routine care and to identify best practices that can be readily scaled up for implementation in multiple settings. We hypothesize that higher overall quality of patient-clinician communication processes will be associated with lower levels of distress and decisional conflict as patients decide whether or not to participate in lung cancer screening. This work is a critical step toward identifying modifiable mechanisms that are associated with high quality of care for the millions of patients who will consider lung cancer screening. Given the enormous potential benefits and burdens of lung cancer screening on patients, clinicians, and the healthcare system, it is important to identify and then scale up quality communication practices that positively influence patient-centered care.

The intelligent OR: design and validation of a context-aware surgical working environment.

PubMed

Franke, Stefan; Rockstroh, Max; Hofer, Mathias; Neumuth, Thomas

2018-05-24

Interoperability of medical devices based on standards starts to establish in the operating room (OR). Devices share their data and control functionalities. Yet, the OR technology rarely implements cooperative, intelligent behavior, especially in terms of active cooperation with the OR team. Technical context-awareness will be an essential feature of the next generation of medical devices to address the increasing demands to clinicians in information seeking, decision making, and human-machine interaction in complex surgical working environments. The paper describes the technical validation of an intelligent surgical working environment for endoscopic ear-nose-throat surgery. We briefly summarize the design of our framework for context-aware system's behavior in integrated OR and present example realizations of novel assistance functionalities. In a study on patient phantoms, twenty-four procedures were implemented in the proposed intelligent surgical working environment based on recordings of real interventions. Subsequently, the whole processing pipeline for context-awareness from workflow recognition to the final system's behavior is analyzed. Rule-based behavior that considers multiple perspectives on the procedure can partially compensate recognition errors. A considerable robustness could be achieved with a reasonable quality of the recognition. Overall, reliable reactive as well as proactive behavior of the surgical working environment can be implemented in the proposed environment. The obtained validation results indicate the suitability of the overall approach. The setup is a reliable starting point for a subsequent evaluation of the proposed context-aware assistance. The major challenge for future work will be to implement the complex approach in a cross-vendor setting.

[Work organisation improvement methods applied to activities of Blood Transfusion Establishments (BTE): Lean Manufacturing, VSM, 5S].

PubMed

Bertholey, F; Bourniquel, P; Rivery, E; Coudurier, N; Follea, G

2009-05-01

Continuous improvement of efficiency as well as new expectations from customers (quality and safety of blood products) and employees (working conditions) imply constant efforts in Blood Transfusion Establishments (BTE) to improve work organisations. The Lean method (from "Lean" meaning "thin") aims at identifying wastages in the process (overproduction, waiting, over-processing, inventory, transport, motion) and then reducing them in establishing a mapping of value chain (Value Stream Mapping). It consists in determining the added value of each step of the process from a customer perspective. Lean also consists in standardizing operations while implicating and responsabilizing all collaborators. The name 5S comes from the first letter of five operations of a Japanese management technique: to clear, rank, keep clean, standardize, make durable. The 5S method leads to develop the team working inducing an evolution of the way in the management is performed. The Lean VSM method has been applied to blood processing (component laboratory) in the Pays de la Loire BTE. The Lean 5S method has been applied to blood processing, quality control, purchasing, warehouse, human resources and quality assurance in the Rhône-Alpes BTE. The experience returns from both BTE shows that these methods allowed improving: (1) the processes and working conditions from a quality perspective, (2) the staff satisfaction, (3) the efficiency. These experiences, implemented in two BTE for different processes, confirm the applicability and usefulness of these methods to improve working organisations in BTE.

Job sharing: a viable option for the clinical nurse specialist.

PubMed

Haibeck, S V; Howard, J L

1991-01-01

NUMEROUS WORK TIME options have been developed to attract, retain and meet the various needs of nurses. Job sharing, a work option little known to nurses, can be a successful alternative for balancing professional and personal lifestyle. The business literature supports job sharing and other innovative work options as successful mechanisms in retaining quality employees in their respective professions. After exploring the literature in this area, a proposal for job sharing the oncology clinical nurse specialist (CNS) position was presented to the Personnel Director and Vice President of Nursing at our institution. The proposal addressed the advantages and disadvantages of the concept. These included: (1) scheduling flexibility, (2) reduced absenteeism and turnover, (3) increased productivity, (4) handling fringe benefits, and (5) job satisfaction. The proposal was accepted, and the job sharing position has been successfully implemented for more than 2 years now. This paper describes issues relevant to designing and implementing job sharing in a CNS position.

Health Monitoring and Management for Manufacturing Workers in Adverse Working Conditions.

PubMed

Xu, Xiaoya; Zhong, Miao; Wan, Jiafu; Yi, Minglun; Gao, Tiancheng

2016-10-01

In adverse working conditions, environmental parameters such as metallic dust, noise, and environmental temperature, directly affect the health condition of manufacturing workers. It is therefore important to implement health monitoring and management based on important physiological parameters (e.g., heart rate, blood pressure, and body temperature). In recent years, new technologies, such as body area networks, cloud computing, and smart clothing, have allowed the improvement of the quality of services. In this article, we first give five-layer architecture for health monitoring and management of manufacturing workers. Then, we analyze the system implementation process, including environmental data processing, physical condition monitoring and system services and management, and present the corresponding algorithms. Finally, we carry out an evaluation and analysis from the perspective of insurance and compensation for manufacturing workers in adverse working conditions. The proposed scheme will contribute to the improvement of workplace conditions, realize health monitoring and management, and protect the interests of manufacturing workers.

Best practices for preventing musculoskeletal disorders in masonry: stakeholder perspectives.

PubMed

Entzel, Pamela; Albers, Jim; Welch, Laura

2007-09-01

Brick masons and mason tenders report a high prevalence of work-related musculoskeletal disorders (WMSDs), many of which can be prevented with changes in materials, work equipment or work practices. To explore the use of "best practices" in the masonry industry, NIOSH organized a 2-day meeting of masonry stakeholders. Attendees included 30 industry representatives, 5 health and safety researchers, 4 health/safety specialists, 2 ergonomic consultants, and 2 representatives of state workers' compensation programs. Small groups discussed ergonomic interventions currently utilized in the masonry industry, including factors affecting intervention implementation and ways to promote diffusion of interventions. Meeting participants also identified various barriers to intervention implementation, including business considerations, quality concerns, design issues, supply problems, jobsite conditions and management practices that can slow or limit intervention diffusion. To be successful, future diffusion efforts must not only raise awareness of available solutions but also address these practical concerns.

Improving the safety and quality of nursing care through standardized operating procedures in Bosnia and Herzegovina.

PubMed

Ausserhofer, Dietmar; Rakic, Severin; Novo, Ahmed; Dropic, Emira; Fisekovic, Eldin; Sredic, Ana; Van Malderen, Greet

2016-06-01

We explored how selected 'positive deviant' healthcare facilities in Bosnia and Herzegovina approach the continuous development, adaptation, implementation, monitoring and evaluation of nursing-related standard operating procedures. Standardized nursing care is internationally recognized as a critical element of safe, high-quality health care; yet very little research has examined one of its key instruments: nursing-related standard operating procedures. Despite variability in Bosnia and Herzegovina's healthcare and nursing care quality, we assumed that some healthcare facilities would have developed effective strategies to elevate nursing quality and safety through the use of standard operating procedures. Guided by the 'positive deviance' approach, we used a multiple-case study design to examine a criterion sample of four facilities (two primary healthcare centres and two hospitals), collecting data via focus groups and individual interviews. In each studied facility, certification/accreditation processes were crucial to the initiation of continuous development, adaptation, implementation, monitoring and evaluation of nursing-related SOPs. In one hospital and one primary healthcare centre, nurses working in advanced roles (i.e. quality coordinators) were responsible for developing and implementing nursing-related standard operating procedures. Across the four studied institutions, we identified a consistent approach to standard operating procedures-related processes. The certification/accreditation process is enabling necessary changes in institutions' organizational cultures, empowering nurses to take on advanced roles in improving the safety and quality of nursing care. Standardizing nursing procedures is key to improve the safety and quality of nursing care. Nursing and Health Policy are needed in Bosnia and Herzegovina to establish a functioning institutional framework, including regulatory bodies, educational systems for developing nurses' capacities or the inclusion of nursing-related standard operating procedures in certification/accreditation standards. © 2016 International Council of Nurses.

Job role quality and intention to leave current facility and to leave profession of direct care workers in Japanese residential facilities for elderly.

PubMed

Nakanishi, Miharu; Imai, Hisato

2012-01-01

The aim of the present study is to examine job role quality relating to intention to leave current facility and to leave profession among direct care workers in residential facilities for elderly in Japan. Direct care workers completed a paper questionnaire on October 2009. From 746 facilities in three prefectures (Tokyo, Shizuoka, and Yamagata) 6428 direct care workers with complete data were included in the analyses. The Job Role Quality (JRQ) scale was translated into Japanese language to assess job role quality. Hierarchical multiple regression analysis showed that intention to leave current facility was primarily associated with job role quality: poor skill discretion, high job demand, and poor relationship with supervisor. Intention to leave profession was primarily associated with poor skill discretion. The results of the present study imply the strategies to direct care worker retention for each facility and policy efforts. Each facility can implement specific strategies such as enhanced variety of work and opportunity for use of skills, adequate job allocation, and improvement of supervisor-employee relationship in work place. Policy efforts should enhance broader career opportunities in care working such as advanced specialization and authorized medical practice. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.

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

PubMed

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

2014-05-22

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

Guidelines to implement quality management systems in microbiology laboratories for tissue banking.

PubMed

Vicentino, W; Rodríguez, G; Saldías, M; Alvarez, I

2009-10-01

Human tissues for implants are a biomedical product that is being used more frequently by many medical disciplines. There are infections in the patients related to the implanted tissues. The early detection of infections transmitted by blood and the microbiological study of tissues before their clinical use are strategies in tissue banks to prevent these situations. This work sought to contribute to establish the bases for the operation of a laboratory applied to the microbiological quality control of tissues. Based on classical microbiological principles, we defined the operation of microbiological control and tissues sterilization since 2003. We determine lists of acceptable microorganisms for every tissue, criteria for the interpretation of results, and a diagnostic algorithm of microbiological quality. We observed that the circumstances of donor death can be a determinant of the quality. The environment and the operator should be investigated as probable sources of contamination in outbreaks. The criteria of work based on a solid methodology must help to avoid the transmission of infections between donor and recipient. This is a critical point in the quality management of a tissue bank.

Advances in drainage: Selected works from the Tenth International Drainage Symposium

USGS Publications Warehouse

Strock, Jeffrey S.; Hay, Christopher; Helmers, Matthew; Nelson, Kelly A.; Sands, Gary R.; Skaggs, R. Wayne; Douglas-Mankin, Kyle R.

2018-01-01

This article introduces a special collection of fourteen articles accepted from among the 140 technical presentations, posters, and meeting papers presented at the 10th International ASABE Drainage Symposium. The symposium continued in the tradition of previous symposia that began in 1965 as a forum for presenting and assessing the progress of drainage research and implementation throughout the world. The articles in this collection address a wide range of topics grouped into five broad categories: (1) crop response, (2) design and management, (3) hydrology and scale, (4) modeling, and (5) water quality. The collection provides valuable information for scientists, engineers, planners, and others working on crop production, water quality, and water quantity issues affected by agricultural drainage. The collection also provides perspectives on the challenges of increasing agricultural production in a changing climate, with ever-greater attention to water quality and quantity concerns that will require integrated technical, economic, and social solutions.

The contribution of the French Muskoka Fund to improving access to essential medicines and priority health products for mothers and children.

PubMed

Macé, C; Nikiema, J-B

2016-11-01

One objective of the French Muskoka Fund since 2011 has been to improve the availability of quality healthcare services for mothers and children and thus to contribute to the continued presence of essential drugs and affordable quality health products and to their rational use by healthcare personnel. This project thus contributed to reinforcing the work of the national regulatory authorities, guarantor of the quality of the products supplied to the populations, but also to strengthening the coordination of supplies at the country level. It also enabled the provision of support for the implementation of drug price controls and helped to strengthen the ability of healthcare staff to optimize their use of the products available to them. This work should be continued in these countries as they meet the agenda of the Sustainable Development Goals, which require the establishment of universal healthcare coverage.

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

PubMed

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

The goal of the perinatal team at Mercy Hospital St. Louis is to provide a quality patient experience during labor and birth. After the move to a new labor and birth unit in 2013, the team recognized many of the routines and practices needed to be modified based on different demands. The Lean process was used to plan and implement required changes. This technique was chosen because it is based on feedback from clinicians, teamwork, strategizing, and immediate evaluation and implementation of common sense solutions. Through rapid improvement events, presence of leaders in the work environment, and daily huddles, team member engagement and communication were enhanced. The process allowed for team members to offer ideas, test these ideas, and evaluate results, all within a rapid time frame. For 9 months, frontline clinicians met monthly for a weeklong rapid improvement event to create better experiences for childbearing women and those who provide their care, using Lean concepts. At the end of each week, an implementation plan and metrics were developed to help ensure sustainment. The issues that were the focus of these process improvements included on-time initiation of scheduled cases such as induction of labor and cesarean birth, timely and efficient assessment and triage disposition, postanesthesia care and immediate newborn care completed within approximately 2 hours, transfer from the labor unit to the mother baby unit, and emergency transfers to the main operating room and intensive care unit. On-time case initiation for labor induction and cesarean birth improved, length of stay in obstetric triage decreased, postanesthesia recovery care was reorganized to be completed within the expected 2-hour standard time frame, and emergency transfers to the main hospital operating room and intensive care units were standardized and enhanced for efficiency and safety. Participants were pleased with the process improvements and quality outcomes. Working together as a team using the Lean process, frontline clinicians identified areas that needed improvement, developed and implemented successful strategies that addressed each gap, and enhanced the quality and safety of care for a large volume perinatal service.

"During early implementation you just muddle through": factors that impacted a statewide arthritis program's implementation.

PubMed

Conte, Kathleen P; Marie Harvey, S; Turner Goins, R

2017-12-01

The need to scale-up effective arthritis self-management programs is pressing as the prevalence of arthritis increases. The CDC Arthritis Program funds state health departments to work with local delivery systems to embed arthritis programs into their day-to-day work. To encourage organizational ownership and sustainability of programs, funding is restricted to offset program start-up costs. The purpose of this study was to identify factors that impacted the success of implementing an evidence-based arthritis self-management program, funded by the CDC Arthritis Program, into the Oregon Extension Service. We interviewed staff and partners involved in implementation who had and had not successfully delivered Walk With Ease (N = 12) to identify barriers and facilitators to scaling-up. Document analysis of administrative records was used to triangulate and expand on findings. Delivery goals defined by the funder were not met in Year 1: only 3 of the expected 28 programs were delivered. Barriers to implementation included insufficient planning for implementation driven by pressure to deliver programs and insufficient resources to support staff time. Facilitators included centralized administration of key implementation activities and staffs' previous experience implementing new programs. The importance of planning and preparing for implementation cannot be overlooked. Funders, however, eager to see deliverables, continue to define implementation goals in terms of program reach, exclusive of capacity-building. Lack of capacity-building can jeopardize staff buy-in, implementation quality, and sustainability. Based on our findings coupled with support from implementation literature, we offer recommendations for future large-scale implementation efforts operating under such funding restrictions.

[Research advances in secondary development of Chinese patent medicines based on quality by design concept].

PubMed

Gong, Xing-Chu; Chen, Teng; Qu, Hai-Bin

2017-03-01

Quality by design (QbD) concept is an advanced pharmaceutical quality control concept. The application of QbD concept in the research and development of pharmaceutical processes of traditional Chinese medicines (TCM) mainly contains five parts, including the definition of critical processes and their evaluation criteria, the determination of critical process parameters and critical material attributes, the establishment of quantitative models, the development of design space, as well as the application and continuous improvement of control strategy. In this work, recent research advances in QbD concept implementation methods in the secondary development of Chinese patent medicines were reviewed, and five promising fields of the implementation of QbD concept were pointed out, including the research and development of TCM new drugs and Chinese medicine granules for formulation, modeling of pharmaceutical processes, development of control strategy based on industrial big data, strengthening the research of process amplification rules, and the development of new pharmaceutical equipment.. Copyright© by the Chinese Pharmaceutical Association.

A reliable low cost integrated wireless sensor network for water quality monitoring and level control system in UAE

NASA Astrophysics Data System (ADS)

Abou-Elnour, Ali; Khaleeq, Hyder; Abou-Elnour, Ahmad

2016-04-01

In the present work, wireless sensor network and real-time controlling and monitoring system are integrated for efficient water quality monitoring for environmental and domestic applications. The proposed system has three main components (i) the sensor circuits, (ii) the wireless communication system, and (iii) the monitoring and controlling unit. LabView software has been used in the implementation of the monitoring and controlling system. On the other hand, ZigBee and myRIO wireless modules have been used to implement the wireless system. The water quality parameters are accurately measured by the present computer based monitoring system and the measurement results are instantaneously transmitted and published with minimum infrastructure costs and maximum flexibility in term of distance or location. The mobility and durability of the proposed system are further enhanced by fully powering via a photovoltaic system. The reliability and effectiveness of the system are evaluated under realistic operating conditions.

[Factors affecting the quality of cardiopulmonary resuscitation in inpatient units: perception of nurses].

PubMed

Citolino, Clairton Marcos Filho; Santos, Eduesley Santana; Silva, Rita de Cassia Gengo E; Nogueira, Lilia de Souza

2015-12-01

To identify, in the perception of nurses, the factors that affect the quality of cardiopulmonary resuscitation (CPR) in adult inpatient units, and investigate the influence of both work shifts and professional experience length of time in the perception of these factors. A descriptive, exploratory study conducted at a hospital specialized in cardiology and pneumology with the application of a questionnaire to 49 nurses working in inpatient units. The majority of nurses reported that the high number of professionals in the scenario (75.5%), the lack of harmony (77.6%) or stress of any member of staff (67.3%), lack of material and/or equipment failure (57.1%), lack of familiarity with the emergency trolleys (98.0%) and presence of family members at the beginning of the cardiopulmonary arrest assistance (57.1%) are factors that adversely affect the quality of care provided during CPR. Professional experience length of time and the shift of nurses did not influence the perception of these factors. The identification of factors that affect the quality of CPR in the perception of nurses serves as parameter to implement improvements and training of the staff working in inpatient units.

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 Central

Odusola, Aina O.; Stronks, Karien; Hendriks, Marleen E.; Schultsz, Constance; Akande, Tanimola; Osibogun, Akin; van Weert, Henk; Haafkens, Joke A.

2016-01-01

Background 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. Objective 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. Design 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. Results 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. Conclusions 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. PMID:26880152

An Incentive Pay Plan for Advanced Practice Registered Nurses: Impact On Provider and Organizational Outcomes.

PubMed

Rhodes, Catherine A; Bechtle, Mavis; McNett, Molly

2015-01-01

Advanced practice registered nurses (APRNs) are integral to the provision of quality, cost-effective health care throughout the continuum of care. To promote job satisfaction and ultimately decrease turnover, an APRN incentive plan based on productivity and quality was formulated. Clinical productivity in the incentive plan was measured by national benchmarks for work relative value units for nonphysician providers. After the first year of implementation, APRNs were paid more for additional productivity and quality and the institution had an increase in patient visits and charges. The incentive plan is a win-win for hospitals that employ APRNs.

Strengthening health workforce capacity through work-based training

PubMed Central

2013-01-01

Background Although much attention has been given to increasing the number of health workers, less focus has been directed at developing models of training that address real-life workplace needs. Makerere University School of Public Health (MakSPH) with funding support from the Centers for Disease Control and Prevention (CDC) developed an eight-month modular, in-service work-based training program aimed at strengthening the capacity for monitoring and evaluation (M&E) and continuous quality improvement (CQI) in health service delivery. Methods This capacity building program, initiated in 2008, is offered to in-service health professionals working in Uganda. The purpose of the training is to strengthen the capacity to provide quality health services through hands-on training that allows for skills building with minimum work disruptions while encouraging greater involvement of other institutional staff to enhance continuity and sustainability. The hands-on training uses practical gaps and challenges at the workplace through a highly participatory process. Trainees work with other staff to design and implement ‘projects’ meant to address work-related priority problems, working closely with mentors. Trainees’ knowledge and skills are enhanced through short courses offered at specific intervals throughout the course. Results Overall, 143 trainees were admitted between 2008 and 2011. Of these, 120 (84%) from 66 institutions completed the training successfully. Of the trainees, 37% were Social Scientists, 34% were Medical/Nursing/Clinical Officers, 5.8% were Statisticians, while 23% belonged to other professions. Majority of the trainees (80%) were employed by Non-Government Organizations while 20% worked with the public health sector. Trainees implemented 66 projects which addressed issues such as improving access to health care services; reducing waiting time for patients; strengthening M&E systems; and improving data collection and reporting. The projects implemented aimed to improve trainees’ skills and competencies in M&E and CQI and the design of the projects was such that they could share these skills with other staff, with minimal interruptions of their work. Conclusions The modular, work-based training model strengthens the capacity of the health workforce through hands-on, real-life experiences in the work-setting and improves institutional capacity, thereby providing a practical example of health systems strengthening through health workforce capacity building. PMID:23347473

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-12-10

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

Use of formwork systems in high-rise construction

NASA Astrophysics Data System (ADS)

Kurakova, Oksana

2018-03-01

Erection of high quality buildings and structures within a reasonable time frame is the crucial factor for the competitiveness of any construction organization. The main material used in high-rise construction is insitu reinforced concrete. The technology of its use is directly related to the use of formwork systems. Formwork systems and formwork technologies basically determine the speed of construction and labor intensity of concreting operations. Therefore, it is also possible to achieve the goal of reducing the construction time and labor intensity of works performed by improving the technology of formwork systems use. Currently there are unresolved issues in the area of implementation of monolithic technology projects, and problems related to the selection of a formwork technology, high labor intensity of works, poor quality of materials and structures, etc. are the main ones. The article presents organizational and technological measures, by means of which introduction it is possible to shorten the duration of construction. A comparison of operations performed during formwork installation according to the conventional technology and taking into account the implemented organizational and technological measures is presented. The results of a comparative analysis of economic efficiency assessments are also presented on the example of a specific construction project before and after the implementation of the above mentioned measures. The study showed that introduction of the proposed organizational and technological model taking into account optimization of reinforcing and concreting works significantly improves the efficiency of a high-rise construction project. And further improvement of technologies for the use of insitu reinforced concrete is a promising direction in the construction of high-rise buildings.

The organizational and financial viability of an orthopedic trauma service.

PubMed

Harris, Mitchel B; Cayen, Barry

2009-12-01

This study was designed to explore the effect of establishing an Orthopedic Trauma Service (OTS) on departmental revenue within an academic orthopedic department. The effect of the OTS on physician and resident perceptions of job satisfaction, education, and quality of patient care were also evaluated. A proforma financial analysis was undertaken using an optimization model to predict the potential financial performance of an OTS before its implementation. Financial data were then collected prospectively for the first year of the OTS and compared with the preceding year's financial data. All residents and faculty in the department completed visual analog scale surveys after the formation of the service. While maintaining a fixed amount of work production (work relative value units [WRVUs]) per year, our model predicted an $111,000 increase in departmental charges as a result of a shift in the elective case mix. After implementation of the OTS, elective charges/WRVU increased by 7.4% while trauma charges/WRVU increased by 2.6%. This, combined with a minor increase in departmental work volume (115,661 WRVUs pre-OTS vs. 117,577 WRVUs post-OTS) and an improvement in collections/charge (47-48%), yielded a departmental collection increase of 11% ($1.1 million). Resident and faculty job satisfaction improved, as did the perception of the quality of trauma care that was being provided. The organization and implementation of an OTS within an academic orthopedic department can lead to an improved professional experience for residents and faculty, the perception of improved patient care for the trauma patient, and an increase in departmental revenue.

Telehealth and Indian healthcare: moving to scale and sustainability.

PubMed

Carroll, Mark; Horton, Mark B

2013-05-01

Telehealth innovation has brought important improvements in access to quality healthcare for American Indian and Alaska Native communities. Despite these improvements, substantive work remains before telehealth capability can be more available and sustainable across Indian healthcare. Some of this work will rely on system change guided by new care model development. Such care model development depends on expansion of telehealth reimbursement. The U.S. Indian healthcare system is an ideal framework for implementing and evaluating large-scale change in U.S. telehealth reimbursement policy.

Flight Dynamics Mission Support and Quality Assurance Process

NASA Technical Reports Server (NTRS)

Oh, InHwan

1996-01-01

This paper summarizes the method of the Computer Sciences Corporation Flight Dynamics Operation (FDO) quality assurance approach to support the National Aeronautics and Space Administration Goddard Space Flight Center Flight Dynamics Support Branch. Historically, a strong need has existed for developing systematic quality assurance using methods that account for the unique nature and environment of satellite Flight Dynamics mission support. Over the past few years FDO has developed and implemented proactive quality assurance processes applied to each of the six phases of the Flight Dynamics mission support life cycle: systems and operations concept, system requirements and specifications, software development support, operations planing and training, launch support, and on-orbit mission operations. Rather than performing quality assurance as a final step after work is completed, quality assurance has been built in as work progresses in the form of process assurance. Process assurance activities occur throughout the Flight Dynamics mission support life cycle. The FDO Product Assurance Office developed process checklists for prephase process reviews, mission team orientations, in-progress reviews, and end-of-phase audits. This paper will outline the evolving history of FDO quality assurance approaches, discuss the tailoring of Computer Science Corporations's process assurance cycle procedures, describe some of the quality assurance approaches that have been or are being developed, and present some of the successful results.

Private primary care physicians' perspectives on factors affecting the adoption of electronic medical records: a qualitative pre-implementation study.

PubMed

Or, Calvin; Wong, Katie; Tong, Ellen; Sek, Antonio

2014-01-01

Use of electronic medical records (EMR) has the potential to offer quality and safety benefits, but without the adoption of the technology, the benefits will not be realized. This study aimed to identify the factors perceived as relevant by private physicians when considering EMR adoption. A qualitative pre-implementation study was conducted using semi-structured, face to face interviews to explore the perspectives of physicians (n=16) operating in private clinics on the factors affecting their adoption of EMR. A multilevel, work system approach and the immersion/crystallization data analysis technique guided the researchers in examining the data, identifying patterns and key themes, and extracting representative quotes to illustrate these themes. The major factors associated with EMR adoption, which relate to the five categories of a work system, were system usefulness; user interface design; technical support; cost; system reliability; the privacy, confidentiality, and security of patient information; physical space in the clinic; data migration process; adverse work-related factors; and the computer and systems skills of physicians. Pre-implementation identification of factors important to adoption can allow system developers to focus proactively on these factors when developing the system and its implementation strategies, to maximize the likelihood of successful introduction.

Experience Of Implementing The Integrated Management System In Manufacturing Companies In Slovakia

NASA Astrophysics Data System (ADS)

Lestyánszka Škůrková, Katarína; Kučerová, Marta; Fidlerová, Helena

2015-06-01

In corporate practice, the term of Integrated Management System means a system the aim of which is to manage an organization regarding the quality, environment, health and safety at work. In the first phase of the VEGA project No. 1/0448/13 "Transformation of ergonomics program into the company management structure through interaction and utilization QMS, EMS, HSMS", we focused on obtaining information about the way or procedure of implementing the integrated management systems in manufacturing companies in Slovakia. The paper considers characteristics of integrated management system, specifies the possibilities for successive integration of the management systems and also describes the essential aspects of the practical implementation of integrated management systems in companies in Slovakia.

Interdisciplinary shared governance: a partnership model for high performance in a managed care environment.

PubMed

Anderson, D A; Bankston, K; Stindt, J L; Weybright, D W

2000-09-01

Today's managed care environment is forcing hospitals to seek new and innovative ways to deliver a seamless continuum of high-quality care and services to defined populations at lower costs. Many are striving to achieve this goal through the implementation of shared governance models that support point-of-service decision making, interdisciplinary partnerships, and the integration of work across clinical settings and along the service delivery continuum. The authors describe the key processes and strategies used to facilitate the design and successful implementation of an interdisciplinary shared governance model at The University Hospital, Cincinnati, Ohio. Implementation costs and initial benefits obtained over a 2-year period also are identified.

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

Federal Register 2010, 2011, 2012, 2013, 2014

2012-05-24

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

Spectrum analysis on quality requirements consideration in software design documents.

PubMed

Kaiya, Haruhiko; Umemura, Masahiro; Ogata, Shinpei; Kaijiri, Kenji

2013-12-01

Software quality requirements defined in the requirements analysis stage should be implemented in the final products, such as source codes and system deployment. To guarantee this meta-requirement, quality requirements should be considered in the intermediate stages, such as the design stage or the architectural definition stage. We propose a novel method for checking whether quality requirements are considered in the design stage. In this method, a technique called "spectrum analysis for quality requirements" is applied not only to requirements specifications but also to design documents. The technique enables us to derive the spectrum of a document, and quality requirements considerations in the document are numerically represented in the spectrum. We can thus objectively identify whether the considerations of quality requirements in a requirements document are adapted to its design document. To validate the method, we applied it to commercial software systems with the help of a supporting tool, and we confirmed that the method worked well.

Electronic health records: critical success factors in implementation.

PubMed

Safdari, Reza; Ghazisaeidi, Marjan; Jebraeily, Mohamad

2015-04-01

EHR implementation results in the improved quality of care, customer-orientation and timely access to complete information. Despite the potential benefits of EHR, its implementation is a difficult and complex task whose success depends on many factors. The purpose of this research is indeed to identify the key success factors of EHR. This is a cross-sectional survey conducted with participation of 340 work forces from different types of job from Hospitals of TUMS in 2014. Data were collected using a self-structured questionnaire which was estimated as both reliable and valid. The data were analyzed by SPSS software descriptive statistics and analytical statistics. 58.2% of respondents were female and their mean age and work experience were 37.7 and 11.2 years, respectively and most respondents (52.5%) was bachelor. In terms of job, the maximum rate was related to nursing (33 %) and physician (21 %). the main category of critical success factors in Implementation EHRs, the highest rate related to Project Management (4.62) and lowest related to Organizational factors (3.98). success in implementation EHRs requirement more centralization to project management and human factors. Therefore must be Creating to EHR roadmap implementation, establishment teamwork to participation of end-users and select prepare leadership, users obtains sufficient training to use of system and also prepare support from maintain and promotion system.

Investigating the use of patient involvement and patient experience in quality improvement in Norway: rhetoric or reality?

PubMed Central

2013-01-01

Background Patient involvement in health care decision making is part of a wider trend towards a more bottom-up approach to service planning and provision, and patient experience is increasingly conceptualized as a core dimension of health care quality. The aim of this multi-level study is two-fold: 1) to describe and analyze how governmental organizations expect acute hospitals to incorporate patient involvement and patient experiences into their quality improvement (QI) efforts and 2) to analyze how patient involvement and patient experiences are used by hospitals to try to improve the quality of care they provide. Methods This multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews and non-participant observation of key meetings and shadowing of staff at the meso and micro levels in two purposively sampled Norwegian hospitals. Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011–2012). Results Governmental documents and regulations at the macro level demonstrated wide-ranging expectations for the integration of patient involvement and patient experiences in QI work in hospitals. The expectations span from systematic collection of patients’ and family members’ experiences for the purpose of improving service quality through establishing patient-oriented arenas for ongoing collaboration with staff to the support of individual involvement in decision making. However, the extent of involvement of patients and application of patient experiences in QI work was limited at both hospitals. Even though patient involvement was gaining prominence at the meso level − and to a lesser extent at the micro level − relevant tools for measuring and using patient experiences in QI work were lacking, and available measures of patient experience were not being used meaningfully or systematically. Conclusions The relative lack of expertise in Norwegian hospitals of adapting and implementing tools and methods for improving patient involvement and patient experiences at the meso and micro levels mark a need for health care policymakers and hospital leaders to learn from experiences of other industries and countries that have successfully integrated user experiences into QI work. Hospital managers need to design and implement wider strategies to help their staff members recognize and value the contribution that patient involvement and patient experiences can make to the improvement of healthcare quality. PMID:23742265

Healthcare quality improvement work: a professional employee perspective.

PubMed

Gadolin, Christian; Andersson, Thomas

2017-06-12

Purpose The purpose of this paper is to describe and analyze conditions that influence how employees engage in healthcare quality improvement (QI) work. Design/methodology/approach Qualitative case study based on interviews ( n=27) and observations ( n=10). Findings The main conditions that influence how employees engage in healthcare QI work are professions, work structures and working relationships. These conditions can both prevent and facilitate healthcare QI. Professions and work structures may cement existing institutional logics and thus prevent employees from engaging in healthcare QI work. However, attempts to align QI with professional logics, together with work structures that empower employees, can make these conditions increase employee engagement, which can be accomplished through positive working relationships that foster institutional work, which bridge different competing institutional logics, making it possible to overcome barriers that professions and work structures may constitute. Practical implications Understanding the conditions that influence how employees engage in healthcare QI work will make initiatives more likely to succeed. Originality/value Healthcare QI has mainly been studied from an implementer perspective, and employees have either been neglected or seen as passive resisters. Weak employee perspectives make healthcare QI research incomplete. In our research, healthcare QI work is studied closely at the actor level to understand healthcare QI from an employee perspective.

An introduction to statistical process control in research proteomics.

PubMed

Bramwell, David

2013-12-16

Statistical process control is a well-established and respected method which provides a general purpose, and consistent framework for monitoring and improving the quality of a process. It is routinely used in many industries where the quality of final products is critical and is often required in clinical diagnostic laboratories [1,2]. To date, the methodology has been little utilised in research proteomics. It has been shown to be capable of delivering quantitative QC procedures for qualitative clinical assays [3] making it an ideal methodology to apply to this area of biological research. To introduce statistical process control as an objective strategy for quality control and show how it could be used to benefit proteomics researchers and enhance the quality of the results they generate. We demonstrate that rules which provide basic quality control are easy to derive and implement and could have a major impact on data quality for many studies. Statistical process control is a powerful tool for investigating and improving proteomics research work-flows. The process of characterising measurement systems and defining control rules forces the exploration of key questions that can lead to significant improvements in performance. This work asserts that QC is essential to proteomics discovery experiments. Every experimenter must know the current capabilities of their measurement system and have an objective means for tracking and ensuring that performance. Proteomic analysis work-flows are complicated and multi-variate. QC is critical for clinical chemistry measurements and huge strides have been made in ensuring the quality and validity of results in clinical biochemistry labs. This work introduces some of these QC concepts and works to bridge their use from single analyte QC to applications in multi-analyte systems. This article is part of a Special Issue entitled: Standardization and Quality Control in Proteomics. Copyright © 2013 The Author. Published by Elsevier B.V. All rights reserved.

The effects of integrated care on quality of work in nursing homes: a quasi-experiment.

PubMed

Boumans, Nicolle P G; Berkhout, Afke J M B; Vijgen, Sylvia M C; Nijhuis, Frans J N; Vasse, Rineke M

2008-08-01

In nursing homes there is a gradual move from traditional care to integrated care. Integrated care means a demand-oriented, small-scale, co-operated and coordinated provision of services by different caregivers. This integration has direct effect on the work of these separate disciplines. With the introduction of integrated care the quality of work of these caregivers should be assured or even be improved. The purpose of this study was to examine the implementation of integrated care in the nursing home sector and its effects on the quality of work of the caregivers (work content, communication and co-operation and worker's outcomes). A non-equivalent pre-test/post-test control group design was used in this study. Two nursing homes in the Netherlands participated in the study. One nursing home provided the five experimental nursing wards and the other nursing home provided four control wards. Data were selected by means of written questionnaires. The results showed that the intervention appeared to be only successful on the somatic wards. The caregivers of these wards were more able to create a home-like environment for their residents, to use a demand-oriented working method and to integrate the provision of care and services. Regarding the effects of the intervention on quality of work factors, the results included an increase of social support by the supervisor, an increase of the degree of collaboration and a decrease in job demands. No changes were found for the worker's outcomes such as job satisfaction. The intervention on the psycho-somatic wards was unsuccessful. Although the introduction of integrated care on the somatic wards was successful, the effects on quality of work were limited. Next to quantitative research, more qualitative in-depth research is needed to examine models of integrated care and their effects on the work of caregivers within health care organisations, with special attention for specific characteristics of different types of nursing home care (somatic vs. psycho-geriatric).

The consistency approach for quality control of vaccines - a strategy to improve quality control and implement 3Rs.

PubMed

De Mattia, Fabrizio; Chapsal, Jean-Michel; Descamps, Johan; Halder, Marlies; Jarrett, Nicholas; Kross, Imke; Mortiaux, Frederic; Ponsar, Cecile; Redhead, Keith; McKelvie, Jo; Hendriksen, Coenraad

2011-01-01

Current batch release testing of established vaccines emphasizes quality control of the final product and is often characterized by extensive use of animals. This report summarises the discussions of a joint ECVAM/EPAA workshop on the applicability of the consistency approach for routine release of human and veterinary vaccines and its potential to reduce animal use. The consistency approach is based upon thorough characterization of the vaccine during development and the principle that the quality of subsequent batches is the consequence of the strict application of a quality system and of a consistent production of batches. The concept of consistency of production is state-of-the-art for new-generation vaccines, where batch release is mainly based on non-animal methods. There is now the opportunity to introduce the approach into established vaccine production, where it has the potential to replace in vivo tests with non-animal tests designed to demonstrate batch quality while maintaining the highest quality standards. The report indicates how this approach may be further developed for application to established human and veterinary vaccines and emphasizes the continuing need for co-ordination and harmonization. It also gives recommendations for work to be undertaken in order to encourage acceptance and implementation of the consistency approach. Copyright © 2011. Published by Elsevier Ltd.. All rights reserved.

Evaluation Methodology for UML and GML Application Schemas Quality

NASA Astrophysics Data System (ADS)

Chojka, Agnieszka

2014-05-01

INSPIRE Directive implementation in Poland has caused the significant increase of interest in making spatial data and services available, particularly among public administration and private institutions. This entailed a series of initiatives that aim to harmonise different spatial data sets, so to ensure their internal logical and semantic coherence. Harmonisation lets to reach the interoperability of spatial databases, then among other things enables joining them together. The process of harmonisation requires either working out new data structures or adjusting existing data structures of spatial databases to INSPIRE guidelines and recommendations. Data structures are described with the use of UML and GML application schemas. Although working out accurate and correct application schemas isn't an easy task. There should be considered many issues, for instance recommendations of ISO 19100 series of Geographic Information Standards, appropriate regulations for given problem or topic, production opportunities and limitations (software, tools). In addition, GML application schema is deeply connected with UML application schema, it should be its translation. Not everything that can be expressed in UML, though can be directly expressed in GML, and this can have significant influence on the spatial data sets interoperability, and thereby the ability to valid data exchange. For these reasons, the capability to examine and estimate UML and GML application schemas quality, therein also the capability to explore their entropy, would be very important. The principal subject of this research is to propose an evaluation methodology for UML and GML application schemas quality prepared in the Head Office of Geodesy and Cartography in Poland within the INSPIRE Directive implementation works.

Organizing a breast cancer database: data management.

PubMed

Yi, Min; Hunt, Kelly K

2016-06-01

Developing and organizing a breast cancer database can provide data and serve as valuable research tools for those interested in the etiology, diagnosis, and treatment of cancer. Depending on the research setting, the quality of the data can be a major issue. Assuring that the data collection process does not contribute inaccuracies can help to assure the overall quality of subsequent analyses. Data management is work that involves the planning, development, implementation, and administration of systems for the acquisition, storage, and retrieval of data while protecting it by implementing high security levels. A properly designed database provides you with access to up-to-date, accurate information. Database design is an important component of application design. If you take the time to design your databases properly, you'll be rewarded with a solid application foundation on which you can build the rest of your application.

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

PubMed

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

2018-02-01

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

A survey on clinical governance awareness among clinical staff: a cross-sectional study.

PubMed

Ravaghi, Hamid; Zarnaq, Rahim Khodayari; Adel, Amin; Badpa, Mahnaz; Adel, Moein; Abolhassani, Nazanin

2014-06-25

Clinical Governance (CG) program has been raised in Iran in order to improve the quality of clinical care. The purpose of this study is to investigate the awareness of clinical governance program among clinical staff working in selected teaching hospitals in Tehran, Iran. To investigate the CG awareness, a cross-sectional survey was conducted among 345 clinical staff working in 20 selected public hospitals in Tehran. Data were gathered using the standardized clinical governance awareness questionnaire. Descriptive statistics were used to analyze the data. The results showed that the level of staff awareness about the concept of CG was low. They perceived continuous quality improvement, responsibility, medical errors reduction and patient safety as the main concepts of the CG framework. Reaching agreement of standards concepts among staff and positive changes in attitudes were considered as two most observed changes. The main perceived barriers to the implementation of clinical governance included lack of proper management and leadership, lack of full support, inappropriate organizational culture, lack of knowledge, poor communication system and insufficient training. The concepts and goals of clinical governance have not been effectively conveyed to the staff and despite its implementation in the hospitals, there has been low clinical governance awareness among the staff. Clinical Governance must be implemented through comprehensive management support and participation of all staff and health professionals at both hospital and policy making level.

"Keeping on track"-Hospital nurses' struggles with maintaining workflow while seeking to integrate evidence-based practice into their daily work: A grounded theory study.

PubMed

Renolen, Åste; Høye, Sevald; Hjälmhult, Esther; Danbolt, Lars Johan; Kirkevold, Marit

2018-01-01

Evidence-based practice is considered a foundation for the provision of quality care and one way to integrate scientific knowledge into clinical problem-solving. Despite the extensive amount of research that has been conducted to evaluate evidence-based practice implementation and research utilization, these practices have not been sufficiently incorporated into nursing practice. Thus, additional research regarding the challenges clinical nurses face when integrating evidence-based practice into their daily work and the manner in which these challenges are approached is needed. The aim of this study was to generate a theory about the general patterns of behaviour that are discovered when clinical nurses attempt to integrate evidence-based practice into their daily work. We used Glaser's classical grounded theory methodology to generate a substantive theory. The study was conducted in two different medical wards in a large Norwegian hospital. In one ward, nurses and nursing assistants were developing and implementing new evidence-based procedures, and in the other ward, evidence-based huddle boards for risk assessment were being implemented. A total of 54 registered nurses and 9 assistant nurses were observed during their patient care and daily activities. Of these individuals, thirteen registered nurses and five assistant nurses participated in focus groups. These participants were selected through theoretical sampling. Data were collected during 90h of observation and 4 focus groups conducted from 2014 to 2015. Each focus group session included four to five participants and lasted between 55 and 65min. Data collection and analysis were performed concurrently, and the data were analysed using the constant comparative method. "Keeping on track" emerged as an explanatory theory for the processes through which the nurses handled their main concern: the risk of losing the workflow. The following three strategies were used by nurses when attempting to integrate evidence-based practices into their daily work: "task juggling", "pausing for considering" and "struggling along with quality improvement". The "keeping on track" theory contributes to the body of knowledge regarding clinical nurses' experiences with evidence-based practice integration. The nurses endeavoured to minimize workflow interruptions to avoid decreasing the quality of patient care provided, and evidence-based practices were seen as a consideration that was outside of their ordinary work duties. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Effectiveness of e-learning in hospitals.

PubMed

Chuo, Yinghsiang; Liu, Chuangchun; Tsai, Chunghung

2015-01-01

Because medical personnel share different work shifts (i.e., three work shifts) and do not have a fixed work schedule, implementing timely, flexible, and quick e-learning methods for their continued education is imperative. Hospitals are currently focusing on developing e-learning. This study aims to explore the key factors that influence the effectiveness of e-learning in medical personnel. This study recruited medical personnel as the study participants and collected sample data by using the questionnaire survey method. This study is based on the information systems success model (IS success model), a significant model in MIS research. This study found that the factors (i.e., information quality, service quality, convenience, and learning climate) influence the e-learning satisfaction and in turn influence effectiveness in medical personnel. This study provided recommendations to medical institutions according to the derived findings, which can be used as a reference when establishing e-learning systems in the future.

The nature nursing quality of work life: an integrative review of literature.

PubMed

Vagharseyyedin, Seyyed Abolfazl; Vanaki, Zohreh; Mohammadi, Eesa

2011-10-01

Studies that have examined the nursing quality of work life (QWL) have not been systematically reviewed in the recent years. Thus, the current study was aimed to identify the predictors of the nurses' QWL and determine the definitions of QWL for nurses. The authors used an integrative review of the literature and identified six themes as the major predictors of the nurses' QWL: leadership and management style/decision-making latitude, shift working, salary and fringe benefits, relationship with colleagues, demographic characteristics, and workload/job strain. Although different researchers had varied perspectives on the QWL in nursing, most viewed QWL as a subjective phenomenon that is influenced by personal feeling and perceptions. A closer review of definitions of QWL indicated that some authors considered QWL as an "outcome," whereas others saw it as a "process." Further research needs to be conducted to determine the relative importance of QWL predictors, and implementation programs to improve the QWL.

Enhancing Research Capacity for Global Health: Evaluation of a Distance-Based Program for International Study Coordinators

ERIC Educational Resources Information Center

Wilson, Lynda Law; Rice, Marti; Jones, Carolynn T.; Joiner, Cynthia; LaBorde, Jennifer; McCall, Kimberly; Jester, Penelope M.; Carter, Sheree C.; Boone, Chrissy; Onwuzuligbo, Uzoma; Koneru, Alaya

2013-01-01

Introduction: Due to the increasing number of clinical trials conducted globally, there is a need for quality continuing education for health professionals in clinical research manager (CRM) roles. This article describes the development, implementation, and evaluation of a distance-based continuing education program for CRMs working outside the…

Can the Tools of Activity Theory Help Us in Advancing Understanding and Organisational Change in Undergraduate Medical Education?

ERIC Educational Resources Information Center

Reid, Anne-Marie; Ledger, Alison; Kilminster, Sue; Fuller, Richard

2015-01-01

Continued changes to healthcare delivery in the UK, and an increasing focus on patient safety and quality improvement, require a radical rethink on how we enable graduates to begin work in challenging, complex environments. Professional regulatory bodies now require undergraduate medical schools to implement an "assistantship" period in…

76 FR 40237 - Approval and Disapproval and Promulgation of Air Quality Implementation Plans; Montana; Revisions...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-07-08

... before permit issuance. The rule only allows installing concrete foundations work, below ground plumbing...)), submitted on May 28, 2003; 17.8.743 (except the phrases ``asphalt concrete plants, mineral crushers'' in 17... following provisions in Subchapter 7: ARM 17.8.743(1)(c) and ARM 17.8.770, the phrase ``asphalt concrete...

Teacher Reflection in Indonesia: Lessons Learnt from a Lesson Study Program

ERIC Educational Resources Information Center

Suratno, Tatang; Iskandar, Sofyan

2010-01-01

Although reflection is seen as a means to improve teacher professionalism, its practice in Indonesia has a scant regard until the lesson study program was implemented around the year 2005. In Indonesian context, lesson study is a process by which teachers and teacher educators work together to critically improve the quality of classroom practice…

Quality of Working Life in the Automobile Industry: A Canada-UK Comparative Study.

ERIC Educational Resources Information Center

Lewchuk, Wayne; Stewart, Paul; Yates, Charlotte

2001-01-01

Surveys in five automobile plants in Canada and the United Kingdom (n=2,600+) indicated that implementation of lean production methods has been uneven across companies and countries and is not associated with greater employee involvement or control. Variations may reflect company-specific responses to the pressures of international competition.…

In-House Course Work for Salary Step Credits: The Program at McLennan Community College.

ERIC Educational Resources Information Center

Harrell, Ann; Schormann, Randall

On-campus credit courses for the professional development of community college faculty have proven to be a highly effective means of improving the quality of instruction at McLennan Community College (Waco, Texas). If carefully designed, implemented, and evaluated, these courses can provide an appropriate alternative to faculty enrollment in…

78 FR 58987 - Approval of Air Quality Implementation Plans; Navajo Nation; Regional Haze Requirements for...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-09-25

... hold five public hearings to accept written and oral comment on our proposed BART determination for NGS. On July 26, 2013, a group of stakeholders, known as the Technical Work Group (TWG), submitted its... included as part of the public comment. If EPA cannot read your comment due to technical difficulties and...

Defense Health Care. Comprehensive Oversight Framework Needed to Help Ensure Effective Implementation of a Deployment Health Quality Assurance Program

DTIC Science & Technology

2007-06-01

Virus IPV Inactivated Poliovirus MMR Measles, Mumps, and Rubella This is a work of the U.S. government and is not subject to copyright protection...rubella), inactivated poliovirus (IPV), hepatitis B, and influenza (once per season). • Pass: all immunizations current • Fail: overdue for one or more

Developing a Learning Object Metadata Application Profile Based on LOM Suitable for the Australian Higher Education Context

ERIC Educational Resources Information Center

Agostinho, Shirley; Bennett, Sue; Lockyer, Lori; Harper, Barry

2004-01-01

This paper reports recent work in developing of structures and processes that support university teachers and instructional designers incorporating learning objects into higher education focused learning designs. The aim of the project is to develop a framework to guide the design and implementation of high quality learning experiences. This…

Lenses on Reading: An Introduction to Theories and Models. Second Edition

ERIC Educational Resources Information Center

Tracey, Diane H.; Morrow, Lesley Mandel

2012-01-01

This widely adopted text explores key theories and models that frame reading instruction and research. Readers learn why theory matters in designing and implementing high-quality instruction and research; how to critically evaluate the assumptions and beliefs that guide their own work; and what can be gained by looking at reading through multiple…

Customization in the Design and Implementation of the RiverWeb Water Quality Simulator (WQS).

ERIC Educational Resources Information Center

Verona, Mary Ellen; Curtis, David

When developing curriculum materials for new contexts, designers feed forward work from similar projects. This customization process must attend to various influences to determine how features from previous efforts will be emphasized and combined. This paper discusses resources and ideas that influenced the design of the RiverWeb Water Quality…

Facilitators and barriers of implementing and delivering social prescribing services: a systematic review.

PubMed

Pescheny, Julia Vera; Pappas, Yannis; Randhawa, Gurch

2018-02-07

Social Prescribing is a service in primary care that involves the referral of patients with non-clinical needs to local services and activities provided by the third sector (community, voluntary, and social enterprise sector). Social Prescribing aims to promote partnership working between the health and the social sector to address the wider determinants of health. To date, there is a weak evidence base for Social Prescribing services. The objective of the review was to identify factors that facilitate and hinder the implementation and delivery of SP services based in general practice involving a navigator. We searched eleven databases, the grey literature, and the reference lists of relevant studies to identify the barriers and facilitators to the implementation and delivery of Social Prescribing services in June and July 2016. Searches were limited to literature written in English. No date restrictions were applied. Findings were synthesised narratively, employing thematic analysis. The Mixed Methods Appraisal Tool Version 2011 was used to evaluate the methodological quality of included studies. Eight studies were included in the review. The synthesis identified a range of factors that facilitate and hinder the implementation and delivery of SP services. Facilitators and barriers were related to: the implementation approach, legal agreements, leadership, management and organisation, staff turnover, staff engagement, relationships and communication between partners and stakeholders, characteristics of general practices, and the local infrastructure. The quality of most included studies was poor and the review identified a lack of published literature on factors that facilitate and hinder the implementation and delivery of Social Prescribing services. The review identified a range of factors that facilitate and hinder the implementation and delivery of Social Prescribing services. Findings of this review provide an insight for commissioners, managers, and providers to guide the implementation and delivery of future Social Prescribing services. More high quality research and transparent reporting of findings is needed in this field.

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

DTIC Science & Technology

1990-05-01

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

Quality management system in the CIEMAT Radiation Dosimetry Service.

PubMed

Martín, R; Navarro, T; Romero, A M; López, M A

2011-03-01

This paper describes the activities realised by the CIEMAT Radiation Dosimetry Service (SDR) for the implementation of a quality management system (QMS) in order to achieve compliance with the requirements of ISO/IEC 17025 and to apply for the accreditation for testing measurements of radiation dose. SDR has decided the accreditation of the service as a whole and not for each of its component laboratories. This makes it necessary to design a QMS common to all, thus ensuring alignment and compliance with standard requirements, and simplifying routine works as possible.

Improving patient care through student leadership in team quality improvement projects.

PubMed

Tschannen, Dana; Aebersold, Michelle; Kocan, Mary Jo; Lundy, Francene; Potempa, Kathleen

2015-01-01

In partnership with a major medical center, senior-level nursing students completed a root cause analysis and implementation plan to address a unit-specific quality issue. To evaluate the project, unit leaders were asked their perceptions of the value of the projects and impact on patient care, as well as to provide exemplars depicting how the student root cause analysis work resulted in improved patient outcome and/or unit processes. Liaisons noted benefits of having an RCA team, with positive impact on patient outcomes and care processes.

Information Management System for the California State Water Resources Control Board (SWRCB)

NASA Technical Reports Server (NTRS)

Heald, T. C.; Redmann, G. H.

1973-01-01

A study was made to establish the requirements for an integrated state-wide information management system for water quality control and water quality rights for the State of California. The data sources and end requirements were analyzed for the data collected and used by the numerous agencies, both State and Federal, as well as the nine Regional Boards under the jurisdiction of the State Board. The report details the data interfaces and outlines the system design. A program plan and statement of work for implementation of the project is included.

Flying qualities criteria for GA single pilot IFR operations

NASA Technical Reports Server (NTRS)

Bar-Gill, A.

1982-01-01

The flying qualities criteria in general aviation (GA) to decrease accidents are discussed. The following in-flight research is discussed: (1) identification of key aerodynamic configurations; (2) implementation of an in-flight simulator; (3) mission matrix design; (4) experimental systems; (5) data reduction; (6) optimal flight path reconstruction. Some of the accomplished work is reported: an integrated flight testing and flight path reconstruction methodology was developd, high accuracy in trajectory estimation was achieved with an experimental setup, and a part of the flight test series was flown.

Working with Research Integrity-Guidance for Research Performing Organisations: The Bonn PRINTEGER Statement.

PubMed

Forsberg, Ellen-Marie; Anthun, Frank O; Bailey, Sharon; Birchley, Giles; Bout, Henriette; Casonato, Carlo; Fuster, Gloria González; Heinrichs, Bert; Horbach, Serge; Jacobsen, Ingrid Skjæggestad; Janssen, Jacques; Kaiser, Matthias; Lerouge, Inge; van der Meulen, Barend; de Rijcke, Sarah; Saretzki, Thomas; Sutrop, Margit; Tazewell, Marta; Varantola, Krista; Vie, Knut Jørgen; Zwart, Hub; Zöller, Mira

2018-05-31

This document presents the Bonn PRINTEGER Consensus Statement: Working with Research Integrity-Guidance for research performing organisations. The aim of the statement is to complement existing instruments by focusing specifically on institutional responsibilities for strengthening integrity. It takes into account the daily challenges and organisational contexts of most researchers. The statement intends to make research integrity challenges recognisable from the work-floor perspective, providing concrete advice on organisational measures to strengthen integrity. The statement, which was concluded February 7th 2018, provides guidance on the following key issues: § 1. Providing information about research integrity § 2. Providing education, training and mentoring § 3. Strengthening a research integrity culture § 4. Facilitating open dialogue § 5. Wise incentive management § 6. Implementing quality assurance procedures § 7. Improving the work environment and work satisfaction § 8. Increasing transparency of misconduct cases § 9. Opening up research § 10. Implementing safe and effective whistle-blowing channels § 11. Protecting the alleged perpetrators § 12. Establishing a research integrity committee and appointing an ombudsperson § 13. Making explicit the applicable standards for research integrity.

Review of implementation strategies to change healthcare provider behaviour in the emergency department.

PubMed

de Wit, Kerstin; Curran, Janet; Thoma, Brent; Dowling, Shawn; Lang, Eddy; Kuljic, Nebojsa; Perry, Jeffrey J; Morrison, Laurie

2018-05-01

Advances in emergency medicine research can be slow to make their way into clinical care, and implementing a new evidence-based intervention can be challenging in the emergency department. The Canadian Association of Emergency Physicians (CAEP) Knowledge Translation Symposium working group set out to produce recommendations for best practice in the implementation of a new science in Canadian emergency departments. A systematic review of implementation strategies to change health care provider behaviour in the emergency department was conducted simultaneously with a national survey of emergency physician experience. We summarized our findings into a list of draft recommendations that were presented at the national CAEP Conference 2017 and further refined based on feedback through social media strategies. We produced 10 recommendations for implementing new evidence-based interventions in the emergency department, which cover identifying a practice gap, evaluating the evidence, planning the intervention strategy, monitoring, providing feedback during implementation, and desired qualities of future implementation research. We present recommendations to guide future emergency department implementation initiatives. There is a need for robust and well-designed implementation research to guide future emergency department implementation initiatives.

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review.

PubMed

O'Reilly, Pauline; Lee, Siew Hwa; O'Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne

2017-01-01

Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362.

Assessing the facilitators and barriers of interdisciplinary team working in primary care using normalisation process theory: An integrative review

PubMed Central

O’Reilly, Pauline; Lee, Siew Hwa; O’Sullivan, Madeleine; Cullen, Walter; Kennedy, Catriona; MacFarlane, Anne

2017-01-01

Background Interdisciplinary team working is of paramount importance in the reform of primary care in order to provide cost-effective and comprehensive care. However, international research shows that it is not routine practice in many healthcare jurisdictions. It is imperative to understand levers and barriers to the implementation process. This review examines interdisciplinary team working in practice, in primary care, from the perspective of service providers and analyses 1 barriers and facilitators to implementation of interdisciplinary teams in primary care and 2 the main research gaps. Methods and findings An integrative review following the PRISMA guidelines was conducted. Following a search of 10 international databases, 8,827 titles were screened for relevance and 49 met the criteria. Quality of evidence was appraised using predetermined criteria. Data were analysed following the principles of framework analysis using Normalisation Process Theory (NPT), which has four constructs: sense making, enrolment, enactment, and appraisal. The literature is dominated by a focus on interdisciplinary working between physicians and nurses. There is a dearth of evidence about all NPT constructs apart from enactment. Physicians play a key role in encouraging the enrolment of others in primary care team working and in enabling effective divisions of labour in the team. The experience of interdisciplinary working emerged as a lever for its implementation, particularly where communication and respect were strong between professionals. Conclusion A key lever for interdisciplinary team working in primary care is to get professionals working together and to learn from each other in practice. However, the evidence base is limited as it does not reflect the experiences of all primary care professionals and it is primarily about the enactment of team working. We need to know much more about the experiences of the full network of primary care professionals regarding all aspects of implementation work. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO 2015: CRD42015019362. PMID:28545038

River Water Pollution Status and Water Policy Scenario in Ethiopia: Raising Awareness for Better Implementation in Developing Countries.

PubMed

Awoke, Aymere; Beyene, Abebe; Kloos, Helmut; Goethals, Peter L M; Triest, Ludwig

2016-10-01

Despite the increasing levels of pollution in many tropical African countries, not much is known about the strength and weaknesses of policy and institutional frameworks to tackle pollution and ecological status of rivers and their impacts on the biota. We investigated the ecological status of four large river basins using physicochemical water quality parameters and bioindicators by collecting samples from forest, agriculture, and urban landscapes of the Nile, Omo-Gibe, Tekeze, and Awash River basins in Ethiopia. We also assessed the water policy scenario to evaluate its appropriateness to prevent and control pollution. To investigate the level of understanding and implementation of regulatory frameworks and policies related to water resources, we reviewed the policy documents and conducted in-depth interviews of the stakeholders. Physicochemical and biological data revealed that there is significant water quality deterioration at the impacted sites (agriculture, coffee processing, and urban landscapes) compared to reference sites (forested landscapes) in all four basins. The analysis of legal, policy, and institutional framework showed a lack of cooperation between stakeholders, lack of knowledge of the policy documents, absence of enforcement strategies, unavailability of appropriate working guidelines, and disconnected institutional setup at the grass root level to implement the set strategies as the major problems. In conclusion, river water pollution is a growing challenge and needs urgent action to implement intersectoral collaboration for water resource management that will eventually lead toward integrated watershed management. Revision of policy and increasing the awareness and participation of implementers are vital to improve ecological quality of rivers.

Application of color mixing for safety and quality inspection of agricultural products

NASA Astrophysics Data System (ADS)

Ding, Fujian; Chen, Yud-Ren; Chao, Kuanglin

2005-11-01

In this paper, color-mixing applications for food safety and quality was studied, including two-color mixing and three-color mixing. It was shown that the chromaticness of the visual signal resulting from two- or three-color mixing is directly related to the band ratio of light intensity at the two or three selected wavebands. An optical visual device using color mixing to implement the band ratio criterion was presented. Inspection through human vision assisted by an optical device that implements the band ratio criterion would offer flexibility and significant cost savings as compared to inspection with a multispectral machine vision system that implements the same criterion. Example applications of this optical color mixing technique were given for the inspection of chicken carcasses with various diseases and for the detection of chilling injury in cucumbers. Simulation results showed that discrimination by chromaticness that has a direct relation with band ratio can work very well with proper selection of the two or three narrow wavebands. This novel color mixing technique for visual inspection can be implemented on visual devices for a variety of applications, ranging from target detection to food safety inspection.

Quality of work life, burnout, and stress in emergency department physicians: a qualitative review.

PubMed

Bragard, Isabelle; Dupuis, Gilles; Fleet, Richard

2015-08-01

A 2006 literature review reported that emergency department (ED) physicians showed elevated burnout levels and highlighted several environment and personal issues contributing toward burnout. Research on burnout in EDs is limited. We propose an updated qualitative review on the relationships between work stress, burnout, and quality of work life in ED physicians. We searched MEDLINE, PsycInfo, and Science Direct for studies published since 2005. Of 491 papers, 10 papers were retained, using validated measures and having a minimum of 75 participants. Data extraction was performed manually by the first author and was reviewed by the second author. The majority of the studies used large samples, cross-sectional designs, random, and/or stratified assignment. ED physicians showed moderate to high levels of burnout with difficult work conditions including significant psychological demands, lack of resources, and poor support. Nonetheless, physicians reported high job satisfaction. Further studies should focus on the implementation of measures designed to prevent burnout.

Pediatric resident perceptions of shift work in ward rotations.

PubMed

Nomura, Osamu; Mishina, Hiroki; Jasti, Harish; Sakai, Hirokazu; Ishiguro, Akira

2017-10-01

Although the long working hours of physicians are considered to be a social issue, no effective policies such as duty hour regulations have so far been proposed in Japan. We implemented an overnight call shift (OCS) system for ward rotations to improve the working environment for residents in a pediatric residency program. We later conducted a cross-sectional questionnaire asking the residents to compare this system with the traditional overnight call system. Forty-one pediatric residents participated in this survey. The residents felt that the quality of patient care improved (80.4% agreed). Most felt that there was less emphasis on education (26.8%) and more emphasis on service (31.7%). Overall, the residents reported that the OCS was beneficial (90.2%). In conclusion, the pediatric residents considered the OCS system during ward rotations as beneficial. Alternative solutions are vital to balance improvements in resident work conditions with the requirement for a high quality of education. © 2017 Japan Pediatric Society.

Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.

PubMed

Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

2014-11-01

Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. WHAT IS KNOWN ABOUT THE TOPIC?: Aboriginal Australians experience disparities in access to recommended care for acute coronary syndrome. This may contribute to the life expectancy gap between Aboriginal and non-Aboriginal Australians. WHAT DOES THIS PAPER ADD?: This paper describes a model of care involving an Aboriginal Hospital Liaisons Officer and a specialist cardiac nurse working together to improve hospital care and attendance at cardiac rehabilitation services for Aboriginal Australians with acute coronary syndrome. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS?: The working together model of care could be implemented across mainstream health services where Aboriginal people attend for specialist care.

77 FR 52277 - Approval of Air Quality Implementation Plans; California; South Coast Air Quality Management...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-08-29

... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... rule. SUMMARY: EPA is proposing approval of a permitting rule submitted for the South Coast Air Quality Management District (District) portion of the California State Implementation Plan (SIP). The State is...

78 FR 63878 - Approval and Promulgation of Air Quality Implementation Plans; Virginia; Revised Ambient Air...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-10-25

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78 FR 30829 - Approval and Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-23

... Promulgation of Air Quality Implementation Plans; Illinois; Air Quality Standards Revision AGENCY... the Illinois State Implementation Plan (SIP) to reflect current national ambient air quality standards...) 692-2450. 4. Mail: Pamela Blakley, Chief, Control Strategies Section, Air Programs Branch (AR-18J), U...

75 FR 19886 - Approval and Promulgation of Air Quality Implementation Plans; Wyoming; Revisions to the Wyoming...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-04-16

... Promulgation of Air Quality Implementation Plans; Wyoming; Revisions to the Wyoming Air Quality Standards and.... Wyoming has revised its Air Quality Standards and Regulations, specifically Chapter 1, Section 5... Wyoming's State Implementation Plan (SIP). These revisions amend Wyoming's Air Quality Standards and...

Taking Root: a grounded theory on evidence-based nursing implementation in China.

PubMed

Cheng, L; Broome, M E; Feng, S; Hu, Y

2018-06-01

Evidence-based nursing is widely recognized as the critical foundation for quality care. To develop a middle-range theory on the process of evidence-based nursing implementation in Chinese context. A grounded theory study using unstructured in-depth individual interviews was conducted with 56 participants who were involved in 24 evidence-based nursing implementation projects in Mainland China from September 2015 to September 2016. A middle-range grounded theory of 'Taking Root' was developed. The theory describes the evidence implementation process consisting of four components (driving forces, process, outcome, sustainment/regression), three approaches (top-down, bottom-up and outside-in), four implementation strategies (patient-centred, nurses at the heart of change, reaching agreement, collaboration) and two patterns (transformational and adaptive implementation). Certain perspectives may have not been captured, as the retrospective nature of the interviewing technique did not allow for 'real-time' assessment of the actual implementation process. The transferability of the findings requires further exploration as few participants with negative experiences were recruited. This is the first study that explored evidence-based implementation process, strategies, approaches and patterns in the Chinese nursing practice context to inform international nursing and health policymaking. The theory of Taking Root described various approaches to evidence implementation and how the implementation can be transformational for the nurses and the setting in which they work. Nursing educators, managers and researchers should work together to improve nurses' readiness for evidence implementation. Healthcare systems need to optimize internal mechanisms and external collaborations to promote nursing practice in line with evidence and achieve clinical outcomes and sustainability. © 2017 International Council of Nurses.

Assessment of an intervention to train teaching hospital care providers in quality management

PubMed Central

Francois, P; Vinck, D; Labarere, J; Reverdy, T; Peyrin, J

2005-01-01

Background: Successful implementation of continuous quality improvement (CQI) programs in hospitals remains rare in all countries, making it necessary to experiment with implementation methods while considering the cultural factors of resistance to change. Objective: To assess the impact of an educational intervention on involvement of clinical department staff in the quality process. Setting: Twelve voluntary clinical departments (six experimental and six controls) in a French 2000-bed university hospital comprising 40 clinical departments. Intervention: Three day training seminar to a group of 12–20 staff members from each department. Design: Quasi-experimental post-test only design study with control group conducted 12 months after the intervention with a questionnaire completed in a face-to-face interview. Subjects: 98 trained staff and 100 untrained staff from the six experimental departments and 100 staff from the six control departments. Principal measurements: Declared knowledge of the CQI methods and participation in quality management activities. Results: 286 people (96%) were involved in the study. More of the trained staff knew the CQI methods (62.4%) than staff in the control departments (16.5%) (adjusted odds ratio (ORa) = 10.6 (95% CI 4.97 to 22.62)). More trained staff also participated in quality improvement work groups than control department staff (76.3% v 14.0%; ORa = 27.4 (95% CI 11.6 to 64.4)). In the experimental departments the untrained staff's knowledge of CQI methods and their participation in work groups did not differ from that of control department staff. Conclusions: A continuing education intervention can involve care providers in CQI. Dissemination of knowledge from trained personnel to other staff members remains limited. PMID:16076785

High quality diabetes care: testing the effectiveness of strategies of regional implementation teams.

PubMed

Drach-Zahavy, Anat; Shadmi, Efrat; Freund, Anat; Goldfracht, Margalit

2009-01-01

The purpose of this article is to identify and test the effectiveness of work strategies employed by regional implementation teams to attain high quality care for diabetes patients. The study was conducted in a major health maintenance organization (HMO) that provides care for 70 per cent of Israel's diabetes patients. A sequential mixed model design, combining qualitative and quantitative methods was employed. In-depth interviews were conducted with members of six regional implementation teams, each responsible for the care of 25,000-34,000 diabetic patients. Content analysis of the interviews revealed that teams employed four key strategies: task-interdependence, goal-interdependence, reliance on top-down standardised processes and team-learning. These strategies were used to predict the mean percentage performance of eight evidence-based indicators of diabetes care: percentage of patients with HbA1c < 7 per cent, blood pressure < or = 130/80 and cholesterol < or = 100; and performance of: HbA1c tests, LDL cholesterol tests, blood pressure measurements, urine protein tests, and ophthalmic examinations. Teams were found to vary in their use of the four strategies. Mixed linear models analysis indicated that type of indicator (simple process, compound process, and outcome) and goal interdependence were significantly linked to team effectiveness. For simple-process indicators, reliance on top-down standardised processes led to team effectiveness, but for outcome measures this strategy was ineffective, and even counter-effective. For outcome measures, team-learning was more beneficial. The findings have implications for the management of chronic diseases. The advantage of allowing team members flexibility in the choice of the best work strategy to attain high quality diabetes care is attested.

78 FR 44485 - Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-07-24

...] Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State Implementation Plan... Rule Regarding ``Implementation of the 2008 National Ambient Air Quality Standards for Ozone: State... ground-level ozone formation. B. What should I consider as I prepare my comments for the EPA? 1...

Pilot trial of IOM duty hour recommendations in neurology residency programs: unintended consequences.

PubMed

Schuh, L A; Khan, M A; Harle, H; Southerland, A M; Hicks, W J; Falchook, A; Schultz, L; Finney, G R

2011-08-30

To study the potential effect of the 2008 Institute of Medicine (IOM) work duty hour (WDH) recommendations on neurology residency programs. This study evaluated resident sleepiness, personal study hours, quality of life, and satisfaction and faculty satisfaction during a control month using the Accreditation Council for Graduate Medical Education WDH requirements and during an intervention month using the IOM WDH recommendations. Resident participation in both schedules was mandatory, but both resident and faculty participation in the outcome measures was voluntary. Thirty-four residents (11 postgraduate year [PGY]-4, 9 PGY-3, and 14 PGY-2) participated. End-of-work shift sleepiness, mean weekly sleep hours, personal study hours, and hours spent in lectures did not differ between the control and intervention months. Resident quality of life measured by the Maslach Burnout Inventory declined for 1 subscore in the intervention month (p = 0.03). Resident education satisfaction declined during the intervention month for issues related to continuity of care, patient hand-offs, and knowledge of their patients. Faculty satisfaction declined during the intervention month, without a decline in quality of life. The results from 3 residency programs suggest that the IOM WDH recommendations may negatively affect neurology resident education. This study was limited by the short duration of implementation, negative bias against the IOM recommendations, and inability to blind faculty. Additional study of the IOM WDH recommendations is warranted before widespread implementation.

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.

Process-driven information management system at a biotech company: concept and implementation.

PubMed

Gobbi, Alberto; Funeriu, Sandra; Ioannou, John; Wang, Jinyi; Lee, Man-Ling; Palmer, Chris; Bamford, Bob; Hewitt, Robin

2004-01-01

While established pharmaceutical companies have chemical information systems in place to manage their compounds and the associated data, new startup companies need to implement these systems from scratch. Decisions made early in the design phase usually have long lasting effects on the expandability, maintenance effort, and costs associated with the information management system. Careful analysis of work and data flows, both inter- and intradepartmental, and identification of existing dependencies between activities are important. This knowledge is required to implement an information management system, which enables the research community to work efficiently by avoiding redundant registration and processing of data and by timely provision of the data whenever needed. This paper first presents the workflows existing at Anadys, then ARISE, the research information management system developed in-house at Anadys. ARISE was designed to support the preclinical drug discovery process and covers compound registration, analytical quality control, inventory management, high-throughput screening, lower throughput screening, and data reporting.

Integrating Science and Engineering to Implement Evidence-Based Practices in Health Care Settings.

PubMed

Wu, Shinyi; Duan, Naihua; Wisdom, Jennifer P; Kravitz, Richard L; Owen, Richard R; Sullivan, J Greer; Wu, Albert W; Di Capua, Paul; Hoagwood, Kimberly Eaton

2015-09-01

Integrating two distinct and complementary paradigms, science and engineering, may produce more effective outcomes for the implementation of evidence-based practices in health care settings. Science formalizes and tests innovations, whereas engineering customizes and optimizes how the innovation is applied tailoring to accommodate local conditions. Together they may accelerate the creation of an evidence-based healthcare system that works effectively in specific health care settings. We give examples of applying engineering methods for better quality, more efficient, and safer implementation of clinical practices, medical devices, and health services systems. A specific example was applying systems engineering design that orchestrated people, process, data, decision-making, and communication through a technology application to implement evidence-based depression care among low-income patients with diabetes. We recommend that leading journals recognize the fundamental role of engineering in implementation research, to improve understanding of design elements that create a better fit between program elements and local context.

[Development and Implementation of a Comprehensive Health Management System (Fit for Work and Life) for Employees of a University Hospital - A Practice Report].

PubMed

Gutenbrunner, C; Egen, C; Kahl, K G; Briest, J; Tegtbur, U; Miede, J; Born, M

2017-07-01

Background: Due to the increase of sick leave, prolonging working life and the prediction of shortage of skilled workers in the future, health management systems are continuously gaining importance. Employees in a University Hospital are exposed to particular stress factors, which are also reflected in a higher than average amount of sick leave. Against this background, the project "Fit for Work and Life" (FWL) was developed and implemented by the Hannover Medical School (MHH). Aims: FWL aims to maintain, improve or recover the work ability of employees by offering both preventive and rehabilitative treatments. A second goal is to significantly reduce the days of sick leave. Methods: The project was jointly developed and implemented by five MHH departments and the DRV Braunschweig-Hannover (DRV BS-H) according to previously defined principles. It was scientifically evaluated by the following outcomes: average days of sick leave, work ability (WAI), quality of life (SF-36, WHOQOL), coping strategies (FERUS) and effort-reward imbalance (ERI). Results and Conclusions: So far, this project is unique in its concept. It has been successfully implemented in the organisational structures of the MHH. 376 employees have registered during the first project year. Up to now, 182 participants have completed their individual programmes. The results show that 60.4% of employees have moderate to poor WAI values. The average of the mental summary scale of the SF-36 was 44.9, indicating a high workload. © Georg Thieme Verlag KG Stuttgart · New York.

Effectiveness of Workplace Interventions in Return-to-Work for Musculoskeletal, Pain-Related and Mental Health Conditions: An Update of the Evidence and Messages for Practitioners.

PubMed

Cullen, K L; Irvin, E; Collie, A; Clay, F; Gensby, U; Jennings, P A; Hogg-Johnson, S; Kristman, V; Laberge, M; McKenzie, D; Newnam, S; Palagyi, A; Ruseckaite, R; Sheppard, D M; Shourie, S; Steenstra, I; Van Eerd, D; Amick, B C

2018-03-01

Purpose The objective of this systematic review was to synthesize evidence on the effectiveness of workplace-based return-to-work (RTW) interventions and work disability management (DM) interventions that assist workers with musculoskeletal (MSK) and pain-related conditions and mental health (MH) conditions with RTW. Methods We followed a systematic review process developed by the Institute for Work & Health and an adapted best evidence synthesis that ranked evidence as strong, moderate, limited, or insufficient. Results Seven electronic databases were searched from January 1990 until April 2015, yielding 8898 non-duplicate references. Evidence from 36 medium and high quality studies were synthesized on 12 different intervention categories across three broad domains: health-focused, service coordination, and work modification interventions. There was strong evidence that duration away from work from both MSK or pain-related conditions and MH conditions were significantly reduced by multi-domain interventions encompassing at least two of the three domains. There was moderate evidence that these multi-domain interventions had a positive impact on cost outcomes. There was strong evidence that cognitive behavioural therapy interventions that do not also include workplace modifications or service coordination components are not effective in helping workers with MH conditions in RTW. Evidence for the effectiveness of other single-domain interventions was mixed, with some studies reporting positive effects and others reporting no effects on lost time and work functioning. Conclusions While there is substantial research literature focused on RTW, there are only a small number of quality workplace-based RTW intervention studies that involve workers with MSK or pain-related conditions and MH conditions. We recommend implementing multi-domain interventions (i.e. with healthcare provision, service coordination, and work accommodation components) to help reduce lost time for MSK or pain-related conditions and MH conditions. Practitioners should also consider implementing these programs to help improve work functioning and reduce costs associated with work disability.

Implementation of a competency assessment tool for agency nurses working in an acute paediatric setting.

PubMed

Hennerby, Cathy; Joyce, Pauline

2011-03-01

This paper reports on the implementation of a competency assessment tool for registered general agency nurses working in an acute paediatric setting, using a change management framework. The increased number of registered general agency nurses working in an acute children's hospital alerted concerns around their competency in working with children. These concerns were initially raised via informal complaints about 'near misses', parental dissatisfaction, perceived competency weaknesses and rising cost associated with their use. [Young's (2009) Journal of Organisational Change, 22, 524-548] nine-stage change framework was used to guide the implementation of the competency assessment tool within a paediatric acute care setting. The ongoing success of the initiative, from a nurse manager's perspective, relies on structured communication with the agency provider before employing competent agency nurses. Sustainability of the change will depend on nurse managers' persistence in attending the concerns of those resisting the change while simultaneously supporting those championing the change. These key communication and supporting roles highlight the pivotal role held by nurse managers, as gate keepers, in safe-guarding children while in hospital. Leadership qualities of nurse managers will also be challenged in continuing to manage and drive the change where resistance might prevail. © 2011 The Authors. Journal compilation © 2011 Blackwell Publishing Ltd.

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.

Implementation and Analysis of Real-Time Streaming Protocols.

PubMed

Santos-González, Iván; Rivero-García, Alexandra; Molina-Gil, Jezabel; Caballero-Gil, Pino

2017-04-12

Communication media have become the primary way of interaction thanks to the discovery and innovation of many new technologies. One of the most widely used communication systems today is video streaming, which is constantly evolving. Such communications are a good alternative to face-to-face meetings, and are therefore very useful for coping with many problems caused by distance. However, they suffer from different issues such as bandwidth limitation, network congestion, energy efficiency, cost, reliability and connectivity. Hence, the quality of service and the quality of experience are considered the two most important issues for this type of communication. This work presents a complete comparative study of two of the most used protocols of video streaming, Real Time Streaming Protocol (RTSP) and the Web Real-Time Communication (WebRTC). In addition, this paper proposes two new mobile applications that implement those protocols in Android whose objective is to know how they are influenced by the aspects that most affect the streaming quality of service, which are the connection establishment time and the stream reception time. The new video streaming applications are also compared with the most popular video streaming applications for Android, and the experimental results of the analysis show that the developed WebRTC implementation improves the performance of the most popular video streaming applications with respect to the stream packet delay.

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.

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

PubMed

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

2013-01-01

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

An in-depth analysis of pharmaceutical regulation in the Republic of Moldova

PubMed Central

2014-01-01

Objective Regulation of the pharmaceutical system is a crucial, yet often neglected, component in ensuring access to safe and effective medicines. The aim of this study was to provide an in-depth analysis of the existing pharmaceutical regulation, including recent changes, in the Republic of Moldova. Methods Data from field work conducted by the World Health Organization (WHO) together with a review of policy documents and quantitative secondary data analysis was used to achieve this aim. Results This analysis identified several ways in which pharmaceutical regulation affects availability of quality medicines in the Republic of Moldova. These include lack of full implementation bioequivalence requirements for generics registration, incomplete implementation of good manufacturing practices and no implementation of good distribution practices, use of quality control instead of quality assurance as a method to ensure quality of medicines, frequent change of power within the Medicines and Medical Devices Agency (MMDA) leading to lack of long-term strategy and plans, conflict of interest between the different functions of the MMDA, the lack of sufficient funding for the MMDA to conduct its activities and to invest in continuous training of its staff (particularly inspectors) and very weak post-marketing control. Notably, several improvements have been recently introduced, including a roadmap for change for the MMDA, the introduction of good manufacturing practices and the drafting of a quality manual for the Agency. Conclusion Based on these findings the authors propose a set of priority actions to address existing gaps and draw lessons learned from other countries. PMID:25848544

Evaluating a community-based program to improve healthcare quality: research design for the Aligning Forces for Quality initiative.

PubMed

Scanlon, Dennis P; Alexander, Jeffrey A; Beich, Jeff; Christianson, Jon B; Hasnain-Wynia, Romana; McHugh, Megan C; Mittler, Jessica N; Shi, Yunfeng; Bodenschatz, Laura J

2012-09-01

The Aligning Forces for Quality (AF4Q) initiative is the Robert Wood Johnson Foundation's (RWJF's) signature effort to increase the overall quality of healthcare in targeted communities throughout the country. In addition to sponsoring this 16-site, complex program, the RWJF funds an independent scientific evaluation to support objective research on the initiative's effectiveness and contributions to basic knowledge in 5 core programmatic areas. The research design, data, and challenges faced in the evaluation of this 10-year initiative are discussed. A descriptive overview of the evaluation research design for a multi-site, community based, healthcare quality improvement initiative is provided. The multiphase research design employed by the evaluation team is discussed. Evaluation provides formative feedback to the RWJF, participants, and other interested audiences in real time; develops approaches to assess innovative and under-studied interventions; furthers the analysis and understanding of effective community-based collaborative work in healthcare; and helps to differentiate the various facilitators, barriers, and contextual dimensions that affect the implementation and outcomes of community-based health interventions. The AF4Q initiative is arguably the largest community-level healthcare improvement demonstration in the United States to date; it is being implemented at a time of rapid change in national healthcare policy. The implementation of large-scale, multi-site initiatives is becoming an increasingly common approach for addressing problems in healthcare. The evaluation research design for the AF4Q initiative, and the lessons learned from its approach, may be valuable to others tasked with evaluating similar community-based initiatives.

Canada-wide standards and innovative transboundary air quality initiatives.

PubMed

Barton, Jane

2008-01-01

Canada's approach to air quality management is one that has brought with it opportunities for the development of unique approaches to risk management. Even with Canada's relatively low levels of pollution, science has demonstrated clearly that air quality and ecosystem improvements are worthwhile. To achieve change and address air quality in Canada, Canadian governments work together since, under the constitution, they share responsibility for the environment. At the same time, because air pollution knows no boundaries, working with the governments of other nations is essential to get results. International cooperation at all levels provides opportunities with potential for real change. Cooperation within transboundary airsheds is proving a fruitful source of innovative opportunities to reduce cross-border barriers to air quality improvements. In relation to the NERAM Colloquium objective to establish principles for air quality management based on the identification of international best practice in air quality policy development and implementation, Canada has developed, both at home and with the United States, interesting air management strategies and initiatives from which certain lessons may be taken that could be useful in other countries with similar situations. In particular, the Canada-wide strategies for smog and acid rain were developed by Canadian governments, strategies that improve and protect air quality at home, while Canada-U.S. transboundary airshed projects provide examples of international initiatives to improve air quality.

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

PubMed

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

2018-05-25

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

75 FR 65594 - Approval and Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-26

... Promulgation of Air Quality Implementation Plans; Ohio; Ohio Ambient Air Quality Standards AGENCY... the Ohio Administrative Code (OAC) relating to the consolidation of Ohio's Ambient Air Quality Standards (AAQS) into Ohio's State Implementation Plan (SIP) under the Clean Air Act. On April 8, 2009, and...

77 FR 12524 - Approval and Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-03-01

... Promulgation of Air Quality Implementation Plans; Indiana; Lead Ambient Air Quality Standards AGENCY... Indiana State Implementation Plan (SIP) for lead (Pb) under the Clean Air Act (CAA). This submittal incorporates the National Ambient Air Quality Standards (NAAQS) for Pb promulgated by EPA in 2008. DATES...

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

PubMed

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

2013-04-05

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

Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis

PubMed Central

Abu Dabrh, Abd Moain; Gionfriddo, Michael R.; Erwin, Patricia; Montori, Victor M.

2018-01-01

Background The Chronic Care Model (CCM) emerged in the 1990s as an approach to re-organize primary care and implement critical elements that enable it to proactively attend to patients with chronic conditions. The chronic care landscape has evolved further, as most patients now present with multiple chronic conditions and increasing psychosocial complexity. These patients face accumulating and overwhelming complexity resulting from the sum of uncoordinated responses to each of their problems. Minimally Disruptive Medicine (MDM) was proposed to respond to this challenge, aiming at improving outcomes that matter to patients with the smallest burden of treatment. We sought to critically appraise the extent to which MDM constructs (e.g., reducing patient work, improving patients’ capacity) have been adopted within CCM implementations. Methods We conducted a systematic review and qualitative thematic synthesis of reports of CCM implementations published from 2011–2016. Results CCM implementations were mostly aligned with the healthcare system’s goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Few implementations aimed at improving functional status or quality of life, and only one-third of studies were targeted for patients of low socioeconomic status. Conclusion MDM provides a lens to operationalize how to care for patients with multiple chronic conditions, but its constructs remain mostly absent from how implementations of the CCM are currently reported. Improvements to the primary care of patients with multimorbidity may benefit from the application of MDM, and the current CCM implementations that do apply MDM constructs should be considered exemplars for future implementation work. PMID:29420543

Implementing quality initiatives in healthcare organizations: drivers and challenges.

PubMed

Abdallah, Abdallah

2014-01-01

Various quality initiatives seem to have successful implementation in some healthcare organizations yet fail in others. This paper sets out to study the literature trying to understand drivers and challenges facing quality initiatives implementation in healthcare organizations then compare findings from literature with those of a structured questionnaire answered by 60 representatives from 18 hospitals. Finally it proposes a framework that mitigates challenges and utilizes drivers to ensure best implementation results. Literature regarding implementing various quality initiatives in the healthcare sector was reviewed. Representatives from several healthcare organizations were surveyed. Results from both approaches are compared to highlight the key challenges and drivers facing implementers. This research reveals that internal factors related to leadership and employees greatly affect quality initiative success or failure. Design and relevance play a major role in successful implementation. PRACTICAL IMPLICATIONs: This research offers healthcare professionals greater success when implementing certain quality initiatives by taking success/failure factors into consideration. A general framework for successful implementation in the healthcare sector is provided. This article uncovers reasons behind success or failure in a comprehensive and practical way. It also explores how most popular quality initiatives are applied in hospitals.

Air quality management: evolution of policy and practice in the UK as exemplified by the experience of English local government

NASA Astrophysics Data System (ADS)

Beattie, C. I.; Longhurst, J. W. S.; Woodfield, N. K.

The air quality management (AQM) framework in the UK is designed to be an effects-based solution to air pollutants currently affecting human health. The AQM process has been legislated through The Environment Act 1995, which required the National Air Quality Strategy (NAQS) to be published. AQM practice and capability within local authorities has flourished since the publication of the NAQS in March 1997. This paper outlines the policy framework within which the UK operates, both at a domestic and European level, and reviews the air quality management process relating to current UK policy and EU policy. Data from questionnaire surveys are used to indicate the involvement of various sectors of local government in the air quality management process. These data indicate an increasing use of monitoring, and use of air dispersion modelling by English local authorities. Data relating to the management of air quality, for example, the existence and work of air quality groups, dissemination of information to the public and policy measures in place on a local scale to improve air quality, have also been reported. The UK NAQS has been reviewed in 1999 to reflect developments in European legislation, technological and scientific advances, improved air pollution modelling techniques and an increasingly better understanding of the socio-economic issues involved. The AQM process, as implemented by UK local authorities, provides an effective model for other European member states with regards to the implementation of the Air Quality Framework Directive. The future direction of air quality policy in the UK is also discussed.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts.

PubMed

Shah, Hemant; Allard, Raymond D; Enberg, Robert; Krishnan, Ganesh; Williams, Patricia; Nadkarni, Prakash M

2012-03-09

A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies.

Requirements for guidelines systems: implementation challenges and lessons from existing software-engineering efforts

PubMed Central

2012-01-01

Background A large body of work in the clinical guidelines field has identified requirements for guideline systems, but there are formidable challenges in translating such requirements into production-quality systems that can be used in routine patient care. Detailed analysis of requirements from an implementation perspective can be useful in helping define sub-requirements to the point where they are implementable. Further, additional requirements emerge as a result of such analysis. During such an analysis, study of examples of existing, software-engineering efforts in non-biomedical fields can provide useful signposts to the implementer of a clinical guideline system. Methods In addition to requirements described by guideline-system authors, comparative reviews of such systems, and publications discussing information needs for guideline systems and clinical decision support systems in general, we have incorporated additional requirements related to production-system robustness and functionality from publications in the business workflow domain, in addition to drawing on our own experience in the development of the Proteus guideline system (http://proteme.org). Results The sub-requirements are discussed by conveniently grouping them into the categories used by the review of Isern and Moreno 2008. We cite previous work under each category and then provide sub-requirements under each category, and provide example of similar work in software-engineering efforts that have addressed a similar problem in a non-biomedical context. Conclusions When analyzing requirements from the implementation viewpoint, knowledge of successes and failures in related software-engineering efforts can guide implementers in the choice of effective design and development strategies. PMID:22405400

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

PubMed

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

2016-09-01

Measuring and monitoring overall health system performance is complex and challenging but is crucial to improving quality of care. Today's health care organizations are increasingly being held accountable to develop and implement actions aimed at improving the quality of care, reducing costs, and achieving better patient-centered care. This paper describes the development of the Collaborative for Excellence in Healthcare Quality (CEHQ), a 5-year initiative to achieve higher quality of patient care in university hospitals across Canada. This bottom-up initiative took place between 2010 and 2015, and was successful in engaging health care leaders in the development of a common framework and set of performance measures for reporting and benchmarking, as well as working on initiatives to improve performance. Despite its successes, future efforts are needed to provide clear national leadership on standards for measuring performance. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Design of Work Facilities for Reducing Musculoskeletal Disorders Risk in Paper Pallet Assembly Station

NASA Astrophysics Data System (ADS)

Mardi Safitri, Dian; Arfi Nabila, Zahra; Azmi, Nora

2018-03-01

Musculoskeletal Disorders (MSD) is one of the ergonomic risks due to manual activity, non-neutral posture and repetitive motion. The purpose of this study is to measure risk and implement ergonomic interventions to reduce the risk of MSD on the paper pallet assembly work station. Measurements to work posture are done by Ovako Working Posture Analysis (OWAS) methods and Rapid Entire Body Assessment (REBA) method, while the measurement of work repetitiveness was using Strain Index (SI) method. Assembly processes operators are identified has the highest risk level. OWAS score, Strain Index, and REBA values are 4, 20.25, and 11. Ergonomic improvements are needed to reduce that level of risk. Proposed improvements will be developed using the Quality Function Deployment (QFD) method applied with Axiomatic House of Quality (AHOQ) and Morphological Chart. As the result, risk level based on OWAS score & REBA score turn out from 4 & 11 to be 1 & 2. Biomechanics analysis of the operator also shows the decreasing values for L4-L5 moment, compression, joint shear, and joint moment strength.

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

PubMed Central

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

2015-01-01

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

Chemometrics-based process analytical technology (PAT) tools: applications and adaptation in pharmaceutical and biopharmaceutical industries.

PubMed

Challa, Shruthi; Potumarthi, Ravichandra

2013-01-01

Process analytical technology (PAT) is used to monitor and control critical process parameters in raw materials and in-process products to maintain the critical quality attributes and build quality into the product. Process analytical technology can be successfully implemented in pharmaceutical and biopharmaceutical industries not only to impart quality into the products but also to prevent out-of-specifications and improve the productivity. PAT implementation eliminates the drawbacks of traditional methods which involves excessive sampling and facilitates rapid testing through direct sampling without any destruction of sample. However, to successfully adapt PAT tools into pharmaceutical and biopharmaceutical environment, thorough understanding of the process is needed along with mathematical and statistical tools to analyze large multidimensional spectral data generated by PAT tools. Chemometrics is a chemical discipline which incorporates both statistical and mathematical methods to obtain and analyze relevant information from PAT spectral tools. Applications of commonly used PAT tools in combination with appropriate chemometric method along with their advantages and working principle are discussed. Finally, systematic application of PAT tools in biopharmaceutical environment to control critical process parameters for achieving product quality is diagrammatically represented.

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

PubMed

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

2015-03-31

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

Practical implementation science: developing and piloting the quality implementation tool.

PubMed

Meyers, Duncan C; Katz, Jason; Chien, Victoria; Wandersman, Abraham; Scaccia, Jonathan P; Wright, Annie

2012-12-01

According to the Interactive Systems Framework for Dissemination and Implementation, implementation is a major mechanism and concern in bridging research and practice. The growing number of implementation frameworks need to be synthesized and translated so that the science and practice of quality implementation can be furthered. In this article, we: (1) use the synthesis of frameworks developed by Meyers et al. (Am J Commun Psychol, 2012) and translate the results into a practical implementation science tool to use for improving quality of implementation (i.e., the Quality Implementation Tool; QIT), and (2) present some of the benefits and limitations of the tool by describing how the QIT was implemented in two different pilot projects. We discuss how the QIT can be used to guide collaborative planning, monitoring, and evaluation of how an innovation is implemented.

Burnout and distress among internal medicine program directors: results of a national survey.

PubMed

West, Colin P; Halvorsen, Andrew J; Swenson, Sara L; McDonald, Furman S

2013-08-01

Physician burnout and distress has been described in national studies of practicing physicians, internal medicine (IM) residents, IM clerkship directors, and medical school deans. However, no comparable national data exist for IM residency program directors. To assess burnout and distress among IM residency program directors, and to evaluate relationships of distress with personal and program characteristics and perceptions regarding implementation and consequences of Accreditation Council for Graduate Medical Education (ACGME) regulations. The 2010 Association of Program Directors in Internal Medicine (APDIM) Annual Survey, developed by the APDIM Survey Committee, was sent in August 2010 to the 377 program directors with APDIM membership, representing 99.0 % of the 381 United States categorical IM residency programs. The 2010 APDIM Annual Survey included validated items on well-being and distress, including questions addressing quality of life, satisfaction with work-life balance, and burnout. Questions addressing personal and program characteristics and perceptions regarding implementation and consequences of ACGME regulations were also included. Of 377 eligible program directors, 282 (74.8 %) completed surveys. Among respondents, 12.4 % and 28.8 % rated their quality of life and satisfaction with work-life balance negatively, respectively. Also, 27.0 % reported emotional exhaustion, 10.4 % reported depersonalization, and 28.7 % reported overall burnout. These rates were lower than those reported previously in national studies of medical students, IM residents, practicing physicians, IM clerkship directors, and medical school deans. Aspects of distress were more common among younger program directors, women, and those reporting greater weekly work hours. Work-home conflicts were common and associated with all domains of distress, especially if not resolved in a manner effectively balancing work and home responsibilities. Associations with program characteristics such as program size and American Board of Internal Medicine (ABIM) pass rates were not found apart from higher rates of depersonalization among directors of community-based programs (23.5 % vs. 8.6 %, p = 0.01). We did not observe any consistent associations between distress and perceptions of implementation and consequences of program regulations. The well-being of IM program directors across domains, including quality of life, satisfaction with work-life balance, and burnout, appears generally superior to that of medical trainees, practicing physicians, and other medical educators nationally. Additionally, it is reassuring that program directors' perceptions of their ability to respond to current regulatory requirements are not adversely associated with distress. However, the increased distress levels among younger program directors, women, and those at community-based training programs reported in this study are important concerns worthy of further study.

2011 John M. Eisenberg Patient Safety and Quality Awards. Mentored implementation: building leaders and achieving results through a collaborative improvement model. Innovation in patient safety and quality at the national level.

PubMed

Maynard, Gregory A; Budnitz, Tina L; Nickel, Wendy K; Greenwald, Jeffrey L; Kerr, Kathleen M; Miller, Joseph A; Resnic, JoAnne N; Rogers, Kendall M; Schnipper, Jeffrey L; Stein, Jason M; Whitcomb, Winthrop F; Williams, Mark V

2012-07-01

The Society of Hospital Medicine (SHM) created "Mentored Implementation" (MI) programs with the dual aims of educating and mentoring hospitalists and their quality improvement (QI) teams and accelerating improvement in the inpatient setting in three signature programs: Venous Thromboembolism (VTE) Prevention, Glycemic Control, and Project BOOST (Better Outcomes for Older adults through Safe Transitions). More than 300 hospital improvement teams were enrolled in SHM MI programs in a series of cohorts. Hospitalist mentors worked with individual hospitals/health systems to guide local teams through the life cycle of a QI project. Implementation Guides and comprehensive Web-based "Resource Rooms," as well as the mentor's own experience, provided best-practice definitions, practical implementation tips, measurement strategies, and other tools. E-mail interactions and mentoring were augmented by regularly scheduled teleconferences; group webinars; and, in some instances, a site visit. Performance was tracked in a centralized data tracking center. Preliminary data on all three MI programs show significant improvement in patient outcomes, as well as enhancements of communication and leadership skills of the hospitalists and their QI teams. Although objective data on outcomes and process measures for the MI program's efficacy remain preliminary at this time, the maturing data tracking system, multiple awards, and early results indicate that the MI programs are successful in providing QI training and accelerating improvement efforts.

Affecting culture change and performance improvement in Medicaid nursing homes: the Promote Understanding, Leadership, and Learning (PULL) Program.

PubMed

Eliopoulos, Charlotte

2013-01-01

A growing number of nursing homes are implementing culture change programming to create a more homelike environment in which residents and direct care staff are empowered with greater participation in care activities. Although nursing homes that have adopted culture change practices have brought about positive transformation in their settings that have improved quality of care and life, as well as increased resident and staff satisfaction, they represent a minority of all nursing homes. Nursing homes that serve primarily a Medicaid population without supplemental sources of funding have been limited in the resources to support such change processes. The purpose of this project was to gain insight into effective strategies to provide culture change and quality improvement programming to low-performing, under-resourced nursing homes that represent the population of nursing homes least likely to have implemented this programming. Factors that interfered with transformation were identified and insights were gained into factors that need to be considered before transformational processes can be initiated. Effective educational strategies and processes that facilitate change in these types of nursing homes were identified. Despite limitations to the study, there was evidence that the experiences and findings can be of value to other low-performing, under-resourced nursing homes. Ongoing clinical work and research are needed to refine the implementation process and increase the ability to help these settings utilize resources and implement high quality cost effective care to nursing home residents. Copyright © 2013 Mosby, Inc. All rights reserved.

Design of a medical and laboratory equipment management program for the new standards certification achievement in Mexico.

PubMed

Franco-Clark, D; Pimentel-Aguilar, A B; Rodriguez-Vera, R

2010-01-01

Certification for healthcare institutions in Mexico is ruled by 2009 standards homologated with the Joint Commission International criteria. Nowadays, healthcare requires of medical equipment and devices, so it has become necessary to implement guidelines for its adequate management in order to reach the highest level of quality and safety at the lowest cost. The objective of this work was to develop a Medical and Laboratory Equipment Management Program, oriented to the improvement of quality, effectiveness and efficiency of the technological resources in order to meet the certification requirements. The result of this work allows to have an auto evaluation tool that focuses the efforts of the National Institute for Respiratory Diseases to the achievement of the new requirements established for the certification.

Improving quality for maternal care - a case study from Kerala, India

PubMed Central

Vlad, Ioana; Paily, VP; Sadanandan, Rajeev; Cluzeau, Françoise; Beena, M; Nair, Rajasekharan; Newbatt, Emma; Ghosh, Sujit; Sandeep, K; Chalkidou, Kalipso

2016-01-01

Background: The implementation of maternal health guidelines remains unsatisfactory, even for simple, well established interventions. In settings where most births occur in health facilities, as is the case in Kerala, India, preventing maternal mortality is linked to quality of care improvements. Context: Evidence-informed quality standards (QS), including quality statements and measurable structure and process indicators, are one innovative way of tackling the guideline implementation gap. Having adopted a zero tolerance policy to maternal deaths, the Government of Kerala worked in partnership with the Kerala Federation of Obstetricians & Gynaecologists (KFOG) and NICE International to select the clinical topic, develop and initiate implementation of the first clinical QS for reducing maternal mortality in the state. Description of practice: The NICE QS development framework was adapted to the Kerala context, with local ownership being a key principle. Locally generated evidence identified post-partum haemorrhage as the leading cause of maternal death, and as the key priority for the QS. A multidisciplinary group (including policy-makers, gynaecologists and obstetricians, nurses and administrators) was established. Multi-stakeholder workshops convened by the group ensured that the statements, derived from global and local guidelines, and their corresponding indicators were relevant and acceptable to clinicians and policy-makers in Kerala. Furthermore, it helped identify practical methods for implementing the standards and monitoring outcomes. Lessons learned: An independent evaluation of the project highlighted the equal importance of a strong evidence-base and an inclusive development process. There is no one-size-fits-all process for QS development; a principle-based approach might be a better guide for countries to adapt global evidence to their local context. PMID:27441084

Interdisciplinary integration for quality improvement: the Cleveland Veterans Affairs Medical Center Firm System.

PubMed

Aucott, J N; Pelecanos, E; Bailey, A J; Shupe, T C; Romeo, J H; Ravdin, J I; Aron, D C

1995-04-01

Many of the characteristics of Firm Systems lend themselves to the application of principles of continuous quality improvement (CQI). A Firm System is defined as two or more parallel practices organized on the principle of continuity of relationships between patients and an interdisciplinary group of health care professionals and trainees. Firm Systems are organized around the care of the patient or customer and emphasize access, continuity, and quality of care. The Firm System was implemented at the Cleveland Veterans Affairs Medical Center (VAMC) not as a CQI initiative per se, but as an effort to coordinate the processes involved in the delivery of patient care. The primary goals of this implementation were to improve the quality of patient care, medical education, and health care research. The main strategy to deal with problems caused by uncoordinated care were to move from a departmental approach to an integrated interdisciplinary approach. This approach represented a paradigm shift within the organization that extended to planning, documentation, and the general work environment. Most important, the institution had leaders who were committed to the Firm System and willing to authorize resources to ensure its success. VA hospitals are ideal settings for Firm Systems because they provide longitudinal, comprehensive care with a centralized, prepaid payment mechanism, and they have well-developed information systems that allow the random assignment of patients to Firms. Recommendations to others interested in implementing Firm Systems include creation of a written plan that can gain general support; identification of resources needed for successful implementation; remembering that the patient is the most important customer, as well as that complex systems have many customers; monitoring of performance; and the importance of randomizing patients and providers.

Low-Cost Oil Quality Sensor Based on Changes in Complex Permittivity

PubMed Central

Pérez, Angel Torres; Hadfield, Mark

2011-01-01

Real time oil quality monitoring techniques help to protect important industry assets, minimize downtime and reduce maintenance costs. The measurement of a lubricant’s complex permittivity is an effective indicator of the oil degradation process and it can be useful in condition based maintenance (CBM) to select the most adequate oil replacement maintenance schedules. A discussion of the working principles of an oil quality sensor based on a marginal oscillator to monitor the losses of the dielectric at high frequencies (>1 MHz) is presented. An electronic design procedure is covered which results in a low cost, effective and ruggedized sensor implementation suitable for use in harsh environments. PMID:22346666

75 FR 61369 - Revisions to the California State Implementation Plan; Sacramento Metropolitan Air Quality...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

... the California State Implementation Plan; Sacramento Metropolitan Air Quality Management District... approve a revision to the Sacramento Metropolitan Air Quality Management District's portion of the... Metropolitan Air Quality Management District (SMAQMD) adopted the ``Ozone State Implementation Plan Revision...

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

PubMed

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

2013-08-01

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

Biomek 3000: the workhorse in an automated accredited forensic genetic laboratory.

PubMed

Stangegaard, Michael; Meijer, Per-Johan; Børsting, Claus; Hansen, Anders J; Morling, Niels

2012-10-01

We have implemented and validated automated protocols for a wide range of processes such as sample preparation, PCR setup, and capillary electrophoresis setup using small, simple, and inexpensive automated liquid handlers. The flexibility and ease of programming enable the Biomek 3000 to be used in many parts of the laboratory process in a modern forensic genetics laboratory with low to medium sample throughput. In conclusion, we demonstrated that sample processing for accredited forensic genetic DNA typing can be implemented on small automated liquid handlers, leading to the reduction of manual work as well as increased quality and throughput.

Improving the Quality of Academic Services through Implementation of Internal Quality Assurance System in State Institute of Islamic Studies STS Jambi

ERIC Educational Resources Information Center

Iskandar

2017-01-01

Implementation of quality assurance systems in IAIN STS Jambi implemented in early 2012, through the build system of internal quality assurance based on ISO 9001: 2008, in the process of implementation required strong reasons behind not growing atmosphere of academic standards of accreditation of study programs and institutions that are reflected…

Governance for public health and health equity: The Tröndelag model for public health work.

PubMed

Lillefjell, Monica; Magnus, Eva; Knudtsen, Margunn SkJei; Wist, Guri; Horghagen, Sissel; Espnes, Geir Arild; Maass, Ruca; Anthun, Kirsti Sarheim

2018-06-01

Multi-sectoral governance of population health is linked to the realization that health is the property of many societal systems. This study aims to contribute knowledge and methods that can strengthen the capacities of municipalities regarding how to work more systematically, knowledge-based and multi-sectoral in promoting health and health equity in the population. Process evaluation was conducted, applying a mixed-methods research design, combining qualitative and quantitative data collection methods. Processes strengthening systematic and multi-sectoral development, implementation and evaluation of research-based measures to promote health, quality of life, and health equity in, for and with municipalities were revealed. A step-by-step model, that emphasizes the promotion of knowledge-based, systematic, multi-sectoral public health work, as well as joint ownership of local resources, initiatives and policies has been developed. Implementation of systematic, knowledge-based and multi-sectoral governance of public health measures in municipalities demand shared understanding of the challenges, updated overview of the population health and impact factors, anchoring in plans, new skills and methods for selection and implementation of measures, as well as development of trust, ownership, shared ethics and goals among those involved.

Implementation of quality management in early stages of research and development projects at a university.

PubMed

Fiehe, Sandra; Wagner, Georg; Schlanstein, Peter; Rosefort, Christiane; Kopp, Rüdger; Bensberg, Ralf; Knipp, Peter; Schmitz-Rode, Thomas; Steinseifer, Ulrich; Arens, Jutta

2014-04-01

The ultimate objective of university research and development projects is usually to create knowledge, but also to successfully transfer results to industry for subsequent marketing. We hypothesized that the university technology transfer requires efficient measures to improve this important step. Besides good scientific practice, foresighted and industry-specific adapted documentation of research processes in terms of a quality management system might improve the technology transfer. In order to bridge the gap between research institute and cooperating industry, a model project has been accompanied by a project specific amount of quality management. However, such a system had to remain manageable and must not constrain the researchers' creativity. Moreover, topics and research team are strongly interdisciplinary, which entails difficulties regarding communication because of different perspectives and terminology. In parallel to the technical work of the model project, an adaptable quality management system with a quality manual, defined procedures, and forms and documents accompanying the research, development and validation was implemented. After process acquisition and analysis the appropriate amount of management for the model project was identified by a self-developed rating system considering project characteristics like size, innovation, stakeholders, interdisciplinarity, etc. Employees were trained according to their needs. The management was supported and the technical documentation was optimized. Finally, the quality management system has been transferred successfully to further projects.

Financial Management. Working for Clean Water: An Information Program for Advisory Groups. Instructor Guide.

ERIC Educational Resources Information Center

Auker, Dennis; And Others

The implementation of water quality programs in the face of rising costs raises many questions for states and local communities, including: How much can taxpayers afford to pay? Who will pay? How can they pay? Described is an hour-long learning session on financial management that is designed to help citizen advisory groups play an integral role…

Tracking Perceived and Observed Growth of Inquiry Practice: A Formative Plan to Improve Professional Development Experiences

ERIC Educational Resources Information Center

Marshall, Jeff C.; Smart, Julie; Horton, Robert M.

2011-01-01

The authors worked with 22 middle school math and science teachers for one year with the goal of improving the quantity and quality of inquiry-based instruction implemented in the classroom. The professional development experience was framed by the 4E x 2 Instruction Model, which combines key components of inquiry instruction (Engage, Explore,…

The (digital) natives are restless: designing and implementing an interactive digital media assignment.

PubMed

Voge, Catherine; Hirvela, Kari; Jarzemsky, Paula

2012-01-01

To create an opportunity for students to connect with the Quality and Safety Education for Nurses competencies and demonstrate learning via knowledge transference, the authors piloted a digital media assignment. Students worked in small groups to create an unfolding patient care scenario with embedded decision points, using presentation software. The authors discuss the assignment and its outcomes.

Skilled nursing facilities reform.

PubMed

1998-06-01

The Medicare prospective payment system for skilled nursing facilities will take effect with cost reporting years beginning on or after July 1, 1998. HCFA is working on the implementation details. While final details are not expected to be published until Summer 1998, the following information has been provided through HCFA and/or the Nursing Home Case-Mix and Quality (NHCMQ) Demonstration project (RUGs-III) procedures.

Creating a Community of Inquiry in Large-Enrollment Online Courses: An Exploratory Study on the Effect of Protocols within Online Discussions

ERIC Educational Resources Information Center

Chen, Baiyun; deNoyelles, Aimee; Patton, Kerry; Zydney, Janet

2017-01-01

It can be difficult to foster focused and effective communication in online discussions within large classes. Implementing protocols is a strategy that may help students communicate more effectively, facilitate their learning process, and improve the quality of their work within online discussions. In this exploratory research study, a protocol…

Building a safety culture in global health: lessons from Guatemala.

PubMed

Rice, Henry E; Lou-Meda, Randall; Saxton, Anthony T; Johnston, Bria E; Ramirez, Carla C; Mendez, Sindy; Rice, Eli N; Aidar, Bernardo; Taicher, Brad; Baumgartner, Joy Noel; Milne, Judy; Frankel, Allan S; Sexton, J Bryan

2018-01-01

Programmes to modify the safety culture have led to lasting improvements in patient safety and quality of care in high-income settings around the world, although their use in low-income and middle-income countries (LMICs) has been limited. This analysis explores (1) how to measure the safety culture using a health culture survey in an LMIC and (2) how to use survey data to develop targeted safety initiatives using a paediatric nephrology unit in Guatemala as a field test case. We used the Safety, Communication, Operational Reliability, and Engagement survey to assess staff views towards 13 health climate and engagement domains. Domains with low scores included personal burnout, local leadership, teamwork and work-life balance. We held a series of debriefings to implement interventions targeted towards areas of need as defined by the survey. Programmes included the use of morning briefings, expansion of staff break resources and use of teamwork tools. Implementation challenges included the need for education of leadership, limited resources and hierarchical work relationships. This report can serve as an operational guide for providers in LMICs for use of a health culture survey to promote a strong safety culture and to guide their quality improvement and safety programmes.

Austin Clean Cities: Implementing a voluntary alternative fuel program in an attainment area, or getting our act together and taking it on the road

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

Hannemann, L.W.

1995-12-31

Austin is the only city in attainment that has chosen to join the Clean Cities program. A recent emissions inventory completed by the City`s Air Quality Program shows that the largest single contributor to Austin`s deteriorating air quality is on-road mobile sources. Implementing the Clean Cities Program is one proactive step they are taking to keep the air clean. Although Austin Clean Cities chose to be fuel neutral they have found that propane and natural gas are the natural choices for them to use. The author was asked to address the potential pitfalls in setting up a Clean Cities program,more » and 20/20 hindsight reveals that Austin had a few housekeeping chores to attend to before starting the real work. There are lots of little details necessary to get an organization like this up and running and then keeping it healthy. These details need to be identified and addressed upfront and before any real work can be done. The advantage is that one gets a network that is able to gather, evaluate and disseminate information, and one gets a clean city.« less

Best evidence on the educational effects of undergraduate portfolios.

PubMed

Buckley, Sharon; Coleman, Jamie; Khan, Khalid

2010-09-01

The great variety of portfolio types and schemes used in the education of health professionals is reflected in the extensive and diverse educational literature relating to portfolio use. We have recently completed a Best Evidence Medical Education (BEME) systematic review of the literature relating to the use of portfolios in the undergraduate setting that offers clinical teachers insights into both their effects on learning and issues to consider in portfolio implementation. Using a methodology based on BEME recommendations, we searched the literature relating to a range of health professions, identifying evidence for the effects of portfolios on undergraduate student learning, and assessing the methodological quality of each study. The higher quality studies in our review report that, when implemented appropriately, portfolios can improve students' ability to integrate theory with practice, can encourage their self-awareness and reflection, and can offer support for students facing difficult emotional situations. Portfolios can also enhance student-tutor relationships and prepare students for the rigours of postgraduate training. However, the time required to complete a portfolio may detract from students' clinical learning. An analysis of methodological quality against year of publication suggests that, across a range of health professions, the quality of the literature relating to the educational effects of portfolios is improving. However, further work is still required to build the evidence base for the educational effects of portfolios, particularly comparative studies that assess effects on learning directly. Our findings have implications for the design and implementation of portfolios in the undergraduate setting. © Blackwell Publishing Ltd 2010.

Commentary: Sense and sensibility: the role of specialists in health care reform.

PubMed

Schwann, Nanette M; Nester, Brian A; McLoughlin, Thomas M

2012-03-01

How to redesign the incentives structure in the United States to reward effective coordinated care rather than production volume is a staggering public health policy challenge. In the mind of the public, there is a fine distinction between health care rationing and rational health care. Specialists have a vital but underappreciated role in reining in health care costs, but specific incentives to elicit behavior change with positive social outcomes remain ambiguous. It is imperative, therefore, that redesigning the incentives structure is thoughtfully considered, modeled, and tested prior to implementation, lest an inferior-quality model is inadvertently adopted and costs are only marginally contained. Quality metrics need to be universal and reflect real patient outcomes instead of the degree of investment by the institution in the reporting tools. Still, specialists should take immediate action to implement safe and efficient procedures and to assess their long-term impact on patients' quality of life. Scientific evaluations should guide both the assessment of the appropriateness and the safe delivery of care. Investment in high-quality data architecture and the science of health delivery implementation is an imperative if health care reform is to achieve its goals. Coordination and collaboration between specialists and primary care physicians is essential to this enterprise. Specialists can champion these efforts as they pertain to their areas of expertise by considering their care episodes in the context of the patient as a whole, working closely with generalists, and returning to the mindset of the specialist as a family doctor.

The promise of spirit at work: increasing job satisfaction and organizational commitment and reducing turnover and absenteeism in long-term care.

PubMed

Kinjerski, Val; Skrypnek, Berna J

2008-10-01

The effectiveness of a spirit at work program in long-term care was evaluated using a quasi-experimental, pretest-posttest design. These findings, along with focus group results, provide strong support that the program increased spirit at work, job satisfaction, organizational commitment, and organizational culture (particularly teamwork and morale), leading to a reduction in turnover and absenteeism--two major concerns in the long-term care sector. This study suggests that implementation of a spirit at work program is a relatively inexpensive way to enhance the work satisfaction of employees, increase their commitment to the organization (thus reducing turnover and absenteeism), and ultimately improve the quality of resident care.

The Value of Electronic Medical Record Implementation in Mental Health Care: A Case Study

PubMed Central

Fischler, Ilan; Stuckey, Melanie I; Klassen, Philip E; Chen, John

2017-01-01

Background Electronic medical records (EMR) have been implemented in many organizations to improve the quality of care. Evidence supporting the value added to a recovery-oriented mental health facility is lacking. Objective The goal of this project was to implement and customize a fully integrated EMR system in a specialized, recovery-oriented mental health care facility. This evaluation examined the outcomes of quality improvement initiatives driven by the EMR to determine the value that the EMR brought to the organization. Methods The setting was a tertiary-level mental health facility in Ontario, Canada. Clinical informatics and decision support worked closely with point-of-care staff to develop workflows and documentation tools in the EMR. The primary initiatives were implementation of modules for closed loop medication administration, collaborative plan of care, clinical practice guidelines for schizophrenia, restraint minimization, the infection prevention and control surveillance status board, drug of abuse screening, and business intelligence. Results Medication and patient scan rates have been greater than 95% since April 2014, mitigating the adverse effects of medication errors. Specifically, between April 2014 and March 2015, only 1 moderately severe and 0 severe adverse drug events occurred. The number of restraint incidents decreased 19.7%, which resulted in cost savings of more than Can $1.4 million (US $1.0 million) over 2 years. Implementation of clinical practice guidelines for schizophrenia increased adherence to evidence-based practices, standardizing care across the facility. Improved infection prevention and control surveillance reduced the number of outbreak days from 47 in the year preceding implementation of the status board to 7 days in the year following. Decision support to encourage preferential use of the cost-effective drug of abuse screen when clinically indicated resulted in organizational cost savings. Conclusions EMR implementation allowed Ontario Shores Centre for Mental Health Sciences to use data analytics to identify and select appropriate quality improvement initiatives, supporting patient-centered, recovery-oriented practices and providing value at the clinical, organizational, and societal levels. PMID:28057607

History of the development of radiotherapy in Latin America.

PubMed

Pinillos, Luis; Pinto, Joseph A; Sarria, Gustavo

2017-01-01

Radiotherapy was the first nonsurgical treatment for malignant tumours and represents one of the oldest disciplines of oncology. In Latin America, as in many parts of the world, the history of modern oncology begins with the implementation of radiation therapy facilities. The development of radiotherapy in Latin America was possible thanks to the seminal work of radiation oncologists in different countries. As a large territory, there is a need to implement modern facilities and equipment, but unfortunately there are disparities in the access and quality of radiotherapy services across Latin America and even within individual countries. In this review, we describe the history, challenges and success in the implementation of radiotherapy and the frustration caused by the lack of facilities in several Latin American countries.

Evaluation of the NASA Quality Surveillance System Pilot in Meeting Requirements for Contractor Surveillance Under Performance Based Contracting

NASA Technical Reports Server (NTRS)

Schmahl, Karen E.

2002-01-01

The use of performance-based contracting at Kennedy Space Center has necessitated a shift from intrusive oversight of contractor activities to an insight surveillance role. This paper describes the results of a pilot implementation of the NASA Quality Surveillance System (NQSS) in the Space Shuttle Main Engines Processing Facility. The NQSS is a system to sample contractor activities using documented procedures, specifications, drawings and observations of work in progress to answer the question "Is the contractor doing what they said they would do?" The concepts of the NQSS are shown to be effective in providing assurance of contractor quality. Many of the concepts proven in the pilot are being considered for incorporation into an overall KSC Quality Surveillance System.

Evaluation Of The NASA Quality Surveillance System Pilot In Meeting Requirements For Contractor Surveillance Under Performance Based Contracting

NASA Technical Reports Server (NTRS)

Schmahl, Karen E.

2001-01-01

The use of performance-based contracting at Kennedy Space Center has necessitated a shift from intrusive oversight of contractor activities to an insight surveillance role. This paper describes the results of a pilot implementation of the NASA Quality Surveillance System (NQSS) in the Space Shuttle Main Engines Processing Facility. The NQSS is a system to sample contractor activities using documented procedures, specifications, drawings and observations of work in progress to answer the question "Is the contractor doing what they said they would do?" The concepts of the NQSS are shown to be effective in providing assurance of contractor quality. Many of the concepts proven in the pilot are being considered for incorporation into an overall KSC Quality Surveillance System.

Real-time assessments of water quality: expanding nowcasting throughout the Great Lakes

USGS Publications Warehouse

,

2013-01-01

Nowcasts are systems that inform the public of current bacterial water-quality conditions at beaches on the basis of predictive models. During 2010–12, the U.S. Geological Survey (USGS) worked with 23 local and State agencies to improve existing operational beach nowcast systems at 4 beaches and expand the use of predictive models in nowcasts at an additional 45 beaches throughout the Great Lakes. The predictive models were specific to each beach, and the best model for each beach was based on a unique combination of environmental and water-quality explanatory variables. The variables used most often in models to predict Escherichia coli (E. coli) concentrations or the probability of exceeding a State recreational water-quality standard included turbidity, day of the year, wave height, wind direction and speed, antecedent rainfall for various time periods, and change in lake level over 24 hours. During validation of 42 beach models during 2012, the models performed better than the current method to assess recreational water quality (previous day's E. coli concentration). The USGS will continue to work with local agencies to improve nowcast predictions, enable technology transfer of predictive model development procedures, and implement more operational systems during 2013 and beyond.

[Colonoscopy quality control as a requirement of colorectal cancer screening].

PubMed

Quintero, Enrique; Alarcón-Fernández, Onofre; Jover, Rodrigo

2013-11-01

The strategies used in population-based colorectal screening strategies culminate in colonoscopy and consequently the success of these programs largely depends on the quality of this diagnostic test. The main factors to consider when evaluating quality are scientific-technical quality, safety, patient satisfaction, and accessibility. Quality indicators allow variability among hospitals, endoscopy units and endoscopists to be determined and can identify those not achieving recommended standards. In Spain, the working group for colonoscopy quality of the Spanish Society of Gastroenterology and the Spanish Society of Gastrointestinal Endoscopy have recently drawn up a Clinical Practice Guideline that contains the available evidence on the quality of screening colonoscopy, as well as the basic requirements that must be met by endoscopy units and endoscopists carrying out this procedure. The implementation of training programs and screening colonoscopy quality controls are strongly recommended to guarantee the success of population-based colorectal cancer screening. Copyright © 2013 Elsevier España, S.L. and AEEH y AEG. All rights reserved.

Implementation of the Child Care and Development Block Grant: a research synthesis.

PubMed

Cohen, Sally S; Lord, Heather

2005-01-01

The Child Care and Development Block Grant (CCDBG) is the largest source of state and federal child care assistance. Between 1996-2004, the number of reports on state implementation of the CCDBG soared. Using the matrix method, this article synthesizes 39 reports from public and private entities on how states differed in the use of CCDBG funds. We found considerable variation among states with regard to populations served, financing of child care through CCDBG and TANF (Temporary Assistance to Needy Families), administration of the CCDBG, and use of its quality set-asides. This issue is of prime importance to nurses who work with low-income families with children, especially because quality, accessibility and affordability of child care affects a child's emotional, social, cognitive, and physical development. The CCDBG reauthorization and annual appropriations are currently on the congressional agenda and warrant nurse's input for ongoing sustainability and support. Recommendations for policy and future research are included.

Quantification of health benefits related with reduction of atmospheric PM₁₀ levels: implementation of population mobility approach.

PubMed

Tchepel, Oxana; Dias, Daniela

2011-06-01

This study is focused on the assessment of potential health benefits by meeting the air quality limit values (2008/50/CE) for short-term PM₁₀ exposure. For this purpose, the methodology of the WHO for Health Impact Assessment and APHEIS guidelines for data collection were applied to Porto Metropolitan Area, Portugal. Additionally, an improved methodology using population mobility data is proposed in this work to analyse number of persons exposed. In order to obtain representative background concentrations, an innovative approach to process air quality time series was implemented. The results provide the number of attributable cases prevented annually by reducing PM(10) concentration. An intercomparison of two approaches to process input data for the health risk analysis provides information on sensitivity of the applied methodology. The findings highlight the importance of taking into account spatial variability of the air pollution levels and population mobility in the health impact assessment.

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice.

PubMed

MacCarthy, Sarah; Reisner, Sari; Hoffmann, Michael; Perez-Brumer, Amaya; Silva-Santisteban, Alfonso; Nunn, Amy; Bastos, Leonardo; Vasconcellos, Mauricio Teixeira Leite de; Kerr, Ligia; Bastos, Francisco Inácio; Dourado, Inês

2016-11-03

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic.

Mind the gap: implementation challenges break the link between HIV/AIDS research and practice

PubMed Central

MacCarthy, Sarah; Reisner, Sari; Hoffmann, Michael; Perez-Brumer, Amaya; Silva-Santisteban, Alfonso; Nunn, Amy; Bastos, Leonardo; de Vasconcellos, Mauricio Teixeira Leite; Kerr, Ligia; Bastos, Francisco Inácio; Dourado, Inês

2018-01-01

Sampling strategies such as respondent-driven sampling (RDS) and time-location sampling (TLS) offer unique opportunities to access key populations such as men who have sex with men (MSM) and transgender women. Limited work has assessed implementation challenges of these methods. Overcoming implementation challenges can improve research quality and increase uptake of HIV services among key populations. Drawing from studies using RDS in Brazil and TLS in Peru, we summarize challenges encountered in the field and potential strategies to address them. In Brazil, study site selection, cash incentives, and seed selection challenged RDS implementation with MSM. In Peru, expansive geography, safety concerns, and time required for study participation complicated TLS implementation with MSM and transgender women. Formative research, meaningful participation of key populations across stages of research, and transparency in study design are needed to link HIV/AIDS research and practice. Addressing implementation challenges can close gaps in accessing services among those most burdened by the epidemic. PMID:27828609

Total Quality Management (TQM). Implementers Workshop

DTIC Science & Technology

1990-05-15

SHEE’T :s t’ii ,rrl DEPARTMENT OF DEFENSE May 15, 1990 Lfl CN I TOTAL QUALITY MANAGEMENT (TQM) Implementers Workshop © Copyright 1990 Booz.Allen...must be continually performed in order to achieve successful TQM implementation. 1-5 = TOTAL QUALITY MANAGEMENT Implementers Workshop Course Content...information, please refer to the student manual, Total Quality Management (TOM) Awareness Seminar, that was provided for the Awareness Course. You may