Applying Lean principles and Kaizen rapid improvement events in public health practice.

PubMed

Smith, Gene; Poteat-Godwin, Annah; Harrison, Lisa Macon; Randolph, Greg D

2012-01-01

This case study describes a local home health and hospice agency's effort to implement Lean principles and Kaizen methodology as a rapid improvement approach to quality improvement. The agency created a cross-functional team, followed Lean Kaizen methodology, and made significant improvements in scheduling time for home health nurses that resulted in reduced operational costs, improved working conditions, and multiple organizational efficiencies.

Integrating Curriculum in a Total Quality School.

ERIC Educational Resources Information Center

Jenkins, Kenneth D.; Jenkins, Doris M.

1998-01-01

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

Quality improvement 101 for surgeons: Navigating the alphabet soup.

PubMed

Santore, Matthew T; Islam, Saleem

2015-12-01

It is a fundamental value of the surgical profession to improve care for its patients. In the last 100 years, the principles of prospective quality improvement have started to work their way into the traditional method of retrospective case review in morbidity and mortality conference. This article summarizes the history of "improvement science" and its intersection with the field of surgery. It attempts to clarify the principles and jargon that may be new or confusing to surgeons with a different vocabulary and experience. This is done to bring the significant power and resources of improvement science to the traditional efforts to improve surgical care. Copyright © 2015 Elsevier Inc. All rights reserved.

Current pulse: can a production system reduce medical errors in health care?

PubMed

Printezis, Antonios; Gopalakrishnan, Mohan

2007-01-01

One of the reasons for rising health care costs is medical errors, a majority of which result from faulty systems and processes. Health care in the past has used process-based initiatives such as Total Quality Management, Continuous Quality Improvement, and Six Sigma to reduce errors. These initiatives to redesign health care, reduce errors, and improve overall efficiency and customer satisfaction have had moderate success. Current trend is to apply the successful Toyota Production System (TPS) to health care since its organizing principles have led to tremendous improvement in productivity and quality for Toyota and other businesses that have adapted them. This article presents insights on the effectiveness of TPS principles in health care and the challenges that lie ahead in successfully integrating this approach with other quality initiatives.

What Should Leaders Do When Inefficiency Is Perceived as a Cost of Inclusivity in Strategic Planning Processes in Health Care?

PubMed

Kochar, Aveena; Chisty, Alia

2017-11-01

During the development of new health care policies, quality improvement teams can face the challenge of weighing differing opinions within the group that can hinder progress. It is essential in such cases to refer to the four keys principles of quality improvement (QI) as a guide to enhance group cooperation and promote development of the mutual objective. Co-production is a model that emphasizes the participation of the patient-a service receiver-in the production of services being rendered by the health care professional. By putting into practice the QI principles and using the model of co-production, quality improvement teams can improve efficiency of health systems and clinical outcomes. © 2017 American Medical Association. All Rights Reserved.

Hospital quality: a product of good management as much as good treatment.

PubMed

Hyde, Andy; Frafjord, Anders

2013-01-01

In Norway, as in most countries, the demands placed on hospitals to reduce costs and improve the quality of services are intense. Although many say that improving quality reduces costs, few can prove it. Futhermore, how many people can show that improving quality improves patient satisfaction. Diakonhjemmet hospital in Norway has designed and implemented a hospital management system based on lean principles and the PDCA (Plan-Do-Check-Act) quality circle introduced by WE Deming (Deming 2000). The results are quite impressive with improvements in quality and patient satisfaction. The hospital also runs at a profit.

Total Quality Education: Profiles of Schools That Demonstrate the Power of Deming's Management Principles.

ERIC Educational Resources Information Center

Schmoker, Michael J.; Wilson, Richard B.

This book presents profiles of schools that have demonstrated the power of Deming's Total Quality Management (TQM) principles. It describes schools that have successfully applied those strategies for change. The book explores what public education needs most--a compelling but flexible action plan for improvement. Chapter 1 offers a rationale for…

Indigenous health: effective and sustainable health services through continuous quality improvement.

PubMed

Bailie, Ross S; Si, Damin; O'Donoghue, Lyn; Dowden, Michelle

2007-05-21

The Australian government's Healthy for Life program is supporting capacity development in Indigenous primary care using continuous quality improvement (CQI) techniques. An important influence on the Healthy for Life program has been the ABCD research project. The key features contributing to the success of the project are described. The ABCD research project: uses a CQI approach, with an ongoing cycle of gathering data on how well organisational systems are functioning, and developing and then implementing improvements; is guided by widely accepted principles of community-based research, which emphasise participation; and adheres to the principles and values of Indigenous health research and service delivery. The potential for improving health outcomes in Aboriginal and Torres Strait Islander communities using a CQI approach should be strengthened by clear clinical and managerial leadership, supporting service organisations at the community level, and applying participatory-action principles.

Human factors systems approach to healthcare quality and patient safety

PubMed Central

Carayon, Pascale; Wetterneck, Tosha B.; Rivera-Rodriguez, A. Joy; Hundt, Ann Schoofs; Hoonakker, Peter; Holden, Richard; Gurses, Ayse P.

2013-01-01

Human factors systems approaches are critical for improving healthcare quality and patient safety. The SEIPS (Systems Engineering Initiative for Patient Safety) model of work system and patient safety is a human factors systems approach that has been successfully applied in healthcare research and practice. Several research and practical applications of the SEIPS model are described. Important implications of the SEIPS model for healthcare system and process redesign are highlighted. Principles for redesigning healthcare systems using the SEIPS model are described. Balancing the work system and encouraging the active and adaptive role of workers are key principles for improving healthcare quality and patient safety. PMID:23845724

Principles of continuous quality improvement applied to intravenous therapy.

PubMed

Dunavin, M K; Lane, C; Parker, P E

1994-01-01

Documentation of the application of the principles of continuous quality improvement (CQI) to the health care setting is crucial for understanding the transition from traditional management models to CQI models. A CQI project was designed and implemented by the IV Therapy Department at Lawrence Memorial Hospital to test the application of these principles to intravenous therapy and as a learning tool for the entire organization. Through a prototype inventory project, significant savings in cost and time were demonstrated using check sheets, flow diagrams, control charts, and other statistical tools, as well as using the Plan-Do-Check-Act cycle. As a result, a primary goal, increased time for direct patient care, was achieved. Eight hours per week in nursing time was saved, relationships between two work areas were improved, and $6,000 in personnel costs, storage space, and inventory were saved.

Florida hospital saves 5.3 M dollars by adopting principles of lean manufacturing.

PubMed

2005-01-01

Florida hospital saves 5.3M dollars by adopting principles of lean manufacturing. Surgery cancellations have been slashed from 13% of cases to less than 3%, while emergency department admissions have increased by 20%. Those are just two of the results of a quality improvement project at Lee Memorial Health System in Fort Myers, FL, that focused on using the principles of lean manufacturing to improve patient flow in the five-hospital system

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

PubMed Central

Lawrence, M; Packwood, T

1996-01-01

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

How Can Quality Improvement Enhance the Lives of Children with Disabilities?

ERIC Educational Resources Information Center

Perrin, James M.

2012-01-01

Much attention has aided measurement and improvement in the quality of health care during the past two decades, with new ways to define and measure quality, recognition that doing so can identify strategies to enhance care, and systematic efforts by both government and private insurers to apply these principles. In this article, James Perrin…

The robust corrective action priority-an improved approach for selecting competing corrective actions in FMEA based on principle of robust design

NASA Astrophysics Data System (ADS)

Sutrisno, Agung; Gunawan, Indra; Vanany, Iwan

2017-11-01

In spite of being integral part in risk - based quality improvement effort, studies improving quality of selection of corrective action priority using FMEA technique are still limited in literature. If any, none is considering robustness and risk in selecting competing improvement initiatives. This study proposed a theoretical model to select risk - based competing corrective action by considering robustness and risk of competing corrective actions. We incorporated the principle of robust design in counting the preference score among corrective action candidates. Along with considering cost and benefit of competing corrective actions, we also incorporate the risk and robustness of corrective actions. An example is provided to represent the applicability of the proposed model.

The promise of Lean in health care.

PubMed

Toussaint, John S; Berry, Leonard L

2013-01-01

An urgent need in American health care is improving quality and efficiency while controlling costs. One promising management approach implemented by some leading health care institutions is Lean, a quality improvement philosophy and set of principles originated by the Toyota Motor Company. Health care cases reveal that Lean is as applicable in complex knowledge work as it is in assembly-line manufacturing. When well executed, Lean transforms how an organization works and creates an insatiable quest for improvement. In this article, we define Lean and present 6 principles that constitute the essential dynamic of Lean management: attitude of continuous improvement, value creation, unity of purpose, respect for front-line workers, visual tracking, and flexible regimentation. Health care case studies illustrate each principle. The goal of this article is to provide a template for health care leaders to use in considering the implementation of the Lean management system or in assessing the current state of implementation in their organizations. Copyright © 2013 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

INTASC Principles: How They Are Addressed by Five Specialty Program Association Standards. inForum

ERIC Educational Resources Information Center

Burdette, Paula

2007-01-01

The Interstate New Teachers Assessment and Support Consortium (INTASC) principles were first developed in May 2001 by the Center for Improving Teacher Quality at the Council for Chief State School Officers. These principles were developed as standards for licensing teachers who work with students with disabilities. Both of the program…

Applying Services Marketing Principles to Postgraduate Supervision

ERIC Educational Resources Information Center

Dann, Stephen

2008-01-01

Purpose: The paper aims to describe the application of two key service quality frameworks for improving the delivery of postgraduate research supervision. The services quality frameworks are used to identify key areas of overlap between services marketing practice and postgraduate supervision that can be used by the supervisor to improve research…

Emergency Manuals: How Quality Improvement and Implementation Science Can Enable Better Perioperative Management During Crises.

PubMed

Goldhaber-Fiebert, Sara N; Macrae, Carl

2018-03-01

How can teams manage critical events more effectively? There are commonly gaps in performance during perioperative crises, and emergency manuals are recently available tools that can improve team performance under stress, via multiple mechanisms. This article examines how the principles of implementation science and quality improvement were applied by multiple teams in the development, testing, and systematic implementations of emergency manuals in perioperative care. The core principles of implementation have relevance for future patient safety innovations perioperatively and beyond, and the concepts of emergency manuals and interprofessional teamwork are applicable for diverse fields throughout health care. Copyright © 2017 Sara N. Goldhaber-Fiebert, Carl Macrae. Published by Elsevier Inc. All rights reserved.

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

NASA Astrophysics Data System (ADS)

Murali, Swetha; Ponmalar, V.

2017-07-01

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

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.

Applying lean management principles to the creation of a postpartum hemorrhage care bundle.

PubMed

Faulkner, Beth

2013-10-01

A lean management process is a set of interventions, each of which creates value for the customer. Lean management is not a new concept, but is relatively new to health care. Postpartum hemorrhage (PPH) is the most common cause of maternal death worldwide in both developing and developed countries. We applied lean management principles as an innovative approach to improving outcomes in patients with PPH. Initial results using principles of lean management indicated significant improvements in response time and family-centered care. When applied rigorously and throughout the organization, lean principles can have a dramatic effect on productivity, cost and quality. © 2013 AWHONN.

Benchmarking, benchmarks, or best practices? Applying quality improvement principles to decrease surgical turnaround time.

PubMed

Mitchell, L

1996-01-01

The processes of benchmarking, benchmark data comparative analysis, and study of best practices are distinctly different. The study of best practices is explained with an example based on the Arthur Andersen & Co. 1992 "Study of Best Practices in Ambulatory Surgery". The results of a national best practices study in ambulatory surgery were used to provide our quality improvement team with the goal of improving the turnaround time between surgical cases. The team used a seven-step quality improvement problem-solving process to improve the surgical turnaround time. The national benchmark for turnaround times between surgical cases in 1992 was 13.5 minutes. The initial turnaround time at St. Joseph's Medical Center was 19.9 minutes. After the team implemented solutions, the time was reduced to an average of 16.3 minutes, an 18% improvement. Cost-benefit analysis showed a potential enhanced revenue of approximately $300,000, or a potential savings of $10,119. Applying quality improvement principles to benchmarking, benchmarks, or best practices can improve process performance. Understanding which form of benchmarking the institution wishes to embark on will help focus a team and use appropriate resources. Communicating with professional organizations that have experience in benchmarking will save time and money and help achieve the desired results.

Using Formative Student Feedback: A Continuous Quality Improvement Approach for Online Course Development

ERIC Educational Resources Information Center

Bloxham, Kristy Taylor

2010-01-01

The objective of this study was to examine the use of frequent, anonymous student course surveys as a tool in supporting continuous quality improvement (CQI) principles in online instruction. The study used a qualitative, multiple-case design involving four separate online courses. Analysis methods included pattern matching/explanation building,…

Continuous Quality Improvement in a University Setting: The Case of the Department of Vocational and Technical Education at the University of Minnesota.

ERIC Educational Resources Information Center

Copa, George H.

1993-01-01

Discusses the application of continuous quality improvement principles in the Department of Vocational and Technical Education at the University of Minnesota. Reviews the processes that the department incorporated to implement this program and lists future steps and categories of action. (Author)

[Lean logistics management in healthcare: a case study].

PubMed

Aguilar-Escobar, V G; Garrido-Vega, P

2013-01-01

To study the applicability of the principles of Lean Production to manage the supply chain of a hospital. In particular, to determine which Lean practices and principles are applicable, the benefits obtained and the main barriers for its implementation. Managing the hospital supply chain is an important issue, both for its effect on the quality of care and its impact on costs. This study is based on a case study. 2005-10. Hospital Virgen Macarena in Seville. Process of implementing a comprehensive logistics management plan based on Lean principles and technological investments. The implementation of the comprehensive plan has reduced inventory, decreased lead times and improved service quality. Also, there have been other important improvements: enhanced employee satisfaction and increased staff productivity, both dedicated to health and the logistics. The experience analysed has shown the applicability and appropriateness of Lean principles and some of its techniques in managing the logistics of hospitals. It also identifies some of the main difficulties that may arise. Copyright © 2011 SECA. Published by Elsevier Espana. All rights reserved.

A Move from Effective to Quality.

ERIC Educational Resources Information Center

Duden, Nancy

1993-01-01

For past three years, Tallahassee, Florida, elementary school has changed from good effective school to quality learning organization. Inspired by Deming's principles, the school's broad-based task force developed a culture suitable for continuous quality improvement. Newly established core values included the importance of individuals, teachers…

Building a Sustainable Quality Matters™ Community of Practice through Social Network Analysis

ERIC Educational Resources Information Center

Cowan, John; Richter, Stephanie; Miller, Tracy; Rhode, Jason; Click, Aline; Underwood, Jason

2017-01-01

The growth of distance education has necessitated strong evidence of quality for institutions of higher education, and numerous standards and principles of quality have been developed, such as Quality Matters™ (Quality Matters). These systems are often considered only at the course level to guide design and improve student outcomes, but they can…

Improving program documentation quality through the application of continuous improvement processes.

PubMed

Lovlien, Cheryl A; Johansen, Martha; Timm, Sandra; Eversman, Shari; Gusa, Dorothy; Twedell, Diane

2007-01-01

Maintaining the integrity of record keeping and retrievable information related to the provision of continuing education credit creates challenges for a large organization. Accurate educational program documentation is vital to support the knowledge and professional development of nursing staff. Quality review and accurate documentation of programs for nursing staff development occurred at one institution through the use of continuous improvement principles. Integration of the new process into the current system maintains the process of providing quality record keeping.

Schools of Quality. Third Edition.

ERIC Educational Resources Information Center

Bonstingl, John Jay

This book presents the concept that quality as a keystone philosophy in today's business world can be applied to school systems as a means to improving education and all aspects of school culture, producing a school of quality. The author uses examples such as Japan's adopting William E. Deming's quality-control principles to help it skyrocket…

The positive impact of simultaneous implementation of the BD FocalPoint GS Imaging System and lean principles on the operation of gynecologic cytology.

PubMed

Wong, Rebecca; Levi, Angelique W; Harigopal, Malini; Schofield, Kevin; Chhieng, David C

2012-02-01

Our cytology laboratory, like many others, is under pressure to improve quality and provide test results faster while decreasing costs. We sought to address these issues by introducing new technology and lean principles. To determine the combined impact of the FocalPoint Guided Screener (GS) Imaging System (BD Diagnostics-TriPath, Burlington, North Carolina) and lean manufacturing principles on the turnaround time (TAT) and productivity of the gynecologic cytology operation. We established a baseline measure of the TAT for Papanicolaou tests. We then compared that to the performance after implementing the FocalPoint GS Imaging System and lean principles. The latter included value-stream mapping, workflow modification, and a first in-first out policy. The mean (SD) TAT for Papanicolaou tests before and after the implementation of FocalPoint GS Imaging System and lean principles was 4.38 (1.28) days and 3.20 (1.32) days, respectively. This represented a 27% improvement in the average TAT, which was statistically significant (P < .001). In addition, the productivity of staff improved 17%, as evidenced by the increase in slides screened from 8.85/h to 10.38/h. The false-negative fraction decreased from 1.4% to 0.9%, representing a 36% improvement. In our laboratory, the implementation of FocalPoint GS Imaging System in conjunction with lean principles resulted in a significant decrease in the average TAT for Papanicolaou tests and a substantial increase in the productivity of cytotechnologists while maintaining the diagnostic quality of gynecologic cytology.

Quality improvement in neonatal digital radiography: implementing the basic quality improvement tools.

PubMed

Eslamy, Hedieh K; Newman, Beverley; Weinberger, Ed

2014-12-01

A quality improvement (QI) program may be implemented using the plan-do-study-act cycle (as a model for making improvements) and the basic QI tools (used to visually display and analyze variation in data). Managing radiation dose has come to the forefront as a safety goal for radiology departments. This is especially true in the pediatric population, which is more radiosensitive than the adult population. In this article, we use neonatal digital radiography to discuss developing a QI program with the principle goals of decreasing the radiation dose, decreasing variation in radiation dose, and optimizing image quality. Copyright © 2014 Elsevier Inc. All rights reserved.

A Framework for Residence Hall Community Development.

ERIC Educational Resources Information Center

Davis, Alan H.; Daugherty, Michael S.

This paper addresses the issue of improving student retention and quality of life on campus through the application of principles expressed by Sabre (1980) involving community development. Sabre's ethical principle of nurturing the capacity for mutual persuasion is discussed as a central vision and purpose for organizing and guiding community…

Guidelines for Document Designers.

ERIC Educational Resources Information Center

Felker, Daniel B.; And Others

Intended to improve the quality of public documents by making them clearer to the people who use them, this book contains document design principles concerned with writing documents that are visually distinct, attractive, and easily understood. Following an introduction, the major portion of the book presents the 25 principles, each of which…

Quality Culture: NMC Ends Report, August 1995.

ERIC Educational Resources Information Center

Merrill, Sherrey; And Others

In an effort to determine success in establishing an internal culture consistent with the principles of total quality management, Northwestern Michigan College (NMC) conducted a study of faculty and staff attitudes and involvement in the college. The study focused on five measurements: improvement on NMC indicators of success, quality training and…

Merging Quality Processes & Tools with DACUM.

ERIC Educational Resources Information Center

McLennan, Krystyna S.

This paper explains how merging DACUM (Developing a Curriculum) analysis with quality initiatives can reduce waste, increase job efficiency, assist in development of standard operating procedures, and involve employees in positive job improvement methods. In the first half of the paper, the following principles of total quality management (TQM)…

Apply TQM to E-Government Outsourcing Management

NASA Astrophysics Data System (ADS)

Huai, Jinmei

This paper developed an approach to e-government outsourcing quality management. E-government initiatives have rapidly increased in the last decades and the success of these activities will largely depend on their operation quality. As an instrument to improve operation quality, outsourcing can be applied to e-government. This paper inspected process of e-government outsourcing and discussed how to improve the outsourcing performance through total quality management (TQM). The characteristics and special requirements of e-government outsourcing were analyzed as the basis for discussion. Then the principles and application of total quality management were interpreted. Finally the process of improving performance of e-government was analyzed in the context of outsourcing.

Applying the Lean principles of the Toyota Production System to reduce wait times in the emergency department.

PubMed

Ng, David; Vail, Gord; Thomas, Sophia; Schmidt, Nicki

2010-01-01

In recognition of patient wait times, and deteriorating patient and staff satisfaction, we set out to improve these measures in our emergency department (ED) without adding any new funding or beds. In 2005 all staff in the ED at Hôtel-Dieu Grace Hospital began a transformation, employing Toyota Lean manufacturing principles to improve ED wait times and quality of care. Lean techniques such as value-stream mapping, just-in-time delivery techniques, workplace organization, reduction of systemic wastes, use of the worker as the source of quality improvement and ongoing refinement of our process steps formed the basis of our project. Our ED has achieved major improvements in departmental flow without adding any additional ED or inpatient beds. The mean registration to physician time has decreased from 111 minutes to 78 minutes. The number of patients who left without being seen has decreased from 7.1% to 4.3%. The length of stay (LOS) for discharged patients has decreased from a mean of 3.6 to 2.8 hours, with the largest decrease seen in our patients triaged at levels 4 or 5 using the Canadian Emergency Department Triage and Acuity Scale. We noted an improvement in ED patient satisfaction scores following the implementation of Lean principles. Lean manufacturing principles can improve the flow of patients through the ED, resulting in greater patient satisfaction along with reduced time spent by the patient in the ED.

Transferring skills in quality collaboratives focused on improving patient logistics.

PubMed

Weggelaar-Jansen, Anne Marie; van Wijngaarden, Jeroen

2018-04-02

A quality improvement collaborative, often used by the Institute for Healthcare Improvement, is used to educate healthcare professionals and improve healthcare at the same time. However, no prior research has been done on the knowledge and skills healthcare professionals need to achieve improvements or the extent to which quality improvement collaboratives help enhance both knowledge and skills. Our research focused on quality improvement collaboratives aiming to improve patient logistics and tried to identify which knowledge and skills are required and to what extent these were enhanced during the QIC. We defined skills important for logistic improvements in a three-phase Delphi study. Based on the Delphi results we made a questionnaire. We surveyed participants in a national quality improvement collaborative to assess the skills rated as 1) important, 2) available and 3) improved during the collaborative. At two sense-making meetings, experts reflected on our findings and hypothesized on how to improve (logistics) collaboratives. The Delphi study found 18 skills relevant for reducing patient access time and 21 for reducing throughput time. All skills retrieved from the Delphi study were scored as 'important' in the survey. Teams especially lacked soft skills connected to project and change management. Analytical skills increased the most, while more reflexive skills needed for the primary goal of the collaborative (reduce access and throughput times) increased modestly. At two sense-making meetings, attendees suggested four improvements for a quality improvement collaborative: 1) shift the focus to project- and change management skills; 2) focus more on knowledge transfer to colleagues; 3) teach participants to adapt the taught principles to their own situations; and 4) foster intra-project reflexive learning to translate gained insights to other projects (inter-project learning). Our findings seem to suggest that Quality collaboratives could benefit if more attention is paid to the transfer of 'soft skills' (e.g. change, project management and communication skills) and reflexive skills (e.g. adjusting logistics principles to specific situations and inter-project translation of experiences).

Total Quality Management (TQM) as the Procedure for Management of Integrated Academics.

ERIC Educational Resources Information Center

Anderson, Lowell D.

Total Quality Management (TQM) is a way of doing business that involves every employee, both labor and management, in an effort to improve quality and productivity. The quality management concept consists of common principles: (1) customer focus; (2) process focus; (3) failure prevention; (4) mobilization of work force; (5) decision making based…

Trials of Intervention Principles: Evaluation Methods for Evolving Behavioral Intervention Technologies

PubMed Central

Schueller, Stephen M; Riley, William T; Brown, C Hendricks; Cuijpers, Pim; Duan, Naihua; Kwasny, Mary J; Stiles-Shields, Colleen; Cheung, Ken

2015-01-01

In recent years, there has been increasing discussion of the limitations of traditional randomized controlled trial (RCT) methodologies for the evaluation of eHealth and mHealth interventions, and in particular, the requirement that these interventions be locked down during evaluation. Locking down these interventions locks in defects and eliminates the opportunities for quality improvement and adaptation to the changing technological environment, often leading to validation of tools that are outdated by the time that trial results are published. Furthermore, because behavioral intervention technologies change frequently during real-world deployment, even if a tested intervention were deployed in the real world, its shelf life would be limited. We argue that RCTs will have greater scientific and public health value if they focus on the evaluation of intervention principles (rather than a specific locked-down version of the intervention), allowing for ongoing quality improvement modifications to the behavioral intervention technology based on the core intervention principles, while continuously improving the functionality and maintaining technological currency. This paper is an initial proposal of a framework and methodology for the conduct of trials of intervention principles (TIPs) aimed at minimizing the risks of in-trial changes to intervention technologies and maximizing the potential for knowledge acquisition. The focus on evaluation of intervention principles using clinical and usage outcomes has the potential to provide more generalizable and durable information than trials focused on a single intervention technology. PMID:26155878

Trials of Intervention Principles: Evaluation Methods for Evolving Behavioral Intervention Technologies.

PubMed

Mohr, David C; Schueller, Stephen M; Riley, William T; Brown, C Hendricks; Cuijpers, Pim; Duan, Naihua; Kwasny, Mary J; Stiles-Shields, Colleen; Cheung, Ken

2015-07-08

In recent years, there has been increasing discussion of the limitations of traditional randomized controlled trial (RCT) methodologies for the evaluation of eHealth and mHealth interventions, and in particular, the requirement that these interventions be locked down during evaluation. Locking down these interventions locks in defects and eliminates the opportunities for quality improvement and adaptation to the changing technological environment, often leading to validation of tools that are outdated by the time that trial results are published. Furthermore, because behavioral intervention technologies change frequently during real-world deployment, even if a tested intervention were deployed in the real world, its shelf life would be limited. We argue that RCTs will have greater scientific and public health value if they focus on the evaluation of intervention principles (rather than a specific locked-down version of the intervention), allowing for ongoing quality improvement modifications to the behavioral intervention technology based on the core intervention principles, while continuously improving the functionality and maintaining technological currency. This paper is an initial proposal of a framework and methodology for the conduct of trials of intervention principles (TIPs) aimed at minimizing the risks of in-trial changes to intervention technologies and maximizing the potential for knowledge acquisition. The focus on evaluation of intervention principles using clinical and usage outcomes has the potential to provide more generalizable and durable information than trials focused on a single intervention technology.

Continuous quality improvement and medical informatics: the convergent synergy.

PubMed

Werth, G R; Connelly, D P

1992-01-01

Continuous quality improvement (CQI) and medical informatics specialists need to converge their efforts to create synergy for improving health care. Health care CQI needs medical informatics' expertise and technology to build the information systems needed to manage health care organizations according to quality improvement principles. Medical informatics needs CQI's philosophy and methods to build health care information systems that can evolve to meet the changing needs of clinicians and other stakeholders. This paper explores the philosophical basis for convergence of CQI and medical informatics efforts, and then examines a clinical computer workstation development project that is applying a combined approach.

How To Improve the Quality of Our Organizations through the Use of TQM, Continuous Improvement Strategies.

ERIC Educational Resources Information Center

Coates, James

As a result of global competition in business, Total Quality Management (TQM) has been seen as necessary to provide competitive products and services that customers want and need at attractive prices. In applying the principles of TQM to higher education, however, the perceived need for survival and competition in business and industry does not…

The primacy of the patient and family in a quality-improvement environment.

PubMed

Walker, J K

1995-09-01

The primary customers of health care services are the patient and family. It is important to adopt a mission and philosophy that put the patient and family at the center of all quality improvement programs. The principles put forth by Deming in his 14 points can be applied to patient-focused quality improvement measures. Creating a foundation for the professional practice of nursing and using and expanding tools that are already in use can help care providers meet the needs of their customers and help people to live healthier, better lives.

Role of Yoga in Cancer Patients: Expectations, Benefits, and Risks: A Review.

PubMed

Rao, Raghavendra Mohan; Amritanshu, Ram; Vinutha, H T; Vaishnaruby, Shanmugaraj; Deepashree, Shashidhara; Megha, Murthy; Geetha, Rajendra; Ajaikumar, B S

2017-01-01

The diagnosis and treatment of cancer poses severe psychologic distress that impacts functional quality of life. While cancer directed treatments are directed purely against tumor killing, interventions that reduce treatment related distress and improve quality of life are the need of the hour. Yoga is one such mind body intervention that is gaining popularity among cancer patients. Several research studies in the last two decades unravel the benefits of yoga in terms of improved mood states, symptom reduction, stress reduction and improved quality of life apart from improving host factors that are known to affect survival in cancer patients. However, several metaanalysis and reviews show equivocal benefits for yoga. In this review, we will study the Yoga interventions in cancer patients with respect to expectations, benefits and risks and analyse the principles behind tailoring yoga interventions in cancer patients. The studies on Yoga show heterogeneity with varied types of Yoga Interventions, duration, exposure, practices and indications. It also elucidates the situational context for reaping benefits and cautions against its use in several others. However, there are several reviews and bibliometric analysis of effects of yoga; most of them have not enlarged the scope of their review to cover the basic principles behind use of these practices in cancer patients. This review offers insight into the principles and practice of yoga in cancer patients.

Is audit research? The relationships between clinical audit and social-research.

PubMed

Hughes, Rhidian

2005-01-01

Quality has an established history in health care. Audit, as a means of quality assessment, is well understood and the existing literature has identified links between audit and research processes. This paper reviews the relationships between audit and research processes, highlighting how audit can be improved through the principles and practice of social research. The review begins by defining the audit process. It goes on to explore salient relationships between clinical audit and research, grouped into the following broad themes: ethical considerations, highlighting responsibilities towards others and the need for ethical review for audit; asking questions and using appropriate methods, emphasising transparency in audit methods; conceptual issues, including identifying problematic concepts, such as "satisfaction", and the importance of reflexivity within audit; emphasising research in context, highlighting the benefits of vignettes and action research; complementary methods, demonstrating improvements for the quality of findings; and training and multidisciplinary working, suggesting the need for closer relationships between researchers and clinical practitioners. Audit processes cannot be considered research. Both audit and research processes serve distinct purposes. Attention to the principles of research when conducting audit are necessary to improve the quality of audit and, in turn, the quality of health care.

Process safety improvement--quality and target zero.

PubMed

Van Scyoc, Karl

2008-11-15

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

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

DTIC Science & Technology

1989-09-01

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

Leadership: The Key to Successful Implementation of Total Quality Management

DTIC Science & Technology

1990-05-01

the implementation of the initiative called Total Quality Management as the philosophy and guiding principles to improve organizational efficiency...where and how to start. This paper presents the critical elements, their interrelationships, and how they can be used to achieve the cultural change necessary for successful implementation of Total Quality Management .

Quality of Life Perceptions and Directions for Urban Regeneration in Hong Kong

ERIC Educational Resources Information Center

Ng, Mee Kam

2005-01-01

Urban regeneration can be an effective tool to promote sustainability and enhance macro-level quality of life if the principles of encouraging participation, building community character, advancing equity, improving environment and enlivening the economy are observed. Through the assessment of various quality of life indicators related to these…

Ten Anchor Points for Teaching Principles of Marketing

ERIC Educational Resources Information Center

Tomkovick, Chuck

2004-01-01

Effective marketing instructors commonly share a love for their students, an affinity for the subject matter, and a devotion to continuous quality improvement. The purpose of this article is to highlight 10 anchor points for teaching Principles of Marketing, which are designed to better engage students in the learning process. These anchor…

Will the 'principles of effectiveness' improve prevention practice? Early findings from a diffusion study.

PubMed

Hallfors, D; Godette, D

2002-08-01

This study examines adoption and implementation of the US Department of Education's new policy, the 'Principles of Effectiveness', from a diffusion of innovations theoretical framework. In this report, we evaluate adoption in relation to Principle 3: the requirement to select research-based programs. Results from a sample of 104 school districts in 12 states indicate that many districts appear to be selecting research-based curricula, but that the quality of implementation is low. Only 19% of the responding district coordinators indicated that schools were implementing a research-based curriculum with fidelity. Common problems included lack of teacher training, lack of requisite materials, use of some but not all of the required lessons and teaching strategies, and failure to deliver lessons to age-appropriate student groups. This study represents the first attempt to assess the quality of implementation of research-based programs as required by the Principles of Effectiveness. We conclude that low levels of funding, inadequate infrastructure, decentralized decision making and lack of program guidance have contributed to the slow progress in improving school-based prevention.

Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology.

PubMed

Esposito, Pasquale; Dal Canton, Antonio

2014-11-06

Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Different tools have been developed, including incident analysis, health technology assessment and clinical audit. The clinical audit consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the effectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings.

Implementing a Quality Management System in the Medical Microbiology Laboratory.

PubMed

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

2018-07-01

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

The Total Quality Classroom.

ERIC Educational Resources Information Center

Bonstingl, John Jay

1992-01-01

Deming's quality-focused principles contradict Taylor's top-down, authoritarian industrial model. Deming advises educators to fix the system instead of blaming individual teachers for student apathy and low achievement. In the new paradigm, education will be a process that encourages continual progress through improving one's abilities, expanding…

Supporting Sustainable Rural Communities

EPA Pesticide Factsheets

Presentation about creating sustainable rural communities discussing principles, energy efficiency, water quality, waste, business, building improvements and restoration, transportation, and green building.transportation, and green building.

Analysis of Tactical, Decisional and Executional Behaviour according to the Level of Expertise in Squash

PubMed Central

Catalán-Eslava, María; González-Víllora, Sixto; Pastor-Vicedo, Juan C.; Contreras-Jordán, Onofre R.

2018-01-01

Abstract The objective of this study was to analyse the differences in tactical principles, decision-making and execution of the return shot and drop shot of squash players at different levels of proficiency. The sample was composed of 80 players, divided into four levels of expertise (first national category, second national category, autonomous regional level and provincial level). The Squash Performance Evaluation Tool was used for recording the level of decision-making and execution. The results revealed that reading of the context of the game improved as the level of the player’s expertise of both the return shot and the drop shot increased. The correlation between correct decision-making and better quality execution for both the return shot and the drop shot in squash also improved with the player’s level of expertise. According to these results, improvements in situational tactical principles and the application of tactical principles, correct decision-making and high-quality execution are essential to develop the athletic performance level among squash players. PMID:29599875

Improving Health Care Workers for Seasonal Influenza Vaccination at University Health System: A Paradigm for Closing the Quality Chasm

PubMed Central

Patterson, Jan E.; Cadena, Jose; Prigmore, Teresa; Bowling, Jason; Ayala, Beth Ann; Kirkman, Leni; Parekh, Amruta; Scepanski, Theresa

2011-01-01

Significant gaps in quality and patient safety in the US health-care system have been identified and were reported in the past decade by the Institute of Medicine. Despite recognition of these gaps in “knowing versus doing,” change in health care is slow and difficult. The quality improvement and clinical safety movement is increasing among US medical centers. Our health science center implemented the UT System Clinical Safety and Effectiveness course, providing project-based teaching of quality-improvement tools and principles of patient safety. A quality-improvement project that increased healthcare workers' influenza vaccination rate by 17.8% from that in 2008 to a rate of 76.6% in 2009 serves as a paradigm of how physicians can lead quality-improvement project teams to narrow the quality chasm (1). Local efforts to narrow the chasm are discussed in the present paper, including inter-professional education in quality improvement and clinical safety. PMID:21686222

Applying Quality Management Process-Improvement Principles to Learning in Reading Courses: An Improved Learning and Retention Method.

ERIC Educational Resources Information Center

Hahn, William G.; Bart, Barbara D.

2003-01-01

Business students were taught a total quality management-based outlining process for course readings and a tally method to measure learning efficiency. Comparison of 233 who used the process and 99 who did not showed that the group means of users' test scores were 12.4 points higher than those of nonusers. (Contains 25 references.) (SK)

Towards a Framework to Improve the Quality of Teaching and Learning: Consciousness and Validation in Computer Engineering Science, UCT

ERIC Educational Resources Information Center

Lévano, Marcos; Albornoz, Andrea

2016-01-01

This paper aims to propose a framework to improve the quality in teaching and learning in order to develop good practices to train professionals in the career of computer engineering science. To demonstrate the progress and achievements, our work is based on two principles for the formation of professionals, one based on the model of learning…

Progress Made on a Plan To Integrate Planning, Budgeting, Assessment and Quality Principles To Achieve Institutional Improvement. First Year Report. AIR 1996 Annual Forum Paper.

ERIC Educational Resources Information Center

Griffith, Susan R.; And Others

This paper describes first year implementation efforts of Southwest Texas (SWT) State University to develop a system to integrate planning, budgeting, assessment, and quality to improve the delivery of education and other services to all the institution's customers. The document addresses the common situation when an organization already has…

A residency clinic chronic condition management quality improvement project.

PubMed

Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon

2007-02-01

Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.

Evidence-based health care: its place within clinical governance.

PubMed

McSherry, R; Haddock, J

This article explores the principles of evidence-based practice and its role in achieving quality improvements within the clinical governance framework advocated by the recent White Papers 'The New NHS: Modern, Dependable' (Department of Health (DoH), 1997) and 'A First Class Service: Quality in the New NHS' (DoH, 1998a). Within these White Papers there is an emphasis on improving quality of care, treatment and services through employing the principles of clinical governance. A major feature of clinical governance is guaranteeing quality to the public and the NHS, and ensuring that clinical, managerial and educational practice is based on scientific evidence. This article also examines what evidence-based practice is and what processes are required to promote effective healthcare interventions. The authors also look at how clinical governance relates to other methods/systems involved in clinical effectiveness. Finally, the importance for nurses and other healthcare professionals of familiarizing themselves with the development of critical appraisal skills, and their implications for developing evidence-based practice, is emphasized.

A Study on Institutional Perception of Student Teachers on the Principles of Total Quality Management

ERIC Educational Resources Information Center

Sundaresan, S.; Muthaiah, N.

2014-01-01

Education shapes the destiny of a nation, and is the principal instrument for developing human capabilities. Educational quality is highly influenced by the learning experiences gained during the teaching-learning process. The concern for improving quality of teaching-learning process is significant, since this is a mechanism through which the…

Faraday's Principle and Air Travel in the Introductory Labs

ERIC Educational Resources Information Center

Abdul-Razzaq, Wathiq; Thakur, Saikat Chakraborty

2017-01-01

We all know that we must improve the quality of teaching in science at all levels. Not only physicists but also many students from other areas of study take the introductory physics courses in college. Physics introductory laboratories (labs) can be one of the best tools to help these students understand applications of scientific principles that…

Factual Approach in Decision Making - the Prerequisite of Success in Quality Management

NASA Astrophysics Data System (ADS)

Kučerová, Marta; Škůrková Lestyánszka, Katarína

2013-12-01

In quality management system as well as in other managerial systems, effective decisions must be always based on the data and information analysis, i.e. based on facts, in accordance with the factual approach principle in quality management. It is therefore necessary to measure and collect the data and information about processes. The article presents the results of a conducted survey, which was focused on application of factual approach in decision making. It also offers suggestions for improvements of application of the principle in business practice. This article was prepared using the research results of VEGA project No. 1/0229/08 "Perspectives of the quality management development in relation to the requirements of market in the Slovak Republic".

Microbial Safety Improvement of Sea Buckthorn by Electron Beam Irradiation

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

Nemtanu, Monica R.; Minea, R.; Mazilu, Elena

2007-04-23

The commercialization of medicinal plants and/or their products is highly increased in Romania lately. One of the most used herbs is sea buckthorn being well known for its quality with a large potential for curing some diseases. Sea buckthorn can be contaminated with undesirable microorganisms which may affect negatively its quality. The paper presents the results regarding the action of a non-conventional technology meaning electron beam technique on sea buckthorn in order to improve its microbiological quality. Our study revealed that the sea buckthorn microbial load has been improved after 3 kGy irradiation keeping its active principles.

Microbial Safety Improvement of Sea Buckthorn by Electron Beam Irradiation

NASA Astrophysics Data System (ADS)

Nemţanu, Monica R.; Minea, R.; Mazilu, Elena; Rǎdulescu, Nora

2007-04-01

The commercialization of medicinal plants and/or their products is highly increased in Romania lately. One of the most used herbs is sea buckthorn being well known for its quality with a large potential for curing some diseases. Sea buckthorn can be contaminated with undesirable microorganisms which may affect negatively its quality. The paper presents the results regarding the action of a non-conventional technology meaning electron beam technique on sea buckthorn in order to improve its microbiological quality. Our study revealed that the sea buckthorn microbial load has been improved after 3 kGy irradiation keeping its active principles.

Total Quality Management: Implications for Educational Assessment.

ERIC Educational Resources Information Center

Rankin, Stuart C.

1992-01-01

Deming's "System of Profound Knowledge" is even more fundamental than his 14-principle system transformation guide and is based on 4 elements: systems theory, statistical variation, a theory of knowledge, and psychology. Management should revamp total system processes so that quality of product is continually improved. Implications for…

Determinants of quality of shared sanitation facilities in informal settlements: case study of Kisumu, Kenya.

PubMed

Simiyu, Sheillah; Swilling, Mark; Cairncross, Sandy; Rheingans, Richard

2017-01-11

Shared facilities are not recognised as improved sanitation due to challenges of maintenance as they easily can be avenues for the spread of diseases. Thus there is need to evaluate the quality of shared facilities, especially in informal settlements, where they are commonly used. A shared facility can be equated to a common good whose management depends on the users. If users do not work collectively towards keeping the facility clean, it is likely that the quality may depreciate due to lack of maintenance. This study examined the quality of shared sanitation facilities and used the common pool resource (CPR) management principles to examine the determinants of shared sanitation quality in the informal settlements of Kisumu, Kenya. Using a multiple case study design, the study employed both quantitative and qualitative methods. In both phases, users of shared sanitation facilities were interviewed, while shared sanitation facilities were inspected. Shared sanitation quality was a score which was the dependent variable in a regression analysis. Interviews during the qualitative stage were aimed at understanding management practices of shared sanitation users. Qualitative data was analysed thematically by following the CPR principles. Shared facilities, most of which were dirty, were shared by an average of eight households, and their quality decreased with an increase in the number of households sharing. The effect of numbers on quality is explained by behaviour reflected in the CPR principles, as it was easier to define boundaries of shared facilities when there were fewer users who cooperated towards improving their shared sanitation facility. Other factors, such as defined management systems, cooperation, collective decision making, and social norms, also played a role in influencing the behaviour of users towards keeping shared facilities clean and functional. Apart from hardware factors, quality of shared sanitation is largely due to group behaviour of users. The CPR principles form a crucial lens through which the dynamics of shared sanitation facilities in informal settlements can be understood. Development and policy efforts should incorporate group behaviour as they determine the quality of shared sanitation facilities.

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

PubMed

Godény, Sándor

2012-02-05

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

Application of the VALUE communication principles in ACTIVE hospice team meetings.

PubMed

Washington, Karla T; Wittenberg-Lyles, Elaine; Parker Oliver, Debra; Demiris, George; Shaunfield, Sara; Crumb, Edith

2013-01-01

The ACTIVE (Assessing Caregivers for Team Intervention through Video Encounters) intervention uses technology to enable family caregivers to participate in hospice interdisciplinary team (IDT) meetings from geographically remote locations. Previous research has suggested that effective communication is critical to the success of these meetings. The purpose of this study was to explore communication in ACTIVE IDT meetings involving family caregivers and to assess the degree to which hospice teams use specific communication principles (summarized in the mnemonic VALUE: value, acknowledge, listen, understand, and elicit), which have been supported in previous research in intensive care settings. Researchers analyzed team-family communication during 84 video- and/or audio-recorded care plan discussions that took place during ACTIVE team meetings, using a template approach to text analysis to determine the extent and quality of VALUE principles. The total content analyzed was 9 hours, 28 minutes in length. Hospice clinicians routinely employed the VALUE communication principles in communication during ACTIVE IDT meetings with family caregivers, but the quality of this communication was frequently rated moderate or poor. The majority of such communication was task-focused. Less often, communication centered on emotional concerns and efforts to gain a more holistic understanding of patients and families. This analysis suggests an opportunity for improving support for family members during ACTIVE IDT meetings. Members of hospice IDTs should remain aware of the opportunity for additional attention to the emotional realities of the hospice experience for family caregivers and could improve support for family caregivers during IDT meetings by ensuring that messages used to exemplify VALUE principles during team-family communication are of a high quality.

The 3R principle and the use of non-human primates in the study of neurodegenerative diseases: the case of Parkinson's disease.

PubMed

Vitale, Augusto; Manciocco, Arianna; Alleva, Enrico

2009-01-01

The aim of this paper is to offer an ethical perspective on the use of non-human primates in neurobiological studies, using the Parkinson's disease (PD) as an important case study. We refer, as theoretical framework, to the 3R principle, originally proposed by Russell and Burch [Russell, W.M.S., Burch, R.L., 1959. The Principles of Humane Experimental Technique. Universities Federation for Animal Welfare Wheathampstead, England (reprinted in 1992)]. Then, the use of non-human primates in the study of PD will be discussed in relation to the concepts of Replacement, Reduction, and Refinement. Replacement and Reduction result to be the more problematic concept to be applied, whereas Refinement offers relatively more opportunities of improvement. However, although in some cases the 3R principle shows its applicative limits, its value, as conceptual and inspirational tool remains extremely valuable. It suggests to the researchers a series of questions, both theoretical and methodological, which can have the results of improving the quality of life on the experimental models, the quality of the scientific data, and the public perception from the non-scientist community.

Why Continuous Improvement Is a Poor Substitute for School Choice

ERIC Educational Resources Information Center

Rose, David C.; Rochester, J. Martin

2008-01-01

Efforts to introduce school choice have produced pressures on public schools to improve their performance. As a result, many public schools have embraced the total quality management principle of continuous improvement. In this article we explain that while this may be well intentioned, it may have perverse unintended consequences. A likely…

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

ERIC Educational Resources Information Center

Needham, Robbie Lee; And Others

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

Clinical audit, a valuable tool to improve quality of care: General methodology and applications in nephrology

PubMed Central

Esposito, Pasquale; Dal Canton, Antonio

2014-01-01

Evaluation and improvement of quality of care provided to the patients are of crucial importance in the daily clinical practice and in the health policy planning and financing. Different tools have been developed, including incident analysis, health technology assessment and clinical audit. The clinical audit consist of measuring a clinical outcome or a process, against well-defined standards set on the principles of evidence-based medicine in order to identify the changes needed to improve the quality of care. In particular, patients suffering from chronic renal diseases, present many problems that have been set as topics for clinical audit projects, such as hypertension, anaemia and mineral metabolism management. Although the results of these studies have been encouraging, demonstrating the effectiveness of audit, overall the present evidence is not clearly in favour of clinical audit. These findings call attention to the need to further studies to validate this methodology in different operating scenarios. This review examines the principle of clinical audit, focusing on experiences performed in nephrology settings. PMID:25374819

Quality, patient safety, and professional values.

PubMed

Skarda, David; Barnhart, Doug

2015-12-01

From the time of Earnest Codman until recently, measuring and improving quality has variably been viewed as a supportive group in the hospital, or an irritating "fringe" movement in health care. A more thoughtful view of quality improvement (QI) is that it is a central tenet of surgical professionalism, and really what we signed up for when we accepted the responsibility of healing patients using surgery as our methodology. The following article uses a patient safety event to highlight the successful use of a well-known method of improving care, while engaging trainees in the principles of physician engagement, accountability, and professionalism. Copyright © 2015 Elsevier Inc. All rights reserved.

The Eighth Annual NASA/Contractors Conference and 1991 National Symposium on Quality and Productivity: Extending the boundaries of total quality management

NASA Technical Reports Server (NTRS)

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

1992-01-01

The Eighth Annual NASA/Contractors Conference and 1991 National Symposium on Quality and Productivity provided a forum to exchange knowledge and experiences in these areas of continuous improvement. The more than 1,100 attendees from government, industry, academia, community groups, and the international arena had a chance to learn about methods, tools, and strategies for excellence and to discuss continuous improvement strategies, successes, and failures. This event, linked via satellite to concurrent conferences hosted by the NASA Goddard Space Flight Center in Greenbelt, Maryland, and Martin Marietta Astronautics Group in Denver, Colorado, also explored extending the boundaries of Total Quality Management to include partnerships for quality within communities and encouraged examination, evaluation, and change to incorporate the principles of continuous improvement.

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

ERIC Educational Resources Information Center

Bayless, David L.; And Others

1992-01-01

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

Application of Total Quality Management System in Thai Primary Schools

ERIC Educational Resources Information Center

Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn

2015-01-01

The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…

The Quality Professor: Implementing TQM in the Classroom.

ERIC Educational Resources Information Center

Cornesky, Robert A.

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

Key Principles of Peer Assessments: A Feedback Strategy to Engage the Postgraduate International Learner

ERIC Educational Resources Information Center

Nagori, Roopa; Cooper, Matthew

2014-01-01

The paper reports the findings of a project that assessed the benefits of peer feedback as a formative assessment intervention for postgraduate international learners in the United Kingdom. The aim was to improve participants' understanding of quality in academic writing, and hence improve the summative assessment scores, by improving the quantity…

[Ethical considerations about research with women in situations of violence].

PubMed

Rafael, Ricardo de Mattos Russo; Soares de Moura, Anna Tereza Miranda

2013-01-01

This essay aims at reflecting on the ethical and methodological principles involved in research with women in situation of violence. The text raises the discussion of the application of the principles of beneficence and non-maleficence during researches involving this issue, pointing to recommendations towards privacy, autonomy and immediate contributions for volunteers. Then, taking as theoretical reference the principles of justice and equity, the authors propose a debate on methodological aspects involved in protection of respondents, with a view at improving the quality of the data obtained and possible social contributions.

[DEONTOLOGICAL QUESTIONS IN PROPHYLACTIC OF ENDOSCOPIC COMPLICATIONS: THE SIGNIFICANCE OF RATIONAL AND PSYCHOLOGICAL FACTORS (analytical overview)].

PubMed

Vernik, N V; Ivantsova, M A; Yashin, D I

2015-01-01

To evaluate the ways of reduction complications during endoscopic procedures based on principals of professional ethics and improving the quality of working area. Data of fundamental literature, evidence based medicine, science publications and internet portals. Deontology is the fundamental principle of medical practice and one of the main factors of professional effectiveness. Complications in endoscopy are often the investigations of deviation from the deontological principals. The whole number of psychological factors influences on professional activity of endoscopists, where the emotional "burn-out" syndrome (EBS) occupies one of the main places. Prophylactic and timely relief of EBS serves improvement of the practical work quality. Creation of favorable working area is the strategically important task in prophylactics of endoscopy complications. The questions of practical realization of deontological principles in endoscopy are the subject of further discussion.

Enhancing clinical evidence by proactively building quality into clinical trials.

PubMed

Meeker-O'Connell, Ann; Glessner, Coleen; Behm, Mark; Mulinde, Jean; Roach, Nancy; Sweeney, Fergus; Tenaerts, Pamela; Landray, Martin J

2016-08-01

Stakeholders across the clinical trial enterprise have expressed concern that the current clinical trial enterprise is unsustainable. The cost and complexity of trials have continued to increase, threatening our ability to generate reliable evidence essential for making appropriate decisions concerning the benefits and harms associated with clinical interventions. Overcoming this inefficiency rests on improving protocol design, trial planning, and quality oversight. The Clinical Trials Transformation Initiative convened a project to evaluate methods to prospectively build quality into the scientific and operational design of clinical trials ("quality-by-design"), such that trials are feasible to conduct and important errors are prevented rather than remediated. A working group evaluated aspects of trial design and oversight and developed the Clinical Trials Transformation Initiative quality-by-design principles document, outlining a series of factors generally relevant to the reliability of trial conclusions and to patient safety. These principles were then applied and further refined during a series of hands-on workshops to evaluate their utility in facilitating proactive, cross-functional dialogue, and decision-making about trial design and planning. Following these workshops, independent qualitative interviews were conducted with 19 workshop attendees to explore the potential challenges for implementing a quality-by-design approach to clinical trials. The Clinical Trials Transformation Initiative project team subsequently developed recommendations and an online resource guide to support implementation of this approach. The Clinical Trials Transformation Initiative quality-by-design principles provide a framework for assuring that clinical trials adequately safeguard participants and provide reliable information on which to make decisions on the effects of treatments. The quality-by-design workshops highlighted the value of active discussions incorporating the different perspectives within and external to an organization (e.g. clinical investigators, research site staff, and trial participants) in improving trial design. Workshop participants also recognized the value of focusing oversight on those aspects of the trial where errors would have a major impact on participant safety and reliability of results. Applying the Clinical Trials Transformation Initiative quality-by-design recommendations and principles should enable organizations to prioritize the most critical determinants of a trial's quality, identify non-essential activities that can be eliminated to streamline trial conduct and oversight, and formulate appropriate plans to define, avoid, mitigate, monitor, and address important errors. © The Author(s) 2016.

Investigating the Quality of Teacher-Produced Tests for EFL Students and the Effects of Training in Test Development Principles and Practices on Improving Test Quality

ERIC Educational Resources Information Center

Coniam, David

2009-01-01

This paper examines the quality of tests that Hong Kong teachers of English as a Foreign Language (EFL) produce for their own EFL students. The paper examines the effects on graduate teachers of a language testing programme where participants produced objective tests, proceeding through the stages of test specification, moderation, and item…

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

PubMed

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

1997-01-01

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

Implementing for Sustainability: Promoting Use of a Measurement Feedback System for Innovation and Quality Improvement.

PubMed

Douglas, Susan; Button, Suzanne; Casey, Susan E

2016-05-01

Measurement feedback systems (MFSs) are increasingly recognized as evidence-based treatments for improving mental health outcomes, in addition to being a useful administrative tool for service planning and reporting. Promising research findings have driven practice administrators and policymakers to emphasize the incorporation of outcomes monitoring into electronic health systems. To promote MFS integrity and protect against potentially negative outcomes, it is vital that adoption and implementation be guided by scientifically rigorous yet practical principles. In this point of view, the authors discuss and provide examples of three user-centered and theory-based principles: emphasizing integration with clinical values and workflow, promoting administrative leadership with the 'golden thread' of data-informed decision-making, and facilitating sustainability by encouraging innovation. In our experience, enacting these principles serves to promote sustainable implementation of MFSs in the community while also allowing innovation to occur, which can inform improvements to guide future MFS research.

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.

Strategies for Meeting High Standards: Quality Management and the Baldrige Criteria in Education. Lessons from the States.

ERIC Educational Resources Information Center

Barth, John; Burk, Zona Sharp; Serfass, Richard; Harms, Barbara Ann; Houlihan, G. Thomas; Anderson, Gerald; Farley, Raymond P.; Rigsby, Ken; O'Rourke, John

This document, one of a series of reports, focuses on the adoption of principles of quality management, originally developed by W. Edwards Deming, and the Baldrige Criteria for use in education. These processes and tools for systemic organizational management, when comprehensively applied, produce performance excellence and continuous improvement.…

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.

The human side of lean teams.

PubMed

Wackerbarth, Sarah B; Strawser-Srinath, Jamie R; Conigliaro, Joseph C

2015-05-01

Organizations use lean principles to increase quality and decrease costs. Lean projects require an understanding of systems-wide processes and utilize interdisciplinary teams. Most lean tools are straightforward, and the biggest barrier to successful implementation is often development of the team aspect of the lean approach. The purpose of this article is to share challenges experienced by a lean team charged with improving a hospital discharge process. Reflection on the experience provides an opportunity to highlight lessons from The Team Handbook by Peter Scholtes and colleagues. To improve the likelihood that process improvement initiatives, including lean projects, will be successful, organizations should consider providing training in organizational change principles and team building. The authors' lean team learned these lessons the hard way. Despite the challenges, the team successfully implemented changes throughout the organization that have had a positive impact. Training to understand the psychology of change might have decreased the resistance faced in implementing these changes. © 2014 by the American College of Medical Quality.

Has compliance with CLIA requirements really improved quality in US clinical laboratories?

PubMed

Ehrmeyer, Sharon S; Laessig, Ronald H

2004-08-02

The Clinical Laboratory Improvement Amendments of 1988 (CLIA'88) mandate universal requirements for all U.S. clinical laboratory-testing sites. The intent of CLIA'88 is to ensure quality testing through a combination of minimum quality practices that incorporate total quality management concepts. These regulations do not contain established, objective indicators or measures to assess quality. However, there is an implicit assumption that compliance with traditionally accepted good laboratory practices--following manufacturers' directions, routinely analysing quality control materials, applying quality assurance principles, employing and assessing competent testing personnel, and participating in external quality assessment or proficiency testing (PT)--will result in improved test quality. The CLIA'88 regulations do include PT performance standards, which intentionally or unintentionally, define intra-laboratory performance. Passing PT has become a prime motivation for improving laboratory performance; it can also be used as an objective indicator to assess whether compliance to CLIA has improved intra-laboratory quality. Data from 1994 through 2002 indicate that the percentage of laboratories passing PT has increased. In addition to PT performance, subjective indicators of improved quality--frequency of inspection deficiencies, the number of government sanctions for non-compliance, and customer satisfaction--were evaluated. The results from these subjective indicators are more difficult to interpret but also seem to show improved quality in US clinical laboratories eleven years post-CLIA'88.

Practice-based learning and improvement: a curriculum in continuous quality improvement for surgery residents.

PubMed

Canal, David F; Torbeck, Laura; Djuricich, Alexander M

2007-05-01

Surgery residents can learn continuous quality improvement (CQI) principles within a structured curriculum and propose quality improvement projects. Curriculum within a surgical residency program. A university surgical residency program with multiple hospital training sites. Fifteen surgical residents during the dedicated research year. A curriculum in CQI that focuses on devising a quality improvement project. Resident self-reported attitudes about quality improvement and implementation of resident-initiated quality improvement projects. Resident survey data demonstrated an improvement in knowledge, self-efficacy, and experiences within CQI. Fifteen individual residents, within smaller teams, created 4 quality improvement projects worthy of implementation. A structured CQI curriculum can be successfully integrated into a general surgery residency program. Residents can learn the skill of constructing CQI project ideas within the framework of the plan-do-study-act cycle. Residents are eager to make improvements in their local system of residency. By giving them the tools to critically investigate systems improvement and a much needed ear to hear their concerns and suggestions for improvement, we found ways to potentially enhance patient care and developed ideas to improve the education of future surgeons. In doing so, we provided the residents with "buy-in" into their residency program, while addressing the competency of practice-based learning and improvement required by the Accreditation Council for Graduate Medical Education for resident education.

Discussion of Policies for Achieving Continuous Improvement in Community Colleges. Commission on Innovation Policy Discussion Paper Number 1.

ERIC Educational Resources Information Center

BW Associates, Berkeley, CA.

Intended to provide background information and preliminary options for the California Community Colleges' Commission on Innovation, this document describes the principles of Continuous Quality Improvement (CQI) and describes policy options for implementation in the state's community colleges. Following introductory materials, the paper recommends…

How an educational improvement project improved the summative evaluation of medical students.

PubMed

Hoffman, K G; Brown, R Margaret A; Gay, J W; Headrick, L A

2009-08-01

At the University of Missouri-Columbia School of Medicine (USA) "commitment to improving quality and safety in healthcare" is one of eight key characteristics set as goals for our graduates. As educators, commitment to continuous improvement in the educational experience has been modelled through improvement of the Medical Student Performance Evaluation (MSPE) letter (formerly the Dean's letter). This educational improvement project decreased waste, increased collaboration and developed locally useful knowledge. By applying continuous improvement principles to the construction of the MSPE the overall efficiency of the process could be enhanced, and the MSPE committee was able to spend less cognitive energy on structure and format and focus more on the content of the letters. Four MSPE cycles have been completed using a new Web-based system; after each cycle, additional enhancements were identified and implemented. This work adds to the literature, as it describes the application of continuous improvement principles to an educational system.

Fostering evidence-based quality improvement for patient-centered medical homes: Initiating local quality councils to transform primary care.

PubMed

Stockdale, Susan E; Zuchowski, Jessica; Rubenstein, Lisa V; Sapir, Negar; Yano, Elizabeth M; Altman, Lisa; Fickel, Jacqueline J; McDougall, Skye; Dresselhaus, Timothy; Hamilton, Alison B

Although the patient-centered medical home endorses quality improvement principles, methods for supporting ongoing, systematic primary care quality improvement have not been evaluated. We introduced primary care quality councils at six Veterans Health Administration sites as an organizational intervention with three key design elements: (a) fostering interdisciplinary quality improvement leadership, (b) establishing a structured quality improvement process, and (c) facilitating organizationally aligned frontline quality improvement innovation. Our evaluation objectives were to (a) assess design element implementation, (b) describe implementation barriers and facilitators, and (c) assess successful quality improvement project completion and spread. We analyzed administrative records and conducted interviews with 85 organizational leaders. We developed and applied criteria for assessing design element implementation using hybrid deductive/inductive analytic techniques. All quality councils implemented interdisciplinary leadership and a structured quality improvement process, and all but one completed at least one quality improvement project and a toolkit for spreading improvements. Quality councils were perceived as most effective when service line leaders had well-functioning interdisciplinary communication. Matching positions within leadership hierarchies with appropriate supportive roles facilitated frontline quality improvement efforts. Two key resources were (a) a dedicated internal facilitator with project management, data collection, and presentation skills and (b) support for preparing customized data reports for identifying and addressing practice level quality issues. Overall, quality councils successfully cultivated interdisciplinary, multilevel primary care quality improvement leadership with accountability mechanisms and generated frontline innovations suitable for spread. Practice level performance data and quality improvement project management support were critical. In order to successfully facilitate systematic, sustainable primary care quality improvement, regional and executive health care system leaders should engage interdisciplinary practice level leadership in a priority-setting process that encourages frontline innovation and establish local structures such as quality councils to coordinate quality improvement initiatives, ensure accountability, and promote spread of best practices.

Taking Human Capital Seriously: Talented Teachers in Every Classroom, Talented Principals in Every School. Principles and Recommendations for the Strategic Management of Human Capital in Public Education

ERIC Educational Resources Information Center

Consortium for Policy Research in Education, 2009

2009-01-01

The Strategic Management of Human Capital in Education Project was founded in 2008 with one goal: to improve student achievement dramatically in the 100 largest urban school districts. Unless teaching quality and principal leadership improve significantly, lasting education improvement is impossible. In policy terms, without "strategic management"…

Surgical education to improve the quality of patient care: the role of practice-based learning and improvement.

PubMed

Sachdeva, Ajit K

2007-11-01

Health care is going through immense change, and concerns regarding the quality of patient care and patient safety continue to be expressed in many national forums. A variety of stakeholders are demanding greater accountability from the health care profession. Education is key to supporting surgeons' efforts to provide high-quality patient care during these challenging times. Educational programs for surgeons should be founded on principles of continuous professional development (CPD) and practice-based learning and improvement (PBLI). CPD focuses on the specific needs of individual surgeons and involves lifelong learning throughout a surgeon's career. It needs to form the basis of PBLI efforts. PBLI involves a cycle of four steps--identifying areas for improvement, engaging in learning, applying new knowledge and skills to practice, and checking for improvement. Ongoing involvement in PBLI activities to address specific learning needs should positively impact a surgeon's practice and improve outcomes of surgical care.

The Art of Chairing: What Deming Taught the Japanese and the Japanese Taught Me.

ERIC Educational Resources Information Center

Rodd, Laurel Rasplica

2001-01-01

Reveals how a business model--based on the work of W. Edwards Deming--helped a foreign language department chair become a better leader. Outlines seven principles for department chairs: create constancy of purpose; change and improvement are ongoing; drive out fear; work with suppliers to continually improve the quality of incoming people,…

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

ERIC Educational Resources Information Center

Grumdahl, Constance Rae

2010-01-01

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

Bringing quality improvement into the intensive care unit.

PubMed

McMillan, Tracy R; Hyzy, Robert C

2007-02-01

During the last several years, many governmental and nongovernmental organizations have championed the application of the principles of quality improvement to the practice of medicine, particularly in the area of critical care. To review the breadth of approaches to quality improvement in the intensive care unit, including measures such as mortality and length of stay, and the use of protocols, bundles, and the role of large, multiple-hospital collaboratives. Several agencies have participated in the application of the quality movement to medicine, culminating in the development of standards such as the intensive care unit core measures of the Joint Commission on Accreditation of Healthcare Organizations. Although "zero defects" may not be possible in all measurable variables of quality in the intensive care unit, several measures, such as catheter-related bloodstream infections, can be significantly reduced through the implementation of improved processes of care, such as care bundles. Large, multiple-center, quality improvement collaboratives, such as the Michigan Keystone Intensive Care Unit Project, may be particularly effective in improving the quality of care by creating a "bandwagon effect" within a geographic region. The quality revolution is having a significant effect in the critical care unit and is likely to be facilitated by the transition to the electronic medical record.

Combination of confocal principle and aperture stop separation improves suppression of crystalline lens fluorescence in an eye model.

PubMed

Klemm, Matthias; Blum, Johannes; Link, Dietmar; Hammer, Martin; Haueisen, Jens; Schweitzer, Dietrich

2016-09-01

Fluorescence lifetime imaging ophthalmoscopy (FLIO) is a new technique to detect changes in the human retina. The autofluorescence decay over time, generated by endogenous fluorophores, is measured in vivo. The strong autofluorescence of the crystalline lens, however, superimposes the intensity decay of the retina fluorescence, as the confocal principle is not able to suppress it sufficiently. Thus, the crystalline lens autofluorescence causes artifacts in the retinal fluorescence lifetimes determined from the intensity decays. Here, we present a new technique to suppress the autofluorescence of the crystalline lens by introducing an annular stop into the detection light path, which we call Schweitzer's principle. The efficacy of annular stops with an outer diameter of 7 mm and inner diameters of 1 to 5 mm are analyzed in an experimental setup using a model eye based on fluorescent dyes. Compared to the confocal principle, Schweitzer's principle with an inner diameter of 3 mm is able to reduce the simulated crystalline lens fluorescence to 4%, while 42% of the simulated retina fluorescence is preserved. Thus, we recommend the implementation of Schweitzer's principle in scanning laser ophthalmoscopes used for fundus autofluorescence measurements, especially the FLIO device, for improved image quality.

Using routinely collected health data for surveillance, quality improvement and research: Framework and key questions to assess ethics, privacy and data access.

PubMed

De Lusignan, Simon; Liyanage, Harshana; Di Iorio, Concetta Tania; Chan, Tom; Liaw, Siaw-Teng

2016-01-19

The use of health data for public health, surveillance, quality improvement and research is crucial to improve health systems and health care. However, bodies responsible for privacy and ethics often limit access to routinely collected health data. Ethical approvals, issues around protecting privacy and data access are often dealt with by different layers of regulations, making approval processes appear disjointed. To create a comprehensive framework for defining the ethical and privacy status of a project and for providing guidance on data access. The framework comprises principles and related questions. The core of the framework will be built using standard terminology definitions such as ethics-related controlled vocabularies and regional directives. It is built in this way to reduce ambiguity between different definitions. The framework is extensible: principles can be retired or added to, as can their related questions. Responses to these questions should allow data processors to define ethical issues, privacy risk and other unintended consequences. The framework contains three steps: (1) identifying possible ethical and privacy principles relevant to the project; (2) providing ethics and privacy guidance questions that inform the type of approval needed; and (3) assessing case-specific ethics and privacy issues. The outputs from this process should inform whether the balance between public interests and privacy breach and any ethical considerations are tipped in favour of societal benefits. If they are then this should be the basis on which data access is permitted. Tightly linking ethical principles to governance and data access may help maintain public trust.

Scalable principles of community-based high-value care for seriously ill individuals: Diamonds in the rough.

PubMed

Parikh, Ravi B; Bowman, Brynn; Dahlin, Constance; Twohig, Jeanne S; Meier, Diane E

2017-03-01

Early, integrated palliative care has been shown to improve quality of life and reduce utilization in both inpatient and outpatient settings. As health systems shift to risk-based payment structures, palliative care will play an increasing role in improving value of care outside of the hospital. Based on successful models of community-based palliative care, we identify six principles - interdisciplinary team-based care; 24/7 access and responsiveness; concurrent palliative care with disease-directed treatment; targeting services to high-risk patients; integrated medical and social supports; and caregiver support - that are widely implemented because of their impact on improving value for seriously ill individuals. Copyright © 2016 Elsevier Inc. All rights reserved.

Coding in Stroke and Other Cerebrovascular Diseases.

PubMed

Korb, Pearce J; Jones, William

2017-02-01

Accurate coding is critical for clinical practice and research. Ongoing changes to diagnostic and billing codes require the clinician to stay abreast of coding updates. Payment for health care services, data sets for health services research, and reporting for medical quality improvement all require accurate administrative coding. This article provides an overview of coding principles for patients with strokes and other cerebrovascular diseases and includes an illustrative case as a review of coding principles in a patient with acute stroke.

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

NASA Astrophysics Data System (ADS)

Kluchnikova, O.; Pobegaylov, O.

2017-11-01

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

Standards for Quality? A Citical Appraisal of the Berlin Principles for International Rankings of Universities

ERIC Educational Resources Information Center

Hägg, Ingemund; Wedlin, Linda

2013-01-01

This article discusses the principles developed to assure the quality of international ranking practices for higher education, the so-called Berlin Principles, and the role given to them in the higher education community. While the principles are generally regarded as proper quality assurance principles, they are problematic both in their content…

Coaching to improve the quality of communication during briefings and debriefings.

PubMed

Kleiner, Catherine; Link, Terri; Maynard, M Travis; Halverson Carpenter, Katherine

2014-10-01

Communication breakdowns have been identified as a root cause of many medical errors. Sentinel events occurring in surgery comprise a significant number of these events. Despite the addition of briefings and debriefings in the OR and the introduction of crew resource management principles, communication problems continue to occur in the surgical setting. The purpose of this research was to evaluate coaching as an intervention to improve the quality of OR briefings and debriefings. A retired orthopedic surgeon conducted coaching that included all members of the perioperative team. The quality of both briefings and debriefings significantly improved after the coaching intervention. Analysis of the results of this study suggests that coaching should be considered as an intervention to improve communication during surgical procedures, especially during briefings and debriefings. Copyright © 2014 AORN, Inc. Published by Elsevier Inc. All rights reserved.

Some Remarks on the Improvement of Engineering Education

NASA Astrophysics Data System (ADS)

Tribus, Myron

2005-03-01

This paper combines the quality management principles of Deming with the educational theories of Feuerstein and Bloom in the design of a system of engineering education in which every student, on graduation, will display mastery of the subjects in the curriculum.

Some Remarks on the Improvement of Engineering Education

ERIC Educational Resources Information Center

Tribus, Myron

2005-01-01

This paper combines the quality management principles of Deming with the educational theories of Feuerstein and Bloom in the design of a system of engineering education in which every student, on graduation, will display mastery of the subjects in the curriculum.

Research Ethics in the Era of Personalized Medicine: Updating Science's Contract with Society

PubMed Central

Meslin, Eric M.; Cho, Mildred K.

2010-01-01

With the completed sequence of the human genome has come the prospect of substantially improving the quality of life for millions through personalized medicine approaches. Still, any advances in this direction require research involving human subjects. For decades science and ethics have enjoyed an allegiance reflected in a common set of ethical principles and procedures guiding the conduct of research with human subjects. Some of these principles emphasize avoiding harm over maximizing benefit. In this paper we revisit the priority given to these ethical principles – particularly the principles that support a cautious approach to science – and propose a reframing of the ‘social contract’ between science and society that emphasizes reciprocity and meeting public needs. PMID:20805701

Restructuring within an academic health center to support quality and safety: the development of the Center for Quality and Safety at the Massachusetts General Hospital.

PubMed

Bohmer, Richard M J; Bloom, Jonathan D; Mort, Elizabeth A; Demehin, Akinluwa A; Meyer, Gregg S

2009-12-01

Recent focus on the need to improve the quality and safety of health care has created new challenges for academic health centers (AHCs). Whereas previously quality was largely assumed, today it is increasingly quantifiable and requires organized systems for improvement. Traditional structures and cultures within AHCs, although well suited to the tripartite missions of teaching, research, and clinical care, are not easily adaptable to the tasks of measuring, reporting, and improving quality. Here, the authors use a case study of Massachusetts General Hospital's efforts to restructure quality and safety to illustrate the value of beginning with a focus on organizational culture, using a systematic process of engaging clinical leadership, developing an organizational framework dependent on proven business principles, leveraging focus events, and maintaining executive dedication to execution of the initiative. The case provides a generalizable example for AHCs of how applying explicit management design can foster robust organizational change with relatively modest incremental financial resources.

Application of quality by design principles to the development and technology transfer of a major process improvement for the manufacture of a recombinant protein.

PubMed

Looby, Mairead; Ibarra, Neysi; Pierce, James J; Buckley, Kevin; O'Donovan, Eimear; Heenan, Mary; Moran, Enda; Farid, Suzanne S; Baganz, Frank

2011-01-01

This study describes the application of quality by design (QbD) principles to the development and implementation of a major manufacturing process improvement for a commercially distributed therapeutic protein produced in Chinese hamster ovary cell culture. The intent of this article is to focus on QbD concepts, and provide guidance and understanding on how the various components combine together to deliver a robust process in keeping with the principles of QbD. A fed-batch production culture and a virus inactivation step are described as representative examples of upstream and downstream unit operations that were characterized. A systematic approach incorporating QbD principles was applied to both unit operations, involving risk assessment of potential process failure points, small-scale model qualification, design and execution of experiments, definition of operating parameter ranges and process validation acceptance criteria followed by manufacturing-scale implementation and process validation. Statistical experimental designs were applied to the execution of process characterization studies evaluating the impact of operating parameters on product quality attributes and process performance parameters. Data from process characterization experiments were used to define the proven acceptable range and classification of operating parameters for each unit operation. Analysis of variance and Monte Carlo simulation methods were used to assess the appropriateness of process design spaces. Successful implementation and validation of the process in the manufacturing facility and the subsequent manufacture of hundreds of batches of this therapeutic protein verifies the approaches taken as a suitable model for the development, scale-up and operation of any biopharmaceutical manufacturing process. Copyright © 2011 American Institute of Chemical Engineers (AIChE).

Clove and rosemary essential oils and encapsuled active principles (eugenol, thymol and vanillin blend) on meat quality of feedlot-finished heifers.

PubMed

de Oliveira Monteschio, Jéssica; de Souza, Kennyson Alves; Vital, Ana Carolina Pelaes; Guerrero, Ana; Valero, Maribel Velandia; Kempinski, Emília Maria Barbosa Carvalho; Barcelos, Vinícius Cunha; Nascimento, Karina Favoreto; do Prado, Ivanor Nunes

2017-08-01

Forty Nellore heifers were fed (73days) with different diets: with or without essential oils (clove and/or rosemary essential oil) and/or active principle blend (eugenol, thymol and vanillin). The pH, fat thickness, marbling, muscle area and water losses (thawing and drip) were evaluated 24h post mortem on the Longissimus thoracis, and the effects of aging (14days) was evaluated on the meat cooking losses, color, texture and lipid oxidation. Antioxidant activity was also evaluated. Treatments had no effect (P>0.05) on pH, fat thickness, marbling, muscle area, thawing and drip losses. However, treatments affected (P<0.05) cooking losses, color, texture and lipid oxidation. The diets with essential oil and the active principle blend reduced the lipid oxidation and reduced the color losses in relation to control diet. Aging affected (P<0.05) texture and lipid oxidation. The essential oil and active principles or its blend have potential use in animal feed aiming to maintain/improve meat quality during shelf-life. Copyright © 2017. Published by Elsevier Ltd.

Departing from PowerPoint default mode: Applying Mayer's multimedia principles for enhanced learning of parasitology.

PubMed

Nagmoti, Jyoti Mahantesh

2017-01-01

PowerPoint (PPT™) presentation has become an integral part of day-to-day teaching in medicine. Most often, PPT™ is used in its default mode which in fact, is known to cause boredom and ineffective learning. Research has shown improved short-term memory by applying multimedia principles for designing and delivering lectures. However, such evidence in medical education is scarce. Therefore, we attempted to evaluate the effect of multimedia principles on enhanced learning of parasitology. Second-year medical students received a series of lectures, half of the lectures used traditionally designed PPT™ and the rest used slides designed by Mayer's multimedia principles. Students answered pre and post-tests at the end of each lecture (test-I) and an essay test after six months (test-II) which assessed their short and long term knowledge retention respectively. Students' feedback on quality and content of lectures were collected. Statistically significant difference was found between post test scores of traditional and modified lectures (P = 0.019) indicating, improved short-term memory after modified lectures. Similarly, students scored better in test II on the contents learnt through modified lectures indicating, enhanced comprehension and improved long-term memory (P < 0.001). Many students appreciated learning through multimedia designed PPT™ and suggested for their continued use. It is time to depart from default PPT™ and adopt multimedia principles to enhance comprehension and improve short and long term knowledge retention. Further, medical educators may be trained and encouraged to apply multimedia principles for designing and delivering effective lectures.

Designing Professional Development around Key Principles and Formative Assessments to Improve Teachers' Knowledge to Teach Mathematics

ERIC Educational Resources Information Center

Vendlinski, Terry P.; Hemberg, Bryan; Mundy, Chris; Phelan, Julia

2009-01-01

The authors' hypothesis is that if teachers (as experts) understand and teach concepts from the position of expertise teacher quality will improve. They believe that focusing on the key ideas will deepen both teacher and student understanding and allow learners to build the concepts necessary to form solid foundations for the application of…

Deliverology

ERIC Educational Resources Information Center

Nordstrum, Lee E.; LeMahieu, Paul G.; Dodd, Karen

2017-01-01

Purpose: This paper is one of seven in this volume elaborating different approaches to quality improvement in education. This paper aims to delineate a methodology called Deliverology. Design/methodology/approach: The paper presents the origins, theoretical foundations, core principles and a case study showing an application of Deliverology in the…

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

NASA Technical Reports Server (NTRS)

1991-01-01

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

Quality of clinical trials: A moving target

PubMed Central

Bhatt, Arun

2011-01-01

Quality of clinical trials depends on data integrity and subject protection. Globalization, outsourcing and increasing complexicity of clinical trials have made the target of achieving global quality challenging. The quality, as judged by regulatory inspections of the investigator sites, sponsors/contract research organizations and Institutional Review Board, has been of concern to the US Food and Drug Administration, as there has been hardly any change in frequency and nature of common deficiencies. To meet the regulatory expectations, the sponsors need to improve quality by developing systems with specific standards for each clinical trial process. The quality systems include: personnel roles and responsibilities, training, policies and procedures, quality assurance and auditing, document management, record retention, and reporting and corrective and preventive action. With an objective to improve quality, the FDA has planned new inspection approaches such as risk-based inspections, surveillance inspections, real-time oversight, and audit of sponsor quality systems. The FDA has partnered with Duke University for Clinical Trials Transformation Initiative, which will conduct research projects on design principles, data quality and quantity including monitoring, study start-up, and adverse event reporting. These recent initiatives will go a long way in improving quality of clinical trials. PMID:22145122

Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1: ASC software quality engineering practices, Version 2.0.

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

Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise

2006-09-01

The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.

A framework for evaluating student perceptions of health policy training in medical school.

PubMed

Patel, Mitesh S; Lypson, Monica L; Miller, D Douglas; Davis, Matthew M

2014-10-01

Nearly half of graduating medical students in the United States report that medical school provides inadequate instruction in topics related to health policy. Although most medical schools report some form of policy education, there lacks a standard for teaching core concepts and evaluating student satisfaction. Responses to the Association of American Medical College's Medical School Graduation Questionnaire were obtained for the years 2007-2008 and 2011-2012 and mapped to domains of training in health policy curricula for four domains: systems and principles; value and equity; quality and safety; and politics and law. Chi-square tests were used to test differences among unadjusted temporal trends. Multiple logistic regression models were fit to the outcome variables and adjusted for student characteristics, student preferences, and medical school characteristics. Compared with 2007-2008, students' perceptions of training in 2011-2012 increased on a relative basis by 11.7% for components within systems and principles, 2.8% for quality and safety, and 6.8% for value and equity. Components within politics and law had a composite decline of 4.8%. Multiple logistic regression models found higher odds of reporting satisfaction with training over time for all components within the domains of systems and principles, quality and safety, and value and equity (P < .01), with the exception of medical economics. Medical student perceptions of training in health policy improved over time. Causal factors for these trends require further study. Despite improvement, nearly 40% of graduating medical students still report inadequate instruction in health policy.

A GIS-based performance measurement system for assessing transportation sustainability and community livability : final report.

DOT National Transportation Integrated Search

2014-08-31

Sustainability and livability in transportation, as the concepts referring to the capability of transportation systems to maintain the well being of our society, have been widely : accepted as the critical principles to improve quality of life and he...

Use of Quality Indicators in Nursing Homes in Victoria, Australia: A Cross-Sectional Descriptive Survey.

PubMed

Ibrahim, Joseph E; Chadwick, Liam; MacPhail, Aleece; McAuliffe, Linda; Koch, Susan; Wells, Yvonne

2014-08-01

This study aimed to characterize the use of mandated quality indicators (QIs) in public sector nursing homes by describing their adherence to established principles of measurement and whether nursing homes respond to QI data to improve care. Data were collected from a descriptive cross-sectional quantitative study using a confidential survey questionnaire distributed electronically to senior staff in all public sector nursing homes in Victoria, Australia. Staff from 113 of 196 facilities completed the survey (58%). Adherence to principles of measurement was suboptimal, with variation in applying QI definitions and infrequent random audits of data (n = 54, 48%). QI data triggered reviews of individual residents (62%-79%), staff practice (44%-65%), and systems of care (45%-55%). Most facilities (58%-75%) reported that beneficial changes in care occurred as a result of using QIs. QI performance data are positively received and used to improve care. Standardization of data collection, analysis, and reporting should strengthen the program's utility. © The Author(s) 2014.

Individualization and quality improvement: two new scales to complement measurement of program fidelity.

PubMed

Bond, Gary R; Drake, Robert E; Rapp, Charles A; McHugo, Gregory J; Xie, Haiyi

2009-09-01

Fidelity scales have been widely used to assess program adherence to the principles of an evidence-based practice, but they do not measure important aspects of quality of care. Pragmatic scales measuring clinical quality of services are needed to complement fidelity scales measuring structural aspects of program implementation. As part of the instrumentation developed for the National Implementing Evidence-Based Practices Project, we piloted a new instrument with two 5-item quality scales, Individualization (a client-level quality scale) and Quality Improvement (an organizational-level quality scale). Pairs of independent fidelity assessors conducted fidelity reviews in 49 sites in 8 states at baseline and at four subsequent 6-month intervals over a 2-year follow-up period. The assessors followed a standardized protocol to administer these quality scales during daylong site visits; during these same visits they assessed programs on fidelity to the evidence-based practice that the site was seeking to implement. Assessors achieved acceptable interrater reliability for both Individualization and Quality Improvement. Principal components factor analysis confirmed the 2-scale structure. The two scales were modestly correlated with each other and with the evidence-based practice fidelity scales. Over the first year, Individualization and Quality Improvement improved, but showed little or no improvement during the last year of follow-up. The two newly developed scales showed adequate psychometric properties in this preliminary study, but further research is needed to assess their validity and utility in routine clinical practice.

A lack of standardization: the basis for the ethical issues surrounding quality and performance reports.

PubMed

Suchy, Kirsten

2010-01-01

Consumers in the United States are taking advantage of the proliferation of publicly available, internet-based performance reports and quality appraisals of health plans, healthcare organizations, hospitals, and physicians to aid in their healthcare decision making. However, these appraisal practices have given rise to controversy and debate over certain distinctive ethical issues. This article advocates a standardized ethical framework to guide current and future development and implementation of performance reports. This framework, which would resolve a number of the major issues, includes the following ethical principles to guide the practice of public reporting on the Internet and facilitate enhanced quality improvement in the healthcare industry: legitimacy, data integrity and quality, transparency, informed understanding, equity, privacy and confidentiality, collaboration, accountability, and evaluation and continuous improvement.

Combination of confocal principle and aperture stop separation improves suppression of crystalline lens fluorescence in an eye model

PubMed Central

Klemm, Matthias; Blum, Johannes; Link, Dietmar; Hammer, Martin; Haueisen, Jens; Schweitzer, Dietrich

2016-01-01

Fluorescence lifetime imaging ophthalmoscopy (FLIO) is a new technique to detect changes in the human retina. The autofluorescence decay over time, generated by endogenous fluorophores, is measured in vivo. The strong autofluorescence of the crystalline lens, however, superimposes the intensity decay of the retina fluorescence, as the confocal principle is not able to suppress it sufficiently. Thus, the crystalline lens autofluorescence causes artifacts in the retinal fluorescence lifetimes determined from the intensity decays. Here, we present a new technique to suppress the autofluorescence of the crystalline lens by introducing an annular stop into the detection light path, which we call Schweitzer’s principle. The efficacy of annular stops with an outer diameter of 7 mm and inner diameters of 1 to 5 mm are analyzed in an experimental setup using a model eye based on fluorescent dyes. Compared to the confocal principle, Schweitzer’s principle with an inner diameter of 3 mm is able to reduce the simulated crystalline lens fluorescence to 4%, while 42% of the simulated retina fluorescence is preserved. Thus, we recommend the implementation of Schweitzer’s principle in scanning laser ophthalmoscopes used for fundus autofluorescence measurements, especially the FLIO device, for improved image quality. PMID:27699092

How to Measure and Interpret Quality Improvement Data.

PubMed

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

2016-05-06

This article will demonstrate how to conduct a quality improvement project using the change idea generated in "How To Use Quality Improvement Tools in Clinical Practice: How To Diagnose Solutions to a Quality of Care Problem" by Dr. Ziv Harel and colleagues in this Moving Points feature. This change idea involves the introduction of a nurse educator into a CKD clinic with a goal of increasing rates of patients performing dialysis independently at home (home hemodialysis or peritoneal dialysis). Using this example, we will illustrate a Plan-Do-Study-Act (PDSA) cycle in action and highlight the principles of rapid cycle change methodology. We will then discuss the selection of outcome, process, and balancing measures, and the practicalities of collecting these data in the clinic environment. We will also introduce the PDSA worksheet as a practical way to oversee the progress of a quality improvement project. Finally, we will demonstrate how run charts are used to visually illustrate improvement in real time, and how this information can be used to validate achievement, respond appropriately to challenges the project may encounter, and prove the significance of results. This article aims to provide readers with a clear and practical framework upon which to trial their own ideas for quality improvement in the clinical setting. Copyright © 2016 by the American Society of Nephrology.

The quality improvement attitude survey: Development and preliminary psychometric characteristics.

PubMed

Dunagan, Pamela B

2017-12-01

To report the development of a tool to measure nurse's attitudes about quality improvement in their practice setting and to examine preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Human factors such as nursing attitudes of complacency have been identified as root causes of sentinel events. Attitudes of nurses concerning use of Quality and Safety Education for nurse's competencies can be most challenging to teach and to change. No tool has been developed measuring attitudes of nurses concerning their role in quality improvement. A descriptive study design with preliminary psychometric evaluation was used to examine the preliminary psychometric characteristics of the Quality Improvement Nursing Attitude Scale. Registered bedside clinical nurses comprised the sample for the study (n = 57). Quantitative data were analysed using descriptive statistics and Cronbach's alpha reliability. Total score and individual item statistics were evaluated. Two open-ended items were used to collect statements about nurses' feelings regarding their experience in quality improvement efforts. Strong support for the internal consistency reliability and face validity of the Quality Improvement Nursing Attitude Scale was found. Total scale scores were high indicating nurse participants valued Quality and Safety Education for Nurse competencies in practice. However, item-level statistics indicated nurses felt powerless when other nurses deviate from care standards. Additionally, the sample indicated they did not consistently report patient safety issues and did not have a feeling of value in efforts to improve care. Findings suggested organisational culture fosters nurses' reporting safety issues and feeling valued in efforts to improve care. Participants' narrative comments and item analysis revealed the need to generate new items for the Quality Improvement Nursing Attitude Scale focused on nurses' perception of their importance in quality and safety and their power to enact principles. The Quality Improvement Nursing Attitude Scale-Revised edition was designed to help in understanding nurses' attitudes and values. It can be used to further explore broad concepts of quality improvement efforts. © 2017 John Wiley & Sons Ltd.

Ten guiding principles for youth mental health services.

PubMed

Hughes, Frank; Hebel, Lisa; Badcock, Paul; Parker, Alexandra G

2018-06-01

Guiding principles are arguably central to the development of any health service. The aim of this article is to report on the outcomes of a youth mental health (YMH) community of practice (CoP), which identified a range of guiding principles that provide a clear point of comparison for the only other set of principles for YMH service delivery proposed to date. A YMH CoP was established in 2010 as part of the Victorian State Government approach to improving YMH care. An initial literature search was undertaken to locate articles on YMH service delivery. A number of common themes were identified, which the YMH community of practice (YMHCoP) members then elaborated upon by drawing from their collective experience of the YMH sector. The resultant themes were then refined through subsequent group discussions to derive a definitive set of guiding principles. These principles were then augmented by a second literature search conducted in July 2015. Fifteen key themes were derived from the initial literature search and YMH CoP discussions. These were refined by the YMH CoP to produce 10 guiding principles for YMH service development. These are discussed through reference to the relevant literature, using the only other article on principles of YMH service delivery as a notable point of comparison. The 10 principles identified may be useful for quality improvement and are likely to have international relevance. We suggest the timely pursuit of an international consensus on guiding principles for service delivery under the auspices of a peak body for YMH. © 2017 John Wiley & Sons Australia, Ltd.

Project-based teaching in health informatics: a course on health care quality improvement.

PubMed

Moehr, J R; Berenji, G R; Green, C J; Kagolovsky, Y

2001-01-01

Teaching the skills and knowledge required in health informatics [1] is a challenge because the skill of applying knowledge in real life requires practice. We relate the experience with introducing a practice component to a course in "Health Care Quality Improvement". Working health care professionals were invited to bring an actual quality problem from their place of work and to work alongside students in running the problem through a quality improvement project lifecycle. Multiple technological and process oriented teaching innovations were employed including project sessions in observation rooms, video recording of these sessions, generation of demonstration examples and distance education components. Both students and their collaborators from the work place developed proficiency in applying quality improvement methods as well as in experiencing the realities of group processes, information gaps and organizational constraints. The principles used to achieve high involvement of the whole class, the employed resources and technical support are described. The resulting academic and practical achievements are discussed in relation to the alternative instructional modalities, and with respect to didactic implications for similar endeavors and beyond to other fields such as systems engineering.

Application of principal component regression and partial least squares regression in ultraviolet spectrum water quality detection

NASA Astrophysics Data System (ADS)

Li, Jiangtong; Luo, Yongdao; Dai, Honglin

2018-01-01

Water is the source of life and the essential foundation of all life. With the development of industrialization, the phenomenon of water pollution is becoming more and more frequent, which directly affects the survival and development of human. Water quality detection is one of the necessary measures to protect water resources. Ultraviolet (UV) spectral analysis is an important research method in the field of water quality detection, which partial least squares regression (PLSR) analysis method is becoming predominant technology, however, in some special cases, PLSR's analysis produce considerable errors. In order to solve this problem, the traditional principal component regression (PCR) analysis method was improved by using the principle of PLSR in this paper. The experimental results show that for some special experimental data set, improved PCR analysis method performance is better than PLSR. The PCR and PLSR is the focus of this paper. Firstly, the principal component analysis (PCA) is performed by MATLAB to reduce the dimensionality of the spectral data; on the basis of a large number of experiments, the optimized principal component is extracted by using the principle of PLSR, which carries most of the original data information. Secondly, the linear regression analysis of the principal component is carried out with statistic package for social science (SPSS), which the coefficients and relations of principal components can be obtained. Finally, calculating a same water spectral data set by PLSR and improved PCR, analyzing and comparing two results, improved PCR and PLSR is similar for most data, but improved PCR is better than PLSR for data near the detection limit. Both PLSR and improved PCR can be used in Ultraviolet spectral analysis of water, but for data near the detection limit, improved PCR's result better than PLSR.

Silicon dendritic web growth

NASA Technical Reports Server (NTRS)

Duncan, S.

1984-01-01

Technological goals for a silicon dendritic web growth program effort are presented. Principle objectives for this program include: (1) grow long web crystals front continuously replenished melt; (2) develop temperature distribution in web and melt; (3) improve reproductibility of growth; (4) develop configurations for increased growth rates (width and speed); (5) develop new growth system components as required for improved growth; and (6) evaluate quality of web growth.

Ethical principles of informed consent: exploring nurses' dual role of care provider and researcher.

PubMed

Judkins-Cohn, Tanya M; Kielwasser-Withrow, Kiersten; Owen, Melissa; Ward, Jessica

2014-01-01

This article describes the ethical principles of autonomy, beneficence, and justice within the nurse researcher-participant relationship as these principles relate to the informed consent process for research. Within this process, the nurse is confronted with a dual role. This article describes how nurses, who are in the dual role of care provider and researcher, can apply these ethical principles to their practice in conjunction with the American Nurses Association's code of ethics for nurses. This article also describes, as an element of ethical practice, the importance of using participant-centered quality measures to aid informed decision making of participants in research. In addition, the article provides strategies for improving the informed consent process in nursing research. Finally, case scenarios are discussed, along with the application of ethical principles within the awareness of the dual role of the nurse as care provider and researcher. Copyright 2014, SLACK Incorporated.

Ethical Perceptions of Customers Towards the Services of Foreign Branch Banks in Northern Cyprus

NASA Astrophysics Data System (ADS)

Veli Safakli, Okan

Nowadays, the ethical principles, which are institutionalized as generally accepted principles like the human rights, have become very popular in the banking sector like in many other sectors. The implementation of these principles provides public trust and reputation as well as competitive edge to the banks. The branches of the foreign banks, which have their head offices in foreign countries, are expected to be in harmony with the ethical principles more than the local banks. Therefore, ethical perceptions of customers towards the services of the foreign branch banks in Northern Cyprus have been researched in this study. According to this survey, it was found out that the foreign branch banks, generally, respect the ethical principles as expected. However, there is a necessity of institutional and administrative restructuring in the direction of improving the quality of the ethic standards used in these banks.

Prioritization for Plastic Surgery Procedures Aimed to Improve Quality of Life: Moral Considerations

PubMed Central

Kolby, Lars; Elander, Anna

2017-01-01

Background: Different health conditions are treated in a Plastic Surgery unit, including those cases whose main goal is to enable patients to feel and integrate better within society and therefore improving quality of life, rather then physical functions. Methods: We discuss moral principles that can be used as a guide for health professionals to revise and create policies for plastic surgery patients presenting with non–life-threatening conditions. Results: A specific anatomical feature is not always an indicator of patient’s well-being and quality of life, and therefore it cannot be used as the sole parameter to identify the worst-off and prioritize the provision of health care. A policy should identify who preoperatively are the worst-off and come to some plausible measure of how much they can be expected to benefit from an operation. Policies that do not track these principles in any reliable way can cause discrimination. Conclusions: A patient-centered operating system and patient’s informed preferences might be implemented in the process of prioritizing health. In circumstances when the effectiveness of a specific treatment is unproven, professionals should not make assumptions based on their own values. PMID:28894658

Evaluation of Preanalytical Quality Indicators by Six Sigma and Pareto`s Principle.

PubMed

Kulkarni, Sweta; Ramesh, R; Srinivasan, A R; Silvia, C R Wilma Delphine

2018-01-01

Preanalytical steps are the major sources of error in clinical laboratory. The analytical errors can be corrected by quality control procedures but there is a need for stringent quality checks in preanalytical area as these processes are done outside the laboratory. Sigma value depicts the performance of laboratory and its quality measures. Hence in the present study six sigma and Pareto principle was applied to preanalytical quality indicators to evaluate the clinical biochemistry laboratory performance. This observational study was carried out for a period of 1 year from November 2015-2016. A total of 1,44,208 samples and 54,265 test requisition forms were screened for preanalytical errors like missing patient information, sample collection details in forms and hemolysed, lipemic, inappropriate, insufficient samples and total number of errors were calculated and converted into defects per million and sigma scale. Pareto`s chart was drawn using total number of errors and cumulative percentage. In 75% test requisition forms diagnosis was not mentioned and sigma value of 0.9 was obtained and for other errors like sample receiving time, stat and type of sample sigma values were 2.9, 2.6, and 2.8 respectively. For insufficient sample and improper ratio of blood to anticoagulant sigma value was 4.3. Pareto`s chart depicts out of 80% of errors in requisition forms, 20% is contributed by missing information like diagnosis. The development of quality indicators, application of six sigma and Pareto`s principle are quality measures by which not only preanalytical, the total testing process can be improved.

Health care professional development: Working as a team to improve patient care

PubMed Central

El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

2014-01-01

In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care. PMID:27493399

Health care professional development: Working as a team to improve patient care.

PubMed

Babiker, Amir; El Husseini, Maha; Al Nemri, Abdurrahman; Al Frayh, Abdurrahman; Al Juryyan, Nasir; Faki, Mohamed O; Assiri, Asaad; Al Saadi, Muslim; Shaikh, Farheen; Al Zamil, Fahad

2014-01-01

In delivering health care, an effective teamwork can immediately and positively affect patient safety and outcome. The need for effective teams is increasing due to increasing co-morbidities and increasing complexity of specialization of care. Time has gone when a doctor or a dentist or any other health practitioner in whatsoever health organization would be able to solely deliver a quality care that satisfies his or her patients. The evolution in health care and a global demand for quality patient care necessitate a parallel health care professional development with a great focus on patient centred teamwork approach. This can only be achieved by placing the patient in the centre of care and through sharing a wide based culture of values and principles. This will help forming and developing an effective team able to deliver exceptional care to the patients. Aiming towards this goal, motivation of team members should be backed by strategies and practical skills in order to achieve goals and overcome challenges. This article highlights values and principles of working as a team and principles and provides team players with a practical approach to deliver quality patient care.

Framework for industry engagement and quality principles for industry-provided medical education in Europe.

PubMed

Allen, Tamara; Donde, Nina; Hofstädter-Thalmann, Eva; Keijser, Sandra; Moy, Veronique; Murama, Jean-Jacques; Kellner, Thomas

2017-01-01

Lifelong learning through continuing professional development (CPD) and medical education is critical for healthcare professionals to stay abreast of knowledge and skills and provide an optimal standard of care to patients. In Europe, CPD and medical education are fragmented as there are numerous models, providers and national regulations and a lack of harmonisation of qualitative criteria. There is continued debate on the appropriate role of pharmaceutical companies in the context of medical education. Accrediting bodies such as European Accreditation Council for Continuing Medical Education do not permit active involvement of the pharmaceutical industry due to concerns around conflicts of interest and potential for bias. However, many examples of active collaboration between pharmaceutical companies and medical societies and scientific experts exist, demonstrating high integrity, clear roles and responsibilities, and fair and balanced content. Medical education experts from 16 pharmaceutical companies met to develop a set of quality principles similar to standards that have been established for clinical trials and in alignment with existing principles of accrediting bodies. This paper outlines their proposal for a framework to improve and harmonise medical education quality standards in Europe, and is also an invitation for all stakeholders to join a discussion on this integrative model.

Introducing a quality improvement programme to primary healthcare teams

PubMed Central

Hearnshaw, H.; Reddish, S.; Carlyle, D.; Baker, R.; Robertson, N.

1998-01-01

OBJECTIVES: To evaluate a programme in which quality improvement was facilitated, based on principles of total quality management, in primary healthcare teams, and to determine its feasibility, acceptability, effectiveness, and the duration of its effect. METHOD: Primary healthcare teams in Leicestershire (n = 147) were invited to take part in the facilitated programme. The programme comprised seven team meetings, led by a researcher, plus up to two facilitated meetings of quality improvement subgroups, appointed by each team to consider specific quality issues. OUTCOME MEASURES: To assess the effect and feasibility of the programme on improving the quality of care provided, the individual quality improvement projects undertaken by the teams were documented and opportunities for improvement were noted at each session by the facilitator. The programme's acceptability was assessed with questionnaires issued in the final session to each participant. To assess the long term impact on teams, interviews with team members were conducted 3 years after the programme ended. RESULTS: 10 of the 27 teams that initially expressed interest in the programme agreed to take part, and six started the programme. Of these, five completed their quality improvement projects and used several different quality tools, and three completed all seven sessions of the programme. The programme was assessed as appropriate and acceptable by the participants. Three years later, the changes made during the programme were still in place in three of the six teams. Four teams had decided to undertake the local quality monitoring programme, resourced and supported by the Health Authority. CONCLUSIONS: The facilitated programme was feasible, acceptable, and effective for a few primary healthcare teams. The outcomes of the programme can be sustained. Research is needed on the characteristics of teams likely to be successful in the introduction and maintenance of quality improvement programmes. PMID:10339022

AACSB Accreditation and Possible Unintended Consequences: A Deming View

ERIC Educational Resources Information Center

Stepanovich, Paul; Mueller, James; Benson, Dan

2014-01-01

The AACSB accreditation process reflects basic quality principles, providing standards and a process for feedback for continuous improvement. However, implementation can lead to unintended negative consequences. The literature shows that while institutionalism and critical theory have been used as a theoretical base for evaluating accreditation,…

Pursuing the perfect patient experience.

PubMed

Kaplan, Gary S

2013-01-01

Adapting the principles and tools of the Toyota Production System to healthcare in the form of the Virginia Mason Production System has enabled Virginia Mason Medical Center to transform itself as an organization. Virginia Mason has worked persistently for more than a decade to apply Toyota methods to eliminate waste, improve safety and quality, and provide the community it serves with the highest-quality healthcare at the lowest cost. We have made great progress in this pursuit.

Design, fabrication, testing, and delivery of improved beam steering devices

NASA Technical Reports Server (NTRS)

1973-01-01

The development, manufacture, and testing of an optical steerer intended for use in spaceborne optical radar systems are described. Included are design principles and design modifications made to harden the device against launch and space environments, the quality program and procedures developed to insure consistent product quality throughout the manufacturing phase, and engineering qualification model testing and evaluation. The delivered hardware design is considered conditionally qualified pending action on further recommended design modifications.

Guidelines for Risk-Based Changeover of Biopharma Multi-Product Facilities.

PubMed

Lynch, Rob; Barabani, David; Bellorado, Kathy; Canisius, Peter; Heathcote, Doug; Johnson, Alan; Wyman, Ned; Parry, Derek Willison

2018-01-01

In multi-product biopharma facilities, the protection from product contamination due to the manufacture of multiple products simultaneously is paramount to assure product quality. To that end, the use of traditional changeover methods (elastomer change-out, full sampling, etc.) have been widely used within the industry and have been accepted by regulatory agencies. However, with the endorsement of Quality Risk Management (1), the use of risk-based approaches may be applied to assess and continuously improve established changeover processes. All processes, including changeover, can be improved with investment (money/resources), parallel activities, equipment design improvements, and standardization. However, processes can also be improved by eliminating waste. For product changeover, waste is any activity not needed for the new process or that does not provide added assurance of the quality of the subsequent product. The application of a risk-based approach to changeover aligns with the principles of Quality Risk Management. Through the use of risk assessments, the appropriate changeover controls can be identified and controlled to assure product quality is maintained. Likewise, the use of risk assessments and risk-based approaches may be used to improve operational efficiency, reduce waste, and permit concurrent manufacturing of products. © PDA, Inc. 2018.

Information technology principles for management, reporting, and research.

PubMed

Gillam, Michael; Rothenhaus, Todd; Smith, Vernon; Kanhouwa, Meera

2004-11-01

Information technology holds the promise to enhance the ability of individuals and organizations to manage emergency departments, improve data sharing and reporting, and facilitate research. The Society for Academic Emergency Medicine (SAEM) Consensus Committee has identified nine principles to outline a path of optimal features and designs for current and future information technology systems. The principles roughly summarized include the following: utilize open database standards with clear data dictionaries, provide administrative access to necessary data, appoint and recognize individuals with emergency department informatics expertise, allow automated alert and proper identification for enrollment of cases into research, provide visual and statistical tools and training to analyze data, embed automated configurable alarm functionality for clinical and nonclinical systems, allow multiexport standard and format configurable reporting, strategically acquire mission-critical equipment that is networked and capable of automated feedback regarding functional status and location, and dedicate resources toward informatics research and development. The SAEM Consensus Committee concludes that the diligent application of these principles will enhance emergency department management, reporting, and research and ultimately improve the quality of delivered health care.

Strategic management of Public Hospitals' medical services.

PubMed

Hao, Aimin; Yi, Tao; Li, Xia; Wei, Lei; Huang, Pei; Xu, Xinzhou; Yi, Lihua

2016-01-01

Purpose: The quality of medical services provided by competing public hospitals is the primary consideration of the public in determining the selection of a specific hospital for treatment. The main objective of strategic planning is to improve the quality of public hospital medical services. This paper provides an introduction to the history, significance, principles and practices of public hospital medical service strategy, as well as advancing the opinion that public hospital service strategy must not merely aim to produce but actually result in the highest possible level of quality, convenience, efficiency and patient satisfaction.

Systems design analysis applied to launch vehicle configuration

NASA Technical Reports Server (NTRS)

Ryan, R.; Verderaime, V.

1993-01-01

As emphasis shifts from optimum-performance aerospace systems to least lift-cycle costs, systems designs must seek, adapt, and innovate cost improvement techniques in design through operations. The systems design process of concept, definition, and design was assessed for the types and flow of total quality management techniques that may be applicable in a launch vehicle systems design analysis. Techniques discussed are task ordering, quality leverage, concurrent engineering, Pareto's principle, robustness, quality function deployment, criteria, and others. These cost oriented techniques are as applicable to aerospace systems design analysis as to any large commercial system.

A ten-year history: the Cancer Quality Council of Ontario.

PubMed

Anas, Rebecca; Bell, Robert; Brown, Adalsteinn; Evans, William; Sawka, Carol

2012-01-01

One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO. Copyright © 2012 Longwoods Publishing.

Audit and feedback interventions to improve endoscopist performance: Principles and effectiveness.

PubMed

Tinmouth, Jill; Patel, Jigisha; Hilsden, Robert J; Ivers, Noah; Llovet, Diego

2016-06-01

There is considerable variation in the quality of colonoscopy, attributable in part to endoscopist performance. Audit and feedback (A&F) provides health professionals with a summary of their performance over a period of time and is a common strategy used to improve provider performance. In this review, we discuss current understanding of the mechanism of A&F and describe specific features of effective A&F. To date, trials of A&F to improve colonoscopy performance report heterogeneous results, in part because colonoscopy is a complex procedural skill but also because the quality improvement interventions were sub-optimally implemented or inadequately evaluated. Nonetheless, evidence from a wide range of literature suggests that A&F has the potential to improve endoscopist performance. We discuss future directions for research in this area and provide guidance for providers or health system planners wishing to implement A&F to address quality of colonoscopy in their practice and/or jurisdiction. Copyright © 2016 Elsevier Ltd. All rights reserved.

Extreme weather events: Should drinking water quality management systems adapt to changing risk profiles?

PubMed

Khan, Stuart J; Deere, Daniel; Leusch, Frederic D L; Humpage, Andrew; Jenkins, Madeleine; Cunliffe, David

2015-11-15

Among the most widely predicted and accepted consequences of global climate change are increases in both the frequency and severity of a variety of extreme weather events. Such weather events include heavy rainfall and floods, cyclones, droughts, heatwaves, extreme cold, and wildfires, each of which can potentially impact drinking water quality by affecting water catchments, storage reservoirs, the performance of water treatment processes or the integrity of distribution systems. Drinking water guidelines, such as the Australian Drinking Water Guidelines and the World Health Organization Guidelines for Drinking-water Quality, provide guidance for the safe management of drinking water. These documents present principles and strategies for managing risks that may be posed to drinking water quality. While these principles and strategies are applicable to all types of water quality risks, very little specific attention has been paid to the management of extreme weather events. We present a review of recent literature on water quality impacts of extreme weather events and consider practical opportunities for improved guidance for water managers. We conclude that there is a case for an enhanced focus on the management of water quality impacts from extreme weather events in future revisions of water quality guidance documents. Copyright © 2015 Elsevier Ltd. All rights reserved.

Approaches to ensuring and improving quality in the context of health system strengthening: a cross-site analysis of the five African Health Initiative Partnership programs

PubMed Central

2013-01-01

Background Integrated into the work in health systems strengthening (HSS) is a growing focus on the importance of ensuring quality of the services delivered and systems which support them. Understanding how to define and measure quality in the different key World Health Organization building blocks is critical to providing the information needed to address gaps and identify models for replication. Description of approaches We describe the approaches to defining and improving quality across the five country programs funded through the Doris Duke Charitable Foundation African Health Initiative. While each program has independently developed and implemented country-specific approaches to strengthening health systems, they all included quality of services and systems as a core principle. We describe the differences and similarities across the programs in defining and improving quality as an embedded process essential for HSS to achieve the goal of improved population health. The programs measured quality across most or all of the six WHO building blocks, with specific areas of overlap in improving quality falling into four main categories: 1) defining and measuring quality; 2) ensuring data quality, and building capacity for data use for decision making and response to quality measurements; 3) strengthened supportive supervision and/or mentoring; and 4) operational research to understand the factors associated with observed variation in quality. Conclusions Learning the value and challenges of these approaches to measuring and improving quality across the key components of HSS as the projects continue their work will help inform similar efforts both now and in the future to ensure quality across the critical components of a health system and the impact on population health. PMID:23819662

[Evaluation on methodological problems in reports concerning quantitative analysis of syndrome differentiation of diabetes mellitus].

PubMed

Chen, Bi-Cang; Wu, Qiu-Ying; Xiang, Cheng-Bin; Zhou, Yi; Guo, Ling-Xiang; Zhao, Neng-Jiang; Yang, Shu-Yu

2006-01-01

To evaluate the quality of reports published in recent 10 years in China about quantitative analysis of syndrome differentiation for diabetes mellitus (DM) in order to explore the methodological problems in these reports and find possible solutions. The main medical literature databases in China were searched. Thirty-one articles were included and evaluated by the principles of clinical epidemiology. There were many mistakes and deficiencies in these articles, such as clinical trial designs, diagnosis criteria for DM, standards of syndrome differentiation of DM, case inclusive and exclusive criteria, sample size and estimation, data comparability and statistical methods. It is necessary and important to improve the quality of reports concerning quantitative analysis of syndrome differentiation of DM in light of the principles of clinical epidemiology.

Learning Evaluation: blending quality improvement and implementation research methods to study healthcare innovations.

PubMed

Balasubramanian, Bijal A; Cohen, Deborah J; Davis, Melinda M; Gunn, Rose; Dickinson, L Miriam; Miller, William L; Crabtree, Benjamin F; Stange, Kurt C

2015-03-10

In healthcare change interventions, on-the-ground learning about the implementation process is often lost because of a primary focus on outcome improvements. This paper describes the Learning Evaluation, a methodological approach that blends quality improvement and implementation research methods to study healthcare innovations. Learning Evaluation is an approach to multi-organization assessment. Qualitative and quantitative data are collected to conduct real-time assessment of implementation processes while also assessing changes in context, facilitating quality improvement using run charts and audit and feedback, and generating transportable lessons. Five principles are the foundation of this approach: (1) gather data to describe changes made by healthcare organizations and how changes are implemented; (2) collect process and outcome data relevant to healthcare organizations and to the research team; (3) assess multi-level contextual factors that affect implementation, process, outcome, and transportability; (4) assist healthcare organizations in using data for continuous quality improvement; and (5) operationalize common measurement strategies to generate transportable results. Learning Evaluation principles are applied across organizations by the following: (1) establishing a detailed understanding of the baseline implementation plan; (2) identifying target populations and tracking relevant process measures; (3) collecting and analyzing real-time quantitative and qualitative data on important contextual factors; (4) synthesizing data and emerging findings and sharing with stakeholders on an ongoing basis; and (5) harmonizing and fostering learning from process and outcome data. Application to a multi-site program focused on primary care and behavioral health integration shows the feasibility and utility of Learning Evaluation for generating real-time insights into evolving implementation processes. Learning Evaluation generates systematic and rigorous cross-organizational findings about implementing healthcare innovations while also enhancing organizational capacity and accelerating translation of findings by facilitating continuous learning within individual sites. Researchers evaluating change initiatives and healthcare organizations implementing improvement initiatives may benefit from a Learning Evaluation approach.

Applying Lean Six Sigma to improve medication management.

PubMed

Nayar, Preethy; Ojha, Diptee; Fetrick, Ann; Nguyen, Anh T

2016-01-01

A significant proportion of veterans use dual care or health care services within and outside the Veterans Health Administration (VHA). In this study conducted at a VHA medical center in the USA, the authors used Lean Six Sigma principles to develop recommendations to eliminate wasteful processes and implement a more efficient and effective process to manage medications for dual care veteran patients. The purpose of this study is to: assess compliance with the VHA's dual care policy; collect data and describe the current process for co-management of dual care veterans' medications; and draft recommendations to improve the current process for dual care medications co-management. Input was obtained from the VHA patient care team members to draw a process map to describe the current process for filling a non-VHA prescription at a VHA facility. Data were collected through surveys and direct observation to measure the current process and to develop recommendations to redesign and improve the process. A key bottleneck in the process that was identified was the receipt of the non-VHA medical record which resulted in delays in filling prescriptions. The recommendations of this project focus on the four domains of: documentation of dual care; veteran education; process redesign; and outreach to community providers. This case study describes the application of Lean Six Sigma principles in one urban Veterans Affairs Medical Center (VAMC) in the Mid-Western USA to solve a specific organizational quality problem. Therefore, the findings may not be generalizable to other organizations. The Lean Six Sigma general principles applied in this project to develop recommendations to improve medication management for dual care veterans are applicable to any process improvement or redesign project and has valuable lessons for other VAMCs seeking to improve care for their dual care veteran patients. The findings of this project will be of value to VA providers and policy makers and health care managers who plan to apply Lean Six Sigma techniques in their organizations to improve the quality of care for their patients.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples

PubMed Central

Selker, Harry P.; Leslie, Laurel K.

2015-01-01

Abstract There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in‐person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. PMID:26332869

Matrix Wings: Continuous Process Improvement an Operator Can Love

DTIC Science & Technology

2016-09-01

could employ the principles in AFSO21 but preferably by em- ploying a version that does not take time away from mission preparation/execution and that...results, the DOD’s director of quality management sent a certified public accountant to Yokota to verify the claims. The CPA validated that

Interdisciplinarity and Education: Towards Principles of Pedagogical Practice

ERIC Educational Resources Information Center

Mulder, Martin

2012-01-01

Disciplines play a major role in agricultural education and extension. Biology, chemistry and physics are all essential to understand nature and to improve the quality of agricultural production. During the past centuries, disciplines have evolved, and a multitude of specialisations emerged, like cell biology, colloid chemistry and geophysics. The…

Continuing Education, Guideline Implementation, and the Emerging Transdisciplinary Field of Knowledge Translation

ERIC Educational Resources Information Center

Davis, Dave

2006-01-01

This article discusses continuing education and the implementation of clinical practice guidelines or best evidence, quality improvement, and patient safety. Continuing education focuses on the perspective of the adult learner and is guided by well-established educational principles. In contrast, guideline implementation and related concepts…

Six Sigma in Education

ERIC Educational Resources Information Center

LeMahieu, Paul G.; Nordstrum, Lee E.; Cudney, Elizabeth A.

2017-01-01

Purpose: This paper is one of seven in this volume that aims to elaborate different approaches to quality improvement in education. It delineates a methodology called Six Sigma. Design/methodology/approach: The paper presents the origins, theoretical foundations, core principles and a case study demonstrating an application of Six Sigma in a…

Positive Deviance: Learning from Positive Anomalies

ERIC Educational Resources Information Center

LeMahieu, Paul G.; Nordstrum, Lee E.; Gale, Dick

2017-01-01

Purpose: This paper is one of seven in this volume, each elaborating different approaches to quality improvement in education. The purpose of this paper is to delineate a methodology called positive deviance. Design/methodology/approach: The paper presents the origins, theoretical foundations, core principles and a case study demonstrating an…

Computer Animations a Science Teaching Aid: Contemplating an Effective Methodology

ERIC Educational Resources Information Center

Tannu, Kirti

2008-01-01

To improve quality of science education, the author suggests use of entertaining and exciting technique of animation for better understanding of scientific principles. Latest technologies are being used with more vigour to spread venomous superstitions. Better understanding of science may help students to better their scientific temper. Keeping…

Designing Educational Software for Tomorrow.

ERIC Educational Resources Information Center

Harvey, Wayne

Designed to address the management and use of computer software in education and training, this paper explores both good and poor software design, calling for improvements in the quality of educational software by attending to design considerations that are based on general principles of learning rather than specific educational objectives. This…

Food Irradiation – Principles and Applications

USDA-ARS?s Scientific Manuscript database

This article deals with the application of ionizing radiation (IR) to foods so as to improve their safety, shelf-life, and quality. The topics covered include: the types of equipment used to generate IR, and their advantages and disadvantages; IR’s mode of action in foods; the latest information on ...

Reducing waste and errors: piloting lean principles at Intermountain Healthcare.

PubMed

Jimmerson, Cindy; Weber, Dorothy; Sobek, Durward K

2005-05-01

The Toyota Production System (TPS), based on industrial engineering principles and operational innovations, is used to achieve waste reduction and efficiency while increasing product quality. Several key tools and principles, adapted to health care, have proved effective in improving hospital operations. Value Stream Maps (VSMs), which represent the key people, material, and information flows required to deliver a product or service, distinguish between value-adding and non-value-adding steps. The one-page Problem-Solving A3 Report guides staff through a rigorous and systematic problem-solving process. PILOT PROJECT at INTERMOUNTAIN HEALTHCARE: In a pilot project, participants made many improvements, ranging from simple changes implemented immediately (for example, heart monitor paper not available when a patient presented with a dysrythmia) to larger projects involving patient or information flow issues across multiple departments. Most of the improvements required little or no investment and reduced significant amounts of wasted time for front-line workers. In one unit, turnaround time for pathologist reports from an anatomical pathology lab was reduced from five to two days. TPS principles and tools are applicable to an endless variety of processes and work settings in health care and can be used to address critical challenges such as medical errors, escalating costs, and staffing shortages.

Process improvement of pap smear tracking in a women's medicine center clinic in residency training.

PubMed

Calhoun, Byron C; Goode, Jeff; Simmons, Kathy

2011-11-01

Application of Six-Sigma methodology and Change Acceleration Process (CAP)/Work Out (WO) tools to track pap smear results in an outpatient clinic in a hospital-based residency-training program. Observational study of impact of changes obtained through application of Six-Sigma principles in clinic process with particular attention to prevention of sentinel events. Using cohort analysis and applying Six-Sigma principles to an interactive electronic medical record Soarian workflow engine, we designed a system of timely accession and reporting of pap smear and pathology results. We compared manual processes from January 1, 2007 to February 28, 2008 to automated processes from March 1, 2008 to December 31, 2009. Using the Six-Sigma principles, CAP/WO tools, including "voice of the customer" and team focused approach, no outlier events went untracked. Applying the Soarian workflow engine to track prescribed 7 day turnaround time for completion, we identified 148 pap results in 3,936, 3 non-gynecological results in 15, and 41 surgical results in 246. We applied Six-Sigma principles to an outpatient clinic facilitating an interdisciplinary team approach to improve the clinic's reporting system. Through focused problem assessment, verification of process, and validation of outcomes, we improved patient care for pap smears and critical pathology. © 2011 National Association for Healthcare Quality.

Proposed correlation of modern processing principles for Ayurvedic herbal drug manufacturing: A systematic review.

PubMed

Jain, Rahi; Venkatasubramanian, Padma

2014-01-01

Quality Ayurvedic herbal medicines are potential, low-cost solutions for addressing contemporary healthcare needs of both Indian and global community. Correlating Ayurvedic herbal preparations with modern processing principles (MPPs) can help develop new and use appropriate technology for scaling up production of the medicines, which is necessary to meet the growing demand. Understanding the fundamental Ayurvedic principles behind formulation and processing is also important for improving the dosage forms. Even though Ayurvedic industry has adopted technologies from food, chemical and pharmaceutical industries, there is no systematic study to correlate the traditional and modern processing methods. This study is an attempt to provide a possible correlation between the Ayurvedic processing methods and MPPs. A systematic literature review was performed to identify the Ayurvedic processing methods by collecting information from English editions of classical Ayurveda texts on medicine preparation methods. Correlation between traditional and MPPs was done based on the techniques used in Ayurvedic drug processing. It was observed that in Ayurvedic medicine preparations there were two major types of processes, namely extraction, and separation. Extraction uses membrane rupturing and solute diffusion principles, while separation uses volatility, adsorption, and size-exclusion principles. The study provides systematic documentation of methods used in Ayurveda for herbal drug preparation along with its interpretation in terms of MPPs. This is the first step which can enable improving or replacing traditional techniques. New technologies or use of existing technologies can be used to improve the dosage forms and scaling up while maintaining the Ayurvedic principles similar to traditional techniques.

The Effect of Multiprofessional Simulation-Based Obstetric Team Training on Patient-Reported Quality of Care: A Pilot Study.

PubMed

Truijens, Sophie E M; Banga, Franyke R; Fransen, Annemarie F; Pop, Victor J M; van Runnard Heimel, Pieter J; Oei, S Guid

2015-08-01

This study aimed to explore whether multiprofessional simulation-based obstetric team training improves patient-reported quality of care during pregnancy and childbirth. Multiprofessional teams from a large obstetric collaborative network in the Netherlands were trained in teamwork skills using the principles of crew resource management. Patient-reported quality of care was measured with the validated Pregnancy and Childbirth Questionnaire (PCQ) at 6 weeks postpartum. Before the training, 76 postpartum women (sample I) completed the questionnaire 6 weeks postpartum. Three months after the training, another sample of 68 postpartum women (sample II) completed the questionnaire. In sample II (after the training), the mean (SD) score of 108.9 (10.9) on the PCQ questionnaire was significantly higher than the score of 103.5 (11.6) in sample I (before training) (t = 2.75, P = 0.007). The effect size of the increase in PCQ total score was 0.5. Moreover, the subscales "personal treatment during pregnancy" and "educational information" showed a significant increase after the team training (P < 0.001). Items with the largest increase in mean scores included communication between health care professionals, clear leadership, involvement in planning, and better provision of information. Despite the methodological restrictions of a pilot study, the preliminary results indicate that multiprofessional simulation-based obstetric team training seems to improve patient-reported quality of care. The possibility that this improvement relates to the training is supported by the fact that the items with the largest increase are about the principles of crew resource management, used in the training.

Development of Team Action Projects in Surgery (TAPS): a multilevel team-based approach to teaching quality improvement.

PubMed

Waits, Seth A; Reames, Bradley N; Krell, Robert W; Bryner, Benjamin; Shih, Terry; Obi, Andrea T; Henke, Peter K; Minter, Rebecca M; Englesbe, Michael J; Wong, Sandra L

2014-01-01

To meet the Accreditation Council for Graduate Medical Education core competency in Practice-Based Learning and Improvement, educational curricula need to address training in quality improvement (QI). We sought to establish a program to train residents in the principles of QI and to provide practical experiences in developing and implementing improvement projects. We present a novel approach for engaging students, residents, and faculty in QI efforts-Team Action Projects in Surgery (TAPS). Large academic medical center and health system. Multiple teams consisting of undergraduate students, medical students, surgery residents, and surgery faculty were assembled and QI projects developed. Using "managing to learn" Lean principles, these multilevel groups approached each project with robust data collection, development of an A3, and implementation of QI activities. A total of 5 resident led QI projects were developed during the TAPS pilot phase. These included a living kidney donor enhanced recovery protocol, consult improvement process, venous thromboembolism prophylaxis optimization, Clostridium difficile treatment standardization, and understanding variation in operative duration of laparoscopic cholecystectomy. Qualitative and quantitative assessment showed significant value for both the learner and stakeholders of QI related projects. Through the development of TAPS, we demonstrate a novel approach to addressing the increasing focus on QI within graduate medical education. Efforts to expand this multilevel team based approach would have value for teachers and learners alike. Copyright © 2014. Published by Elsevier Inc.

Improvement in Stress, General Self-Efficacy, and Health Related Quality of Life following Patient Education for Patients with Neuroendocrine Tumors: A Pilot Study.

PubMed

Haugland, Trude; Veenstra, Marijke; Vatn, Morten H; Wahl, Astrid K

2013-01-01

The purpose of the study was to evaluate changes in general self-efficacy, health related quality of life (HRQoL), and stress among patients with neuroendocrine tumors (NET) following a multidisciplinary educational intervention. Forty-one patients were enrolled in this exploratory pilot study. A total of 37 patients completed the full 26-week intervention based on the principles of self-efficacy. General self-efficacy was measured by the General Self-Efficacy Scale, HRQoL was measured with the SF-36, and stress was measured with the Impact of Event Scale. Mixed effect models were used to evaluate changes in general self-efficacy, mental and physical components of HRQoL, and stress adjusting for demographic and clinical variables. Results showed significant improvements in patients' general self-efficacy (β = 0.71; P < 0.05), physical component scores of HRQoL (β = 3.09; P < 0.01), and stress (β = -2.10, P = 0.008). Findings suggest that patients with NET have the capacity to improve their ability to cope with their disease, problem-solve, improve their physical status, and reduce their stress following an educational intervention based on the principles of self-efficacy. These preliminary data provide a basis for future randomized controlled trials to test interventions to improve HRQoL for patients with NET.

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

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.

Fermentation Quality and Additives: A Case of Rice Straw Silage

PubMed Central

Oladosu, Yusuff; Magaji, Usman; Hussin, Ghazali; Ramli, Asfaliza; Miah, Gous

2016-01-01

Rice cultivation generates large amount of crop residues of which only 20% are utilized for industrial and domestic purposes. In most developing countries especially southeast Asia, rice straw is used as part of feeding ingredients for the ruminants. However, due to its low protein content and high level of lignin and silica, there is limitation to its digestibility and nutritional value. To utilize this crop residue judiciously, there is a need for improvement of its nutritive value to promote its utilization through ensiling. Understanding the fundamental principle of ensiling is a prerequisite for successful silage product. Prominent factors influencing quality of silage product include water soluble carbohydrates, natural microbial population, and harvesting conditions of the forage. Additives are used to control the fermentation processes to enhance nutrient recovery and improve silage stability. This review emphasizes some practical aspects of silage processing and the use of additives for improvement of fermentation quality of rice straw. PMID:27429981

Fermentation Quality and Additives: A Case of Rice Straw Silage.

PubMed

Oladosu, Yusuff; Rafii, Mohd Y; Abdullah, Norhani; Magaji, Usman; Hussin, Ghazali; Ramli, Asfaliza; Miah, Gous

2016-01-01

Rice cultivation generates large amount of crop residues of which only 20% are utilized for industrial and domestic purposes. In most developing countries especially southeast Asia, rice straw is used as part of feeding ingredients for the ruminants. However, due to its low protein content and high level of lignin and silica, there is limitation to its digestibility and nutritional value. To utilize this crop residue judiciously, there is a need for improvement of its nutritive value to promote its utilization through ensiling. Understanding the fundamental principle of ensiling is a prerequisite for successful silage product. Prominent factors influencing quality of silage product include water soluble carbohydrates, natural microbial population, and harvesting conditions of the forage. Additives are used to control the fermentation processes to enhance nutrient recovery and improve silage stability. This review emphasizes some practical aspects of silage processing and the use of additives for improvement of fermentation quality of rice straw.

The experience factory: Can it make you a 5? or what is its relationship to other quality and improvement concepts?

NASA Technical Reports Server (NTRS)

Basili, Victor R.

1992-01-01

The concepts of quality improvements have permeated many businesses. It is clear that the nineties will be the quality era for software and there is a growing need to develop or adapt quality improvement approaches to the software business. Thus we must understand software as an artifact and software as a business. Since the business we are dealing with is software, we must understand the nature of software and software development. The software discipline is evolutionary and experimental; it is a laboratory science. Software is development not production. The technologies of the discipline are human based. There is a lack of models that allow us to reason about the process and the product. All software is not the same; process is a variable, goals are variable, etc. Packaged, reusable, experiences require additional resources in the form of organization, processes, people, etc. There have been a variety of organizational frameworks proposed to improve quality for various businesses. The ones discussed in this presentation include: Plan-Do-Check-Act, a quality improvement process based upon a feedback cycle for optimizing a single process model/production line; the Experience Factory/Quality Improvement Paradigm, continuous improvements through the experimentation, packaging, and reuse of experiences based upon a business's needs; Total Quality Management, a management approach to long term success through customer satisfaction based on the participation of all members of an organization; the SEI capability maturity model, a staged process improvement based upon assessment with regard to a set of key process areas until you reach a level 5 which represents a continuous process improvement; and Lean (software) Development, a principle supporting the concentration of the production on 'value added' activities and the elimination of reduction of 'not value added' activities.

A disease management programme for patients with diabetes mellitus is associated with improved quality of care within existing budgets.

PubMed

Steuten, L M G; Vrijhoef, H J M; Landewé-Cleuren, S; Schaper, N; Van Merode, G G; Spreeuwenberg, C

2007-10-01

To assess the impact of a disease management programme for patients with diabetes mellitus (Type 1 and Type 2) on cost-effectiveness, quality of life and patient self-management. By organizing care in accordance with the principles of disease management, it is aimed to increase quality of care within existing budgets. Single-group, pre-post design with 2-year follow-up in 473 patients. Substantial significant improvements in glycaemic control, health-related quality of life (HRQL) and patient self-management were found. No significant changes were detected in total costs of care. The probability that the disease management programme is cost-effective compared with usual care amounts to 74%, expressed in an average saving of 117 per additional life year at 5% improved HRQL. Introduction of a disease management programme for patients with diabetes is associated with improved intermediate outcomes within existing budgets. Further research should focus on long-term cost-effectiveness, including diabetic complications and mortality, in a controlled setting or by using decision-analytic modelling techniques.

Pharmaceutical product development: A quality by design approach

PubMed Central

Pramod, Kannissery; Tahir, M. Abu; Charoo, Naseem A.; Ansari, Shahid H.; Ali, Javed

2016-01-01

The application of quality by design (QbD) in pharmaceutical product development is now a thrust area for the regulatory authorities and the pharmaceutical industry. International Conference on Harmonization and United States Food and Drug Administration (USFDA) emphasized the principles and applications of QbD in pharmaceutical development in their guidance for the industry. QbD attributes are addressed in question-based review, developed by USFDA for chemistry, manufacturing, and controls section of abbreviated new drug applications. QbD principles, when implemented, lead to a successful product development, subsequent prompt regulatory approval, reduce exhaustive validation burden, and significantly reduce post-approval changes. The key elements of QbD viz., target product quality profile, critical quality attributes, risk assessments, design space, control strategy, product lifecycle management, and continual improvement are discussed to understand the performance of dosage forms within design space. Design of experiments, risk assessment tools, and process analytical technology are also discussed for their role in QbD. This review underlines the importance of QbD in inculcating science-based approach in pharmaceutical product development. PMID:27606256

Pharmaceutical product development: A quality by design approach.

PubMed

Pramod, Kannissery; Tahir, M Abu; Charoo, Naseem A; Ansari, Shahid H; Ali, Javed

2016-01-01

The application of quality by design (QbD) in pharmaceutical product development is now a thrust area for the regulatory authorities and the pharmaceutical industry. International Conference on Harmonization and United States Food and Drug Administration (USFDA) emphasized the principles and applications of QbD in pharmaceutical development in their guidance for the industry. QbD attributes are addressed in question-based review, developed by USFDA for chemistry, manufacturing, and controls section of abbreviated new drug applications. QbD principles, when implemented, lead to a successful product development, subsequent prompt regulatory approval, reduce exhaustive validation burden, and significantly reduce post-approval changes. The key elements of QbD viz., target product quality profile, critical quality attributes, risk assessments, design space, control strategy, product lifecycle management, and continual improvement are discussed to understand the performance of dosage forms within design space. Design of experiments, risk assessment tools, and process analytical technology are also discussed for their role in QbD. This review underlines the importance of QbD in inculcating science-based approach in pharmaceutical product development.

Zen and the Art of Living Mindfully: The Health-Enhancing Potential of Zen Aesthetics.

PubMed

Lomas, T; Etcoff, N; Van Gordon, W; Shonin, E

2017-10-01

Amidst the burgeoning enthusiasm for mindfulness in the West, there is a concern that the largely secular 'de-contextualized' way in which it is being harnessed is denuding it of its potential to improve health and well-being. As such, efforts are underway to 're-contextualize' mindfulness, explicitly drawing on the wider framework of Buddhist ideas and practices in which it was initially developed. This paper aims to contribute to this, doing so by focusing on Zen Buddhism, and in particular on Zen aesthetic principles. The article concentrates on the seven principles identified by Hisamatsu (1971) in his classic text Zen and the Fine Arts: kanso (simplicity); fukinsei (asymmetry); koko (austere sublimity); shizen (naturalness); daisuzoku (freedom from routine); sei-jaku (tranquillity); and yūgen (profound grace). The presence of these principles in works of art is seen as reflecting and communicating insights that are central to Buddhism, such as non-attachment. Moreover, these principles do not only apply to the creation and appreciation of art, but have clear applications for treating health-related issues, and improving quality of life more generally. This paper makes the case that embodying these principles in their lives can help people enhance their psychosomatic well-being, and come to a truer understanding of the essence of mindful living.

ESIP Information Quality Cluster (IQC)

NASA Technical Reports Server (NTRS)

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

2016-01-01

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

Assessing Quality of Data Standards: Framework and Illustration Using XBRL GAAP Taxonomy

NASA Astrophysics Data System (ADS)

Zhu, Hongwei; Wu, Harris

The primary purpose of data standards or metadata schemas is to improve the interoperability of data created by multiple standard users. Given the high cost of developing data standards, it is desirable to assess the quality of data standards. We develop a set of metrics and a framework for assessing data standard quality. The metrics include completeness and relevancy. Standard quality can also be indirectly measured by assessing interoperability of data instances. We evaluate the framework using data from the financial sector: the XBRL (eXtensible Business Reporting Language) GAAP (Generally Accepted Accounting Principles) taxonomy and US Securities and Exchange Commission (SEC) filings produced using the taxonomy by approximately 500 companies. The results show that the framework is useful and effective. Our analysis also reveals quality issues of the GAAP taxonomy and provides useful feedback to taxonomy users. The SEC has mandated that all publicly listed companies must submit their filings using XBRL. Our findings are timely and have practical implications that will ultimately help improve the quality of financial data.

Catholic social teaching: Precepts for healthcare reform

PubMed Central

Condit, Donald P.

2016-01-01

The Patient Protection and Affordable Health Care Act of 2010 accelerated bureaucratic appropriation of health care in the United States. Persuaded by laudable intentions of expanded access to care for millions of uninsured Americans, healthcare cost control, and improved medical quality, supporters are now confronted by the unintended consequences of greater government control of health care. The four primary principles of Catholic social teaching guide a best response to our neighbor's healthcare needs. The presence of these principles in the founding documents of the United States facilitates advocacy the public square. Lay summary: Catholic social teaching presents a Magisterial gift to each generation to help build a just society. The four principles, Human Dignity, Common Good, Solidarity, and Subsidiarity, can guide reform of a healthcare system in crisis. These precepts, clearly present in the United States founding documents, and persuasive in the public square, serve as a foundation upon which to improve the medical care of the sick and injured. PMID:28392586

Car Assembly Line Efficiency Improvement by Lean Principle

NASA Astrophysics Data System (ADS)

Sawassalung, Suwalee; Chutima, Parames

2017-06-01

This research aimed to increase the efficiency of actual working time to compare to design standard time ratio (DSTR) as per analysing process of Lean System of the assembly line in a car manufacturer in Thailand. Currently, the case study factory and its group of factories, which have many branches all over the world, have competed with each other on quality, delivered time and production cost. The production cost which can reduce without affecting quality and acceptable by clients is the manpower cost. The index of competition is DSTR. The factory now has DSTR of 6.13 and DSTR of the assembly department is 4.24 which is very high comparing to other departments. The low DSTR indicates that the factory has good quality. The ways to solve the problem are to apply the following tools, i.e. Lean principle, Value Stream Mapping (VSM), Waste Analysis and ECRS. After implementing the above tools, the results showed that DSTR decreased from 4.24 to 4.06 or 4.25%.

Sandia National Laboratories Advanced Simulation and Computing (ASC) software quality plan. Part 1 : ASC software quality engineering practices version 1.0.

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

Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert

2005-01-01

The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management andmore » software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.« less

Continuous improvement of the quality reporting system of a medium-size company

NASA Astrophysics Data System (ADS)

Hawkins, Anthony; Onuh, Spencer

2001-10-01

Many companies are faced with quality improvement issues on a daily basis but their response to this problem varies. This paper discusses the improvement in the defect reporting system at a medium sized manufacturing company following the appointment of an experienced, motivated, design engineer to be dedicated to that task. It sets out the situation that the engineer inherited and details the changes that were incorporated; it assesses which were successful and which failed. Following a survey of current literature, it was seen that there is little written specifically on the subject of audited defect reporting. It is felt that this study goes some way to filling that void. A successful survey of engineering companies in Southern Hampshire reinforces the principle findings, that the emphasising of the Check part of Demming's Plan-Do-Check-Act cycle is a novel approach to the Quality Improvement Process, and that it has reduced the cost of rework by an audited 80% in a period of two years.

Cost and impact of a quality improvement programme in mental health services.

PubMed

Beecham, Jennifer; Ramsay, Angus; Gordon, Kate; Maltby, Sophie; Walshe, Kieran; Shaw, Ian; Worrall, Adrian; King, Sarah

2010-04-01

To estimate the cost and impact of a centrally-driven quality improvement initiative in four UK mental health communities. Total costs in year 1 were identified using documentation, a staff survey, semi-structured interviews and discussion groups. Few outcome data were collected within the programme so thematic analysis was used to identify the programme's impact within its five broad underlying principles. The survey had a 40% response. Total costs ranged between pound164,000 and pound458,000 per site, plus staff time spent on workstreams. There was a very hazy view of the resources absorbed and poor recording of expenditure and activity. The initiative generated little demonstrable improvements in service quality but some participants reported changes in attitudes. Given the difficult contexts, short time-scales and capacity constraints, the programme's lack of impact is not surprising. It may, however, represent a worthwhile investment in cultural change which might facilitate improvements in how services are delivered.

Applying athletic principles to medical rounds to improve teaching and patient care.

PubMed

Southwick, Frederick; Lewis, Michelle; Treloar, Dina; Cherabuddi, Kartikeya; Radhakrishnan, Nila; Leverence, Robert; Han, Xiaoxia; Cottler, Linda

2014-07-01

Teaching hospital multidisciplinary work rounds are often inefficient, delaying the completion of patient care tasks and detracting from teaching. Participants often act as working groups rather than interdependent teams. Athletic principles were used to train multidisciplinary rounding teams to adopt the systems used by manufacturing to improve the efficiency and quality of patient care, as well as teamwork and didactic teaching. Experimental groups of general medical rounding teams-faculty member, house staff, medical students, bedside nurses, pharmacists, and a case manager-were introduced to individual job descriptions (playbooks), key customer-supplier relation ships, and efficient communication protocols, accompanied by weekly feed back (game films). A two-phase pilot 11-month prospective trial (February to July 2009 and September 2011 to January 2012) compared the experimental and control rounding teams on the basis of length of stay, 30-day readmission rates, and physician, student, and patient satisfaction. These interventions resulted in a 30% reduction in 30-day readmissions and, in the 2011-2012 phase, an 18% shorter length of stay. Anonymous surveys documented greater satisfaction of faculty, residents, and medical students, and student ratings of teaching were markedly improved. Patient satisfaction did not change. The new rounding system has the potential to reduce waste and improve the quality of patient care while improving caregiver satisfaction and medical student teaching. Adaptive leadership skills will be required to overcome resistance to change. The use of athletic analogies can improve teamwork and facilitate the adoption of a systems approach to the delivery of patient care.

Public-Private Convergence and the Special Case of Voucher-Receiving Schools

ERIC Educational Resources Information Center

Loomis, Steven R.; Rodriguez, Jacob P.; Honeycutt, Jared; Arellano, Manuel

2006-01-01

Many arguments in favour of school voucher programs are based upon libertarian free agency principles. Viewed at the organizational level, allowing persons to exercise choice in education would seem to offer incentives for all educational organizations within that framework to improve overall product quality and thus more effectively obtain the…

Effects of Business School Student's Study Time on the Learning Process

ERIC Educational Resources Information Center

Tetteh, Godson Ayertei

2016-01-01

Purpose: This paper aims to clarify the relationship between the student's study time and the learning process in the higher education system by adapting the total quality management (TQM) principles-process approach. Contrary to Deming's (1982) constancy of purpose to improve the learning process, some students in higher education postpone their…

Organizational Performance Improvement in Higher Education Student Affairs: A Phenomenographic Study

ERIC Educational Resources Information Center

Froehlich, Jill Carrie Menk

2011-01-01

The aim of this study was to gain a better understanding of the experiences of student services staff in a midwestern university during an organizational change: implementation of quality practices and principles. The experiences were captured as they reflected during the interview process. The interview data were organized into 35 concepts from…

Teacher Development Program: A Vehicle for Assisting Pre-Service Teachers

ERIC Educational Resources Information Center

Wood, Frances B.

2010-01-01

In 1990 the Teacher Development Program was created by the Office of Professional Field Experiences at Southeastern Louisiana University to better the quality and improve the success rate of teacher candidates and student teachers. The fundamental principle behind the program was to provide assistance for pre-service teachers who need immediate…

Ethical and Privacy Principles for Learning Analytics

ERIC Educational Resources Information Center

Pardo, Abelardo; Siemens, George

2014-01-01

The massive adoption of technology in learning processes comes with an equally large capacity to track learners. Learning analytics aims at using the collected information to understand and improve the quality of a learning experience. The privacy and ethical issues that emerge in this context are tightly interconnected with other aspects such as…

[Principles in the organization of voluntary certifying system for studies and services in pathologic anatomy].

PubMed

Pal'tsev, M A; Kakturskiĭ, L V

2006-01-01

The aim of voluntary certification is to improve the quality of pathology service and to implement it under the Russian Federation's laws and existing standards. The noncommercial organization "Voluntary Certifying System for Postmortem Studies" has been set up, which includes expert groups comprising highly skilled specialists.

The productive operating theatre and lean thinking systems.

PubMed

Kasivisvanathan, R; Chekairi, A

2014-11-01

The concept of 'lean thinking' first originated in the manufacturing industry as a means of improving productivity whilst maintaining quality through eliminating wasteful processes. The purpose of this article is to demonstrate how the principles of 'lean thinking' are relevant to healthcare and the operating theatre, with reference to our own institutional experience.

Evaluation of Online Education about Diabetes Management in the School Setting

ERIC Educational Resources Information Center

Bachman, Jean A.; Hsueh, Kuei-Hsiang

2008-01-01

There are a variety of initiatives to provide education to improve the quality of care for children with diabetes in the school setting. This study piloted and evaluated an online continuing education program for school nurses about diabetes management for children in schools using current practice principles. The evaluation determined if…

Hearing the voices of women in war through continuous quality improvement.

PubMed

Farrell, M; Farrell, J D

1998-04-01

During the war in Bosnia-Herzegovina (BIH), the infrastructure of the health care system was destroyed and health officials, health care providers, and women experienced the war from their own perspectives. Using the principles of continuous quality improvement (CQI), these perspectives were honored and served as the basis for an international training program to hear the voices of women in war and the concerns of those who cared for them. With the results of a comprehensive national survey of all partners, the World Health Organization's European Regional Office held a five-day workshop that used CQI methods. The facilitators and 18 nurses, midwives, and physicians from six cantons developed interventions to address the women's needs, as detailed from the women's stories and from the professional perspectives of governmental authorities and health providers. The effort illustrates the ways in which the principles and tools of CQI can be used to capture the needs of the users of the services with those responsible for restructuring the health service and those with overall responsibility for the health of woman throughout the country.

Effectiveness of Quality Improvement Strategies for the Management of CKD: A Meta-Analysis.

PubMed

Silver, Samuel A; Bell, Chaim M; Chertow, Glenn M; Shah, Prakesh S; Shojania, Kaveh; Wald, Ron; Harel, Ziv

2017-10-06

Quality improvement interventions have enhanced care for other chronic illnesses, but their effectiveness for patients with CKD is unknown. We sought to determine the effects of quality improvement strategies on clinical outcomes in adult patients with nondialysis-requiring CKD. We conducted a systematic review of randomized trials, searching Medline and the Cochrane Effective Practice and Organization of Care database from January of 2003 to April of 2015. Eligible studies evaluated one or more of 11 prespecified quality improvement strategies, and prespecified study outcomes included at least one process of care measure, surrogate outcome, or hard clinical outcome. We used a random effects model to estimate the pooled risk ratio (RR; dichotomous data) or the mean difference (continuous data). We reviewed 15 patient-level randomized trials ( n =3298 patients), and six cluster-randomized trials ( n =30,042 patients). Quality improvement strategies reduced dialysis incidence (seven trials; RR, 0.85; 95% confidence interval [95% CI], 0.74 to 0.97) and LDL cholesterol concentrations (four trials; mean difference, -17.6 mg/dl; 95% CI, -28.7 to -6.5), and increased the likelihood that patients received renin-angiotensin-aldosterone system inhibitors (nine trials; RR, 1.16; 95% CI, 1.06 to 1.27). We did not observe statistically significant effects on mortality, cardiovascular events, eGFR, glycated hemoglobin, and systolic or diastolic BP. Quality improvement interventions yielded significant beneficial effects on three elements of CKD care. Estimates of the effectiveness of quality improvement strategies were limited by study number and adherence to quality improvement principles. This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_09_06_CJASNPodcast_17_10.mp3. Copyright © 2017 by the American Society of Nephrology.

Eliminating Undesirable Variation in Neonatal Practice: Balancing Standardization and Customization.

PubMed

Balakrishnan, Maya; Raghavan, Aarti; Suresh, Gautham K

2017-09-01

Consistency of care and elimination of unnecessary and harmful variation are underemphasized aspects of health care quality. This article describes the prevalence and patterns of practice variation in health care and neonatology; discusses the potential role of standardization as a solution to eliminating wasteful and harmful practice variation, particularly when it is founded on principles of evidence-based medicine; and proposes ways to balance standardization and customization of practice to ultimately improve the quality of neonatal care. Copyright © 2017 Elsevier Inc. All rights reserved.

Using the Malcolm Baldrige "are we making progress" survey for organizational self-assessment and performance improvement.

PubMed

Shields, Judith A; Jennings, Jerry L

2013-01-01

A national healthcare company applied the Malcolm Baldrige Criteria for Performance Excellence and its "Are We Making Progress?" survey as an annual organizational self-assessment to identify areas for improvement. For 6 years, Liberty Healthcare Corporation reviewed the survey results on an annual basis to analyze positive and negative trends, monitor company progress toward targeted goals and develop new initiatives to address emerging areas for improvement. As such, the survey provided a simple and inexpensive methodology to gain useful information from employees at all levels and from multiple service sites and business sectors. In particular, it provided a valuable framework for assessing and improving the employees' commitment to the company's mission and values, high standards and ethics, quality of work, and customer satisfaction. The methodology also helped the company to incorporate the philosophy and principles of continuous quality improvement in a unified fashion. Corporate and local leadership used the same measure to evaluate the performance of individual programs relative to each other, to the company as a whole, and to the "best practices" standard of highly successful companies that received the Malcolm Baldrige National Quality Award. © 2012 National Association for Healthcare Quality.

Framework for industry engagement and quality principles for industry-provided medical education in Europe

PubMed Central

Allen, Tamara; Donde, Nina; Hofstädter-Thalmann, Eva; Keijser, Sandra; Moy, Veronique; Murama, Jean-Jacques; Kellner, Thomas

2017-01-01

ABSTRACT Lifelong learning through continuing professional development (CPD) and medical education is critical for healthcare professionals to stay abreast of knowledge and skills and provide an optimal standard of care to patients. In Europe, CPD and medical education are fragmented as there are numerous models, providers and national regulations and a lack of harmonisation of qualitative criteria. There is continued debate on the appropriate role of pharmaceutical companies in the context of medical education. Accrediting bodies such as European Accreditation Council for Continuing Medical Education do not permit active involvement of the pharmaceutical industry due to concerns around conflicts of interest and potential for bias. However, many examples of active collaboration between pharmaceutical companies and medical societies and scientific experts exist, demonstrating high integrity, clear roles and responsibilities, and fair and balanced content. Medical education experts from 16 pharmaceutical companies met to develop a set of quality principles similar to standards that have been established for clinical trials and in alignment with existing principles of accrediting bodies. This paper outlines their proposal for a framework to improve and harmonise medical education quality standards in Europe, and is also an invitation for all stakeholders to join a discussion on this integrative model. PMID:29644135

Deploying Team Science Principles to Optimize Interdisciplinary Lung Cancer Care Delivery: Avoiding the Long and Winding Road to Optimal Care.

PubMed

Osarogiagbon, Raymond U; Rodriguez, Hector P; Hicks, Danielle; Signore, Raymond S; Roark, Kristi; Kedia, Satish K; Ward, Kenneth D; Lathan, Christopher; Santarella, Scott; Gould, Michael K; Krasna, Mark J

2016-11-01

The complexity of lung cancer care mandates interaction between clinicians with different skill sets and practice cultures in the routine delivery of care. Using team science principles and a case-based approach, we exemplify the need for the development of real care teams for patients with lung cancer to foster coordination among the multiple specialists and staff engaged in routine care delivery. Achieving coordinated lung cancer care is a high-priority public health challenge because of the volume of patients, lethality of disease, and well-described disparities in quality and outcomes of care. Coordinating mechanisms need to be cultivated among different types of specialist physicians and care teams, with differing technical expertise and practice cultures, who have traditionally functioned more as coactively working groups than as real teams. Coordinating mechanisms, including shared mental models, high-quality communication, mutual trust, and mutual performance monitoring, highlight the challenge of achieving well-coordinated care and illustrate how team science principles can be used to improve quality and outcomes of lung cancer care. To develop the evidence base to support coordinated lung cancer care, research comparing the effectiveness of a diverse range of multidisciplinary care team approaches and interorganizational coordinating mechanisms should be promoted.

Medical image enhancement using resolution synthesis

NASA Astrophysics Data System (ADS)

Wong, Tak-Shing; Bouman, Charles A.; Thibault, Jean-Baptiste; Sauer, Ken D.

2011-03-01

We introduce a post-processing approach to improve the quality of CT reconstructed images. The scheme is adapted from the resolution-synthesis (RS)1 interpolation algorithm. In this approach, we consider the input image, scanned at a particular dose level, as a degraded version of a high quality image scanned at a high dose level. Image enhancement is achieved by predicting the high quality image by classification based linear regression. To improve the robustness of our scheme, we also apply the minimum description length principle to determine the optimal number of predictors to use in the scheme, and the ridge regression to regularize the design of the predictors. Experimental results show that our scheme is effective in reducing the noise in images reconstructed from filtered back projection without significant loss of image details. Alternatively, our scheme can also be applied to reduce dose while maintaining image quality at an acceptable level.

ïSCOPE: Safer care for older persons (in residential) environments: A study protocol

PubMed Central

2011-01-01

Background The current profile of residents living in Canadian nursing homes includes elder persons with complex physical and social needs. High resident acuity can result in increased staff workload and decreased quality of work life. Aims Safer Care for Older Persons [in residential] Environments is a two year (2010 to 2012) proof-of-principle pilot study conducted in seven nursing homes in western Canada. The purpose of the study is to evaluate the feasibility of engaging front line staff to use quality improvement methods to integrate best practices into resident care. The goals of the study are to improve the quality of work life for staff, in particular healthcare aides, and to improve residents' quality of life. Methods/design The study has parallel research and quality improvement intervention arms. It includes an education and support intervention for direct caregivers to improve the safety and quality of their care delivery. We hypothesize that this intervention will improve not only the care provided to residents but also the quality of work life for healthcare aides. The study employs tools adapted from the Institute for Healthcare Improvement's Breakthrough Series: Collaborative Model and Canada's Safer Healthcare Now! improvement campaign. Local improvement teams in each nursing home (1 to 2 per facility) are led by healthcare aides (non-regulated caregivers) and focus on the management of specific areas of resident care. Critical elements of the program include local measurement, virtual and face-to-face learning sessions involving change management, quality improvement methods and clinical expertise, ongoing virtual and in person support, and networking. Discussion There are two sustainability challenges in this study: ongoing staff and leadership engagement, and organizational infrastructure. Addressing these challenges will require strategic planning with input from key stakeholders for sustaining quality improvement initiatives in the long-term care sector. PMID:21745382

An Application of Total Quality Principles in Transforming the Culture of Classrooms

ERIC Educational Resources Information Center

Algozzine, Bob; Audette, Robert H.; Marr, Mary Beth; Algozzine, Kate

2005-01-01

During the 1990s, many public schools began to apply the principles of Total Quality Management. As they moved ahead, they discovered that most of the separate principles that comprise Total Quality Management are not new to public education. Theories and practices using similar and related ideas have been championed by educators for generations.…

Leveraging lean principles in creating a comprehensive quality program: The UCLA health readmission reduction initiative.

PubMed

Afsar-Manesh, Nasim; Lonowski, Sarah; Namavar, Aram A

2017-12-01

UCLA Health embarked to transform care by integrating lean methodology in a key clinical project, Readmission Reduction Initiative (RRI). The first step focused on assembling a leadership team to articulate system-wide priorities for quality improvement. The lean principle of creating a culture of change and accountability was established by: 1) engaging stakeholders, 2) managing the process with performance accountability, and, 3) delivering patient-centered care. The RRI utilized three major lean principles: 1) A3, 2) root cause analyses, 3) value stream mapping. Baseline readmission rate at UCLA from 9/2010-12/2011 illustrated a mean of 12.1%. After the start of the RRI program, for the period of 1/2012-6/2013, the readmission rate decreased to 11.3% (p<0.05). To impact readmissions, solutions must evolve from smaller service- and location-based interventions into strategies with broader approach. As elucidated, a systematic clinical approach grounded in lean methodologies is a viable solution to this complex problem. Copyright © 2017 Elsevier Inc. All rights reserved.

Principles on integrating behavioral health into medical homes must not designate leaders as "physicians only".

PubMed

Golden, Angela; Miller, Kenneth

2014-06-01

Nurse practitioners have long included high-quality behavioral health in the care they provide to individuals and families nationwide. Just as the principles of the medical home have been an integral part of nurse practitioners' practice, so has the concept of whole person orientation incorporating both physical and mental or behavioral health care. It is therefore encouraging that organized medicine has embraced integrated physical and behavioral health care in patient-centered medical homes, a position that could help improve the wellbeing of patients all throughout the United States. Although the American Association of Nurse Practitioners (AANP) has long supported such integration, we do not support the physician-centric joint principles included in the current issue of Annals of Family Medicine (The Working Party Group on Integrated Behavioral Healthcare et al., 2014), as they create provider and leadership roles that are too narrow and restrictive for the provision of health care in the 21st century. As written, they limit access to high-quality care and restrict patient choice of health care providers.

Using evidence-based practice to create a venous access team: the Venous Access Task Force of the Children's Hospital of Denver.

PubMed

MacPhee, Maura

2002-12-01

The following article is an example of evidence-based practice applied to an institutional Quality Improvement (QI) project. QI originated in the 1980s and is best associated with the work of W. Deming (1986). It is also known as Continuous Quality Improvement, because a major principle of this approach is constant improvement of services or products. This improvement process contains other critical components: scientific method, employee participation and teamwork, accountable leadership, appropriate training and ongoing education, and client focus (Demming, 1986). QI has been globally successful and has helped transform American industry, including health care services. The following clinically based project illustrates the application of QI concepts and evidence-based practice to enhance outcomes. Copyright 2002, Elsevier Science (USA). All rights reserved.

Effectiveness of teaching quality improvement to clinicians: a systematic review.

PubMed

Boonyasai, Romsai T; Windish, Donna M; Chakraborti, Chayan; Feldman, Leonard S; Rubin, Haya R; Bass, Eric B

2007-09-05

Accreditation requirements mandate teaching quality improvement (QI) concepts to medical trainees, yet little is known about the effectiveness of teaching QI. To perform a systematic review of the effectiveness of published QI curricula for clinicians and to determine whether teaching methods influence the effectiveness of such curricula. The electronic literature databases of MEDLINE, EMBASE, CINAHL, and ERIC were searched for English-language articles published between January 1, 1980, and April 30, 2007. Experts in the field of QI were queried about relevant studies. Two independent reviewers selected studies for inclusion if the curriculum taught QI principles to clinicians and the evaluation used a comparative study design. Information about the features of each curriculum, its use of 9 principles of adult learning, and the type of educational and clinical outcomes were extracted. The relationship between the outcomes and the number of educational principles used was assessed. Of 39 studies that met eligibility criteria, 31 described team-based projects; 37 combined didactic instruction with experiential learning. The median number of adult learning principles used was 7 (range, 2-8). Evaluations included 22 controlled trials (8 randomized and 14 nonrandomized) and 17 pre/post or time series studies. Fourteen studies described educational outcomes (attitudes, knowledge, or skills or behaviors) and 28 studies described clinical process or patient outcomes. Nine of the 10 studies that evaluated knowledge reported only positive effects but only 2 of these described a validated assessment tool. The 6 assessments of attitudes found mixed results. Four of the 6 studies on skill or behavior outcomes reported only positive effects. Eight of the 28 studies of clinical outcomes reported only beneficial effects. Controlled studies were more likely than other studies to report mixed or null effects. Only 4 studies evaluated both educational and clinical outcomes, providing limited evidence that educational outcomes influence the clinical effectiveness of the interventions. Most published QI curricula apply sound adult learning principles and demonstrate improvement in learners' knowledge or confidence to perform QI. Additional studies are needed to determine whether educational methods have meaningful clinical benefits.

Exploration of multidimensional interactive classroom teaching for CCD principle and application course

NASA Astrophysics Data System (ADS)

Fu, Xinghu; Tan, Ailing; Zhang, Baojun; Fu, Guangwei; Bi, Weihong

2017-08-01

The CCD principle and application course is professional and comprehensive. It involves many subject contents. The course content includes eight aspects. In order to complete the teaching tasks within a limited time, improve the classroom teaching quality and prompt students master the course content faster and better, so the multidimensional interactive classroom teaching is proposed. In the teaching practice, the interactive relationship between the frontier science, scientific research project, living example and classroom content is researched detailedly. Finally, it has been proved practically that the proposed multidimensional interactive classroom teaching can achieved good teaching effect.

Utilization of lean management principles in the ambulatory clinic setting.

PubMed

Casey, Jessica T; Brinton, Thomas S; Gonzalez, Chris M

2009-03-01

The principles of 'lean management' have permeated many sectors of today's business world, secondary to the success of the Toyota Production System. This management method enables workers to eliminate mistakes, reduce delays, lower costs, and improve the overall quality of the product or service they deliver. These lean management principles can be applied to health care. Their implementation within the ambulatory care setting is predicated on the continuous identification and elimination of waste within the process. The key concepts of flow time, inventory and throughput are utilized to improve the flow of patients through the clinic, and to identify points that slow this process -- so-called bottlenecks. Nonessential activities are shifted away from bottlenecks (i.e. the physician), and extra work capacity is generated from existing resources, rather than being added. The additional work capacity facilitates a more efficient response to variability, which in turn results in cost savings, more time for the physician to interact with patients, and faster completion of patient visits. Finally, application of the lean management principle of 'just-in-time' management can eliminate excess clinic inventory, better synchronize office supply with patient demand, and reduce costs.

[Process orientation as a tool of strategic approaches to corporate governance and integrated management systems].

PubMed

Sens, Brigitte

2010-01-01

The concept of general process orientation as an instrument of organisation development is the core principle of quality management philosophy, i.e. the learning organisation. Accordingly, prestigious quality awards and certification systems focus on process configuration and continual improvement. In German health care organisations, particularly in hospitals, this general process orientation has not been widely implemented yet - despite enormous change dynamics and the requirements of both quality and economic efficiency of health care processes. But based on a consistent process architecture that considers key processes as well as management and support processes, the strategy of excellent health service provision including quality, safety and transparency can be realised in daily operative work. The core elements of quality (e.g., evidence-based medicine), patient safety and risk management, environmental management, health and safety at work can be embedded in daily health care processes as an integrated management system (the "all in one system" principle). Sustainable advantages and benefits for patients, staff, and the organisation will result: stable, high-quality, efficient, and indicator-based health care processes. Hospitals with their broad variety of complex health care procedures should now exploit the full potential of total process orientation. Copyright © 2010. Published by Elsevier GmbH.

Quality management of human resources. Providers should begin by focusing on education, performance management, and reward systems.

PubMed

Blair, C S; Fordyce, M; Barney, S M

1993-10-01

For a quality management transformation to occur, a healthcare organization must focus on education and development, performance management, and recognition and reward systems during the first years of implementation. Education and development are perhaps the most important human resource management functions when implementing quality management principles and processes because behavioral changes will be required at all organizational levels. Specific programs that support an organization's quality management effort will vary but should include the conceptual, cultural, and technical aspects of quality management. The essence of quality management is to always satisfy the customer and to continuously improve the services and products the organization offers. The approach to performance management should therefore rely on customer feedback and satisfaction. An organization committed to quality management should base its performance management approach on customer orientation, process improvement, employee involvement, decision making with data, and continuous improvement. Managers and trustees are being challenged to provide innovative recognition and reward systems that reinforce the values and behaviors consistent with quality management. Such systems must also be aligned with the behaviors and outcomes that support the philosophy, mission, and values of the Catholic healthcare ministry. The following components should be considered for a recognition and reward system: base pay, incentives, benefits, and nonmonetary rewards.

A Study on Improving Logistics in a Production Enterprise in the Automotive Domain

NASA Astrophysics Data System (ADS)

Muntean, A.; Inţă, M.; Stroilă, I. A.

2016-11-01

In order to remain on the market and to overcome competition, companies need to develop and implement a strategy of continuous improvement. This is based on customer satisfaction needs, management based on realities and respect for people. In order to meet market requirements global road Faurecia Company uses a system called "Faurecia Excellence System", a system that promotes continuous improvement. FES system controls all activities of Faurecia, from research and development to sales including production and company functions and implements all 114 main procedures. This paper examines the current activity and introduce the new methods to improve manufacturing processes. These new methods are based on some fundamental concepts, namely: a high level of stocks blocks resources and can mask other problems decreasing visibility and communication; product quality is essential and the goods must be produced only when needed using Kanban principle. Additional expenditure with purchased raw materials regarding storage until they are needed, identification and packaging for storage, inventory costs were reduced using a JIT based principle in purchasing.Thus, the paper proposes reorganizing production by reducing the level of stocks using JIT principle and production time. The application made in software Arena refers to simulating the fabrication process to reduce throughput time.

Partnering to develop a talent pipeline for emerging health leaders in operations research.

PubMed

Ng, Alfred; Henshaw, Carly; Carter, Michael

2017-05-01

In initiating its first central office for Quality Improvement (QI), The Scarborough Hospital (TSH) sought to accelerate momentum towards achieving its "Quality and Sustainability" strategic priority by building internal capacity in the emerging QI specialty of operations research. The Scarborough Hospital reviewed existing models of talent management in conjunction with Lean and improvement philosophies. Through simple guiding principles and in collaboration with the University of Toronto's Centre for Healthcare Engineering, TSH developed a targeted approach to talent management for Operations Research (OR) in the Office of Innovation and Performance Improvement, reduced the time from staffing need to onboarding, accelerated the development of new staff in delivering QI and OR projects, and defined new structures and processes to retain and develop this group of new emerging health leaders.

SU-E-T-191: PITSTOP: Process Improvement Techniques, Software Tools, and Operating Principles for a Quality Initiative Discovery Framework.

PubMed

Siochi, R

2012-06-01

To develop a quality initiative discovery framework using process improvement techniques, software tools and operating principles. Process deviations are entered into a radiotherapy incident reporting database. Supervisors use an in-house Event Analysis System (EASy) to discuss incidents with staff. Major incidents are analyzed with an in-house Fault Tree Analysis (FTA). A meta-Analysis is performed using association, text mining, key word clustering, and differential frequency analysis. A key operating principle encourages the creation of forcing functions via rapid application development. 504 events have been logged this past year. The results for the key word analysis indicate that the root cause for the top ranked key words was miscommunication. This was also the root cause found from association analysis, where 24% of the time that an event involved a physician it also involved a nurse. Differential frequency analysis revealed that sharp peaks at week 27 were followed by 3 major incidents, two of which were dose related. The peak was largely due to the front desk which caused distractions in other areas. The analysis led to many PI projects but there is still a major systematic issue with the use of forms. The solution we identified is to implement Smart Forms to perform error checking and interlocking. Our first initiative replaced our daily QA checklist with a form that uses custom validation routines, preventing therapists from proceeding with treatments until out of tolerance conditions are corrected. PITSTOP has increased the number of quality initiatives in our department, and we have discovered or confirmed common underlying causes of a variety of seemingly unrelated errors. It has motivated the replacement of all forms with smart forms. © 2012 American Association of Physicists in Medicine.

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.

Spatially-controlled illumination with rescan confocal microscopy enhances image quality, resolution and reduces photodamage

NASA Astrophysics Data System (ADS)

Krishnaswami, Venkataraman; De Luca, Giulia M. R.; Breedijk, Ronald M. P.; Van Noorden, Cornelis J. F.; Manders, Erik M. M.; Hoebe, Ron A.

2017-02-01

Fluorescence microscopy is an important tool in biomedical imaging. An inherent trade-off lies between image quality and photodamage. Recently, we have introduced rescan confocal microscopy (RCM) that improves the lateral resolution of a confocal microscope down to 170 nm. Previously, we have demonstrated that with controlled-light exposure microscopy, spatial control of illumination reduces photodamage without compromising image quality. Here, we show that the combination of these two techniques leads to high resolution imaging with reduced photodamage without compromising image quality. Implementation of spatially-controlled illumination was carried out in RCM using a line scanning-based approach. Illumination is spatially-controlled for every line during imaging with the help of a prediction algorithm that estimates the spatial profile of the fluorescent specimen. The estimation is based on the information available from previously acquired line images. As a proof-of-principle, we show images of N1E-115 neuroblastoma cells, obtained by this new setup with reduced illumination dose, improved resolution and without compromising image quality.

A new framework for designing programmes of assessment

PubMed Central

Van der Vleuten, C. P. M.; Schuwirth, L. W. T.

2009-01-01

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals. PMID:19821042

A new framework for designing programmes of assessment.

PubMed

Dijkstra, J; Van der Vleuten, C P M; Schuwirth, L W T

2010-08-01

Research on assessment in medical education has strongly focused on individual measurement instruments and their psychometric quality. Without detracting from the value of this research, such an approach is not sufficient to high quality assessment of competence as a whole. A programmatic approach is advocated which presupposes criteria for designing comprehensive assessment programmes and for assuring their quality. The paucity of research with relevance to programmatic assessment, and especially its development, prompted us to embark on a research project to develop design principles for programmes of assessment. We conducted focus group interviews to explore the experiences and views of nine assessment experts concerning good practices and new ideas about theoretical and practical issues in programmes of assessment. The discussion was analysed, mapping all aspects relevant for design onto a framework, which was iteratively adjusted to fit the data until saturation was reached. The overarching framework for designing programmes of assessment consists of six assessment programme dimensions: Goals, Programme in Action, Support, Documenting, Improving and Accounting. The model described in this paper can help to frame programmes of assessment; it not only provides a common language, but also a comprehensive picture of the dimensions to be covered when formulating design principles. It helps identifying areas concerning assessment in which ample research and development has been done. But, more importantly, it also helps to detect underserved areas. A guiding principle in design of assessment programmes is fitness for purpose. High quality assessment can only be defined in terms of its goals.

Noise and acoustics in renal units and hospitals [corrected].

PubMed

James, Ray

2008-03-01

The quality of the patient's life while in the hospital setting is important and hence the quality of the hospital environment is equally important. The effect of noise on health varies depending upon the susceptibility of the individual, but can include higher blood pressure, stress and annoyance in staff, and can erode quality of care. This paper ascertains what the noise levels are in a typical renal unit and considers the potential effects on staff and patients. The quality of the hospital environment plays an important part in treating patients effectively and efficiently. The use of acoustic design principles can reduce the level and impact of noise and, in doing so, improve the quality of care and the patient experience.

Quality of publication ethics in the instructions to the authors of Iranian journals of medical sciences.

PubMed

Salamat, Fatemeh; Sobhani, Abdol-Rasoul; Mallaei, Mahin

2013-03-01

Providing a perfect instruction to authors can prevent most potential publication ethics errors. This study was conducted to determine the quality of ethical considerations in the instructions to the authors of Iranian research scientific journals of medical sciences (accredited by the Commission for Accreditation and Improvement of Iranian Medical Journals) in October 2011. Checklist items (n=15) were extracted from the national manual of ethics in medical research publications, and the validity of the manual of ethics was assessed. All the accredited Iranian journals of medical sciences (n=198) were entered into the study. The instructions to the authors of 160 accredited Iranian journals were available online and were reviewed. The ANOVA and Kendall Correlation coefficient were performed to analyze the results. A total of 76 (47.5%) of the 160 journals were in English and 84 (52.5%) were in Farsi. The most frequently mentioned items related to publication ethics comprised "commitment not to send manuscripts to other journals and re-publish manuscripts" (85%, 83.8%), "aim and scope" of the journal (81.9%), "principles of medical ethics in the use of human samples" (74.4%), and "review process" (74.4%). On the other hand, the items of "principles of advertising" (1.2%), "authorship criteria" (15%), and "integrity in publication of clinical trial results" (30.6%) were the least frequently mentioned ones. Based on the study findings, the quality of publication ethics, as instructed to the authors, can improve the quality of the journals.

From Adversary to Partner: Have Quality Improvement Organizations Made the Transition?

PubMed Central

Bradley, Elizabeth H; Carlson, Melissa DA; Gallo, William T; Scinto, Jeanne; Campbell, Miriam K; Krumholz, Harlan M

2005-01-01

Objective To describe the perceived impact of the Centers for Medicare and Medicaid Services Quality Improvement Organizations (QIOs) on quality of care for patients hospitalized with acute myocardial infarction, in the context of new efforts to work more collaboratively with hospitals in the pursuit of quality improvement. Data Source Primary data collected from a national random sample of 105 hospital quality management directors interviewed between January and July 2002. Study Design We interviewed quality management directors concerning their interactions with the QIO interventions, the helpfulness of QIO interventions and the degree to which they helped or hindered their hospital quality efforts, and their recommendations for improving QIO effectiveness. Principle Findings More than 90% of hospitals reported that their QIO had initiated specific interventions, the most common being the provision of educational materials, benchmark data, and hospital performance data. Many respondents (60%) rated most QIO interventions as helpful or very helpful, although only one-quarter of respondents believed quality of care would have been worse without the QIO interventions. To increase QIO efficacy, respondents recommended that QIOs appeal more directly to senior administration, target physicians (not just hospital employees), and enhance the perceived validity and timeliness of data used in quality indicators. Conclusions Our study demonstrates that the QIOs have overcome, to some degree, the previously adversarial and punitive roles of Peer Review Organizations with hospitals. The generally positive view among most hospital quality improvement directors concerning the QIO interventions suggests that QIOs are potentially poised to take a leading role in promoting quality of care. However, the full potential of QIOs will likely not be realized until QIOs are able to engender greater engagement from senior hospital administration and physicians. PMID:15762902

Six Sigma arises from the ashes of TQM with a twist.

PubMed

Black, Ken; Revere, Lee

2006-01-01

This paper sets out to analyse the use of the Six Sigma methodology to improve quality in healthcare. It looks at how Six Sigma grew out of the concept of Total Quality Management (TQM). Six Sigma is a quality improvement methodology that has been widely adopted by companies since the early 1990s and has grown exponentially in the healthcare industry during the past five years. Some of the main tenets of Six Sigma have emerged from the principles of TQM, including the notion that the entire organization must support the quality effort; that there should be a vigorous education effort; and that a quality improvement process should emphasize root cause analysis. In spite of its early success, TQM "crashed and burned" for several reasons including the fact that financial benefits were difficult to assign to TQM efforts, root cause was not always determined resulting in recurring errors, there was no common metric to measure the level of quality attained, and quality efforts were sometimes aimed at processes or operations that were not critical to the customer. Six Sigma filled the vacuums created by these TQM failures in several ways. Under the Six Sigma methodology, quality improvement projects are carefully defined so that they can be successfully completed within a relatively short time frame. Financials are applied to each completed project so that management knows how much the project saves the institution. On each project, intense study is used to determine root cause analysis; and in the end, a metric known as "sigma level" can be assigned to signify the level of quality. Six Sigma has a "critical to quality" dimension that keeps the quality effort focused on improving only those things that really matter to the customer.

Applying Process Improvement Methods to Clinical and Translational Research: Conceptual Framework and Case Examples.

PubMed

Daudelin, Denise H; Selker, Harry P; Leslie, Laurel K

2015-12-01

There is growing appreciation that process improvement holds promise for improving quality and efficiency across the translational research continuum but frameworks for such programs are not often described. The purpose of this paper is to present a framework and case examples of a Research Process Improvement Program implemented at Tufts CTSI. To promote research process improvement, we developed online training seminars, workshops, and in-person consultation models to describe core process improvement principles and methods, demonstrate the use of improvement tools, and illustrate the application of these methods in case examples. We implemented these methods, as well as relational coordination theory, with junior researchers, pilot funding awardees, our CTRC, and CTSI resource and service providers. The program focuses on capacity building to address common process problems and quality gaps that threaten the efficient, timely and successful completion of clinical and translational studies. © 2015 The Authors. Clinical and Translational Science published by Wiley Periodicals, Inc.

Taking a unified approach to teaching and implementing quality improvements across multiple residency programs: the Atlantic Health experience.

PubMed

Daniel, Donna M; Casey, Donald E; Levine, Jeffrey L; Kaye, Susan T; Dardik, Raquel B; Varkey, Prathibha; Pierce-Boggs, Kimberly

2009-12-01

The Accreditation Council for Graduate Medical Education recently emphasized the importance of systems-based practice and systems-based learning; however, successful models of collaborative quality improvement (QI) initiatives in residency training curricula are not widely available. Atlantic Health successfully conceptualized and implemented a QI collaborative focused on medication safety across eight residency training programs representing 219 residents. During a six-month period, key faculty and resident leaders from 8 (of 10) Atlantic Health residency training programs participated in three half-day collaborative learning sessions focused on improving medication reconciliation. Each session included didactic presentations from a multidisciplinary team of clinical experts as well as the application of principles that identified challenges, barriers, and solutions to QI initiatives. The learning sessions emphasized the fundamental principles of medication reconciliation, its critical importance as a vital part of patient handoff in all health care settings, and the challenges of achieving successful medication reconciliation improvement in light of work hours restrictions and patient loads. Each residency program developed a detailed implementation and measurement plan for individual "action learning" projects, using the Plan-Do-Study-Act method of improvement. Each program then implemented its QI project, and expert faculty (e.g., physicians, nurses, pharmacists, QI staff) provided mentoring between learning sessions. Several projects resulted in permanent changes in medication reconciliation processes, which were then adopted by other programs. The structure, process, and outcomes of this effort are described in detail.

Application of Six Sigma towards improving surgical outcomes.

PubMed

Shukla, P J; Barreto, S G; Nadkarni, M S

2008-01-01

Six Sigma is a 'process excellence' tool targeting continuous improvement achieved by providing a methodology for improving key steps of a process. It is ripe for application into health care since almost all health care processes require a near-zero tolerance for mistakes. The aim of this study is to apply the Six Sigma methodology into a clinical surgical process and to assess the improvement (if any) in the outcomes and patient care. The guiding principles of Six Sigma, namely DMAIC (Define, Measure, Analyze, Improve, Control), were used to analyze the impact of double stapling technique (DST) towards improving sphincter preservation rates for rectal cancer. The analysis using the Six Sigma methodology revealed a Sigma score of 2.10 in relation to successful sphincter preservation. This score demonstrates an improvement over the previous technique (73% over previous 54%). This study represents one of the first clinical applications of Six Sigma in the surgical field. By understanding, accepting, and applying the principles of Six Sigma, we have an opportunity to transfer a very successful management philosophy to facilitate the identification of key steps that can improve outcomes and ultimately patient safety and the quality of surgical care provided.

Brain Hemispheric Consensus and the Quality of Investment Decisions.

ERIC Educational Resources Information Center

Boyd, Michael

This on-going study explores the hypothesis that stock fund managers who underperform do so because they make bad decisions, and examines whether their choices can be improved by using a decision model that invokes principles of brain hemispheric consensus. The study, begun in fall 1999, involves two groups of business students: the control group…

Classroom Learning Environment & Student Motivational Differences between Exemplary, Recognized, & Acceptable Urban Middle Level Schools

ERIC Educational Resources Information Center

Waxman, Hersh C.; Garcia, Andres; Read, Lisa L.

2008-01-01

One of the essential principles for improving middle grade education is to establish a safe and healthy school environment (Jackson & Davis, 2000; Price & Waxman, 2005). The overall quality of the school climate or school environment has been argued to be one of the central problems of urban schools (Waxman & Huang, 1997). Several…

IMPROVING RESEARCH IN BUSINESS EDUCATION. DELTA PI EPSILON MONOGRAPH 105.

ERIC Educational Resources Information Center

LOMAX, PAUL S.; WILSON, W. HARMON

THE PURPOSE OF THIS MONOGRAPH IS TO DISCUSS SOME PRINCIPLES OR GUIDES THAT SHOULD BE KEPT IN MIND TO INSURE DEVELOPMENT OF SOUND RESEARCH CONCLUSIONS AND RECOMMENDATIONS BY WHICH THE QUALITY OF BUSINESS EDUCATION CAN BE UPGRADED. THE MAJOR DIVISIONS ARE (1) NATURE OF SCIENCE AND ITS RELATIONSHIP TO PHILOSOPHY AND ART, (2) NATURE OF SCIENTIFIC OR…

39 CFR 3050.11 - Proposals to change an accepted analytical principle applied in the Postal Service's annual...

Code of Federal Regulations, 2010 CFR

2010-07-01

...) To improve the quality, accuracy, or completeness of the data or analysis of data contained in the... include the data, analysis, and documentation on which the proposal is based, and, where feasible, include... the petitioner requests access to data from the Postal Service to support the assertions or...

Motivational Qualities of Mathematical Experiences for Turkish Preservice Kindergarten Teachers

ERIC Educational Resources Information Center

Bintas, Jale

2008-01-01

This study is based on the principle that the mathematical anxiety in preservice kindergarten teachers-to-be should be removed and they should be encouraged towards mathematics. It is expected from teachers-to-be who are able to construct this confidence to prepare exercises improving mathematical ideas for their students. This study was carried…

Decent Work and Its Implications for Careers

ERIC Educational Resources Information Center

Athanasou, James A.

2010-01-01

The principle of decent work was first espoused in the 1948 Universal Declaration of Human Rights. Since 1999 the International Labour Organisation has operated according to a Decent Work Agenda and in recent times the movement towards the provision of decent work as a means of improving the quality of life has gathered momentum. Decent work is…

The Discussion of Citizenship in Spanish Education: Schooling Model and Cultural Codes

ERIC Educational Resources Information Center

Sanchez, Ana

2008-01-01

Education is considered to be a crucial element of social development, but, in the global society, the legitimising principle of educational equality is altered by the neoliberal view that competition will improve the quality of any service made available in a society, which in turn will have a positive effect on the general welfare. The…

Accomplishing reform: successful case studies drawn from the health systems of 60 countries.

PubMed

Braithwaite, Jeffrey; Mannion, Russell; Matsuyama, Yukihiro; Shekelle, Paul; Whittaker, Stuart; Al-Adawi, Samir; Ludlow, Kristiana; James, Wendy; Ting, Hsuen P; Herkes, Jessica; Ellis, Louise A; Churruca, Kate; Nicklin, Wendy; Hughes, Clifford

2017-10-01

Healthcare reform typically involves orchestrating a policy change, mediated through some form of operational, systems, financial, process or practice intervention. The aim is to improve the ways in which care is delivered to patients. In our book 'Health Systems Improvement Across the Globe: Success Stories from 60 Countries', we gathered case-study accomplishments from 60 countries. A unique feature of the collection is the diversity of included countries, from the wealthiest and most politically stable such as Japan, Qatar and Canada, to some of the poorest, most densely populated or politically challenged, including Afghanistan, Guinea and Nigeria. Despite constraints faced by health reformers everywhere, every country was able to share a story of accomplishment-defining how their case example was managed, what services were affected and ultimately how patients, staff, or the system overall, benefited. The reform themes ranged from those relating to policy, care coverage and governance; to quality, standards, accreditation and regulation; to the organization of care; to safety, workforce and resources; to technology and IT; through to practical ways in which stakeholders forged collaborations and partnerships to achieve mutual aims. Common factors linked to success included the 'acorn-to-oak tree' principle (a small scale initiative can lead to system-wide reforms); the 'data-to-information-to-intelligence' principle (the role of IT and data are becoming more critical for delivering efficient and appropriate care, but must be converted into useful intelligence); the 'many-hands' principle (concerted action between stakeholders is key); and the 'patient-as-the-pre-eminent-player' principle (placing patients at the centre of reform designs is critical for success). © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care.

Launch vehicle systems design analysis

NASA Technical Reports Server (NTRS)

Ryan, Robert; Verderaime, V.

1993-01-01

Current launch vehicle design emphasis is on low life-cycle cost. This paper applies total quality management (TQM) principles to a conventional systems design analysis process to provide low-cost, high-reliability designs. Suggested TQM techniques include Steward's systems information flow matrix method, quality leverage principle, quality through robustness and function deployment, Pareto's principle, Pugh's selection and enhancement criteria, and other design process procedures. TQM quality performance at least-cost can be realized through competent concurrent engineering teams and brilliance of their technical leadership.

The CIQG International Quality Principles: Toward a Shared Understanding of Quality. CIQG Publication Series

ERIC Educational Resources Information Center

Uvalic-Trumbic, Stamenka

2016-01-01

The idea of developing International Quality Principles emerged from a dialogue and debate among colleagues from many countries at the Council for Higher Education Accreditation (CHEA) International Quality Group (CIQG) 2014 Annual Meeting. The discussion focused on whether a single set of international standards for academic quality in higher…

Kaizen: a process improvement model for the business of health care and perioperative nursing professionals.

PubMed

Tetteh, Hassan A

2012-01-01

Kaizen is a proven management technique that has a practical application for health care in the context of health care reform and the 2010 Institute of Medicine landmark report on the future of nursing. Compounded productivity is the unique benefit of kaizen, and its principles are change, efficiency, performance of key essential steps, and the elimination of waste through small and continuous process improvements. The kaizen model offers specific instruction for perioperative nurses to achieve process improvement in a five-step framework that includes teamwork, personal discipline, improved morale, quality circles, and suggestions for improvement. Published by Elsevier Inc.

Lean health care: what can hospitals learn from a world-class automaker?

PubMed

Kim, Christopher S; Spahlinger, David A; Kin, Jeanne M; Billi, John E

2006-05-01

With health care costs continuing to rise, a variety of process improvement methodologies have been proposed to address the reported inefficiencies in health care delivery. Lean production is one such method. The management philosophy and tools of lean production come from the manufacturing industry, where they were pioneered by Toyota Motor Corporation, which is viewed as the leader in utilizing these performance improvement methods. Lean has already enjoyed tremendous success in improving quality and efficiency in both the manufacturing and the service sector industries. Health care systems have just begun to utilize lean methods, with reports of improvements just beginning to appear in the literature. We describe some of the basic philosophy and principles of lean production methods and how these concepts can be applied in the health care environment. We describe some of the early success stories and ongoing endeavors of lean production in various health care organizations. We believe the hospital is an ideal setting for use of the lean production method, which could significantly affect how health care is delivered to patients. We conclude by discussing some of the potential challenges in introducing and implementing lean production methods in the health care environment. Lean production is a novel approach to delivering high-quality and efficient care to patients, and we believe that the health care sector can anticipate the same high level of success that the manufacturing and service industries have achieved using this approach. Hospitalists are primed to take action in delivering care of greater quality with more efficiency by applying these new principles in the hospital setting. (c) 2006 Society of Hospital Medicine.

Using quality indicators in anaesthesia: feeding back data to improve care.

PubMed

Benn, J; Arnold, G; Wei, I; Riley, C; Aleva, F

2012-07-01

After recent UK policy developments, considerable attention has been focused upon how clinical specialties measure and report on the quality of care delivered to patients. Defining the right indicators alone is insufficient to close the feedback loop. This narrative review aims to describe and synthesize a diverse body of research relevant to the question of how information from quality indicators can be fed back and used effectively to improve care. Anaesthesia poses certain challenges in the identification of valid outcome indicators sensitive to variations in anaesthetic care. Metrics collected during the immediate post-anaesthetic recovery period, such as patient temperature, patient-reported quality of recovery, and pain and nausea, provide potentially useful information for the anaesthetist, yet this information is not routinely fed back. Reviews of the effects of feeding back performance data to healthcare providers suggest that this may result in small to moderate positive effects upon outcomes and professional practice, with stronger effects where feedback is integrated within a broader quality improvement strategy. The dominant model for use of data within quality improvement is based upon the industrial process control approach, in which care processes are monitored continuously for process changes which are rapidly detectable for corrective action. From this review and experience of implementing these principles in practice, effective feedback from quality indicators is timely, credible, confidential, tailored to the recipient, and continuous. Considerable further work is needed to understand how information from quality indicators can be fed back in an effective way to clinicians and clinical units, in order to support revalidation and continuous improvement.

[Quality management (TQM) in public health-care (PHC): principles for cost-performance calculations and cost reductions with better quality].

PubMed

Bergholz, W

2008-11-01

In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.

[Compatibility of different quality control systems].

PubMed

Invernizzi, Enrico

2002-01-01

Management of the good laboratory practice (GLP) quality system presupposes its linking to a basic recognized and approved quality system, from which it can draw on management procedures common to all quality systems, such as the ISO 9000 set of norms. A quality system organized in this way can also be integrated with other dedicated quality systems, or parts of them, to obtain principles or management procedures for specific topics. The aim of this organization is to set up a reliable, recognized quality system compatible with the principles of GLP and other quality management systems, which provides users with a simplified set of easily accessible management tools and answers. The organization of this quality system is set out in the quality assurance programme, which is actually the document in which the test facility incorporates the GLP principles into its own quality organization.

Nursing role innovations: improved outcomes in a trauma center.

PubMed

Holmquist, P J; Yamamoto, L; DiDonna, D; Sise, M J

1996-01-01

Trauma systems operate on the principle that people with severe injuries require special medical capabilities if they are to have their best chance of recovery. However, optimal trauma care is threatened by the problems of inadequate financial reimbursement. This threatens the ability to deliver trauma patient care. A variety of strategies is necessary to continue to provide care. Two specific nursing role innovations provide the opportunity to improve the ability to provide coordinated, efficient, and cost-effective quality care.

Efficient Project Delivery Using Lean Principles - An Indian Case Study

NASA Astrophysics Data System (ADS)

Kovvuri, P. Ramachandra Reddy; Sawhney, Anil; Ahuja, Ritu; Sreekumar, Aiswarya

2016-03-01

Construction industry in India is growing at a rapid pace. Along with this growth, the industry is facing numerous challenges that are making delivery of projects inefficient. Experts believe that capacity constraints in the industry need to be addressed immediately. Government has recommended `introduction of efficient technologies and modern management techniques' to increase the productivity of the industry. In this context, lean principles can act as a lever to make project delivery more efficient and provide the much needed impetus to the Indian construction sector. Around the globe lean principles are showing positive results on the projects. Project teams are reporting improvements in construction time, cost and quality along with softer benefits of enhanced collaboration, coordination and trust in project teams. Can adoption of lean principles provide similar benefits in the Indian construction sector? This research was conducted to answer this question. Using an action research approach a key lean construction tool called Last Planner System (LPS) was tested on a large Indian construction project. The work described in this work investigates the improvements achieved in project delivery by adopting LPS in Indian construction sector. Comparison in pre- and post-implementation data demonstrates increase in the certainty of work-flow and improves schedule compliance. This is measured through a simple LPS metric called percent plan complete. Explicit improvements in schedule performance are seen during 8 week LPS implementation along with implicit improvements in coordination, collaboration and trust in the project team. This work reports the findings of LPS implementation on the case study project outlining the barriers and drivers to adoption, strategies needed to ensure successful implementation and roadmap for implementation. Based on the findings the authors envision that lean construction can make project delivery more efficient in India.

Design and implementation of software for automated quality control and data analysis for a complex LC/MS/MS assay for urine opiates and metabolites.

PubMed

Dickerson, Jane A; Schmeling, Michael; Hoofnagle, Andrew N; Hoffman, Noah G

2013-01-16

Mass spectrometry provides a powerful platform for performing quantitative, multiplexed assays in the clinical laboratory, but at the cost of increased complexity of analysis and quality assurance calculations compared to other methodologies. Here we describe the design and implementation of a software application that performs quality control calculations for a complex, multiplexed, mass spectrometric analysis of opioids and opioid metabolites. The development and implementation of this application improved our data analysis and quality assurance processes in several ways. First, use of the software significantly improved the procedural consistency for performing quality control calculations. Second, it reduced the amount of time technologists spent preparing and reviewing the data, saving on average over four hours per run, and in some cases improving turnaround time by a day. Third, it provides a mechanism for coupling procedural and software changes with the results of each analysis. We describe several key details of the implementation including the use of version control software and automated unit tests. These generally useful software engineering principles should be considered for any software development project in the clinical lab. Copyright © 2012 Elsevier B.V. All rights reserved.

New Paradigms for Creating Quality Schools.

ERIC Educational Resources Information Center

Greene, Brad

The Quality Schools movement combines the principles of control theory with Edward Deming's principles of total quality management. The outcome is a school environment in which the focus is on quality work, discipline is maintained without coercion, and students continuously evaluate their own work. This book describes the application of Quality…

Chemistry and quality of Hibiscus (Hibiscus sabdariffa) for developing the natural-product industry in Senegal.

PubMed

Juliani, H R; Welch, C R; Wu, Q; Diouf, B; Malainy, D; Simon, J E

2009-03-01

The objectives of this study were to assess and improve the quality of the hibiscus calyces from Senegal over 2 production seasons (2004 to 2005), to develop and adapt new procedures for the determination of hibiscus anthocyanins and analysis of the 2 major ones, delphinidin-3-sambubioside and cyanidin-3-sambubioside. The foreign matter, total ashes, and acid insoluble ashes showed that the calyces harvested in 2005 were produced following hygienic practices, while the color assessment of the calyces and analysis of hibiscus active principles also showed higher amounts of anthocyanins in 2005. A protocol to measure anthocyanins by pH-differential UV-Vis spectrophotometry was adapted to measure the hibiscus anthocyanins from a water extract. The spectrophotometric method for quantitation of total anthocyanins showed a close correlation (r(2)= 0.82) when compared with the HPLC method, suggesting the use of the colorimetric method in quality control programs as an affordable alternative method to assess anthocyanin content in hibiscus. New and raised standards for the cleanliness and active principle content in hibiscus are also proposed. This study demonstrated that the implementation of a quality control program and the application of agricultural good practices in the production and processing of hibiscus calyces can lead to higher quality natural plant products.

High-Capacity Cathode Material with High Voltage for Li-Ion Batteries

DOE PAGES

Shi, Ji -Lei; Xiao, Dong -Dong; Ge, Mingyuan; ...

2018-01-15

Electrochemical energy storage devices with a high energy density are an important technology in modern society, especially for electric vehicles. The most effective approach to improve the energy density of batteries is to search for high-capacity electrode materials. According to the concept of energy quality, a high-voltage battery delivers a highly useful energy, thus providing a new insight to improve energy density. Based on this concept, a novel and successful strategy to increase the energy density and energy quality by increasing the discharge voltage of cathode materials and preserving high capacity is proposed. The proposal is realized in high-capacity Li-richmore » cathode materials. The average discharge voltage is increased from 3.5 to 3.8 V by increasing the nickel content and applying a simple after-treatment, and the specific energy is improved from 912 to 1033 Wh kg-1. The current work provides an insightful universal principle for developing, designing, and screening electrode materials for high energy density and energy quality.« less

High-Capacity Cathode Material with High Voltage for Li-Ion Batteries

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

Shi, Ji -Lei; Xiao, Dong -Dong; Ge, Mingyuan

Electrochemical energy storage devices with a high energy density are an important technology in modern society, especially for electric vehicles. The most effective approach to improve the energy density of batteries is to search for high-capacity electrode materials. According to the concept of energy quality, a high-voltage battery delivers a highly useful energy, thus providing a new insight to improve energy density. Based on this concept, a novel and successful strategy to increase the energy density and energy quality by increasing the discharge voltage of cathode materials and preserving high capacity is proposed. The proposal is realized in high-capacity Li-richmore » cathode materials. The average discharge voltage is increased from 3.5 to 3.8 V by increasing the nickel content and applying a simple after-treatment, and the specific energy is improved from 912 to 1033 Wh kg-1. The current work provides an insightful universal principle for developing, designing, and screening electrode materials for high energy density and energy quality.« less

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

Peck, T; Sparkman, D; Storch, N

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

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.

[Nursing care of patients fitted with a tracheostomy speaking valve].

PubMed

Liao, Shu-Chen; Lin, Chia-Ling; Kao, Wei-Hwa; Chang, Yueh-Jiuan

2006-08-01

As the number of patients who are ventilator dependent increase, the tracheostomy has become an increasingly popular procedure. Inability to either communicate verbally or take food and liquids orally constitute the main distress symptom of patients, which can delay progress in treating the conditions of patients undergoing tracheostomies. Passy-Muir speaking valves (PMV) succeed in overcoming the abovementioned problems and clinical practice is gradually broadening. This article introduces the relevant underlying principles, indications, advantages, disadvantages and nursing principles of PMV. We hope this article can provide new information related to the PMV speaking valve and, as a result, help improve patient's security and medical quality.

[Strategy Development for International Cooperation in the Clinical Laboratory Field].

PubMed

Kudo, Yoshiko; Osawa, Susumu

2015-10-01

The strategy of international cooperation in the clinical laboratory field was analyzed to improve the quality of intervention by reviewing documents from international organizations and the Japanese government. Based on the world development agenda, the target of action for health has shifted from communicable diseases to non-communicable diseases (NCD). This emphasizes the importance of comprehensive clinical laboratories instead of disease-specific examinations in developing countries. To achieve this goal, the World Health Organization (WHO) has disseminated to the African and Asian regions the Laboratory Quality Management System (LQMS), which is based on the same principles of the International Organization of Standardization (ISO) 15189. To execute this strategy, international experts must have competence in project management, analyze information regarding the target country, and develop a strategy for management of the LQMS with an understanding of the technical aspects of laboratory work. However, there is no appropriate pre- and post-educational system of international health for Japanese international workers. Universities and academic organizations should cooperate with the government to establish a system of education for international workers. Objectives of this education system must include: (1) training for the organization and understanding of global health issues, (2) education of the principles regarding comprehensive management of clinical laboratories, and (3) understanding the LQMS which was employed based on WHO's initiative. Achievement of these objectives will help improve the quality of international cooperation in the clinical laboratory field.

Lean principles optimize on-time vascular surgery operating room starts and decrease resident work hours.

PubMed

Warner, Courtney J; Walsh, Daniel B; Horvath, Alexander J; Walsh, Teri R; Herrick, Daniel P; Prentiss, Steven J; Powell, Richard J

2013-11-01

Lean process improvement techniques are used in industry to improve efficiency and quality while controlling costs. These techniques are less commonly applied in health care. This study assessed the effectiveness of Lean principles on first case on-time operating room starts and quantified effects on resident work hours. Standard process improvement techniques (DMAIC methodology: define, measure, analyze, improve, control) were used to identify causes of delayed vascular surgery first case starts. Value stream maps and process flow diagrams were created. Process data were analyzed with Pareto and control charts. High-yield changes were identified and simulated in computer and live settings prior to implementation. The primary outcome measure was the proportion of on-time first case starts; secondary outcomes included hospital costs, resident rounding time, and work hours. Data were compared with existing benchmarks. Prior to implementation, 39% of first cases started on time. Process mapping identified late resident arrival in preoperative holding as a cause of delayed first case starts. Resident rounding process inefficiencies were identified and changed through the use of checklists, standardization, and elimination of nonvalue-added activity. Following implementation of process improvements, first case on-time starts improved to 71% at 6 weeks (P = .002). Improvement was sustained with an 86% on-time rate at 1 year (P < .001). Resident rounding time was reduced by 33% (from 70 to 47 minutes). At 9 weeks following implementation, these changes generated an opportunity cost potential of $12,582. Use of Lean principles allowed rapid identification and implementation of perioperative process changes that improved efficiency and resulted in significant cost savings. This improvement was sustained at 1 year. Downstream effects included improved resident efficiency with decreased work hours. Copyright © 2013 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

[Importance of social tuberculosis prophylaxis for the Armed Forces in present conditions].

PubMed

Muchaidze, R D; Dantsev, V V; Beznosik, R V; Spitsyn, M G; Shitov, Yu N

2016-02-01

Lately social prophylaxis of tuberculosis has taken on special significance in the Armed Forces of the Russian Federation. Thank to social measures of the modern military reform, such as reduction of conscription term, territorial principle of recruitment for the army, improvement of habitation, service and recreation conditions, improvement of quality and organization of a diet, improvement of quality of a uniform it succeeded in reducing tuberculosis morbidity in military servicemen from 2007 up to 2014 up to 65 percent. Nevertheless, the main ways of tuberculosis control in the army (military service prohibition for citizens with tuberculosis, early active case detection, prophylaxis in risk group, anti-epidemic measures in the army nidus of tuberculosis etc.) are still urgent. To increase an effectiveness of the work done it is necessary to specify procedure and period of preventive fluorography in military servicemen.

[Disease management from the economic point of view].

PubMed

Oberender, Peter; Zerth, Jürgen

2003-06-01

The introduction of disease management programs for chronic diseases aims to achieve a permanent improvement of care. Such an improvement cannot be reached without effective incentives. However, the incentives set in the German Health Care System may cause reactions on the micro level that do not correspond to the aims on the macro level. In the long term, patient empowerment will be needed in order to enable a shared-decision-making of patients and physicians. A market-oriented solution consists of quality competition allowing for various delivery systems and the search for new models that lead to an improvement of care. However, quality competition will have to respect the traditional principle of solidarity underlying the German health care system. Disease management will contribute to an integrated, incentive-oriented delivery system but only if it allows for a variety of care.

An Electronic Nursing Patient Care Plan Helps in Clinical Decision Support.

PubMed

Wong, C M; Wu, S Y; Ting, W H; Ho, K H; Tong, L H; Cheung, N T

2015-01-01

Information technology can help to improve health care delivery. The utilisation of informatics principle enhances the quality of nursing practices through improved communication, documentation and efficiency. The Nursing Profession constitutes 34% of the total workforce in the Hong Kong Hospital Authority (HA) and includes 21,000 nurses in 2012. To enhance the quality of care and patient safety in both hospitals and community care setting, it is essential that an integrated electronic decision support system for nurses is designed to track documentation and support care or service including observations, decisions, actions and outcomes throughout the care process at each point-of-care. The Patient Care Plan project was set up to achieve these objectives. The Project adheres to strict documentation information architecture to ensure data sharing is freely available. Preliminary results showed very promising improvement in clinical care.

[Surgery of benign vocal fold lesions].

PubMed

Olthoff, A

2016-09-01

Surgical treatment of benign vocal fold lesions can be indicated for clinical or functional reasons. The principles of phonosurgery have to be maintained in either case. The appropriate phonosurgical technique depends on the type of vocal fold lesion. Depending on the findings, phonosurgery aims to maintain or improve voice quality. The evaluation of clinical and functional results includes indirect laryngoscopy, videostroboscopy, and voice analysis.

Quality Control Review of the Dixon Hughes Goodman LLP FY 2014 Single Audit of Logistics Management Institute

DTIC Science & Technology

2016-09-29

independent, relevant, and timely oversight of the Department of Defense that supports the warfighter; promotes accountability , integrity, and...compliance testing for the allowable costs/cost principles compliance requirement to ensure the review of indirect costs is adequately performed...consulting services in logistics, acquisition and financial management, infrastructure management, information management, organizational improvement, and

An Investigation of English Language Teachers and Students' Views on Ethical Principles towards Students

ERIC Educational Resources Information Center

Cephe, Pasa Tevfik; Keles, Yener

2015-01-01

The purpose of this study is to raise the quality of teaching English language and to contribute to the improvement of ELT Teachers profession by investigating the extent to which English teachers at Mugla Sitki Koçman University apply the ethical code towards students during their teaching process. The study was conducted in Preparatory School of…

Adoption of Lean Principles in a High-Volume Molecular Diagnostic Microbiology Laboratory

PubMed Central

Mitchell, P. Shawn; Mandrekar, Jayawant N.

2014-01-01

Clinical laboratories are constantly facing challenges to do more with less, enhance quality, improve test turnaround time, and reduce operational expenses. Experience with adopting and applying lean concepts and tools used extensively in the manufacturing industry is described for a high-volume clinical molecular microbiology laboratory, illustrating how operational success and benefits can be achieved. PMID:24829247

Research on improvement strategies of elite culture, mass culture and the comprehensive quality of undergraduates

NASA Astrophysics Data System (ADS)

Wang, Hongling

2011-10-01

This article, placed the comprehensive quality improvement of undergraduates under the background of elite culture and mass culture, analyzed the influences and challenges brought by elite culture and mass culture on the undergraduate education from multiple perspectives of philosophy, ethics, economics, education, sociology and etc. and combing some foreign developed countries' experiences proposed the principles should be insisted by high schools in the context of elite culture and mass culture. With the development of times, undergraduate education should also constantly develop into new historical starting points and thoroughly reform the undergraduate education from content to essence, perception to format with a globalized horizon, so as to be able to reflect the time characteristics and better promote the overall development of undergraduates. Exactly based on such a view, this article, on the premise of full recognition that the flourishing and development of elite culture and mass culture has promoted China into a multicultural situation, proposed the principles for university moral education, such as education should promote the integration of undergraduate multi-values, sticking to the integration of unary guidance with diverse development, insisting on seeking common points while reserving differences and harmony but with differences, and etc.

[Research ethics committees: a necessary good].

PubMed

Riera, Alejandra V

2013-12-01

The Nuremberg Code, issued as the result of the deliberations of the Nuremberg Trials, which judged the atrocities carried out during Nazi Germany (1933-1945), was the first universal document that defined research ethics principles for human experimentation. This code served as the basis for the subsequent ethical codes and principles used today by the Research Ethics Committees. The Research Ethics Committee is a multidisciplinary body whose primary role is to protect the rights and welfare of research subjects through the review of research protocols, ensuring compliance with internationally and locally accepted ethical guidelines. Worldwide, there have been important improvements in order to promote and regulate bioethics in medical research. In Venezuela, several national organizations have been constituted with the aim of promoting the establishment of ethics committees; however, there has not been a significant progress in the quantity or quality of the functioning of Research Ethics Committees in the country. It is imperative for each research institution to establish and work to improve their ethics committee to ensure the quality of the clinical research conducted, making it adherent to ethical codes, and safeguarding the integrity and credibility of the investigators and the research institutions, and more importantly, the patient's rights.

[Application of Raman Spectroscopy Technique to Agricultural Products Quality and Safety Determination].

PubMed

Liu, Yan-de; Jin, Tan-tan

2015-09-01

The quality and safety of agricultural products and people health are inseparable. Using the conventional chemical methods which have so many defects, such as sample pretreatment, complicated operation process and destroying the samples. Raman spectroscopy as a powerful tool of analysing and testing molecular structure, can implement samples quickly without damage, qualitative and quantitative detection analysis. With the continuous improvement and the scope of the application of Raman spectroscopy technology gradually widen, Raman spectroscopy technique plays an important role in agricultural products quality and safety determination, and has wide application prospects. There have been a lot of related research reports based on Raman spectroscopy detection on agricultural product quality safety at present. For the understanding of the principle of detection and the current development situation of Raman spectroscopy, as well as tracking the latest research progress both at home and abroad, the basic principles and the development of Raman spectroscopy as well as the detection device were introduced briefly. The latest research progress of quality and safety determination in fruits and vegetables, livestock and grain by Raman spectroscopy technique were reviewed deeply. Its technical problems for agricultural products quality and safety determination were pointed out. In addition, the text also briefly introduces some information of Raman spectrometer and the application for patent of the portable Raman spectrometer, prospects the future research and application.

Quality Assurance in Higher Education: Proposals for Consultation.

ERIC Educational Resources Information Center

Higher Education Funding Council for England, Bristol.

This document sets out for consultation proposals for a revised method for quality assurance of teaching and learning in higher education. The proposals cover: (1) the objectives and principles of quality assurance; (2) an approach to quality assurance based on external audit principles; (3) the collection and publication of information; (4)…

Making Quality Health Websites a National Public Health Priority: Toward Quality Standards.

PubMed

Devine, Theresa; Broderick, Jordan; Harris, Linda M; Wu, Huijuan; Hilfiker, Sandra Williams

2016-08-02

Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out of 100 (58.0%) websites met 3 or more out of 6 reliability criteria. For objective HC/HIT-8.2, a total of 42 out of 100 (42.0%) websites followed 10 or more out of 19 established usability principles. On the basis of these baseline data points, ODPHP set targets for the year 2020 that meet the minimal statistical significance-increasing objective HC/HIT-8.1 data point to 70.5% and objective HC/HIT-8.2 data point to 55.7%. This research is a critical first step in evaluating the quality of Web-based health information. The criteria proposed by ODPHP provide methods to assess website quality for professionals designing, developing, and managing health-related websites. The criteria, baseline data, and targets are valuable tools for driving quality improvement.

Making Quality Health Websites a National Public Health Priority: Toward Quality Standards

PubMed Central

2016-01-01

Background Most US adults have limited health literacy skills. They struggle to understand complex health information and services and to make informed health decisions. The Internet has quickly become one of the most popular places for people to search for information about their health, thereby making access to quality information on the Web a priority. However, there are no standardized criteria for evaluating Web-based health information. Every 10 years, the US Department of Health and Human Services' Office of Disease Prevention and Health Promotion (ODPHP) develops a set of measurable objectives for improving the health of the nation over the coming decade, known as Healthy People. There are two objectives in Healthy People 2020 related to website quality. The first is objective Health Communication and Health Information Technology (HC/HIT) 8.1: increase the proportion of health-related websites that meet 3 or more evaluation criteria for disclosing information that can be used to assess information reliability. The second is objective HC/HIT-8.2: increase the proportion of health-related websites that follow established usability principles. Objective The ODPHP conducted a nationwide assessment of the quality of Web-based health information using the Healthy People 2020 objectives. The ODPHP aimed to establish (1) a standardized approach to defining and measuring the quality of health websites; (2) benchmarks for measurement; (3) baseline data points to capture the current status of website quality; and (4) targets to drive improvement. Methods The ODPHP developed the National Quality Health Website Survey instrument to assess the quality of health-related websites. The ODPHP used this survey to review 100 top-ranked health-related websites in order to set baseline data points for these two objectives. The ODPHP then set targets to drive improvement by 2020. Results This study reviewed 100 health-related websites. For objective HC/HIT-8.1, a total of 58 out of 100 (58.0%) websites met 3 or more out of 6 reliability criteria. For objective HC/HIT-8.2, a total of 42 out of 100 (42.0%) websites followed 10 or more out of 19 established usability principles. On the basis of these baseline data points, ODPHP set targets for the year 2020 that meet the minimal statistical significance—increasing objective HC/HIT-8.1 data point to 70.5% and objective HC/HIT-8.2 data point to 55.7%. Conclusions This research is a critical first step in evaluating the quality of Web-based health information. The criteria proposed by ODPHP provide methods to assess website quality for professionals designing, developing, and managing health-related websites. The criteria, baseline data, and targets are valuable tools for driving quality improvement. PMID:27485512

Principles and Planning in Nasal and Facial Reconstruction: Making a Normal Face.

PubMed

Menick, Frederick J

2016-06-01

After reading this article, the participant should be able to: 1. Understand the rationale and value of principles of facial reconstruction in the complex patient. 2. Understand the importance of diagnosis and planning. 3. Appreciate the value of surgical staging. 4. Modify tissues to the requirements of the defect. 5. Know how to treat ischemic cover and lining complications. 6. Learn methods of late revision. It is easy to be overwhelmed by a complex defect. What to do? How? When? In what order? Success is determined by careful planning, guided by principles. The aesthetic and anatomical deficiencies must be identified. Then, what is absent, both visually and anatomically, and what is missing must be determined. What are the priorities? What is the best timing for each stage? What are the available options and what will be the likely result? Should I choose another option? How can the surgeon maintain vascularity, transfer tissue, and improve tissue quality and contour? What are potential backup salvage maneuvers? Sound surgical principles based on the contributions of Gillies and Millard provide strategic instructions that help the surgeon "make sense" of a complex problem. They provide coordinated rules that clarify the diagnosis, planning, timing, and stages of repair. These should be combined with a regional unit approach to facial repair that provides tactical rules to establish the skin quality, border outline, and three-dimensional shape of the normal face.

How nurse-led practices perceive implementation of the patient-centered medical home.

PubMed

Frasso, Rosemary; Golinkoff, A; Klusaritz, Heather; Kellom, Katherine; Kollar-McArthur, Helen; Miller-Day, Michelle; Gabbay, Robert; Cronholm, Peter F

2017-04-01

The Affordable Care Act (ACA) promotes the Patient-Centered Medical Home (PCMH) model as a way to improve healthcare quality, the patient experience, and has identified nurse-led primary care as a mechanism meeting the increasing demand for quality primary care. The purpose of this study was to investigate the implementation of a PCMH model in nurse-led primary care practices and to identify facilitators and barriers to the implementation of this model. Data were collected through in-depth interviews with providers and staff in nurse-led practices. These data suggest two categories of processes that facilitate the integration of PCMH in the nurse-led practice setting: patient-oriented facilitators and organizational facilitators. In addition, a number of barriers were identified to implementing the PCMH model. Overall, these practices creatively engaged in the transformation process by structuring themselves as a complex adaptive system and building upon the core principles of nurse-led care. Since the core principles of nurse-led care map onto many of the same principles of the PCMH model, this study discusses the possibility that nurse-led practices may experience fewer barriers when transitioning into PCMHs. Copyright © 2017 Elsevier Inc. All rights reserved.

Measurement standards for interdisciplinary medical rehabilitation.

PubMed

Johnston, M V; Keith, R A; Hinderer, S R

1992-12-01

Rehabilitation must address problems inherent in the measurement of human function and health-related quality of life, as well as problems in diagnosis and measurement of impairment. This educational document presents an initial set of standards to be used as guidelines for development and use of measurement and evaluation procedures and instruments for interdisciplinary, health-related rehabilitation. Part I covers general measurement principles and technical standards, beginning with validity, the central consideration for use of measures. Subsequent sections focus on reliability and errors of measurement, norms and scaling, development of measures, and technical manuals and guides. Part II covers principles and standards for use of measures. General principles of application of measures in practice are discussed first, followed by standards to protect persons being measured and then by standards for administrative applications. Many explanations, examples, and references are provided to help professionals understand measurement principles. Improved measurement will ensure the basis of rehabilitation as a science and nourish its success as a clinical service.

Using Behavioral Economics to Design Physician Incentives That Deliver High-Value Care.

PubMed

Emanuel, Ezekiel J; Ubel, Peter A; Kessler, Judd B; Meyer, Gregg; Muller, Ralph W; Navathe, Amol S; Patel, Pankaj; Pearl, Robert; Rosenthal, Meredith B; Sacks, Lee; Sen, Aditi P; Sherman, Paul; Volpp, Kevin G

2016-01-19

Behavioral economics provides insights about the development of effective incentives for physicians to deliver high-value care. It suggests that the structure and delivery of incentives can shape behavior, as can thoughtful design of the decision-making environment. This article discusses several principles of behavioral economics, including inertia, loss aversion, choice overload, and relative social ranking. Whereas these principles have been applied to motivate personal health decisions, retirement planning, and savings behavior, they have been largely ignored in the design of physician incentive programs. Applying these principles to physician incentives can improve their effectiveness through better alignment with performance goals. Anecdotal examples of successful incentive programs that apply behavioral economics principles are provided, even as the authors recognize that its application to the design of physician incentives is largely untested, and many outstanding questions exist. Application and rigorous evaluation of infrastructure changes and incentives are needed to design payment systems that incentivize high-quality, cost-conscious care.

Aligning quality and payment for heart failure care: defining the challenges.

PubMed

Havranek, Edward P; Krumholz, Harlan M; Dudley, R Adams; Adams, Kirkwood; Gregory, Douglas; Lampert, Steven; Lindenfeld, Joann; Massie, Barry M; Pina, Ileana; Restaino, Susan; Rich, Michael W; Konstam, Marvin A

2003-08-01

Hospitals may not support programs that improve the quality of care delivered to heart failure patients because these programs lower readmission rates and empty beds, and therefore further diminish already-declining revenues. A conflict between the highest quality of care and financial solvency does not serve the interests of patients, physicians, hospitals, or payers. In principle, resolution of this conflict is simple: reimbursement systems should reward higher quality care. In practice, resolving the conflict is not simple. A recent roundtable discussion sponsored by the Heart Failure Society of America identified 4 major challenges to the design and implementation of reimbursement schemes that promote higher quality care for heart failure: defining quality, accounting for differences in disease severity, crafting novel payment mechanisms, and overcoming professional parochialism. This article describes each of these challenges in turn.

ACA and the Triple Aim: Musings of a Health Care Actuary.

PubMed

McCarthy, Mac

2015-01-01

In 2008, the Institute for Healthcare Improvement (IHI) promulgated the Triple Aim, which advocates simultaneous improvements in patient experiences, improved population health and lower cost per capita. In 2010, the Patient Protection and Affordable Care Act (ACA) promised quality, affordable health care for all Americans. It's fair to assume that the framers of ACA were aware of the Triple Aim, and it is likely that much of ACA was heavily influenced by IHI's positions. So it is reasonable, from time to time, to assess ACA's impact on health care against the Triple Aim principles.

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2011 CFR

2011-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2012 CFR

2012-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2014 CFR

2014-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2013 CFR

2013-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

21 CFR 104.5 - General principles.

Code of Federal Regulations, 2010 CFR

2010-04-01

... CONSUMPTION NUTRITIONAL QUALITY GUIDELINES FOR FOODS General Provisions § 104.5 General principles. (a) A nutritional quality guideline prescribes the minimum level or range of nutrient composition (nutritional... requirements of the nutritional quality guideline established for its class of food may state “This product...

Vacuum cooling of meat products: current state-of-the-art research advances.

PubMed

Feng, Chaohui; Drummond, Liana; Zhang, Zhihang; Sun, Da-Wen; Wang, Qijun

2012-01-01

Vacuum cooling (VC) is commonly applied for cooling of several foodstuffs, to provide exceptionally rapid cooling rates with low energy consumption and resulting in high-quality food products. However, for products such as meat and cooked meat products, the higher cooling loss of vacuum cooling compared with established methods still means lower yields, and important meat quality parameters can be negatively affected. Substantial efforts during the past ten years have aimed to improve the technology in order to offer the meat industry, especially the cooked meat industry, optimized production in terms of safety regulations and guidelines, as well as meat quality. This review presents and discusses recent VC developments directed to the cooked meat industry. The principles of VC, and the basis for improvements of this technology, are firstly discussed; future prospects for research and development in this area are later explored, particularly in relation to cooling of cooked meat and meat products.

Does improved access to water supply by rural households enhance the concept of safe water at the point of use? A case study from deep rural South Africa.

PubMed

Jagals, P

2006-01-01

The concept of safe water is defined by three principles: the health-related quality must be suitable, the supply/source must be accessible and the water must constantly be available in quantities sufficient for the intended use. If any one (or more) of these three elements is missing from a water services improvement programme, providing safe water is not successfully achieved. A study in a deep rural area in South Africa showed that providing small communities, using untreated river water as their only water source, with good quality water through a piped distribution system and accessible at communal taps did not fall within our parameters of safe water. The parameters for measuring the three principles were: absence of Escherichia coli in drinking water samples; accessibility by improving tap distances to within 200 m from each household; availability by assessing whether households have at least 25 L per person per day. Results show that although E. coli levels were reduced significantly, households were still consuming water with E. coli numbers at non-compliant levels. Access (distance) was improved from an average of 750 m from households to river source to an average of 120 m to new on-tap source points. This did not result in significant increases in household quantities, which on average remained around 18 L per person per day.

Improving rates of cotrimoxazole prophylaxis in resource-limited settings: implementation of a quality improvement approach.

PubMed

Bardfield, J; Agins, B; Palumbo, M; Wei, A L; Morris, J; Marston, B

2014-12-01

To demonstrate the effectiveness of quality improvement methods to monitor and improve administration of cotrimoxazole (CTX) prophylaxis to improve health outcomes among adults living with HIV/AIDS in low resource countries. Program evaluation. HIV/AIDS health care facilities in Uganda, Mozambique, Namibia and Haiti. Performance measures based on national guidelines are developed in each country. These may include CD4 monitoring, ART adherence and uptake of CTX prophylaxis. CTX prophylaxis is routinely selected, because it has been shown to reduce HIV-related morbidity and mortality. Patient records are sampled using a standard statistical table to achieve a minimum confidence interval of 90% with a spread of ±8% in participating clinics. If an electronic medical record is available, all patients are reviewed. Routine review of performance measures, usually every 6 months, is conducted to identify gaps in care. Improvement interventions are developed and implemented at health facilities, informed by performance results, and local/national public health priorities. Median clinic rates of CTX prophylaxis. Median performance rates of CTX prophylaxis generally improved for adult HIV+ patients between 2006 and 2013 across countries, with median clinic rates higher than baseline at follow-up in 16 of 18 groups of clinics implementing CTX -focused improvement projects. Quality management offers a data-driven method to improve the quality of HIV care in low resource countries. Application of improvement principles has been shown to be effective to increase the rates of CTX prophylaxis in national HIV programs in multiple countries. © The Author 2014. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.

The Application of Lean Thinking to the Care of Patients With Bone and Brain Metastasis With Radiation Therapy

PubMed Central

Kim, Christopher S.; Hayman, James A.; Billi, John E.; Lash, Kathy; Lawrence, Theodore S.

2007-01-01

Purpose Patients with bone and brain metastases are among the most symptomatic nonemergency patients treated by radiation oncologists. Treatment should begin as soon as possible after the request is generated. We tested the hypothesis that the operational improvement method based on lean thinking could help streamline the treatment of our patients referred for bone and brain metastases. Methods University of Michigan Health System has adopted lean thinking as a consistent approach to quality and process improvement. We applied the principles and tools of lean thinking, especially value as defined by the customer, value stream mapping processes, and one piece flow, to improve the process of delivering care to patients referred for bone or brain metastases. Results and Conclusion The initial evaluation of the process revealed that it was rather chaotic and highly variable. Implementation of the lean thinking principles permitted us to improve the process by cutting the number of individual steps to begin treatment from 27 to 16 and minimize variability by applying standardization. After an initial learning period, the percentage of new patients with brain or bone metastases receiving consultation, simulation, and treatment within the same day rose from 43% to nearly 95%. By implementing the ideas of lean thinking, we improved the delivery of clinical care for our patients with bone or brain metastases. We believe these principles can be applied to much of the care administered throughout our and other health care delivery areas. PMID:20859409

The application of lean thinking to the care of patients with bone and brain metastasis with radiation therapy.

PubMed

Kim, Christopher S; Hayman, James A; Billi, John E; Lash, Kathy; Lawrence, Theodore S

2007-07-01

Patients with bone and brain metastases are among the most symptomatic nonemergency patients treated by radiation oncologists. Treatment should begin as soon as possible after the request is generated. We tested the hypothesis that the operational improvement method based on lean thinking could help streamline the treatment of our patients referred for bone and brain metastases. University of Michigan Health System has adopted lean thinking as a consistent approach to quality and process improvement. We applied the principles and tools of lean thinking, especially value as defined by the customer, value stream mapping processes, and one piece flow, to improve the process of delivering care to patients referred for bone or brain metastases. The initial evaluation of the process revealed that it was rather chaotic and highly variable. Implementation of the lean thinking principles permitted us to improve the process by cutting the number of individual steps to begin treatment from 27 to 16 and minimize variability by applying standardization. After an initial learning period, the percentage of new patients with brain or bone metastases receiving consultation, simulation, and treatment within the same day rose from 43% to nearly 95%. By implementing the ideas of lean thinking, we improved the delivery of clinical care for our patients with bone or brain metastases. We believe these principles can be applied to much of the care administered throughout our and other health care delivery areas.

Small cause - big effect: improvement in interface design results in improved data quality - a multicenter crossover study.

PubMed

Ahlbrandt, Janko; Henrich, Michael; Hartmann, Bernd A; Bundschuh, Bettina B; Schwarz, Julia; Klasen, Joachim; Röhrig, Rainer

2012-01-01

In Germany the core data set for anesthesia version 3.0 was recently introduced for external quality assurance, which includes five surgical tracer procedures. We found a low rate of correctly documented tracers when compared to procedure data (OPS-Codes) documented separately. Examination revealed that the graphical user interface (GUI) contravened the dialogue principles as defined in EN ISO 9241-110. We worked with the manufacturer to implement small improvements and roll out the software. A crossover study was conducted at a university hospital and a municipal hospital chain with five hospitals. All study sites and surgical tracer procedures combined, we found an improvement from 42% to 65% (p<0.001; N=34,610) correctly documented anesthesias. We also saw improvements for most of the observed surgical tracer procedures at all hospitals. Our results show the big effect small changes to the GUI can have on data quality. They also raise the question, if highly flexible and parameterized clinical documentation systems are suited to achieve high usability. Finding the right balance between GUIs designed by usability experts and the flexibility of parameterization by administrators will be a difficult task for the future and subject to further research.

Drug-device combination products in the twenty-first century: epinephrine auto-injector development using human factors engineering.

PubMed

Edwards, Eric S; Edwards, Evan T; Simons, F Estelle R; North, Robert

2015-05-01

The systematic application of human factors engineering (HFE) principles to the development of drug-device combination products, including epinephrine auto-injectors (EAIs), has the potential to improve the effectiveness and safety of drug administration. A PubMed search was performed to assess the role of HFE in the development of drug-device combination products. The following keywords were used in different combinations: 'human factors engineering,' 'human factors,' 'medical products,' 'epinephrine/adrenaline auto-injector,' 'healthcare' and 'patient safety.' This review provides a summary of HFE principles and their application to the development of drug-device combination products as advised by the US FDA. It also describes the HFE process that was applied to the development of Auvi-Q, a novel EAI, highlighting specific steps that occurred during the product-development program. For drug-device combination products, device labeling and usability are critical and have the potential to impact clinical outcomes. Application of HFE principles to the development of drug-delivery devices has the potential to improve product quality and reliability, reduce risk and improve patient safety when applied early in the development process. Additional clinical and real-world studies will confirm whether the application of HFE has helped to develop an EAI that better meets the needs of patients at risk of anaphylaxis.

Fostering a Commitment to Quality: Best Practices in Safety-net Hospitals.

PubMed

Hochman, Michael; Briggs-Malonson, Medell; Wilkes, Erin; Bergman, Jonathan; Daskivich, Lauren Patty; Moin, Tannaz; Brook, Ilanit; Ryan, Gery W; Brook, Robert H; Mangione, Carol M

2016-01-01

In 2007, the Martin Luther King, Jr.-Harbor Hospital (MLK-Harbor), which served a large safety-net population in South Los Angeles, closed due to quality challenges. Shortly thereafter, an agreement was made to establish a new hospital, Martin Luther King, Jr. Community Hospital (MLKCH), to serve the unmet needs of the community. To assist the newly appointed MLKCH Board of Directors in building a culture of quality, we conducted a series of interviews with five high-performing hospital systems. In this report, we describe our findings. The hospitals we interviewed achieved a culture of quality by: 1) developing guiding principles that foster quality; 2) hiring and retaining personnel who are stewards of quality; 3) promoting efficient resource utilization; 4) developing a well-organized quality improvement infrastructure; and 5) cultivating integrated, patient-centric care. The institutions highlighted in this report provide important lessons for MLKCH and other safety-net institutions.

International perspectives on air quality: risk management principles for policy development--conference statement.

PubMed

Craig, Lorraine; Krewski, Dan; Samet, Jonathan; Shortreed, John; van Bree, Leendert; Krupnick, Alan J

2008-01-01

This statement is the result of discussions held at the 2005 NERAM IV Colloquium "International Perspectives on Air Quality: Risk Management Principles for Policy Development" and represents the collective views of 35 delegates, including international air quality policy analysts, academics, nongovernmental organizations, industry representatives, and decision makers from Mexico, Canada, the United States, the United Kingdom, Brazil, Hong Kong, and The Netherlands on principles for global air quality management. The objective of the colloquium was to "establish principles for air quality management based on the identification of international best practice in air quality policy development and implementation." This statement represents the main findings of a breakout group discussion session, presentations of an international panel of speakers from Canada, the United States, Mexico, and Hong Kong and views of the delegates expressed in plenary discussions. NERAM undertook a transparent process to try to ensure that the statement would accurately reflect the conference discussions, including documenting the proceedings and inviting delegates' comments on draft versions of the statement.

National Impact of the EPEC-Pediatrics Enhanced Train-the-Trainer Model for Delivering Education on Pediatric Palliative Care.

PubMed

Widger, Kimberley; Wolfe, Joanne; Friedrichsdorf, Stefan; Pole, Jason D; Brennenstuhl, Sarah; Liben, Stephen; Greenberg, Mark; Bouffet, Eric; Siden, Harold; Husain, Amna; Whitlock, James A; Leyden, Myra; Rapoport, Adam

2018-05-21

Lack of pediatric palliative care (PPC) training impedes successful integration of PPC principles into pediatric oncology. We examined the impact of an enhanced implementation of the Education in Palliative and End-of-Life Care for Pediatrics (EPEC ® -Pediatrics) curriculum on the following: (1) knowledge dissemination; (2) health professionals' knowledge; (3) practice change; and (4) quality of PPC. An integrated knowledge translation approach was used with pre-/posttest evaluation of care quality. Setting/Subjects/Measurements: Regional Teams of 3-6 health professionals based at 15 pediatric oncology programs in Canada became EPEC-Pediatrics Trainers who taught the curriculum to health professionals (learners) and implemented quality improvement (QI) projects. Trainers recorded the number of learners at each education session and progress on QI goals. Learners completed knowledge surveys. Care quality was assessed through surveys with a cross-sectional sample of children with cancer and their parents about symptoms, quality of life, and care quality plus reviews of deceased patients' health records. Seventy-two Trainers taught 3475 learners; the majority (96.7%) agreed that their PPC knowledge improved. In addition, 10/15 sites achieved practice change QI goals. The only improvements in care quality were an increased number of days from referral to PPC teams until death by a factor of 1.54 (95% confidence interval [CI] = 1.17-2.03) and from first documentation of advance care planning until death by a factor of 1.50 (95% CI = 1.06-2.11), after adjusting for background variables. While improvements in care quality were only seen in two areas, our approach was highly effective in achieving knowledge dissemination, knowledge improvement, and practice change goals.

[The design and experiment of multi-parameter water quality monitoring microsystem based on MOEMS microspectrometer].

PubMed

Wei, Kang-Lin; Wen, Zhi-Yu; Guo, Jian; Chen, Song-Bo

2012-07-01

Aiming at the monitoring and protecting of water resource environment, a multi-parameter water quality monitoring microsystem based on microspectrometer was put forward in the present paper. The microsystem is mainly composed of MOEMS microspectrometer, flow paths system and embedded measuring & controlling system. It has the functions of self-injecting samples and detection regents, automatic constant temperature, self -stirring, self- cleaning and samples' spectrum detection. The principle prototype machine of the microsystem was developed, and its structure principle was introduced in the paper. Through experiment research, it was proved that the principle prototype machine can rapidly detect quite a few water quality parameters and can meet the demands of on-line water quality monitoring, moreover, the principle prototype machine has strong function expansibility.

Effectiveness of Aquatic Exercise in Improving Lower Limb Strength in Musculoskeletal Conditions: A Systematic Review and Meta-Analysis.

PubMed

Heywood, Sophie; McClelland, Jodie; Mentiplay, Benjamin; Geigle, Paula; Rahmann, Ann; Clark, Ross

2017-01-01

To investigate the effectiveness of aquatic exercise in improving lower limb strength in people with musculoskeletal conditions. A systematic search used 5 databases, including MEDLINE, CINAHL, Embase, SPORTDiscus, and The Cochrane Library. Randomized controlled trials evaluating aquatic exercise with a resistance training component for adults with musculoskeletal conditions compared with no intervention or land-based exercise were identified. Fifteen studies from the initial yield of 1214 met these criteria. Data related to participant demographics, study design, and methods, interventions, and outcomes, including numerical means and SDs, were extracted independently by 2 reviewers. Nine of the 15 studies were of high quality, scoring at least 6 on the Physiotherapy Evidence Database Scale. Limited consideration of the prescription of resistance in the aquatic exercise and application of resistance training principles existed. Low- or very low-quality evidence indicates there was no difference in average effect between aquatic exercise and no exercise in improving hip abductor strength (standardized mean difference [SMD], .28; 95% confidence interval [CI], -.04 to .59), knee extensor strength (SMD, .18; 95% CI, -.03 to .40), knee flexor strength (SMD, .13; 95% CI, -.20 to .45), or lower limb endurance (SMD, .35; 95% CI, -.06 to .77). Low-quality evidence indicates no difference in average effect between aquatic and land exercise for knee extensor (SMD, -.24; 95% CI, -.49 to .02) or flexor strength (SMD, -.15; 95% CI, -.53 to .22). It is likely that the inadequate application of resistance in water is a significant contributor to the limited effectiveness of aquatic exercise interventions in improving hip and knee muscle strength in people with musculoskeletal conditions. Future research is needed to quantify resistance with aquatic exercises and to determine if using opportunities for greater resistance in aquatic rehabilitation and appropriate resistance training principles can be more effective in improving muscle strength. Copyright © 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

Mazda's new V-6 gasoline engine and its innovative induction system

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

Hatamura, K.; Morishita, K.; Asanomi, K.

1987-01-01

Mazda succeeded in the development of a new V-type 6-cylinder engine series comprising 2-liter JF naturally aspirated and turbocharged units and also a 3-liter JE naturally aspirated unit. This engine is 60-degree-banked and has 18 valves: two intake valves and one exhaust valve per cylinder. Various techniques, such as High Rigidity Cylinder Block and HLA, are adopted to upgrade quietness and smoothness. The Dynamic Charge Effects system, a combination of inertia and resonance charge effects, is modeled on the principle of two-degree-of-freedom system. The application of this principle helped develop the Induction system that is compatible with the three enginemore » types. The turbocharger adopted on the JF engine is of a twin scroll type to considerably improve power response quality and increase torque at low speed. Triple Port Induction Control System is used to help improve fuel economy and running performance.« less

Position statement: Gender dysphoria in childhood and adolescence. Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN).

PubMed

Esteva de Antonio, Isabel; Asenjo Araque, Nuria; Hurtado Murillo, Felipe; Fernández Rodríguez, María; Vidal Hagemeijer, Ángela; Moreno-Pérez, Oscar; Lucio Pérez, María Jesús; López Siguero, Juan Pedro

2015-10-01

Gender dysphoria (GD) in childhood and adolescence is a complex condition where early detection and comprehensive treatment are essential to improve quality of life, decrease mental comorbidity, and improve GD. In this position statement, the Working Group on Gender Identity and Sexual Development of the Spanish Society of Endocrinology and Nutrition (GIDSEEN), consisting of specialists in Endocrinology, Psychology, Psychiatry, Pediatrics and Sociology, sets out recommendations for evaluation and treatment of GD in children and adolescents. Interdisciplinary management of GD should be carried out at specialized units (UTIGs), considering that any clinical intervention should follow the principles of scientific rigor, experience, ethical and deontological principles, and the necessary caution in front of chronic, aggressive, and irreversible treatments. Copyright © 2015 SEEN. Published by Elsevier España, S.L.U. All rights reserved.

Integrating automated support for a software management cycle into the TAME system

NASA Technical Reports Server (NTRS)

Sunazuka, Toshihiko; Basili, Victor R.

1989-01-01

Software managers are interested in the quantitative management of software quality, cost and progress. An integrated software management methodology, which can be applied throughout the software life cycle for any number purposes, is required. The TAME (Tailoring A Measurement Environment) methodology is based on the improvement paradigm and the goal/question/metric (GQM) paradigm. This methodology helps generate a software engineering process and measurement environment based on the project characteristics. The SQMAR (software quality measurement and assurance technology) is a software quality metric system and methodology applied to the development processes. It is based on the feed forward control principle. Quality target setting is carried out before the plan-do-check-action activities are performed. These methodologies are integrated to realize goal oriented measurement, process control and visual management. A metric setting procedure based on the GQM paradigm, a management system called the software management cycle (SMC), and its application to a case study based on NASA/SEL data are discussed. The expected effects of SMC are quality improvement, managerial cost reduction, accumulation and reuse of experience, and a highly visual management reporting system.

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

PubMed

Roche, B G; Sommer, C

1995-01-01

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

Engaging Frontline Leaders and Staff in Real-Time Improvement.

PubMed

Phillips, Jennifer; Hebish, Linda J; Mann, Sharon; Ching, Joan M; Blackmore, C Craig

2016-04-01

The relationship of staff satisfaction and engagement to organizational success, along with the integral influence of frontline managers on this dimension, is well established in health care and other industries. To specifically address staff engagement, Virginia Mason Medical Center, an integrated, single-hospital health system, developed an approach that involved leaders, through the daily use of standard work for leaders, as well as staff, through a Lean-inspired staff idea system. Kaizen Promotion Office (KPO) staff members established three guiding principles: (1) Staff engagement begins with leader engagement; (2) Integrate daily improve- ment (kaizen) as a habitual way of life not as an add-on; and (3) Create an environment in which staff feel psycho- logically safe and valued. Two design elements--Standard Work for Leaders (SWL) and Everyday Lean Ideas (ELIs) were implemented. For the emergency department (ED), an early adopter of the staff engagement work, the challenge was to apply the guiding principles to improve staff engagement while improving quality and patient and staff satisfaction, even as patient volumes were increasing. Daily huddles for the KPO staff members and weekly leader rounds are used to elicit staff ideas and foster ELIs in real time. Overall progress to date has been tracked in terms of staff satisfaction surveys, voluntary staff turnover, adoption of SWL, and testing and implementation of staff ideas. For example, voluntary turnover of ED staff decreased from 14.6% in 2011 to 7.5% in 2012, and 2.0% in 2013. Organizationwide, at least 800 staff ideas are in motion at any given time, with finished ones posted in an idea supermarket website. A leadership and staff engagement approach that focuses on SWL and on capturing staff ideas for daily problem solving and improvement can contribute to organization success and improve the quality of health care delivery.

Seeking high reliability in primary care: Leadership, tools, and organization.

PubMed

Weaver, Robert R

2015-01-01

Leaders in health care increasingly recognize that improving health care quality and safety requires developing an organizational culture that fosters high reliability and continuous process improvement. For various reasons, a reliability-seeking culture is lacking in most health care settings. Developing a reliability-seeking culture requires leaders' sustained commitment to reliability principles using key mechanisms to embed those principles widely in the organization. The aim of this study was to examine how key mechanisms used by a primary care practice (PCP) might foster a reliability-seeking, system-oriented organizational culture. A case study approach was used to investigate the PCP's reliability culture. The study examined four cultural artifacts used to embed reliability-seeking principles across the organization: leadership statements, decision support tools, and two organizational processes. To decipher their effects on reliability, the study relied on observations of work patterns and the tools' use, interactions during morning huddles and process improvement meetings, interviews with clinical and office staff, and a "collective mindfulness" questionnaire. The five reliability principles framed the data analysis. Leadership statements articulated principles that oriented the PCP toward a reliability-seeking culture of care. Reliability principles became embedded in the everyday discourse and actions through the use of "problem knowledge coupler" decision support tools and daily "huddles." Practitioners and staff were encouraged to report unexpected events or close calls that arose and which often initiated a formal "process change" used to adjust routines and prevent adverse events from recurring. Activities that foster reliable patient care became part of the taken-for-granted routine at the PCP. The analysis illustrates the role leadership, tools, and organizational processes play in developing and embedding a reliable-seeking culture across an organization. Progress toward a reliability-seeking, system-oriented approach to care remains ongoing, and movement in that direction requires deliberate and sustained effort by committed leaders in health care.

[The significance of meat quality in marketing].

PubMed

Kallweit, E

1994-07-01

Food quality in general and meat quality in particular are not only evaluated by means of objective quality traits but the entire production process is gaining more attention by the modern consumer. Due to this development quality programs were developed to define the majority of the processes in all production and marketing steps which are again linked by contracts. Not all of these items are quality relevant, but are concessions to ethic principles (animal welfare etc.). This is demonstrated by the example of Scharrel-pork production. The price differentiation at the pork market is still influenced predominantly by quantitative carcass traits. On the European market quality programs still are of minor significance. Premiums which are paid for high quality standards are more or less compensated by higher production costs and lower lean meat percentages, which must be expected in stress susceptible strains. The high efforts to establish quality programs, however, help to improve the quality level in general, and secure the market shares for local producers.

Recommendations for Preoperative Management of Frailty from the Society for Perioperative Assessment and Quality Improvement (SPAQI).

PubMed

Alvarez-Nebreda, Maria Loreto; Bentov, Nathalie; Urman, Richard D; Setia, Sabeena; Huang, Joe Chin-Sun; Pfeifer, Kurt; Bennett, Katherine; Ong, Thuan D; Richman, Deborah; Gollapudi, Divya; Alec Rooke, G; Javedan, Houman

2018-06-01

Frailty is an age-related, multi-dimensional state of decreased physiologic reserve that results in diminished resiliency and increased vulnerability to stressors. It has proven to be an excellent predictor of unfavorable health outcomes in the older surgical population. There is agreement in recommending that a frailty evaluation should be part of the preoperative assessment in the elderly. However, the consensus is still building with regards to how it should affect perioperative care. The Society for Perioperative Assessment and Quality Improvement (SPAQI) convened experts in the fields of gerontology, anesthesiology and preoperative assessment to outline practical steps for clinicians to assess and address frailty in elderly patients who require elective intermediate or high risk surgery. These recommendations summarize evidence-based principles of measuring and screening for frailty, as well as basic interventions that can help improve patient outcomes. Copyright © 2018 Elsevier Inc. All rights reserved.

Heuristics and Cognitive Error in Medical Imaging.

PubMed

Itri, Jason N; Patel, Sohil H

2018-05-01

The field of cognitive science has provided important insights into mental processes underlying the interpretation of imaging examinations. Despite these insights, diagnostic error remains a major obstacle in the goal to improve quality in radiology. In this article, we describe several types of cognitive bias that lead to diagnostic errors in imaging and discuss approaches to mitigate cognitive biases and diagnostic error. Radiologists rely on heuristic principles to reduce complex tasks of assessing probabilities and predicting values into simpler judgmental operations. These mental shortcuts allow rapid problem solving based on assumptions and past experiences. Heuristics used in the interpretation of imaging studies are generally helpful but can sometimes result in cognitive biases that lead to significant errors. An understanding of the causes of cognitive biases can lead to the development of educational content and systematic improvements that mitigate errors and improve the quality of care provided by radiologists.

Just-in-Time Training: A Novel Approach to Quality Improvement Education.

PubMed

Knutson, Allison; Park, Nesha D; Smith, Denise; Tracy, Kelly; Reed, Danielle J W; Olsen, Steven L

2015-01-01

Just-in-time training (JITT) is accepted in medical education as a training method for newer concepts or seldom-performed procedures. Providing JITT to a large nursing staff may be an effective method to teach quality improvement (QI) initiatives. We sought to determine if JITT could increase knowledge of a specific nutrition QI initiative. Members of the nutrition QI team interviewed staff using the Frontline Contextual Inquiry to assess knowledge regarding the specific QI project. The inquiry was completed pre- and post-JITT. A JITT educational cart was created, which allowed trainers to bring the educational information to the bedside for a short, small group educational session. The results demonstrated a marked improvement in the knowledge of the frontline staff regarding our Vermont Oxford Network involvement and the specifics of the nutrition QI project. Just-in-time training can be a valuable and effective method to disseminate QI principles to a large audience of staff members.

The costs of caring: medical costs of Alzheimer's disease and the managed care environment.

PubMed

Murman, D L

2001-01-01

This review summarizes the medical costs associated with Alzheimer's disease (AD) and related dementias, as well as the payers responsible for these medical costs in the US health care system. It is clear from this review that AD and related dementias are associated with substantial medical costs. The payers responsible for a majority of these costs are families of patients with AD and the US government through the Medicare and Medicaid programs. In an attempt to control expenditures, Medicare and Medicaid have turned to managed care principles and managed care organizations. The increase in "managed" dementia care gives rise to several potential problems for patients with AD, along with many opportunities for systematic improvement in the quality of dementia care. Evidence-based disease management programs provide the greatest opportunities for improving managed dementia care but will require the development of dementia-specific quality of care measures to evaluate and continually improve them.

The principles of ultrasound and its application in freezing related processes of food materials: A review.

PubMed

Cheng, Xinfeng; Zhang, Min; Xu, Baoguo; Adhikari, Benu; Sun, Jincai

2015-11-01

Ultrasonic processing is a novel and promising technology in food industry. The propagation of ultrasound in a medium generates various physical and chemical effects and these effects have been harnessed to improve the efficiency of various food processing operations. Ultrasound has also been used in food quality control as diagnostic technology. This article provides an overview of recent developments related to the application of ultrasound in low temperature and closely related processes such as freezing, thawing, freeze concentration and freeze drying. The applications of high intensity ultrasound to improve the efficiency of freezing process, to control the size and size distribution of ice crystals and to improve the quality of frozen foods have been discussed in considerable detail. The use of low intensity ultrasound in monitoring the ice content and to monitor the progress of freezing process has also been highlighted. Copyright © 2015 Elsevier B.V. All rights reserved.

Ultrasmooth Perovskite Film via Mixed Anti-Solvent Strategy with Improved Efficiency.

PubMed

Yu, Yu; Yang, Songwang; Lei, Lei; Cao, Qipeng; Shao, Jun; Zhang, Sheng; Liu, Yan

2017-02-01

Most antisolvents employed in previous research were miscible with perovskite precursor solution. They always led to fast formation of perovskite even if the intermediate stage existed, which was not beneficial to obtain high quality perovskite films and made the formation process less controllable. In this work, a novel ethyl ether/n-hexane mixed antisolvent (MAS) was used to achieve high nucleation density and slow down the formation process of perovskite, producing films with improved orientation of grains and ultrasmooth surfaces. These high quality films exhibited efficient charge transport at the interface of perovskite/hole transport material and perovskite solar cells based on these films showed greatly improved performance with the best power conversion efficiency of 17.08%. This work also proposed a selection principle of MAS and showed that solvent engineering by designing the mixed antisolvent system can lead to the fabrication of high-performance perovskite solar cells.

Logarithmic profile mapping multi-scale Retinex for restoration of low illumination images

NASA Astrophysics Data System (ADS)

Shi, Haiyan; Kwok, Ngaiming; Wu, Hongkun; Li, Ruowei; Liu, Shilong; Lin, Ching-Feng; Wong, Chin Yeow

2018-04-01

Images are valuable information sources for many scientific and engineering applications. However, images captured in poor illumination conditions would have a large portion of dark regions that could heavily degrade the image quality. In order to improve the quality of such images, a restoration algorithm is developed here that transforms the low input brightness to a higher value using a modified Multi-Scale Retinex approach. The algorithm is further improved by a entropy based weighting with the input and the processed results to refine the necessary amplification at regions of low brightness. Moreover, fine details in the image are preserved by applying the Retinex principles to extract and then re-insert object edges to obtain an enhanced image. Results from experiments using low and normal illumination images have shown satisfactory performances with regard to the improvement in information contents and the mitigation of viewing artifacts.

Improving the Level and Quality of Ethics Review in Chinese Medicine and Integrative Medicine.

PubMed

Zhang, Cheng-Bin; Li, En-Chang

2018-04-01

Three features of ethics review in Chinese medicine (CM) and integrative medicine (IM) were put forward in this paper. It is consistent with the principles of ethical review in Western medicine; it has to be compliant with the laws of CM and IM; emphasis should be laid on the review of clinical practice facts and experience. Three problems were pointed out. The characteristics of CM and IM are not distinctive enough, operation procedures need to be refined and effectiveness remains to be improved. Based on the mentioned above, seven measures were proposed to improve the level and quality of ethics review in CM and IM, including better brand awareness, considerable tolerance, treatment based on disease differentiation and syndrome differentiation, scientific review and toxicity and side effects of CM, perfection of the ethics review system, reasonable procedures of ethics review and more specialized ethics review workers.

Coordinating Council. Ninth Meeting: Total Quality Management

NASA Technical Reports Server (NTRS)

1992-01-01

This report summarizes the 9th meeting of the STI Coordinating Council. The council listened to the speakers' understanding of Total Quality Management (TQM) principles and heard stories of successful applications of these principles. Definitions of quality stated were focused on customer satisfaction. Reports presented by the speakers are also included.

Diabetes care may be improved with Steno Quality Assurance Tool--a self-assessment tool in diabetes management.

PubMed

Bjerre-Christensen, Ulla; Nielsen, Annemette Anker; Binder, Christian; Hansen, Jes B; Eldrup, Ebbe

2014-08-01

To evaluate if improvements in the quality of diabetes care in Indian clinics can be obtained by simple self-surveillance PC-based software. Nineteen Indian diabetes clinics were introduced to the principles of quality assurance (QA), and to a software program, the Steno Quality Assurance Tool (SQAT). Data was entered for an initial 3 months period. Subsequently data were analyzed by the users, who designed plans to improve indicator status and set goals for the upcoming period. A second data entry period followed after 7-9 months. QA data was analyzed from 4487 T2DM patients (baseline) and 4440 (follow-up). The average examination frequency per clinic of the following indicators increased significantly: lipid examination (72-87%) (p=0.007), foot examination (80-94%) (p=0.02), HbA1c investigation (59-77%) (p=0.006), and urine albumin excretion investigation (72-87%) (p=0.006). Outcome parameters also improved significantly: mean (SD) fasting and post prandial BG reduced from 144(16) to 132(16)mg/dl (p=0.02) and 212(24)-195(29)mg/dl (p=0.03), respectively. Systolic BP reduced from 139(6) to 133(4) (p=0.0008)mmHg and diastolic BP from 83(3) to 81(3)mmHg (p=0.002). Quality of diabetes care can be improved by applying SQAT, a QA self-surveillance software that enables documentation of changes in process and outcome indicators. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

The development of a quality appraisal tool for studies of diagnostic reliability (QAREL).

PubMed

Lucas, Nicholas P; Macaskill, Petra; Irwig, Les; Bogduk, Nikolai

2010-08-01

In systematic reviews of the reliability of diagnostic tests, no quality assessment tool has been used consistently. The aim of this study was to develop a specific quality appraisal tool for studies of diagnostic reliability. Key principles for the quality of studies of diagnostic reliability were identified with reference to epidemiologic principles, existing quality appraisal checklists, and the Standards for Reporting of Diagnostic Accuracy (STARD) and Quality Assessment of Diagnostic Accuracy Studies (QUADAS) resources. Specific items that encompassed each of the principles were developed. Experts in diagnostic research provided feedback on the items that were to form the appraisal tool. This process was iterative and continued until consensus among experts was reached. The Quality Appraisal of Reliability Studies (QAREL) checklist includes 11 items that explore seven principles. Items cover the spectrum of subjects, spectrum of examiners, examiner blinding, order effects of examination, suitability of the time interval among repeated measurements, appropriate test application and interpretation, and appropriate statistical analysis. QAREL has been developed as a specific quality appraisal tool for studies of diagnostic reliability. The reliability of this tool in different contexts needs to be evaluated. Copyright (c) 2010 Elsevier Inc. All rights reserved.

Quality assurance guides health reform in Jordan.

PubMed

Abubaker, W; Abdulrahman, M

1996-01-01

In November 1995, a World Bank mission went to Jordan to conduct a study of the health sector. The study recommended three strategies to reform the health sector: decentralization of Ministry of Health (MOH) management; improvement of clinical practices, quality of care, and consumer satisfaction; and adoption of treatment protocols and standards. The MOH chose quality assurance (QA) methods and quality management (QM) techniques to accomplish these reforms. The Monitoring and QA Directorate oversees QA applications within MOH. It also institutes and develops the capacity of local QA units in the 12 governorates. The QA units implement and monitor day-to-day QA activities. The QM approach encompasses quality principles: establish objectives; use a systematic approach; teach lessons learned and applicable research; use QA training to teach quality care, quality improvement, and patient satisfaction; educate health personnel about QM approaches; use assessment tools and interviews; measure the needs and expectations of local health providers and patients; ensure feedback on QA improvement projects; ensure valid and reliable data; monitor quality improvement efforts; standardize systemic data collection and outcomes; and establish and disseminate QA standards and performance improvement efforts. The Jordan QA Project has helped with the successful institutionalization of a QA system at both the central and local levels. The bylaws of the QA councils and committees require team participation in the decision-making process. Over the last two years, the M&QA Project has adopted 21 standards for nursing, maternal and child health care centers, pharmacies, and medications. The Balqa pilot project has developed 44 such protocols. Quality improvement (COUGH) studies have examined hyper-allergy, analysis of patient flow rate, redistribution of nurses, vaccine waste, and anemic pregnant women. There are a considerable number of on-going clinical and non-clinical COUGH studies. Four epidemiological studies are examining maternal mortality, causes of death, morbidity, and perinatal mortality.

A survey-based benchmarking approach for health care using the Baldrige quality criteria.

PubMed

Jennings, K; Westfall, F

1994-09-01

Since 1988, manufacturing and service industries have been using the Malcolm Baldrige National Quality Award to assess their management processes (for example, leadership, information, and analysis) against critical performance criteria. Recognizing that the typical Baldrige assessment is time intensive and dependent on intensive training, The Pacer Group, a consulting firm in Dayton, Ohio, developed a self-assessment tool based on the Baldrige criteria which provides a snapshot assessment of an organization's management practices. The survey was administered at 25 hospitals within a health care system. Hospitals were able to compare their scores with other hospitals in the system, as well as the scores of a Baldrige award winner. Results were also analyzed on a systemwide basis to identify strengths and weaknesses across the system. For all 25 hospitals, the following areas were identified as strengths: management of process quality, leadership, and customer focus and satisfaction. Weaknesses included lack of employee involvement in the quality planning process, poor design of quality systems, and lack of cross-departmental cooperation. One of the surveyed hospitals launched improvement initiatives in knowledge of improvement tools and methods and in a patient satisfaction focus. A team was formed to improve the human resource management system. Also, a new unit was designed using patient-centered care principles. A team re-evaluated every operation that affected patients on the unit. A survey modeled after the Baldrige Award criteria can be useful in benchmarking an organization's quality improvement practices.

Transforming the Primary Care Training Clinic: New York State's Hospital Medical Home Demonstration Pilot.

PubMed

Angelotti, Marietta; Bliss, Kathryn; Schiffman, Dana; Weaver, Erin; Graham, Laura; Lemme, Thomas; Pryor, Veronica; Gesten, Foster C

2015-06-01

Training in patient-centered medical home (PCMH) settings may prepare new physicians to measure quality of care, manage the health of populations, work in teams, and include cost information in decision making. Transforming resident clinics to PCMHs requires funding for additional staff, electronic health records, training, and other resources not typically available to residency programs. Describe how a 1115 Medicaid waiver was used to transform the majority of primary care training sites in New York State to the PCMH model and improve the quality of care provided. The 2013-2014 Hospital Medical Home Program provided awards to 60 hospitals and 118 affiliated residency programs (training more than 5000 residents) to transform outpatient sites into PCMHs and provide high-quality, coordinated care. Site visits, coaching calls, resident surveys, data reporting, and feedback were used to promote and monitor change in resident continuity and quality of care. Descriptive analyses measured improvements in these areas. A total of 156 participating outpatient sites (100%) received PCMH recognition. All sites enhanced resident education using PCMH principles through patient empanelment, development of quality dashboards, and transforming resident scheduling and training. Clinical quality outcomes showed improvement across the demonstration, including better performance on colorectal and breast cancer screening rates (rate increases of 13%, P≤.001, and 11%, P=.011, respectively). A 1115 Medicaid waiver is a viable mechanism for states to transform residency clinics to reflect new primary care models. The PCMH transformation of 156 sites led to improvements in resident continuity and clinical outcomes.

Russell and Burch's 3Rs Then and Now: The Need for Clarity in Definition and Purpose

PubMed Central

Tannenbaum, Jerrold; Bennett, B Taylor

2015-01-01

Russell and Burch's The Principles of Humane Experimental Technique was first published in 1959. A Special Edition containing the original text was reissued in 1992, after its ideas had gained widespread interest in the scientific community. In the Principles, Russell and Burch proposed a new applied science that would improve the treatment of laboratory animals while advancing the quality of science in studies that use animals. They introduced and defined the terms replacement, reduction, and refinement, which subsequently have become known as ‘alternatives’ or ‘alternative methods’ for minimizing the potential for animal pain and distress in biomedical research. Here we describe and explain the original definitions of the 3Rs in the Principles, examine how current definitions differ among themselves and from Russell and Burch's definitions, and suggest relevant considerations for evaluating all definitions of the 3Rs. PMID:25836957

Russell and Burch's 3Rs then and now: the need for clarity in definition and purpose.

PubMed

Tannenbaum, Jerrold; Bennett, B Taylor

2015-03-01

Russell and Burch's The Principles of Humane Experimental Technique was first published in 1959. A Special Edition containing the original text was reissued in 1992, after its ideas had gained widespread interest in the scientific community. In the Principles, Russell and Burch proposed a new applied science that would improve the treatment of laboratory animals while advancing the quality of science in studies that use animals. They introduced and defined the terms replacement, reduction, and refinement, which subsequently have become known as 'alternatives' or 'alternative methods' for minimizing the potential for animal pain and distress in biomedical research. Here we describe and explain the original definitions of the 3Rs in the Principles, examine how current definitions differ among themselves and from Russell and Burch's definitions, and suggest relevant considerations for evaluating all definitions of the 3Rs.

Successful affiliations: principles and practices.

PubMed

Rice, Ann Madden

2011-01-01

An affiliation can help a healthcare provider prepare for the challenges of healthcare reform, the rapidly changing landscapes of the commercial insurance industry, and the public's expectations about service and quality. UC Davis Medical Center, a 645-bed tertiary hospital in Sacramento, California, with many hospital-based clinics and a community-based group of primary care clinics, has developed a number of principles for affiliation. These principles are based on its experience in legal and financial affiliations with an academic practice group, with individual and small groups of primary care physicians, and with community hospitals around oncology services linked with U.C. Davis' National Cancer Institute-designated cancer center. This article offers a process for evaluating the appropriateness of an affiliation. The chances for a successful affiliation improve if each party has indicated the value it hopes to derive and how to measure that value, has communicated with all affected constituents, and has an agreed-upon method for resolving disputes.

Effectiveness of a self-regulated remedial program for handwriting difficulties.

PubMed

Van Waelvelde, Hilde; De Roubaix, Amy; Steppe, Lien; Troubleyn, Evy; De Mey, Barbara; Dewitte, Griet; Debrabant, Julie; Van de Velde, Dominique

2017-09-01

Handwriting difficulties may have pervasive effects on a child's school performance. I Can! is a remedial handwriting program with a focus on self-regulated learning and applying motor learning principles combined with a behavioural approach. It is developed for typically developing children with handwriting problems. The study aim was to evaluate the program's effectiveness. Thirty-one children aged 7-8 year participated in a cross-over study. Handwriting quality and speed were repeatedly assessed by means of the Systematic Screening of Handwriting Difficulties test. Difficulties addressed were fluency in letter formation, fluency in letter connections, letter height, regularity of letter height, space between words, and line path. Mixed model analysis revealed improved quality of writing and speed for all children but significantly more improvement in handwriting quality for the children participating in the program. Although writing speed improved over time, no additional effects of the program occurred. 'I Can!' is found to be an effective instructive program to ameliorate handwriting quality in typically developing children with handwriting difficulties. The program's success was by a therapy burst of only 7 weeks focusing on the child's self-regulated learning capacities, within an individualized education plan according to their needs and goals.

[Principles of direct surgical procedures on the pancreas in surgical treatment of chronic pancreatitis].

PubMed

Kopchak, V M; Khomiak, I V; Cheverdiuk, D A; Kopchak, K V; Duvalko, A V; Serdiuk, V P

2012-01-01

An analysis of treatment of 584 patients with complicated forms of chronic pancreatitis operated during 2000-2100 years was carried out. Quality of life of postoperative patients was estimated according to a technique of calculations of modules EORTC QLQ-C30 and EORTC QLQ-PAN26. The indicators of quality of life have improved by 19.7% in performance of saving duodenal outflow of operations of pancreatic juice. Change of the surgical strategy has led to decreased number of postoperative complications by 4.6% and to satisfactory long-term results in 92.6% of the patients.

National survey on internal quality control for tumour markers in clinical laboratories in China.

PubMed

Wang, Wei; Zhong, Kun; Yuan, Shuai; He, Falin; Du, Yuxuan; Hu, Zhehui; Wang, Zhiguo

2018-06-15

This survey was initiated to obtain knowledge on the current situation of internal quality control (IQC) practice for tumour markers (TMs) in China. Additionally, we tried to acquire the most appropriate quality specifications. This survey was a current status survey. The IQC information had been collected via online questionnaires. All of 1821 clinical laboratories which participated in the 2016 TMs external quality assessment (EQA) programme had been enrolled. The imprecision evaluation criteria were the minimal, desirable, and optimal allowable imprecisions based on biological variations, and 1/3 total allowable error (TEa) and 1/4 TEa. A total of 1628 laboratories answered the questionnaires (89%). The coefficients of variation (CVs) of the IQC of participant laboratories varied greatly from 1% (5 th percentile) to 13% (95 th percentile). More than 82% (82 - 91%) of participant laboratories two types of CVs met 1/3 TEa except for CA 19-9. The percentiles of current CVs were smaller than cumulative CVs. A number of 1240 laboratories (76%) reported their principles and systems used. The electrochemiluminescence was the most used principle (45%) and had the smallest CVs. The performance of laboratories for TMs IQC has yet to be improved. On the basis of the obtained results, 1/3 TEa would be realistic and attainable quality specification for TMs IQC for clinical laboratories in China.

Service quality in health care.

PubMed

Kenagy, J W; Berwick, D M; Shore, M F

1999-02-17

Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them.

Critical Analysis of the Quality, Readability, and Technical Aspects of Online Information Provided for Neck-Lifts.

PubMed

Rayess, Hani; Zuliani, Giancarlo F; Gupta, Amar; Svider, Peter F; Folbe, Adam J; Eloy, Jean Anderson; Carron, Michael A

2017-03-01

The number of patients using the internet to obtain health information is growing. This material is unregulated and heterogeneous and can influence patient decisions. To compare the quality, readability, and technical aspects of online information about neck-lifts provided by private practice websites vs academic medical centers and reference sources. In this cross-sectional analysis conducted between November 2015 and January 2016, a Google search of the term neck-lift was performed, and the first 45 websites were evaluated. The websites were categorized as private practice vs other. Private websites (PWs) included sites created by private practice physicians. Other websites (OWs) were created by academic medical centers or reference sources. Quality, readability, and technical aspects of online websites related to neck-lifts. Quality was assessed using the DISCERN criteria and the Health on the Net principles (HONcode). Readability was assessed using 7 validated and widely used criteria. Consensus US reading grade level readability was provided by a website (readabilityformulas.com). Twelve technical aspects were evaluated based on criteria specified by medical website creators. Forty-five websites (8 OWs [18%] and 37 PWs [82%]) were analyzed. There was a significant difference in quality between OWs and PWs based on the DISCERN criteria and HONcode principles. The DISCERN overall mean (SD) scores were 2.3 (0.5) for OWs and 1.3 (0.3) for PWs (P < .001). Of a total possible score of 14 using the HONcode analysis, the mean (SD) was 8.6 (1.8) (range, 5-11) for OW, and the mean (SD) was 5.8 (1.7) (range, 2-9) for PW. The mean (SD) readability consensus reading grade level scores were 11.7 (1.9) for OWs and 10.6 (1.9) for PWs. Of a total possible score of 12, the mean (SD) technical scores were 6.3 (1.8) (range, 4-9) for OWs and 6.4 (1.5) (range, 3-9) for PWs. Compared with PWs, OWs had a significantly higher quality score based on both the DISCERN criteria and HONcode principles. The mean readability for OWs and PWs was grade 11 and grade 10, respectively, significantly higher than the grade 7 level recommended by the National Institutes of Health. Assessment of technical criteria demonstrated room for improvement in providing links to social media and blogs and reducing advertisements. Improving the quality and readability of online information may result in increased patient understanding, more active patient involvement, and ultimately better outcomes. Enhancing the technical aspects of websites may increase website traffic and patient volume. NA.

Ensuring the reliability of stable isotope ratio data--beyond the principle of identical treatment.

PubMed

Carter, J F; Fry, B

2013-03-01

The need for inter-laboratory comparability is crucial to facilitate the globalisation of scientific networks and the development of international databases to support scientific and criminal investigations. This article considers what lessons can be learned from a series of inter-laboratory comparison exercises organised by the Forensic Isotope Ratio Mass Spectrometry (FIRMS) network in terms of reference materials (RMs), the management of data quality, and technical limitations. The results showed that within-laboratory precision (repeatability) was generally good but between-laboratory accuracy (reproducibility) called for improvements. This review considers how stable isotope laboratories can establish a system of quality control (QC) and quality assurance (QA), emphasising issues of repeatability and reproducibility. For results to be comparable between laboratories, measurements must be traceable to the international δ-scales and, because isotope ratio measurements are reported relative to standards, a key aspect is the correct selection, calibration, and use of international and in-house RMs. The authors identify four principles which promote good laboratory practice. The principle of identical treatment by which samples and RMs are processed in an identical manner and which incorporates three further principles; the principle of identical correction (by which necessary corrections are identified and evenly applied), the principle of identical scaling (by which data are shifted and stretched to the international δ-scales), and the principle of error detection by which QC and QA results are monitored and acted upon. To achieve both good repeatability and good reproducibility it is essential to obtain RMs with internationally agreed δ-values. These RMs will act as the basis for QC and can be used to calibrate further in-house QC RMs tailored to the activities of specific laboratories. In-house QA standards must also be developed to ensure that QC-based calibrations and corrections lead to accurate results for samples. The δ-values assigned to RMs must be recorded and reported with all data. Reference materials must be used to determine what corrections are necessary for measured data. Each analytical sequence of samples must include both QC and QA materials which are subject to identical treatment during measurement and data processing. Results for these materials must be plotted, monitored, and acted upon. Periodically international RMs should be analysed as an in-house proficiency test to demonstrate results are accurate.

Got (the Right) Milk? How a Blended Quality Improvement Approach Catalyzed Change.

PubMed

Luton, Alexandra; Bondurant, Patricia G; Campbell, Amy; Conkin, Claudia; Hernandez, Jae; Hurst, Nancy

2015-10-01

The expression, storage, preparation, fortification, and feeding of breast milk are common ongoing activities in many neonatal intensive care units (NICUs) today. Errors in breast milk administration are a serious issue that should be prevented to preserve the health and well-being of NICU babies and their families. This paper describes how a program to improve processes surrounding infant feeding was developed, implemented, and evaluated. The project team used a blended quality improvement approach that included the Model for Improvement, Lean and Six Sigma methodologies, and principles of High Reliability Organizations to identify and drive short-term, medium-term, and long-term improvement strategies. Through its blended quality improvement approach, the team strengthened the entire dispensation system for both human milk and formula and outlined a clear vision and plan for further improvements as well. The NICU reduced feeding errors by 83%. Be systematic in the quality improvement approach, and apply proven methods to improving processes surrounding infant feeding. Involve expert project managers with nonclinical perspective to guide work in a systematic way and provide unbiased feedback. Create multidisciplinary, cross-departmental teams that include a vast array of stakeholders in NICU feeding processes to ensure comprehensive examination of current state, identification of potential risks, and "outside the box" potential solutions. As in the realm of pharmacy, the processes involved in preparing feedings for critically ill infants should be carried out via predictable, reliable means including robust automated verification that integrates seamlessly into existing processes. The use of systems employed in pharmacy for medication preparation should be considered in the human milk and formula preparation setting.

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

Integrating modal-based NDE techniques and bridge management systems using quality management

NASA Astrophysics Data System (ADS)

Sikorsky, Charles S.

1997-05-01

The intent of bridge management systems is to help engineers and managers determine when and where to spend bridge funds such that commerce and the motoring public needs are satisfied. A major shortcoming which states are experiencing is the NBIS data available is insufficient to perform certain functions required by new bridge management systems, such as modeling bridge deterioration and predicting costs. This paper will investigate how modal based nondestructive damage evaluation techniques can be integrated into bridge management using quality management principles. First, quality from the manufacturing perspective will be summarized. Next, the implementation of quality management in design and construction will be reinterpreted for bridge management. Based on this, a theory of approach will be formulated to improve the productivity of a highway transportation system.

ISTC projects devoted to improving laser beam quality

NASA Astrophysics Data System (ADS)

Malakhov, Yu. I.

2007-05-01

Short overview is done about the activity of ISTC in a direction concerned with improving powerful laser beam quality by means of nonlinear and linear adaptive optics methods. Completed projects #0591 and #1929 resulted in the development of a stimulated Brillouin scattering (SBS) phase conjugation mirror of superhigh fidelity employing the kinoform optical elements (rasters of small lenses) of new generation designed for pulsed or pulse-periodic lasers with nanosecond scale pulse duration. Project #2631 is devoted to development of an adaptive optical system for phase registration and correction of laser beams with wave front vortices. The principles of operation of conventional adaptive systems are based on the assumption that the phase is a smooth continuous function in space. Therefore the solution of the Project tasks will assume a new step in adaptive optics.

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

PubMed

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

2013-01-01

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

Integrating Quality Matters into Hybrid Course Design: A Principles of Marketing Case Study

ERIC Educational Resources Information Center

Young, Mark R.

2014-01-01

Previous research supports the idea that the success of hybrid or online delivery modes is more a function of course design than delivery media. This article describes a case study of a hybrid Principles of Marketing course that implemented a comprehensive redesign based on design principles espoused by the Quality Matters Program, a center for…

Quality monitoring of salt produced in Indonesia through seawater evaporation on HDPE geomembrane lined ponds

NASA Astrophysics Data System (ADS)

Jumaeri; Sulistyaningsih, T.; Alighiri, D.

2018-03-01

Salt is one of the primary ingredients that humans always need for various purposes, both for consumption and industry. The need for high-quality salt continues to increase, as long as industry growth. It must improve product quality through the development of salt production process technology. In this research, the quality monitoring of salt produced in Indonesia by evaporation of seawater on ponds lined using high-density polyethylene (HDPE) geomembrane has been studied. The manufacturing of salt carried out through the gradual precipitation principle on prepared ponds. HDPE geomembrane is used to coat evaporation ponds with viscosity 12-22°Be and crystallization ponds with a viscosity of 23°Be. The monitoring of the product is carried out in the particular periods during the salt production period. The result of control shows that the quality of salt produced in HDPE geomembrane coated salt ponds has an average NaCl content of 95.75%, so it has fulfilled with Indonesia National Standard (SNI), that is NaCl> 94.70%. The production of salt with HDPE geomembrane can improve the quality of salt product from NaCl 85.4% (conventional system) to 95.75%.

Principles and Recommendations for the Provision of Healthcare in Canada to Adolescent and Young Adult–Aged Cancer Patients and Survivors

PubMed Central

Fernandez, Conrad; Fraser, Graeme A.M.; Freeman, Carolyn; Grunfeld, Eva; Gupta, Abha; Mery, Leslie Stephen; De Pauw, Sonja

2011-01-01

Adolescents and young adults (AYA) with cancer and survivors of cancer in childhood, adolescence, and young adulthood are a constituency facing disparities of care affecting quality of life and other outcomes in many parts of the world. In Canada, this situation occurs in a nation with population-based cancer control programs and a government-funded healthcare system. The Canadian Task Force on Adolescents and Young Adults with Cancer was established in 2008 with a mission to ensure that AYA-aged Canadians with cancer and AYA survivors of cancer have prompt, equitable access to the best care, and to establish and support research to identify how their health outcomes and quality of life can be optimized. Following a survey of existing services, and in consultation with survivors, healthcare professionals, and policy makers, the Task Force identified principles of care, priority issues for research and the establishment of outcome metrics, and strategies for implementing change that are designed to improve the outcomes and quality of life of this specific cohort of patients and survivors with unique developmental needs. The six broad recommendations highlight the need for age-appropriate psychosocial, survivorship, palliative, and medical care as well as research to redress inequities in the care provided to this group relative to both younger and older cancer patients. Improved care for this group will enable individuals to reach their full potential as productive, functioning members of society, and will provide economic and other societal benefits. PMID:23610731

Use of lean sigma principles in a tertiary care otolaryngology clinic to improve efficiency.

PubMed

Lin, Sandra Y; Gavney, Dean; Ishman, Stacey L; Cady-Reh, Julie

2013-11-01

To apply Lean Sigma, a quality-improvement strategy supported by tactical tools to eliminate waste and reduce variation, to improve efficiency of patient flow in a large tertiary otolaryngology clinic. The project goals were to decrease overall lead time from patient arrival to start of interaction with care provider, improve on-time starts of patient visits, and decrease excess staff/patient motion. Prospective observational study. Patient flow was mapped through the clinic, including preregistration processes. A time-stamp observation study was performed on 188 patient visits over 5 days. Using Lean Sigma principles, time stamps were analyzed to identify patient flow constraints and areas for potential interventions. Interventions were evaluated and adjusted based on feedback from shareholders: removal of bottlenecks in clinic flow, elimination of non-value added registration staff tasks, and alignment of staff hours to accommodate times of high patient census. A postintervention time observation study of 141 patients was performed 5 months later. Patient lead time from clinic arrival to exam start time decreased by 12.2% on average (P = .042). On-time starts for patient exams improved by 34% (χ(2) = 16.091, P < .001). Excess patient motion was reduced by 74 feet per patient, which represents a 34% reduction in motion per visit. Use of Lean Sigma principles in a large tertiary otolaryngology clinic led to decreased patient wait time and significant improvements in on-time patient exam start time. Process mapping, engagement of leadership and staff, and elimination of non-value added steps or processes were key to improvement. Copyright © 2013 The American Laryngological, Rhinological and Otological Society, Inc.

First principles kinetic Monte Carlo study on the growth patterns of WSe2 monolayer

NASA Astrophysics Data System (ADS)

Nie, Yifan; Liang, Chaoping; Zhang, Kehao; Zhao, Rui; Eichfeld, Sarah M.; Cha, Pil-Ryung; Colombo, Luigi; Robinson, Joshua A.; Wallace, Robert M.; Cho, Kyeongjae

2016-06-01

The control of domain morphology and defect level of synthesized transition metal dichalcogenides (TMDs) is of crucial importance for their device applications. However, current TMDs synthesis by chemical vapor deposition and molecular beam epitaxy is in an early stage of development, where much of the understanding of the process-property relationships is highly empirical. In this work, we use a kinetic Monte Carlo coupled with first principles calculations to study one specific case of the deposition of monolayer WSe2 on graphene, which can be expanded to the entire TMD family. Monolayer WSe2 domains are investigated as a function of incident flux, temperature and precursor ratio. The quality of the grown WSe2 domains is analyzed by the stoichiometry and defect density. A phase diagram of domain morphology is developed in the space of flux and the precursor stoichiometry, in which the triangular compact, fractal and dendritic domains are identified. The phase diagram has inspired a new synthesis strategy for large TMD domains with improved quality.

Application of Transformational Leadership Principles in the Development and Integration of Palliative Care Within an Advanced Heart Failure Program.

PubMed

George, Susan; Leasure, A Renee

2016-01-01

Heart failure (HF) is a major health problem in United States, and it has reached epidemic proportions. Heart failure is associated with significant morbidity, mortality, and cost. Although the prognosis of HF is worse than many forms of cancer, many patients, families, and clinicians are unaware of the dire prognosis. As the disease progress to advanced HF, patients are faced with many challenges, such as poor quality of life due to worsening symptoms and frequent hospitalizations. Heart failure management adds significant financial burden to the health care system. Palliative care can be integrated into HF care to improve quality of life and symptom management and to address physical, spiritual, and psychosocial needs of patients and families. Palliative care can be used concurrently with or independent of curative or life-prolonging HF therapies. Transformational leadership principles were used to guide the development of a plan to enhance integration of palliative care within traditional advanced HF care.

FIVQ algorithm for interference hyper-spectral image compression

NASA Astrophysics Data System (ADS)

Wen, Jia; Ma, Caiwen; Zhao, Junsuo

2014-07-01

Based on the improved vector quantization (IVQ) algorithm [1] which was proposed in 2012, this paper proposes a further improved vector quantization (FIVQ) algorithm for LASIS (Large Aperture Static Imaging Spectrometer) interference hyper-spectral image compression. To get better image quality, IVQ algorithm takes both the mean values and the VQ indices as the encoding rules. Although IVQ algorithm can improve both the bit rate and the image quality, it still can be further improved in order to get much lower bit rate for the LASIS interference pattern with the special optical characteristics based on the pushing and sweeping in LASIS imaging principle. In the proposed algorithm FIVQ, the neighborhood of the encoding blocks of the interference pattern image, which are using the mean value rules, will be checked whether they have the same mean value as the current processing block. Experiments show the proposed algorithm FIVQ can get lower bit rate compared to that of the IVQ algorithm for the LASIS interference hyper-spectral sequences.

Motivation for documentation.

PubMed

Graham, Denise H

2004-11-01

The quality improvement plan relies on controlling quality of care through improving the process or system as a whole. Your ongoing data collection is paramount to the process of system-wide improvement and performance, enhancement of financial performance, operational performance and overall service performance and satisfaction. The threat of litigation and having to defend yourself from a claim of wrongdoing still looms every time your wheels turn. Your runsheet must serve and protect you. Look at the NFPA 1710 standard, which was enacted to serve and protect firefighters. This standard was enacted with their personal safety and well-being as the principle behind staffing requirements. At what stage of draft do you suppose the NFPA 1710 standard would be today if the relative data were collected sporadically or were not tracked for each service-related death? It may have taken many more service-related deaths to effect change for a system-wide improvement in operational performance. Every call merits documentation and data collection. Your data are catalysts for change.

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

Turkington, T.

This education session will cover the physics and operation principles of gamma cameras and PET scanners. The first talk will focus on PET imaging. An overview of the principles of PET imaging will be provided, including positron decay physics, and the transition from 2D to 3D imaging. More recent advances in hardware and software will be discussed, such as time-of-flight imaging, and improvements in reconstruction algorithms that provide for options such as depth-of-interaction corrections. Quantitative applications of PET will be discussed, as well as the requirements for doing accurate quantitation. Relevant performance tests will also be described. Learning Objectives: Bemore » able to describe basic physics principles of PET and operation of PET scanners. Learn about recent advances in PET scanner hardware technology. Be able to describe advances in reconstruction techniques and improvements Be able to list relevant performance tests. The second talk will focus on gamma cameras. The Nuclear Medicine subcommittee has charged a task group (TG177) to develop a report on the current state of physics testing of gamma cameras, SPECT, and SPECT/CT systems. The report makes recommendations for performance tests to be done for routine quality assurance, annual physics testing, and acceptance tests, and identifies those needed satisfy the ACR accreditation program and The Joint Commission imaging standards. The report is also intended to be used as a manual with detailed instructions on how to perform tests under widely varying conditions. Learning Objectives: At the end of the presentation members of the audience will: Be familiar with the tests recommended for routine quality assurance, annual physics testing, and acceptance tests of gamma cameras for planar imaging. Be familiar with the tests recommended for routine quality assurance, annual physics testing, and acceptance tests of SPECT systems. Be familiar with the tests of a SPECT/CT system that include the CT images for SPECT reconstructions. Become knowledgeable of items to be included in annual acceptance testing reports including CT dosimetry and PACS monitor measurements. T. Turkington, GE Healthcare.« less

Quality in Higher Education: The Contribution of Edward Demings Principles

ERIC Educational Resources Information Center

Redmond, Richard; Curtis, Elizabeth; Noone, Tom; Keenan, Paul

2008-01-01

Purpose--There can be little doubt about the importance and relevance of quality for any service industry. One of the most influential contributors to service quality developments was W. Edwards Deming (1900-1993). An important component of Demings philosophy is reflected in his 14-principles for transforming a service as they indicate what…

Systematic development and implementation of interventions to OPtimise Health Literacy and Access (Ophelia).

PubMed

Beauchamp, Alison; Batterham, Roy W; Dodson, Sarity; Astbury, Brad; Elsworth, Gerald R; McPhee, Crystal; Jacobson, Jeanine; Buchbinder, Rachelle; Osborne, Richard H

2017-03-03

The need for healthcare strengthening to enhance equity is critical, requiring systematic approaches that focus on those experiencing lesser access and outcomes. This project developed and tested the Ophelia (OPtimising HEalth LIteracy and Access) approach for co-design of interventions to improve health literacy and equity of access. Eight principles guided this development: Outcomes focused; Equity driven, Needs diagnosis, Co-design, Driven by local wisdom, Sustainable, Responsive and Systematically applied. We report the application of the Ophelia process where proof-of-concept was defined as successful application of the principles. Nine sites were briefed on the aims of the project around health literacy, co-design and quality improvement. The sites were rural/metropolitan, small/large hospitals, community health centres or municipalities. Each site identified their own priorities for improvement; collected health literacy data using the Health Literacy Questionnaire (HLQ) within the identified priority groups; engaged staff in co-design workshops to generate ideas for improvement; developed program-logic models; and implemented their projects using Plan-Do-Study-Act (PDSA) cycles. Evaluation included assessment of impacts on organisations, practitioners and service users, and whether the principles were applied. Sites undertook co-design workshops involving discussion of service user needs informed by HLQ (n = 813) and interview data. Sites generated between 21 and 78 intervention ideas and then planned their selected interventions through program-logic models. Sites successfully implemented interventions and refined them progressively with PDSA cycles. Interventions generally involved one of four pathways: development of clinician skills and resources for health literacy, engagement of community volunteers to disseminate health promotion messages, direct impact on consumers' health literacy, and redesign of existing services. Evidence of application of the principles was found in all sites. The Ophelia approach guided identification of health literacy issues at each participating site and the development and implementation of locally appropriate solutions. The eight principles provided a framework that allowed flexible application of the Ophelia approach and generation of a diverse set of interventions. Changes were observed at organisational, staff, and community member levels. The Ophelia approach can be used to generate health service improvements that enhance health outcomes and address inequity of access to healthcare.

Deming meets Braverman: toward a progressive analysis of the continuous quality improvement paradigm.

PubMed

Schiff, G D; Goldfield, N I

1994-01-01

The continuous quality improvement (CQI) model has rapidly become the dominant management paradigm in U.S. industrial and health care leadership circles. Despite its widespread corporate acceptance and its relevance to public sector policy issues, there has been a paucity of progressive analysis of CQI. The authors begin by noting remarkable similarities between CQI critiques of Taylorism (so-called scientific management of work) with those made by Braverman, a leading Marxist analyst of the work process. Each of the 14 principles of CQI pioneer W. E. Deming are explained and analyzed for their progressive content. These pluses are then contrasted with 18 problematic issues in an attempt to challenge and go beyond the constraints of CQI as it is currently being applied in health care and other sectors. These issues include (1) mismatch between rhetoric and reality, (2) public sector issues, and (3) broader contradictions. The authors emphasize the genuine need for improving health care quality and the relevance of CQI for addressing this need. They challenge progressives to grapple with the profound contradictions by the CQI paradigm inviting a broader dialogue on CQI's meaning for improving the public's health.

The American College of Surgeons Children's Surgery Verification and Quality Improvement Program: implications for anesthesiologists.

PubMed

Houck, Constance S; Deshpande, Jayant K; Flick, Randall P

2017-06-01

The Task Force for Children's Surgical Care, an ad-hoc multidisciplinary group of invited leaders in pediatric perioperative medicine, was assembled in May 2012 to consider approaches to optimize delivery of children's surgical care in today's competitive national healthcare environment. Over the subsequent 3 years, with support from the American College of Surgeons (ACS) and Children's Hospital Association (CHA), the group established principles regarding perioperative resource standards, quality improvement and safety processes, data collection, and verification that were used to develop an ACS-sponsored Children's Surgery Verification and Quality Improvement Program (ACS CSV). The voluntary ACS CSV was officially launched in January 2017 and more than 125 pediatric surgical programs have expressed interest in verification. ACS CSV-verified programs have specific requirements for pediatric anesthesia leadership, resources, and the availability of pediatric anesthesiologists or anesthesiologists with pediatric expertise to care for infants and young children. The present review outlines the history of the ACS CSV, key elements of the program, and the standards specific to pediatric anesthesiology. As with the pediatric trauma programs initiated more than 40 years ago, this program has the potential to significantly improve surgical care for infants and children in the United States and Canada.

Sensor of total hip arthoplasty wear designed on principle of scanning profilometry

NASA Astrophysics Data System (ADS)

Rössler, Tomas; Mandat, Dusan; Gallo, Jiri; Hrabovsky, Miroslav; Pochmon, Michal; Havranek, Vitezslav

2008-12-01

Total hip arthroplasty significantly improves the quality of life in majority of patients with osteoarthritis. However, prosthetic wear is a problem because of inducing the development of aseptic loosening and periprosthetic osteolysis which needs the revision surgery. Thus, the polyethylene wear measurement is the central to contemporary orthopaedics and this interesting has encouraged the development and improvement of both radiologic (in vivo) and non-radiologic (in vitro) methods for polyethylene wear quantification. The principles of polyethylene liner wear measurements are predominantly geometric; nevertheless, the realization of individual types of in vivo measurements brings with it the necessity of many simplifications and compromising steps to acquire approximately accurate values. In fact, the volumetric wear can be obtained by mathematical conversion based on the most linear shift of femoral head in the cup. However, such approach is understood to be somewhat insufficient. Our ongoing research pointed to the development of optical non-contact method for wear measurement and its results are introduced in this paper including the methodology designed for the usability validation of the method for the given purpose and the description of sensor, its principle, technical realization, design and parameters.

All inclusive benchmarking.

PubMed

Ellis, Judith

2006-07-01

The aim of this article is to review published descriptions of benchmarking activity and synthesize benchmarking principles to encourage the acceptance and use of Essence of Care as a new benchmarking approach to continuous quality improvement, and to promote its acceptance as an integral and effective part of benchmarking activity in health services. The Essence of Care, was launched by the Department of Health in England in 2001 to provide a benchmarking tool kit to support continuous improvement in the quality of fundamental aspects of health care, for example, privacy and dignity, nutrition and hygiene. The tool kit is now being effectively used by some frontline staff. However, use is inconsistent, with the value of the tool kit, or the support clinical practice benchmarking requires to be effective, not always recognized or provided by National Health Service managers, who are absorbed with the use of quantitative benchmarking approaches and measurability of comparative performance data. This review of published benchmarking literature, was obtained through an ever-narrowing search strategy commencing from benchmarking within quality improvement literature through to benchmarking activity in health services and including access to not only published examples of benchmarking approaches and models used but the actual consideration of web-based benchmarking data. This supported identification of how benchmarking approaches have developed and been used, remaining true to the basic benchmarking principles of continuous improvement through comparison and sharing (Camp 1989). Descriptions of models and exemplars of quantitative and specifically performance benchmarking activity in industry abound (Camp 1998), with far fewer examples of more qualitative and process benchmarking approaches in use in the public services and then applied to the health service (Bullivant 1998). The literature is also in the main descriptive in its support of the effectiveness of benchmarking activity and although this does not seem to have restricted its popularity in quantitative activity, reticence about the value of the more qualitative approaches, for example Essence of Care, needs to be overcome in order to improve the quality of patient care and experiences. The perceived immeasurability and subjectivity of Essence of Care and clinical practice benchmarks means that these benchmarking approaches are not always accepted or supported by health service organizations as valid benchmarking activity. In conclusion, Essence of Care benchmarking is a sophisticated clinical practice benchmarking approach which needs to be accepted as an integral part of health service benchmarking activity to support improvement in the quality of patient care and experiences.

ANIMAL WELFARE FROM MOUSE TO MOOSE--IMPLEMENTING THE PRINCIPLES OF THE 3RS IN WILDLIFE RESEARCH.

PubMed

Lindsjö, Johan; Fahlman, Åsa; Törnqvist, Elin

2016-04-01

The concept of the 3Rs (replacement, reduction, and refinement) was originally developed for improving laboratory animal welfare and is well known in biomedical and toxicologic research. The 3Rs have so far gained little attention in wildlife research, and there could be several reasons for this. First, researchers may prioritize the welfare of populations and ecosystems over the welfare of individual animals. The effects of research on individual animals can, however, impact welfare and research quality at group and population levels. Second, researchers may find it difficult to apply the 3Rs to studies of free-living wildlife because of the differences between laboratory and wild animals, species, research environment, and purpose and design of the studies. There are, however, several areas where it is possible to transfer the 3R principles to wildlife research, including replacement with noninvasive research techniques, reduction with optimized experimental design, and refinement with better methods of capture, anesthesia, and handling. Third, researchers may not have been trained in applying the 3Rs in wildlife research. This training is needed since ethics committees, employers, journal publishers, and funding agencies increasingly require researchers to consider the welfare implications of their research. In this paper, we compare the principles of the 3Rs in various research areas to better understand the possibilities and challenges of the 3Rs in wildlife research. We emphasize the importance of applying the 3Rs systematically throughout the research process. Based on experiences from laboratory research, we suggest three key factors to enhance implementation of the 3Rs in wildlife research: 1) organizational structure and management, 2) 3R awareness, and 3) research innovation, validation, and implementation. Finally, we encourage an interdisciplinary approach to incorporate the 3R principles in wildlife research. For improved animal welfare and increased research quality, researchers have moral obligations to include the 3Rs into all research areas, including wildlife research.

Identifying best practice principles of audit in health care.

PubMed

Patel, S

Audit is recognised as a crucial component of improving the quality of patient care. Examples include giving patients safe, reliable and dignified care, enhancing their experiences and satisfaction by encouraging them to self-direct their recovery, and reducing the length of stay in hospital, readmission rates and delayed discharge. This article describes clinical audit, the stages involved in the process and the support required to achieve strategic objectives.

Lean six sigma in healthcare.

PubMed

de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

2006-01-01

Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.

Expectations About Civilian Labor Markets and Army Officer Retention

DTIC Science & Technology

2011-01-01

when-50-year-olds-decide Kotler , Philip , Ned Roberto, and Nancy Lee, Social Marketing: Improving the Quality of Life, Thousand Oaks, Calif.: Sage...three relevant channels, or methods, to disseminate information to officers (Weinreich, 1999; Kotler , Roberto, and Lee, 2002): 3 Social marketing...is “the use of marketing principles and techniques to influence a target audience to voluntarily . . . modify . . . behavior” ( Kotler , Roberto, and

Adoption of lean principles in a high-volume molecular diagnostic microbiology laboratory.

PubMed

Mitchell, P Shawn; Mandrekar, Jayawant N; Yao, Joseph D C

2014-07-01

Clinical laboratories are constantly facing challenges to do more with less, enhance quality, improve test turnaround time, and reduce operational expenses. Experience with adopting and applying lean concepts and tools used extensively in the manufacturing industry is described for a high-volume clinical molecular microbiology laboratory, illustrating how operational success and benefits can be achieved. Copyright © 2014, American Society for Microbiology. All Rights Reserved.

Linking European Environmental Policies with the new CAP after 2020.

NASA Astrophysics Data System (ADS)

Bouma, Johan

2017-04-01

Linking European Environmental Policies with the new CAP after 2020. J.Bouma Em.prof soil science, Wageningen University, the Netherlands EU policy guidelines have been quite successful during the last decades to improve environmental quality of air, water and soil. This deserves credit. For example, the nitrate guideline of 1992 was introduced to deal with an emergency condition of groundwater in many areas of Europa and its quality has greatly improved. Comparable conclusions can be reached for other environmental components. As much new information and technologies have emerged and stakeholders become much more knowlegeable in the modern internet society, it is necessary and possible at this point in time to shift to more local approaches that are fine-tuned to local conditions and that approach land users as partners rather than as adversaries. A unique opportunity arises as the Common Agricultural Policy is being revised and a new policy will be introduced after 2020. Some suggestions will be made, based on the subsidiarity principle where the detail of measures should be in balance with the spatiale level at which they will be enforced: very general at EU level and more specific as one moves down to the level of individual enterprises. The UN Sustainable Development Goals would be an excellent guiding principle at EU level.

Factors affecting acquisition of psychomotor clinical skills by student nurses and midwives in CHAM Nursing Colleges in Malawi: A qualitative exploratory study.

PubMed

Mwale, Omero Gonekani; Kalawa, Roselyn

2016-01-01

Acquisition of psychomotor clinical skills has been shown to improve the quality of care provided to patients when care providers are competent. The aim of this study was to explore students, nurses and tutors experience on factors affecting acquisition of psychomotor clinical skills. The study employed an exploratory qualitative research design. The population was students, clinical nurses and tutors from a nursing College and mission hospital in the southern region of Malawi. In depth interviews using a semi structured guide was used to collect data. Thematic analysis method was employed to analyze the collected data. Ethical principles of respect of human dignity, beneficence and justice were observed. The findings have shown that acquisition of psychomotor skills is affected by: student motivation, lack of resources, learning environment, knowledge gap between the qualified nurses and tutors, and role modeling. In principle when student nurses have acquired necessary skills the quality of care provided to patients improve. Basing on the findings of this study it is recommended that Student should be well prepared before clinical placement Nurses and tutors should also update their knowledge and clinical teaching skills for them to adequately guide students. The clinical arena should have adequate resources.

A comprehensive health service evaluation and monitoring framework.

PubMed

Reeve, Carole; Humphreys, John; Wakerman, John

2015-12-01

To develop a framework for evaluating and monitoring a primary health care service, integrating hospital and community services. A targeted literature review of primary health service evaluation frameworks was performed to inform the development of the framework specifically for remote communities. Key principles underlying primary health care evaluation were determined and sentinel indicators developed to operationalise the evaluation framework. This framework was then validated with key stakeholders. The framework includes Donabedian's three seminal domains of structure, process and outcomes to determine health service performance. These in turn are dependent on sustainability, quality of patient care and the determinants of health to provide a comprehensive health service evaluation framework. The principles underpinning primary health service evaluation were pertinent to health services in remote contexts. Sentinel indicators were developed to fit the demographic characteristics and health needs of the population. Consultation with key stakeholders confirmed that the evaluation framework was applicable. Data collected routinely by health services can be used to operationalise the proposed health service evaluation framework. Use of an evaluation framework which links policy and health service performance to health outcomes will assist health services to improve performance as part of a continuous quality improvement cycle. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

The Theory of Value-Based Payment Incentives and Their Application to Health Care.

PubMed

Conrad, Douglas A

2015-12-01

To present the implications of agency theory in microeconomics, augmented by behavioral economics, for different methods of value-based payment in health care; and to derive a set of future research questions and policy recommendations based on that conceptual analysis. Original literature of agency theory, and secondarily behavioral economics, combined with applied research and empirical evidence on the application of those principles to value-based payment. Conceptual analysis and targeted review of theoretical research and empirical literature relevant to value-based payment in health care. Agency theory and secondarily behavioral economics have powerful implications for design of value-based payment in health care. To achieve improved value-better patient experience, clinical quality, health outcomes, and lower costs of care-high-powered incentives should directly target improved care processes, enhanced patient experience, and create achievable benchmarks for improved outcomes. Differing forms of value-based payment (e.g., shared savings and risk, reference pricing, capitation, and bundled payment), coupled with adjunct incentives for quality and efficiency, can be tailored to different market conditions and organizational settings. Payment contracts that are "incentive compatible"-which directly encourage better care and reduced cost, mitigate gaming, and selectively induce clinically efficient providers to participate-will focus differentially on evidence-based care processes, will right-size and structure incentives to avoid crowd-out of providers' intrinsic motivation, and will align patient incentives with value. Future research should address the details of putting these and related principles into practice; further, by deploying these insights in payment design, policy makers will improve health care value for patients and purchasers. © Health Research and Educational Trust.

Organic food processing: a framework for concept, starting definitions and evaluation.

PubMed

Kahl, Johannes; Alborzi, Farnaz; Beck, Alexander; Bügel, Susanne; Busscher, Nicolaas; Geier, Uwe; Matt, Darja; Meischner, Tabea; Paoletti, Flavio; Pehme, Sirli; Ploeger, Angelika; Rembiałkowska, Ewa; Schmid, Otto; Strassner, Carola; Taupier-Letage, Bruno; Załęcka, Aneta

2014-10-01

In 2007 EU Regulation (EC) 834/2007 introduced principles and criteria for organic food processing. These regulations have been analysed and discussed in several scientific publications and research project reports. Recently, organic food quality was described by principles, aspects and criteria. These principles from organic agriculture were verified and adapted for organic food processing. Different levels for evaluation were suggested. In another document, underlying paradigms and consumer perception of organic food were reviewed against functional food, resulting in identifying integral product identity as the underlying paradigm and a holistic quality view connected to naturalness as consumers' perception of organic food quality. In a European study, the quality concept was applied to the organic food chain, resulting in a problem, namely that clear principles and related criteria were missing to evaluate processing methods. Therefore the goal of this paper is to describe and discuss the topic of organic food processing to make it operational. A conceptual background for organic food processing is given by verifying the underlying paradigms and principles of organic farming and organic food as well as on organic processing. The proposed definition connects organic processing to related systems such as minimal, sustainable and careful, gentle processing, and describes clear principles and related criteria. Based on food examples, such as milk with different heat treatments, the concept and definitions were verified. Organic processing can be defined by clear paradigms and principles and evaluated according criteria from a multidimensional approach. Further work has to be done on developing indicators and parameters for assessment of organic food quality. © 2013 Society of Chemical Industry.

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

Process Improvement Tools, Commitment to Change Lead to Serious Turnaround.

PubMed

Birznieks, Derek; Zane, Richard

2017-05-01

The ED at the University of Colorado Hospital (UCH) has undergone a dramatic transformation in recent years, doubling in size while also using process improvement methods to dramatically reduce wait times, eliminate ambulance diversion, and boost patient satisfaction. Throughout this period, volume has continued to increase while the cost per patient and avoidable hospital admissions have experienced steady declines. Guiding the effort has been a series of core principles, with a particular focus on making sure that all processes are patient-centered. . To begin the improvement effort, ED leaders established a leadership team, and hired a process improvement chief with no previous experience in healthcare to provide fresh, outside perspective on processes. . In addition to mandating that all processes be patient-centered, the other guiding principles included a commitment to use and track data, to speak with one voice, to value everyone's perspective, to deliver high-quality care to all patients, and to set a standard for other academic medical centers. . To get points on the board early and win approval from staff, one of the first changes administrators implemented was to hire scribes for every physician so they wouldn't be bogged down with data input. The approach has essentially paid for itself. . Among the biggest changes was the elimination of triage, a process that improvement teams found no longer added value or quality to the patient experience. . Leadership also has moved to equilibrate the size and staff of the various zones in the ED so that they are more generic and less specialized. The move has facilitated patient flow, enabling patients in zones with resuscitation bays to connect with providers quickly.

From the traditional concept of safety management to safety integrated with quality.

PubMed

García Herrero, Susana; Mariscal Saldaña, Miguel Angel; Manzanedo del Campo, Miguel Angel; Ritzel, Dale O

2002-01-01

This editorial reviews the evolution of the concepts of safety and quality that have been used in the traditional workplace. The traditional programs of safety are explored showing strengths and weaknesses. The concept of quality management is also viewed. Safety management and quality management principles, stages, and measurement are highlighted. The concepts of quality and safety guarantee are assessed. Total Quality Management concepts are reviewed and applied to safety quality. Total safety management principles are discussed. Finally, an analysis of the relationship between quality and safety from data collected from a company in Spain is presented.

Creating Learning Organizations: The Deming Management Method Applied to Instruction (Quality Teaching & Quality Learning). A Paradigm Application.

ERIC Educational Resources Information Center

Loehr, Peter

This paper presents W. Edwards Deming's 14 management points, 7 deadly diseases, and 4 obstacles that thwart productivity, and discusses how these principles relate to teaching and learning. Application of these principles is expected to increase the quality of learning in classrooms from kindergarten through graduate level. Examples of the…

Conceptual Principles of Quality of Life: An Empirical Exploration

ERIC Educational Resources Information Center

Bramston, P.; Chipuer, H.; Pretty, G.

2005-01-01

Background: Quality of life is a popular measure of outcomes and its widespread use has led to recent calls for a better understanding of the construct, emphasizing the need to build a substantial body of knowledge around what determines perceptions of life quality. Three widely reported and used conceptual principles are examined in this study.…

75 FR 9878 - Draft Principles and Standards Sections of the “Economic and Environmental Principles and...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-03-04

... COUNCIL ON ENVIRONMENTAL QUALITY Draft Principles and Standards Sections of the ``Economic and Environmental Principles and Guidelines for Water and Related Land Resources Implementation Studies... the ``Economic and Environmental Principles and Guidelines for Water and Related Land Resources...

Managed care and total quality management: a necessary integration.

PubMed

Phoon, J; Corder, K; Barter, M

1996-01-01

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

Weaknesses in Applying a Process Approach in Industry Enterprises

NASA Astrophysics Data System (ADS)

Kučerová, Marta; Mĺkva, Miroslava; Fidlerová, Helena

2012-12-01

The paper deals with a process approach as one of the main principles of the quality management. Quality management systems based on process approach currently represents one of a proofed ways how to manage an organization. The volume of sales, costs and profit levels are influenced by quality of processes and efficient process flow. As results of the research project showed, there are some weaknesses in applying of the process approach in the industrial routine and it has been often only a formal change of the functional management to process management in many organizations in Slovakia. For efficient process management it is essential that companies take attention to the way how to organize their processes and seek for their continuous improvement.

Effects of aquatic physiotherapy on the improvement of balance and corporal symmetry in stroke survivors.

PubMed

Montagna, Jéssica Cristine; Santos, Bárbara C; Battistuzzo, Camila R; Loureiro, Ana Paula C

2014-01-01

One of the main problems associate with hemiparesis after stroke is the decrease in balance during static and dynamic postures which can highly affect daily life activities. To assess the effects of aquatic physiotherapy on the balance and quality of life (SS-QoL) of people with pos stroke. Chronic stroke participants received at total 18 individual sessions of aquatic physiotherapy using the principle of Halliwick (2x of 40 minutes per week). The outcomes measured were: Berg Balance scale, Timed up & go test (TUG), Stroke Specific Quality of Life Scale (SS-QoL) and baropodometric analysis. These assessment were performed before and one week after intervention. Fifteen participants were included in this study. The mean age was 58.5 and 54% was male. After intervention, participants had a significant improvement on their static balance measured by Berg Balance scale and TUG. Dynamic balance had a significant trend of improvement in mediolateral domain with eyes closed and during sit-to-stand. The mobility domain of the SS-QoL questionnaire was significant higher after intervention. Our results suggest that aquatic physiotherapy using the method of Halliwick can be a useful tool during stroke rehabilitation to improve balance. However, this improvement may not have significant impact of their quality of life.

Improving oxygen therapy for children and neonates in secondary hospitals in Nigeria: study protocol for a stepped-wedge cluster randomised trial.

PubMed

Graham, Hamish R; Ayede, Adejumoke I; Bakare, Ayobami A; Oyewole, Oladapo B; Peel, David; Gray, Amy; McPake, Barbara; Neal, Eleanor; Qazi, Shamim; Izadnegahdar, Rasa; Falade, Adegoke G; Duke, Trevor

2017-10-27

Oxygen is a life-saving, essential medicine that is important for the treatment of many common childhood conditions. Improved oxygen systems can reduce childhood pneumonia mortality substantially. However, providing oxygen to children is challenging, especially in small hospitals with weak infrastructure and low human resource capacity. This trial will evaluate the implementation of improved oxygen systems at secondary-level hospitals in southwest Nigeria. The improved oxygen system includes: a standardised equipment package; training of clinical and technical staff; infrastructure support (including improved power supply); and quality improvement activities such as supportive supervision. Phase 1 will involve the introduction of pulse oximetry alone; phase 2 will involve the introduction of the full, improved oxygen system package. We have based the intervention design on a theory-based analysis of previous oxygen projects, and used quality improvement principles, evidence-based teaching methods, and behaviour-change strategies. We are using a stepped-wedge cluster randomised design with participating hospitals randomised to receive an improved oxygen system at 4-month steps (three hospitals per step). Our mixed-methods evaluation will evaluate effectiveness, impact, sustainability, process and fidelity. Our primary outcome measures are childhood pneumonia case fatality rate and inpatient neonatal mortality rate. Secondary outcome measures include a range of clinical, quality of care, technical, and health systems outcomes. The planned study duration is from 2015 to 2018. Our study will provide quality evidence on the effectiveness of improved oxygen systems, and how to better implement and scale-up oxygen systems in resource-limited settings. Our results should have important implications for policy-makers, hospital administrators, and child health organisations in Africa and globally. Australian New Zealand Clinical Trials Registry: ACTRN12617000341325 . Retrospectively registered on 6 March 2017.

Medicare and Medicaid programs: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; electronic reporting pilot; Inpatient Rehabilitation Facilities Quality Reporting Program; revision to Quality Improvement Organization regulations. Final rule with comment period.

PubMed

2012-11-15

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2013 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, the ASC Quality Reporting (ASCQR) Program, and the Inpatient Rehabilitation Facility (IRF) Quality Reporting Program. We are continuing the electronic reporting pilot for the Electronic Health Record (EHR) Incentive Program, and revising the various regulations governing Quality Improvement Organizations (QIOs), including the secure transmittal of electronic medical information, beneficiary complaint resolution and notification processes, and technical changes. The technical changes to the QIO regulations reflect CMS' commitment to the general principles of the President's Executive Order on Regulatory Reform, Executive Order 13563 (January 18, 2011).

Clinical practice guideline development manual: a quality-driven approach for translating evidence into action.

PubMed

Rosenfeld, Richard M; Shiffman, Richard N

2009-06-01

Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing health-care variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective-or potentially harmful-interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations. This manual describes the principles and practices used successfully by the American Academy of Otolaryngology-Head and Neck Surgery to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for action-ready recommendations with multidisciplinary applicability. The development process, which allows moving from conception to completion in 12 months, emphasizes a logical sequence of key action statements supported by amplifying text, evidence profiles, and recommendation grades that link action to evidence. As clinical practice guidelines become more prominent as a key metric of quality health care, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are-and are not-and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals.

Learning to leverage existing information systems: Part 1. Principles.

PubMed

Neil, Nancy; Nerenz, David

2003-10-01

The success of performance improvement efforts depends on effective measurement and feedback regarding clinical processes and outcomes. Yet most health care organizations have fragmented rather than integrated data systems. Methods and practical guidance are provided for leveraging available information sources to obtain and create valid performance improvement-related information for use by clinicians and administrators. At Virginia Mason Health System (VMHS; Seattle), a vertically integrated hospital and multispecialty group practice, patient records are paper based and are supplemented with electronic reporting for laboratory and radiology services. Despite growth in the resources and interest devoted to organization-wide performance measurement, quality improvement, and evidence-based tools, VMHS's information systems consist of largely stand-alone, legacy systems organized around the ability to retrieve information on patients, one at a time. By 2002, without any investment in technology, VMHS had developed standardized, clinic-wide key indicators of performance updated and reported regularly at the patient, provider, site, and organizational levels. On the basis of VHMS's experience, principles can be suggested to guide other organizations to explore solutions using their own information systems: for example, start simply, but start; identify information needs; tap multiple data streams; and improve incrementally.

The Taguchi Method Application to Improve the Quality of a Sustainable Process

NASA Astrophysics Data System (ADS)

Titu, A. M.; Sandu, A. V.; Pop, A. B.; Titu, S.; Ciungu, T. C.

2018-06-01

Taguchi’s method has always been a method used to improve the quality of the analyzed processes and products. This research shows an unusual situation, namely the modeling of some parameters, considered technical parameters, in a process that is wanted to be durable by improving the quality process and by ensuring quality using an experimental research method. Modern experimental techniques can be applied in any field and this study reflects the benefits of interacting between the agriculture sustainability principles and the Taguchi’s Method application. The experimental method used in this practical study consists of combining engineering techniques with experimental statistical modeling to achieve rapid improvement of quality costs, in fact seeking optimization at the level of existing processes and the main technical parameters. The paper is actually a purely technical research that promotes a technical experiment using the Taguchi method, considered to be an effective method since it allows for rapid achievement of 70 to 90% of the desired optimization of the technical parameters. The missing 10 to 30 percent can be obtained with one or two complementary experiments, limited to 2 to 4 technical parameters that are considered to be the most influential. Applying the Taguchi’s Method in the technique and not only, allowed the simultaneous study in the same experiment of the influence factors considered to be the most important in different combinations and, at the same time, determining each factor contribution.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme: An Evaluation.

PubMed

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations.

Barking, Havering and Redbridge University Hospitals NHS Trust Fellowships in Clinical Leadership Programme

PubMed Central

Miani, Celine; Marjanovic, Sonja; Jones, Molly Morgan; Marshall, Martin; Meikle, Samantha; Nolte, Ellen

2013-01-01

Abstract Leadership is seen to be central to improving the quality of healthcare and existing research suggests that absence of leadership is related to poor quality and safety performance. Leadership training might therefore provide an important means through which to promote quality improvement and, more widely, performance within the healthcare environment. This article presents an evaluation of the Fellowships in Clinical Leadership Programme, which combines leadership training and quality improvement initiatives with the placement of temporary external clinical champions in Barking, Havering and Redbridge University Hospitals NHS Trust. We assessed impacts of the Programme on individual and organisational change, alongside core enablers and barriers for Programme success. Analyses drew on the principles of a theory-of-change-led realist evaluation, using logic modelling to specify the underlying causal mechanisms of the Programme. Data collection involved a stakeholder workshop, online questionnaires of programme participants, senior managers and support staff (n=114), and follow-up in-depth semi-structured interviews with a subsample of survey participants (n=15). We observed that the Programme had notable impacts at individual and organisational levels. Examples of individual impact included enhanced communication and negotiation skills or increased confidence as a result of multi-modal leadership training. At the organisational level, participants reported indications of behaviour change among staff, with evidence of spill-over effects to non-participants towards a greater focus on patient-centred care. Our findings suggest that there is potential for combined leadership training and quality improvement programmes to contribute to strengthening a culture of care quality in healthcare organisations. Our study provides useful insights into strategies seeking to achieve sustainable improvement in NHS organisations. PMID:28083304

Implementation of the OECD principles of good laboratory practice in test facilities complying with a quality system accredited to the ISO/IEC 17025 standard.

PubMed

Feller, Etty

2008-01-01

Laboratories with a quality system accredited to the ISO/IEC 17025 standard have a definite advantage, compared to non-accredited laboratories, when preparing their facilities for the implementation of the principles of good laboratory practice (GLP) of the Organisation for Economic Co-operation and Development (OECD). Accredited laboratories have an established quality system covering the administrative and technical issues specified in the standard. The similarities and differences between the ISO/IEC 17025 standard and the OECD principles of GLP are compared and discussed.

Manage your human sigma.

PubMed

Fleming, John H; Coffman, Curt; Harter, James K

2005-01-01

If sales and service organizations are to improve, they must learn to measure and manage the quality of the employee-customer encounter. Quality improvement methodologies such as Six Sigma are extremely useful in manufacturing contexts, but they're less useful when it comes to human interactions. To address this problem, the authors have developed a quality improvement approach they refer to as Human Sigma. It weaves together a consistent method for assessing the employee-customer encounter and a disciplined process for managing and improving it. There are several core principles for measuring and managing the employee-customer encounter: It's important not to think like an economist or an engineer when assessing interactions because emotions inform both sides' judgments and behavior. The employee-customer encounter must be measured and managed locally, because there are enormous variations in quality at the work-group and individual levels. And to improve the quality of the employee-customer interaction, organizations must conduct both short-term, transactional interventions and long-term, transformational ones. Employee engagement and customer engagement are intimately connected--and, taken together, they have an outsized effect on financial performance. They therefore need to be managed holistically. That is, the responsibility for measuring and monitoring the health of employee-customer relationships must reside within a single organizational structure, with an executive champion who has the authority to initiate and manage change. Nevertheless, the local manager remains the single most important factor in local group performance. A local manager whose work group shows suboptimal performance should be encouraged to conduct interventions, such as targeted training, performance reviews, action learning, and individual coaching.

Design of an Intelligent Nursing Clinical Pathway and Nursing Order Support System for Traditional Chinese Medicine.

PubMed

Ding, Bao-Fen; Chang, Polun; Wang, Ping; Li, Hai-Ting; Kuo, Ming-Chuan

2017-01-01

With an in-depth analysis of nursing work in 14 hospitals over a period of two years, one unique total nursing information system framework was established where the nursing clinical pathways are used as the main frame and the nursing orders as the nodes on the frame. We used the nursing order concept with the principles of nursing process. A closed-loop management model composed of the nursing orders was set up to solve nursing problems. Based on the principles of traditional Chinese medicine, we further designed an intelligent support module to automatically deduct clinical nursing pathways to promote standardized management and improve the quality of nursing care. The system has successfully been implemented in some facilities since 2015.

Quality assurance in pathology in colorectal cancer screening and diagnosis—European recommendations

PubMed Central

Quirke, Phil; Risio, Mauro; Lambert, René; von Karsa, Lawrence

2010-01-01

In Europe, colorectal cancer is the most common newly diagnosed cancer and the second most common cause of cancer deaths, accounting for approximately 436,000 incident cases and 212,000 deaths in 2008. The potential of high-quality screening to improve control of the disease has been recognized by the Council of the European Union who issued a recommendation on cancer screening in 2003. Multidisciplinary, evidence-based European Guidelines for quality assurance in colorectal cancer screening and diagnosis have recently been developed by experts in a pan-European project coordinated by the International Agency for Research on Cancer. The full guideline document consists of ten chapters and an extensive evidence base. The content of the chapter dealing with pathology in colorectal cancer screening and diagnosis is presented here in order to promote international discussion and collaboration leading to improvements in colorectal cancer screening and diagnosis by making the principles and standards recommended in the new EU Guidelines known to a wider scientific community. PMID:21061133

ISTC Projects from RFNC-VNIIEF Devoted to Improving Laser Beam Quality

NASA Astrophysics Data System (ADS)

Starikov, F.; Kochemasov, G.

Information is given about the Projects # 1929 and # 2631 supported by ISTC and concerned with improving laser beam quality and interesting for adaptive optics community. One of them, Project # 1929 has been recently finished. It has been devoted to development of an SBS phase conjugation mirror of superhigh conjugation quality employing the kinoform optics for high-power lasers with nanosecond scale pulse duration. With the purpose of reaching ideal PC fidelity, the SBS mirror includes the raster of small lenses that has been traditionally used as the lenslet in Shack-Hartmann wavefront sensor in adaptive optics. The second of them, Project # 2631, is concerned with the development of an adaptive optical system for phase correction of laser beams with wavefront vortex. The principles of operation of modern adaptive systems are based on the assumption that the phase is a smooth continuous function in space. Therefore the solution of the Project tasks will assume a new step in adaptive optics.

Multidisciplinary breast centres in Germany: a review and update of quality assurance through benchmarking and certification.

PubMed

Wallwiener, Markus; Brucker, Sara Y; Wallwiener, Diethelm

2012-06-01

This review summarizes the rationale for the creation of breast centres and discusses the studies conducted in Germany to obtain proof of principle for a voluntary, external benchmarking programme and proof of concept for third-party dual certification of breast centres and their mandatory quality management systems to the German Cancer Society (DKG) and German Society of Senology (DGS) Requirements of Breast Centres and ISO 9001 or similar. In addition, we report the most recent data on benchmarking and certification of breast centres in Germany. Review and summary of pertinent publications. Literature searches to identify additional relevant studies. Updates from the DKG/DGS programmes. Improvements in surrogate parameters as represented by structural and process quality indicators suggest that outcome quality is improving. The voluntary benchmarking programme has gained wide acceptance among DKG/DGS-certified breast centres. This is evidenced by early results from one of the largest studies in multidisciplinary cancer services research, initiated by the DKG and DGS to implement certified breast centres. The goal of establishing a nationwide network of certified breast centres in Germany can be considered largely achieved. Nonetheless the network still needs to be improved, and there is potential for optimization along the chain of care from mammography screening, interventional diagnosis and treatment through to follow-up. Specialization, guideline-concordant procedures as well as certification and recertification of breast centres remain essential to achieve further improvements in quality of breast cancer care and to stabilize and enhance the nationwide provision of high-quality breast cancer care.

Functional Quality Criterion of Rock Handling Mechanization at Open-pit Mines

NASA Astrophysics Data System (ADS)

Voronov, Yuri; Voronov, Artyoni

2017-11-01

Overburden and mining operations at open-pit mines are performed mainly by powerful shovel-truck systems (STSs). One of the main problems of the STSs is a rather low level of their operating quality, mainly due to unjustified over-trucking. In this article, a functional criterion for assessing the qualify of the STS operation at open-pit mines is formulated, derived and analyzed. We introduce the rationale and general principles for the functional criterion formation, its general form, as well as variations for various STS structures: a mixed truck fleet and a homogeneous shovel fleet, a mixed shove! fleet and a homogeneous truck fleet, mixed truck and shovel fleets. The possibility of assessing the quality of the STS operation is of great importance for identifying the main directions for improving their operational performance and operating quality, optimizing the main performance indicators by the qualify criterion, and. as a result, for possible saving of material and technical resources for open-pit mining. Improvement of the quality of the STS operation also allows increasing the mining safety and decreasing the atmosphere pollution - by means of possible reducing of the number of the operating trucks.

What kind of information will be required if we are to reform health care?

PubMed

Kaplan, J G

1994-10-01

The only logical way to avoid unnecessary future costs and improve quality is to analyze the past, providing input for the present. The informational management strategies are ready. There is continuous quality improvement, profiling with case-mix adjustment, and other techniques that will help us manage care and caring. But these strategies all rely on the customer being empowered to make truly informed decisions (the ethical principle of autonomy) and for us to advocate for patients (beneficence). Translating relevant data into information is the concentration of medical informatics. Virtually everyone in medical management can attest to the fact that, competitive forces notwithstanding, it is time for us to recognize not only that we are in the information business, but also that this information belongs to a larger community. Clearly, it is time to collaborate!

Use of Multiple Methodologies for Developing a Customer-Oriented Model of Total Quality Management in Higher Education

ERIC Educational Resources Information Center

Sahney, Sangeeta

2016-01-01

Purpose: Educational institutes must embrace the principles of total quality management (TQM) if they seek to remain competitive, and survive and succeed in the long run. An educational institution must embrace the principles of quality management and incorporate them into all of their activities. Starting with a theoretical background, the paper…

Improving the evidence base for better comparative effectiveness research.

PubMed

Brophy, James M

2015-09-01

The last 20 years has documented that the evidence base for informed clinical decision-making is often suboptimal. It is hoped that high-quality comparative effectiveness research may fill these knowledge gaps. Implicit in these changing paradigms is the underlying assumption that the published evidence, when available, is valid. It is posited here that this assumption is sometimes questionable. However, several recent methods that may improve the design and analysis of comparative effectiveness research have appeared and are discussed here. Examples from the cardiology literature are provided, but it is believed the highlighted principles are applicable to other branches of medicine.

Process-based costing.

PubMed

Lee, Robert H; Bott, Marjorie J; Forbes, Sarah; Redford, Linda; Swagerty, Daniel L; Taunton, Roma Lee

2003-01-01

Understanding how quality improvement affects costs is important. Unfortunately, low-cost, reliable ways of measuring direct costs are scarce. This article builds on the principles of process improvement to develop a costing strategy that meets both criteria. Process-based costing has 4 steps: developing a flowchart, estimating resource use, valuing resources, and calculating direct costs. To illustrate the technique, this article uses it to cost the care planning process in 3 long-term care facilities. We conclude that process-based costing is easy to implement; generates reliable, valid data; and allows nursing managers to assess the costs of new or modified processes.

Clinical pathway for thoracic surgery in the United States

PubMed Central

Wei, Benjamin

2016-01-01

The paradigm for postoperative care for thoracic surgical patients in the United States has shifted with efforts to reduce hospital length of stay and improve quality of life. The increasing usage of minimally invasive techniques in thoracic surgery has been an important part of this. In this review we will examine our standard practices as well as the evidence behind both general contemporary postoperative care principles and those specific to certain operations. PMID:26941967

Principles of disease management in neonatology.

PubMed

Bowen, F W; Gwiazdowski, S

1998-06-01

This article emphasizes the emerging facets of disease-management practice that impact directly on establishing a measured care system that can produce the information needed to establish a continuous quality improvement program. The areas discussed are risk assessment, clinical management guidelines and carepaths, and the measurement of system output known as clinical outcomes. The remainder of the article details the aspects of risk assessment, guideline function, and outcome assessment, critical in a disease-managed measured care system.

Optical cylinder designs to increase the field of vision in the osteo-odonto-keratoprosthesis.

PubMed

Hull, C C; Liu, C S; Sciscio, A; Eleftheriadis, H; Herold, J

2000-12-01

The single optical cylinders used in the osteo-odonto-keratoprosthesis (OOKP) are known to produce very small visual fields. Values of 40 degrees are typically quoted. The purpose of this paper is to present designs for new optical cylinders that significantly increase the field of view and therefore improve the visual rehabilitation of patients having an OOKP. Computer ray-tracing techniques were used to design and analyse improved one- and two-piece optical cylinders made from polymethyl methacrylate. All designs were required to have a potential visual acuity of 6/6 before consideration was given to the visual field and optimising off-axis image quality. Aspheric surfaces were used where this significantly improved off-axis image quality. Single optical cylinders, with increased posterior cylinder (intraocular) diameters, gave an increase in the theoretical visual field of 18% (from 76 degrees to 90 degrees) over current designs. Two-piece designs based on an inverted telephoto principle gave theoretical field angles over 120 degrees. Aspheric surfaces were shown to improve the off-axis image quality while maintaining a potential visual acuity of at least 6/6. This may well increase the measured visual field by improving the retinal illuminance off-axis. Results demonstrate that it is possible to significantly increase the theoretical maximum visual field through OOKP optical cylinders. Such designs will improve the visual rehabilitation of patients undergoing this procedure.

Expanding the three Rs to meet new challenges in humane animal experimentation.

PubMed

Schuppli, Catherine A; Fraser, David; McDonald, Michael

2004-11-01

The Three Rs are the main principles used by Animal Ethics Committees in the governance of animal experimentation, but they appear not to cover some ethical issues that arise today. These include: a) claims that certain species should be exempted on principle from harmful research; b) increased emphasis on enhancing quality of life of research animals; c) research involving genetically modified (GM) animals; and d) animals bred as models of disease. In some cases, the Three Rs can be extended to cover these developments. The burgeoning use of GM animals in science calls for new forms of reduction through improved genetic modification technology, plus continued attention to alternative approaches and cost-benefit analyses that include the large numbers of animals involved indirectly. The adoption of more expanded definitions of refinement that go beyond minimising distress will capture concerns for enhancing the quality of life of animals through improved husbandry and handling. Targeting refinement to the unpredictable effects of gene modification may be difficult; in these cases, careful attention to monitoring and endpoints are the obvious options. Refinement can also include sharing data about the welfare impacts of gene modifications, and modelling earlier stages of disease, in order to reduce the potential suffering caused to disease models. Other issues may require a move beyond the Three Rs. Certain levels of harm, or numbers and use of certain species, may be unacceptable, regardless of potential benefits. This can be addressed by supplementing the utilitarian basis of the Three Rs with principles based on deontological and relational ethics. The Three Rs remain very useful, but they require thoughtful interpretation and expansion in order for Animal Ethics Committees to address the full range of issues in animal-based research.

Creating a safer operating room: Groups, team dynamics and crew resource management principles.

PubMed

Wakeman, Derek; Langham, Max R

2018-04-01

The operating room (OR) is a special place wherein groups of highly skilled individuals must work in a coordinated and harmonious fashion to deliver optimal patient care. Team dynamics and human factors principles were initially studied by the aviation industry to better understand and prevent airline accidents. As a result, crew resource management (CRM) training was designed for all flight personnel to create a highly reliable industry with a commitment to a culture of safety. CRM has since been adapted to health care, resulting in care improvement and harm reduction across a wide variety of medical specialties. When implemented in the OR, CRM has been shown not only to improve communication and morale for OR staff, but also reduce morbidity and mortality for patients. As increasing focus is placed on quality, safety, and high-reliability, surgeons will be expected to participate and lead efforts to facilitate a team approach in this new era of patient care. Copyright © 2018 Elsevier Inc. All rights reserved.

Making progress with the automation of systematic reviews: principles of the International Collaboration for the Automation of Systematic Reviews (ICASR).

PubMed

Beller, Elaine; Clark, Justin; Tsafnat, Guy; Adams, Clive; Diehl, Heinz; Lund, Hans; Ouzzani, Mourad; Thayer, Kristina; Thomas, James; Turner, Tari; Xia, Jun; Robinson, Karen; Glasziou, Paul

2018-05-19

Systematic reviews (SR) are vital to health care, but have become complicated and time-consuming, due to the rapid expansion of evidence to be synthesised. Fortunately, many tasks of systematic reviews have the potential to be automated or may be assisted by automation. Recent advances in natural language processing, text mining and machine learning have produced new algorithms that can accurately mimic human endeavour in systematic review activity, faster and more cheaply. Automation tools need to be able to work together, to exchange data and results. Therefore, we initiated the International Collaboration for the Automation of Systematic Reviews (ICASR), to successfully put all the parts of automation of systematic review production together. The first meeting was held in Vienna in October 2015. We established a set of principles to enable tools to be developed and integrated into toolkits.This paper sets out the principles devised at that meeting, which cover the need for improvement in efficiency of SR tasks, automation across the spectrum of SR tasks, continuous improvement, adherence to high quality standards, flexibility of use and combining components, the need for a collaboration and varied skills, the desire for open source, shared code and evaluation, and a requirement for replicability through rigorous and open evaluation.Automation has a great potential to improve the speed of systematic reviews. Considerable work is already being done on many of the steps involved in a review. The 'Vienna Principles' set out in this paper aim to guide a more coordinated effort which will allow the integration of work by separate teams and build on the experience, code and evaluations done by the many teams working across the globe.

Academic Success Through Quality-Managed Course Design.

ERIC Educational Resources Information Center

Reese, Andy C.; Mobley, Mary F.

1996-01-01

Principles of quality management, focusing on defect prevention rather than correction, were applied to the design of a graduate biomedicine course in immunology. The principles require clearly stated course mission and objectives, numerous intermediate steps to achieving objectives, immediate feedback on student performance, and immediate…

Developing and integrating a practice model for health finance reform into wound healing programs: an examination of the triple aim approach.

PubMed

Flattau, Anna; Thompson, Maureen; Meara, Anne

2013-10-01

Throughout the United States, government and private payers are exploring new payment models such as accountable care organizations and shared savings agreements. These models are widely based on the construct of the Triple Aim, a set of three principles for health services reform: improving population-based outcomes, improving patient care experiences, and reducing costs through better delivery systems. Wound programs may adapt to the new health financing environment by incorporating initiatives known to promote the Triple Aim, such as diabetes amputation reduction and pressure ulcer prevention programs, and by rethinking how health services can best be delivered to meet these new criteria. The existing literature supports that programmatic approaches can improve care, quality, and cost, especially in the field of diabetic foot ulcers. Wound healing programs have opportunities to develop new business plan models that provide quality, cost-efficient care to their patient population and to be leaders in the development of new types of partnerships with payers and health delivery organizations.

Teaching a Systems Approach: An Innovative Quality Improvement Project.

PubMed

Hamrin, Vanya; Vick, Rose; Brame, Cynthia; Simmons, Megan; Smith, Letizia; Vanderhoef, Dawn

2016-04-01

Nurse practitioners are required to navigate complex health care systems. Quality improvement (QI) projects provide the opportunity for nurse practitioner students to learn systems knowledge and improve health care outcomes in patient populations. A gap in the literature exists around how to systematically teach, apply, and measure QI curricular objectives at the master's level. Six faculty evaluated the QI project for the psychiatric nurse practitioner master's program by identifying the most challenging QI concepts for students to apply, revising their teaching strategies to address gaps, and retrospectively evaluating the outcomes of these curriculum changes by comparing student outcomes before and after the curricular changes. A significant difference was noted on QI project performance between students in the 2014 and 2015 graduating classes, measured by the scores earned on students' final papers (t[92] = 1.66, p = .05, d = .34, r(2) = .0289). Theoretical principles of adult and cooperative learning were used to inform curricular changes to enhance student's acquisition of QI skills. Copyright 2016, SLACK Incorporated.

Overcoming a perfect storm: an academic cardiology section's story of survival.

PubMed

Calvin, James E

2007-03-01

Increasingly, academic institutions are grappling with financial pressures that threaten the academic mission. The author presents an actual case history in which a section of cardiology in an academic health center was confronted with huge projected deficits that had to be eliminated within the fiscal year. The section used eight principles to shift from deficit to profitability (i.e., having revenue exceed costs). These principles included confronting the brutal facts, managing costs and revenue cycles, setting expectations for faculty, and quality improvement. The section accomplished deficit reduction through reducing faculty salaries (nearly $2 million) and nonfaculty salaries ($1.3 million) and reducing operational costs while maintaining revenues by increasing individual faculty productivity and reducing accounts receivable. In the face of these reductions, clinical revenues were maintained, but research revenue and productivity fell (but research is being fostered now that clinical services are profitable again). These principles can be used to stabilize the financial position of clinical practices in academic settings that are facing financial challenges.

Evaluating the Quality of Transfer versus Nontransfer Accounting Principles Grades.

ERIC Educational Resources Information Center

Colley, J. R.; And Others

1996-01-01

Using 1989-92 student records from three colleges accepting large numbers of transfers from junior schools into accounting, regression analyses compared grades of transfer and nontransfer students. Quality of accounting principle grades of transfer students was not equivalent to that of nontransfer students. (SK)

Total Quality Management, the Learning Organisation and Post-Compulsory Education.

ERIC Educational Resources Information Center

Holloway, David G.

1994-01-01

Reviews application of total quality management (TQM) principles to higher education and the relationship of learning organizations and TQM; compares TQM principles to other organizational behavior concepts. Concludes that TQM treats organizational change in educational institutions as unproblematic, ignoring issues of power, authority, resistance…

Action Research and Narrative Inquiry: Five Principles for Validation Revisited

ERIC Educational Resources Information Center

Heikkinen, Hannu L. T.; Huttunen, Rauno; Syrjala, Leena; Pesonen, Jyri

2012-01-01

The article continues the discussion of the five quality principles proposed by Heikkinen, Huttunen, and Syrjala, published in 2007 in "Educational Action Research". In the present article, the authors reconsider the five principles: historical continuity; reflexivity; dialectics; workability; and evocativeness. These five principles are…

Conceptual principles of quality of life: an empirical exploration.

PubMed

Bramston, P; Chipuer, H; Pretty, G

2005-10-01

Quality of life is a popular measure of outcomes and its widespread use has led to recent calls for a better understanding of the construct, emphasizing the need to build a substantial body of knowledge around what determines perceptions of life quality. Three widely reported and used conceptual principles are examined in this study. Self-ratings of life quality and three likely determinants at an individual level (stress), an interactional level (social support) and a community level (neighbourhood belonging) were used. The study involved two groups of young adults from an urban community, one identified as having an intellectual disability (ID). RESULTS Young adults with ID rated their satisfaction with health significantly higher and intimacy and community involvement lower than the comparison group. Social support emerged as the strongest predictor of life satisfaction across both groups. The conceptual principles of subjective quality of life provide a useful framework to discuss findings and to stimulate further research.

A modified Continuous Quality Improvement approach to improve culturally and socially inclusive care within rural health services.

PubMed

Mitchell, Olivia; Malatzky, Christina; Bourke, Lisa; Farmer, Jane

2018-06-01

The sickest Australians are often those belonging to non-privileged groups, including Indigenous Australians, gay, lesbian, bisexual, transsexual, intersex and queer people, people from culturally and linguistically diverse backgrounds, socioeconomically disadvantaged groups, and people with disabilities and low English literacy. These consumers are not always engaged by, or included within, mainstream health services, particularly in rural Australia where health services are limited in number and tend to be generalist in nature. The aim of this study was to present a new approach for improving the sociocultural inclusivity of mainstream, generalist, rural, health care organisations. This approach combines a modified Continuous Quality Improvement framework with Participatory Action Research principles and Foucault's concepts of power, discourse and resistance to develop a change process that deconstructs the power relations that currently exclude marginalised rural health consumers from mainstream health services. It sets up processes for continuous learning and consumer responsiveness. The approach proposed could provide a Continuous Quality Improvement process for creating more inclusive mainstream health institutions and fostering better engagement with many marginalised groups in rural communities to improve their access to health care. The approach to improving cultural inclusion in mainstream rural health services presented in this article builds on existing initiatives. This approach focuses on engaging on-the-ground staff in the need for change and preparing the service for genuine community consultation and responsive change. It is currently being trialled and evaluated. © 2018 National Rural Health Alliance Ltd.

The future of monitoring in clinical research - a holistic approach: linking risk-based monitoring with quality management principles.

PubMed

Ansmann, Eva B; Hecht, Arthur; Henn, Doris K; Leptien, Sabine; Stelzer, Hans Günther

2013-01-01

Since several years risk-based monitoring is the new "magic bullet" for improvement in clinical research. Lots of authors in clinical research ranging from industry and academia to authorities are keen on demonstrating better monitoring-efficiency by reducing monitoring visits, monitoring time on site, monitoring costs and so on, always arguing with the use of risk-based monitoring principles. Mostly forgotten is the fact, that the use of risk-based monitoring is only adequate if all mandatory prerequisites at site and for the monitor and the sponsor are fulfilled.Based on the relevant chapter in ICH GCP (International Conference on Harmonisation of technical requirements for registration of pharmaceuticals for human use - Good Clinical Practice) this publication takes a holistic approach by identifying and describing the requirements for future monitoring and the use of risk-based monitoring. As the authors are operational managers as well as QA (Quality Assurance) experts, both aspects are represented to come up with efficient and qualitative ways of future monitoring according to ICH GCP.

Prioritizing health services research: an economic perspective.

PubMed

Gandjour, Afschin

2016-05-01

Given limited resources policymakers need to decide about how much and in what areas of health services research (HSR) to invest. The purpose of this study is to provide guidance for priority setting of HSR projects based on economic theory. The conceptual analysis starts from the premise that competition in health care is valuable-a position that seems to predominate among Western policymakers. The principle of competition rests on economic theory and, in particular, its branch of welfare economics. Based on economic theory, the role of HSR is to detect and alleviate information asymmetry, negative externalities, and harm caused by competition and inappropriate incentives for competition. A hierarchy of HSR projects is provided; following the ethical principle of harm ('do not harm'), the detection and prevention of harm would receive highest priority among HSR projects. Agreeing that competition is valuable in achieving efficiency and quality of care (and therefore agreeing to the assumptions of economic theory) implies accepting the role of HSR in detecting market failure and the HSR hierarchy as suggested. Disagreement would require an alternative coherent concept of improving efficiency and quality of care.

Total Quality Management for Schools.

ERIC Educational Resources Information Center

Greenwood, Malcolm S.; Gaunt, Helen J.

Education in the United Kingdom has been shaped by the advent of local school management and the rapid growth of grant-maintained schools. Total Quality Management (TQM) offers a new way of looking at management principles and structures by identifying the needs of both internal and external customers. This book applies principles of TQM…

Role of Service Learning in Water Quality Studies

ERIC Educational Resources Information Center

Richards, Wilfred Sugumar

2009-01-01

Background: Chemistry students often complain that they are unmotivated because they see no applications of chemical principles in "real life." It was thus decided to put into use the knowledge gained during the course on water quality and analysis. Learning the principles of quantitative chemical analysis requires innovative, hands-on…

TQM Reaches the Academy.

ERIC Educational Resources Information Center

Marchese, Ted

1991-01-01

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

Self-Evaluation Instrument: Awards Program for Indoor Air Quality Management in Schools.

ERIC Educational Resources Information Center

Maryland State Dept. of Education, Baltimore.

This self-evaluation instrument is used to nominate and evaluate schools for the Indoor Air Quality Management in Schools award. The evaluation contains three categories: Communications/Training; Design; and Operations/Maintenance. Each principle is detailed along with the required criteria used to meet that principle. Communications/Training…

Deconstructing Clinical Workflow: Identifying Teaching-Learning Principles for Barcode Electronic Medication Administration With Nursing Students.

PubMed

Booth, Richard G; Sinclair, Barbara; Strudwick, Gillian; Brennan, Laura; Morgan, Lisa; Collings, Stephanie; Johnston, Jessica; Loggie, Brittany; Tong, James; Singh, Chantal

The purpose of this quality improvement project was to better understand how to teach medication administration underpinned by an electronic medication administration record (eMAR) system used in simulated, prelicensure nursing education. Methods included a workflow and integration analysis and a detailed process mapping of both an oral and a sublingual medication administration. Procedural and curriculum development considerations related to medication administration using eMAR technology are presented for nurse educators.

Behavior analysis: the science of training.

PubMed

Farhoody, Parvene

2012-09-01

Behavior analysis is a data-driven science dedicated to understanding the mechanisms of behavior. Applied behavior analysis is a branch of this scientific field that systematically applies scientific principles to real-world problems in an effort to improve quality of life. The use of the behavioral technology provides a way to teach human and nonhuman animals more effectively and efficiently and offers those using this technology increased success in achieving behavioral goals. Copyright © 2012 Elsevier Inc. All rights reserved.

Servant leadership: enhancing quality of care and staff satisfaction.

PubMed

Neill, Mark W; Saunders, Nena S

2008-09-01

Servant leadership encompasses a powerful skill set that is particularly effective in implementing a team approach to the delivery of nursing practice. This model encourages the professional growth of nurses and simultaneously promotes the improved delivery of healthcare services through a combination of interdisciplinary teamwork, shared decision making, and ethical behavior. The authors describe the case application of servant leadership principles in a Department of Veterans Affairs Medical Intensive Care Unit located in a large urban center.

IFLA General Conference, 1990. Division of Special Libraries: Section of Administrative Libraries; Section of Social Science Libraries; Section of Science and Technology Libraries; Section of Biological and Medical Sciences Libraries; Section of Art Libraries. Booklet 2.

ERIC Educational Resources Information Center

International Federation of Library Associations, The Hague (Netherlands).

The 23 papers in this collection were presented at 5 sections of the Division of Special Libraries: (1) "Principles of Government Librarianship" (Hans H. van der Neut); (2) "Strategic Planning as an Instrument of Improving Library Quality" (Maurice B. Line); (3) "Library Staff Development Consultancy: A Means to Achieve a…

Upper Extremity Amputations and Prosthetics

PubMed Central

Ovadia, Steven A.; Askari, Morad

2015-01-01

Upper extremity amputations are most frequently indicated by severe traumatic injuries. The location of the injury will determine the level of amputation. Preservation of extremity length is often a goal. The amputation site will have important implications on the functional status of the patient and options for prosthetic reconstruction. Advances in amputation techniques and prosthetic reconstructions promote improved quality of life. In this article, the authors review the principles of upper extremity amputation, including techniques, amputation sites, and prosthetic reconstructions. PMID:25685104

The bioethics of separating conjoined twins in plastic surgery.

PubMed

Lee, Michelle; Gosain, Arun K; Becker, Devra

2011-10-01

The incidence of craniopagus twins approximates four to six per 10 million births. Although rare, surgical separation of conjoined twins poses significant technical and ethical challenges. The present report uses the case of craniopagus twins AD and TD to examine the bioethical issues faced by a multidisciplinary medical team in planning the separation of craniopagus twins. AD and TD are craniopagus twins conjoined at the head. TD's head is conjoined to the back of AD's head. Neurologically, AD has the dominant cerebral circulation. TD has two normal kidneys, whereas AD has none. AD depends on TD's renal function and, on separation, will require either a kidney transplant or lifelong dialysis. This case report reviews one approach to analyzing and solving complex ethical dilemmas in pediatric plastic surgery. The principles reviewed are (1) autonomy and informed consent, focusing especially on the role of children in the informed consent process; (2) beneficence and nonmaleficence, two intricately intertwined principles because separation could potentially cause irreversible harm to one twin while improving the quality of life for the other (as separation is not a life-saving procedure, is it ethical to perform a procedure with unknown surgical risk to improve children's quality of life?); and (3) justice (is it fair to allocate excessive medical resources for the twins' separation?). The present report explores the ethics behind such decisions with respect to the separation of conjoined twins.

[Comprehensive quality management in hospitals--experience and recommendations].

PubMed

Schubert, H J

1999-03-01

Total quality management concepts, increasingly being introduced into hospitals, offer opportunities for integrative leadership concepts because of their multidimensional character viewed from the aspects of results and from the standpoint of organisational design. Customized for leadership and organisation of hospitals in Germany, questions of introduction strategies as well as recommendations for the integration of total quality understanding into the daily practice of management and employees are discussed. The active support of top and middle management and a combination of radical change in selected problem areas and continual incremental improvements on a broad base have been proven as significant factors for the success in the introductory phase. For a lasting integration of the principles of a comprehensive quality management concept in a hospital, it will be necessary to carry out regularly relevant measurements of success. The results become an important part of agreements with management.

Public-private partnerships to improve primary healthcare surgeries: clarifying assumptions about the role of private provider activities.

PubMed

Mudyarabikwa, Oliver; Tobi, Patrick; Regmi, Krishna

2017-07-01

Aim To examine assumptions about public-private partnership (PPP) activities and their role in improving public procurement of primary healthcare surgeries. PPPs were developed to improve the quality of care and patient satisfaction. However, evidence of their effectiveness in delivering health benefits is limited. A qualitative study design was employed. A total of 25 interviews with public sector staff (n=23) and private sector managers (n=2) were conducted to understand their interpretations of assumptions in the activities of private investors and service contractors participating in Local Improvement Finance Trust (LIFT) partnerships. Realist evaluation principles were applied in the data analysis to interpret the findings. Six thematic areas of assumed health benefits were identified: (i) quality improvement; (ii) improved risk management; (iii) reduced procurement costs; (iv) increased efficiency; (v) community involvement; and (vi) sustainable investment. Primary Care Trusts that chose to procure their surgeries through LIFT were expected to support its implementation by providing an environment conducive for the private participants to achieve these benefits. Private participant activities were found to be based on a range of explicit and tacit assumptions perceived helpful in achieving government objectives for LIFT. The success of PPPs depended upon private participants' (i) capacity to assess how PPP assumptions added value to their activities, (ii) effectiveness in interpreting assumptions in their expected activities, and (iii) preparedness to align their business principles to government objectives for PPPs. They risked missing some of the expected benefits because of some factors constraining realization of the assumptions. The ways in which private participants preferred to carry out their activities also influenced the extent to which expected benefits were achieved. Giving more discretion to public than private participants over critical decisions may help in ensuring that assumptions in PPP activities result in outcomes that match the anticipated health benefits.

Turning patient-centeredness from ideal to real: lessons from 2 success stories.

PubMed

Millenson, Michael L; DiGioia, Anthony M; Greenhouse, Pamela K; Swieskowski, David

2013-01-01

The Institute of Medicine's 2001 Crossing the Quality Chasm report established patient-centeredness as 1 of 6 core principles for health system redesign. Yet, turning aspiration into accomplishment has proven arduous. Patient-centered care has components that challenge established professional norms, and the term itself has not always been clearly defined. However, these barriers can be overcome using Rogers' principles of diffusion of innovation, as is shown by 2 case histories. One involves care at an urban academic medical center, the other outpatient care at multiple physician sites located in urban, suburban, and rural locations. At the University of Pittsburgh Medical Center, the Patient- and Family-Centered Care Methodology and Practice has become the new "operating system" in 60 clinical areas, using a 6-step approach to engage patients and families as codesigners of ideal care. Meanwhile, the Health Coach Program at Mercy Clinics, Inc, Des Moines, Iowa, has used a "high-tech/high-touch" combined approach to change the organizational culture through patient-centered initiatives. By doing so, it has put the organization in a position to accept risk for populations of patients. Importantly, both programs have been financially and clinically successful, are accepted by frontline physicians and senior management, and are nationally recognized. Common principles include physician leadership, comfort with uncertainty during innovation, organizational structures that send a consistent message about expectations, and quality improvement as a constant cycle with no end point.

78 FR 18562 - Economic and Environmental Principles and Requirements for Water and Related Land Resources...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-27

... COUNCIL ON ENVIRONMENTAL QUALITY Economic and Environmental Principles and Requirements for Water... ``Economic and Environmental Principles and Guidelines for Water and Related Land Resources Implementation... Secretary of the Army to revise the ``Economic and Environmental Principles and Guidelines for Water and...

78 FR 31521 - Economic and Environmental Principles and Guidelines for Water and Related Land Resources...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-05-24

... COUNCIL ON ENVIRONMENTAL QUALITY Economic and Environmental Principles and Guidelines for Water... the Army to revise the ``Economic and Environmental Principles and Guidelines for Water and Related.... L. 110-114) directed the Secretary of the Army to revise the ``Economic and Environmental Principles...

78 FR 18562 - Economic and Environmental Principles and Guidelines for Water and Related Land Resources...

Federal Register 2010, 2011, 2012, 2013, 2014

2013-03-27

... COUNCIL ON ENVIRONMENTAL QUALITY Economic and Environmental Principles and Guidelines for Water... the Army to revise the ``Economic and Environmental Principles and Guidelines for Water and Related... Army to revise the ``Economic and Environmental Principles and Guidelines for Water and Related Land...

[Clinical trial data management and quality metrics system].

PubMed

Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan

2015-11-01

Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.

[Improvement of medical processes with Six Sigma - practicable zero-defect quality in preparation for surgery].

PubMed

Sobottka, Stephan B; Töpfer, Armin; Eberlein-Gonska, Maria; Schackert, Gabriele; Albrecht, D Michael

2010-01-01

Six Sigma is an innovative management- approach to reach practicable zero- defect quality in medical service processes. The Six Sigma principle utilizes strategies, which are based on quantitative measurements and which seek to optimize processes, limit deviations or dispersion from the target process. Hence, Six Sigma aims to eliminate errors or quality problems of all kinds. A pilot project to optimize the preparation for neurosurgery could now show that the Six Sigma method enhanced patient safety in medical care, while at the same time disturbances in the hospital processes and failure costs could be avoided. All six defined safety relevant quality indicators were significantly improved by changes in the workflow by using a standardized process- and patient- oriented approach. Certain defined quality standards such as a 100% complete surgical preparation at start of surgery and the required initial contact of the surgeon with the patient/ surgical record on the eve of surgery could be fulfilled within the range of practical zero- defect quality. Likewise, the degree of completion of the surgical record by 4 p.m. on the eve of surgery and their quality could be improved by a factor of 170 and 16, respectively, at sigma values of 4.43 and 4.38. The other two safety quality indicators "non-communicated changes in the OR- schedule" and the "completeness of the OR- schedule by 12:30 a.m. on the day before surgery" also show an impressive improvement by a factor of 2.8 and 7.7, respectively, corresponding with sigma values of 3.34 and 3.51. The results of this pilot project demonstrate that the Six Sigma method is eminently suitable for improving quality of medical processes. In our experience this methodology is suitable, even for complex clinical processes with a variety of stakeholders. In particular, in processes in which patient safety plays a key role, the objective of achieving a zero- defect quality is reasonable and should definitely be aspirated. Copyright © 2010. Published by Elsevier GmbH.

Adapting evidence-based interventions using a common theory, practices, and principles.

PubMed

Rotheram-Borus, Mary Jane; Swendeman, Dallas; Becker, Kimberly D

2014-01-01

Hundreds of validated evidence-based intervention programs (EBIP) aim to improve families' well-being; however, most are not broadly adopted. As an alternative diffusion strategy, we created wellness centers to reach families' everyday lives with a prevention framework. At two wellness centers, one in a middle-class neighborhood and one in a low-income neighborhood, popular local activity leaders (instructors of martial arts, yoga, sports, music, dancing, Zumba), and motivated parents were trained to be Family Mentors. Trainings focused on a framework that taught synthesized, foundational prevention science theory, practice elements, and principles, applied to specific content areas (parenting, social skills, and obesity). Family Mentors were then allowed to adapt scripts and activities based on their cultural experiences but were closely monitored and supervised over time. The framework was implemented in a range of activities (summer camps, coaching) aimed at improving social, emotional, and behavioral outcomes. Successes and challenges are discussed for (a) engaging parents and communities; (b) identifying and training Family Mentors to promote children and families' well-being; and (c) gathering data for supervision, outcome evaluation, and continuous quality improvement. To broadly diffuse prevention to families, far more experimentation is needed with alternative and engaging implementation strategies that are enhanced with knowledge harvested from researchers' past 30 years of experience creating EBIP. One strategy is to train local parents and popular activity leaders in applying robust prevention science theory, common practice elements, and principles of EBIP. More systematic evaluation of such innovations is needed.

Effects of aquatic physiotherapy on the improvement of balance and corporal symmetry in stroke survivors

PubMed Central

Montagna, Jéssica Cristine; Santos, Bárbara C; Battistuzzo, Camila R; Loureiro, Ana Paula C

2014-01-01

Introduction: One of the main problems associate with hemiparesis after stroke is the decrease in balance during static and dynamic postures which can highly affect daily life activities. Objective: To assess the effects of aquatic physiotherapy on the balance and quality of life (SS-QoL) of people with pos stroke. Methods: Chronic stroke participants received at total 18 individual sessions of aquatic physiotherapy using the principle of Halliwick (2x of 40 minutes per week). The outcomes measured were: Berg Balance scale, Timed up & go test (TUG), Stroke Specific Quality of Life Scale (SS-QoL) and baropodometric analysis. These assessment were performed before and one week after intervention. Results: Fifteen participants were included in this study. The mean age was 58.5 and 54% was male. After intervention, participants had a significant improvement on their static balance measured by Berg Balance scale and TUG. Dynamic balance had a significant trend of improvement in mediolateral domain with eyes closed and during sit-to-stand. The mobility domain of the SS-QoL questionnaire was significant higher after intervention. Conclusions: Our results suggest that aquatic physiotherapy using the method of Halliwick can be a useful tool during stroke rehabilitation to improve balance. However, this improvement may not have significant impact of their quality of life. PMID:24955206

The effect of errorless learning on quality of life in patients with Korsakoff's syndrome.

PubMed

Rensen, Yvonne Cm; Egger, Jos Im; Westhoff, Josette; Walvoort, Serge Jw; Kessels, Roy Pc

2017-01-01

Errorless learning (EL) is a promising rehabilitation principle for (re)learning instrumental activities in patients with amnesia, including patients with Korsakoff's syndrome (KS). Successfully (re)learning tasks might improve the sense of competence and independence, and subsequently the quality of life. Quality of life in patients with KS has received limited attention, and no studies have been conducted to experimentally examine the effect of EL on quality of life in patients in this patient group. The QUALIDEM, an observation scale for quality of life, was completed by professional nurses before and after EL training in a group of fifty-one patients with KS. This scale was also completed for a group of thirty-one control patients receiving care as usual but no EL training. Quality of life was significantly increased on eight of the nine subscales in the Korsakoff group who participated in an EL training. There was a trend toward a significant increase in "positive affect" (ie, the ninth subscale). In contrast, no changes over time were found on any of the subscales in the control group that did not participate in any EL training. Despite severe memory impairments, patients with KS still have the potential to (partially) (re)learn tasks using EL. This potential should be exploited, as the successes of (re)-learning might improve the quality of life of Korsakoff patients in nursing homes.

The roles of government in improving health care quality and safety.

PubMed

Tang, Ning; Eisenberg, John M; Meyer, Gregg S

2004-01-01

Discussions surrounding the role of government have been and continue to be a favorite American pastime. A framework is provided for understanding the 10 roles that government plays in improving health care quality and safety in the United States. Examples of proposed federal actions to reduce medical errors and enhance patient safety are provided to illustrate the 10 roles: (1) purchase health care, (2) provide health care, (3) ensure access to quality care for vulnerable populations, (4) regulate health care markets, (5) support acquisition of new knowledge, (6) develop and evaluate health technologies and practices, (7) monitor health care quality, (8) inform health care decision makers, (9) develop the health care workforce, and (10) convene stakeholders from across the health care system. Government's responsibility to protect and advance the interests of society includes the delivery of high-quality health care. Because the market alone cannot ensure all Americans access to quality health care, the government must preserve the interests of its citizens by supplementing the market where there are gaps and regulating the market where there is inefficiency or unfairness. The ultimate goal of achieving high quality of care will require strong partnerships among federal, state, and local governments and the private sector. Translating general principles regarding the appropriate role of government into specific actions within a rapidly changing, decentralized delivery system will require the combined efforts of the public and private sectors.

Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India.

PubMed

Fischer, Elizabeth A; Jayana, Krishnamurthy; Cunningham, Troy; Washington, Maryann; Mony, Prem; Bradley, Janet; Moses, Stephen

2015-12-01

High-quality care during labor, delivery, and the postpartum period is critically important since maternal and child morbidity and mortality are linked to complications that arise during these stages. A nurse mentoring program was implemented in northern Karnataka, India, to improve quality of services at primary health centers (PHCs), the lowest level in the public health system that offers basic obstetric care. The intervention, conducted between August 2012 and July 2014, employed 53 full-time nurse mentors and was scaled-up in 385 PHCs in 8 poor rural districts. Each mentor was responsible for 6 to 8 PHCs and conducted roughly 6 mentoring visits per PHC in the first year. This paper reports the results of a qualitative inquiry, conducted between September 2012 and April 2014, assessing the program's successes and challenges from the perspective of mentors and PHC teams. Data were gathered through 13 observations, 9 focus group discussions with mentors, and 25 individual and group interviews with PHC nurses, medical officers, and district health officers. Mentors and PHC staff and leaders reported a number of successes, including development of rapport and trust between mentors and PHC staff, introduction of team-based quality improvement processes, correct and consistent use of a new case sheet to ensure adherence to clinical guidelines, and increases in staff nurses' knowledge and skills. Overall, nurses in many PHCs reported an increased ability to provide care according to guidelines and to handle maternal and newborn complications, along with improvements in equipment and supplies and referral management. Challenges included high service delivery volumes and/or understaffing at some PHCs, unsupportive or absent PHC leadership, and cultural practices that impacted quality. Comprehensive mentoring can build competence and improve performance by combining on-the-job clinical and technical support, applying quality improvement principles, and promoting team-based problem solving. © Fischer et al.

Nurse Mentors to Advance Quality Improvement in Primary Health Centers: Lessons From a Pilot Program in Northern Karnataka, India

PubMed Central

Fischer, Elizabeth A; Jayana, Krishnamurthy; Cunningham, Troy; Washington, Maryann; Mony, Prem; Bradley, Janet; Moses, Stephen

2015-01-01

High-quality care during labor, delivery, and the postpartum period is critically important since maternal and child morbidity and mortality are linked to complications that arise during these stages. A nurse mentoring program was implemented in northern Karnataka, India, to improve quality of services at primary health centers (PHCs), the lowest level in the public health system that offers basic obstetric care. The intervention, conducted between August 2012 and July 2014, employed 53 full-time nurse mentors and was scaled-up in 385 PHCs in 8 poor rural districts. Each mentor was responsible for 6 to 8 PHCs and conducted roughly 6 mentoring visits per PHC in the first year. This paper reports the results of a qualitative inquiry, conducted between September 2012 and April 2014, assessing the program's successes and challenges from the perspective of mentors and PHC teams. Data were gathered through 13 observations, 9 focus group discussions with mentors, and 25 individual and group interviews with PHC nurses, medical officers, and district health officers. Mentors and PHC staff and leaders reported a number of successes, including development of rapport and trust between mentors and PHC staff, introduction of team-based quality improvement processes, correct and consistent use of a new case sheet to ensure adherence to clinical guidelines, and increases in staff nurses’ knowledge and skills. Overall, nurses in many PHCs reported an increased ability to provide care according to guidelines and to handle maternal and newborn complications, along with improvements in equipment and supplies and referral management. Challenges included high service delivery volumes and/or understaffing at some PHCs, unsupportive or absent PHC leadership, and cultural practices that impacted quality. Comprehensive mentoring can build competence and improve performance by combining on-the-job clinical and technical support, applying quality improvement principles, and promoting team-based problem solving. PMID:26681711

The classroom competence and attitudes towards pedagogical principles of beginning teachers.

PubMed

Preece, P F

1994-06-01

The relationship between preservice education students' (N = 135) attitudes towards general pedagogical principles and the quality of their classroom teaching was investigated. A weak negative relationship was obtained between students' attitudes and the assessment category 'relationships with children'. This suggests that fostering positive attitudes in preservice students towards general pedagogical principles, based on practices in themselves directly associated with enhancing pupil achievement, may result in lower quality teaching because of an adverse effect this has on pupil-teacher relationships.

From Toyota to the bedside: nurses can lead the lean way in health care reform.

PubMed

Johnson, Joyce E; Smith, Amy L; Mastro, Kari A

2012-01-01

The advent of health care reform means new pressures on American hospitals, which will be forced to do more with less. In the next decade, increased use of "Lean" principles and practices in hospitals can create real value by reducing waste and improving productivity, costs, quality, and the timely delivery of patient care services. In 2010, the Institute of Medicine recommended that nurses lead collaborative quality improvement efforts and assume a major role in redesigning health care in the United States. In this article, we provide an overview of the use of Lean techniques in health care and 2 case studies of successful, nurse-directed Lean initiatives at the Robert Wood Johnson University Hospital. The article concludes with some lessons we have learned and implications for nursing education in the future that must include the concepts, tools, and skills required for adapting Lean to the patient care environment.

[A modified speech enhancement algorithm for electronic cochlear implant and its digital signal processing realization].

PubMed

Wang, Yulin; Tian, Xuelong

2014-08-01

In order to improve the speech quality and auditory perceptiveness of electronic cochlear implant under strong noise background, a speech enhancement system used for electronic cochlear implant front-end was constructed. Taking digital signal processing (DSP) as the core, the system combines its multi-channel buffered serial port (McBSP) data transmission channel with extended audio interface chip TLV320AIC10, so speech signal acquisition and output with high speed are realized. Meanwhile, due to the traditional speech enhancement method which has the problems as bad adaptability, slow convergence speed and big steady-state error, versiera function and de-correlation principle were used to improve the existing adaptive filtering algorithm, which effectively enhanced the quality of voice communications. Test results verified the stability of the system and the de-noising performance of the algorithm, and it also proved that they could provide clearer speech signals for the deaf or tinnitus patients.

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings

PubMed Central

Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-01-01

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals’ quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers. PMID:27800337

Evaluation Model of Plate Waste to Monitor Food Consumption in Two Different Catering Settings.

PubMed

Saccares, Stefano; Scognamiglio, Umberto; Moroni, Catia; Marani, Alessandra; Calcaterra, Veronica; Amendola, Mariano; Civitelli, Giulia; Cattaruzza, Maria Sofia; Ermenegildi, Arianna; Morena, Valeria

2014-04-17

An increasing number of people regularly eats lunch away from home, using catering services. In this context, therefore, it is extremely important to improve the meals' quality, remaining faithful to the principles of hygiene, nutritional and organoleptic quality and proper food handling. At the same time, it is necessary to promote food choices, nutritionally correct, by evaluations of appropriateness of menus. The study of food waste allows an evaluation of the nutritional habits of consumers and an important economic consideration of the costs incurred for the implementation of the service. This becomes even more important in some particularly sensitive groups, such as children and elderly. The purpose of this work is to test a model of semi-quantitative evaluation of waste to monitor food consumption in two different catering contexts (educational and business), in order to improve the service for school students and other consumers.

Continual improvement plan

NASA Technical Reports Server (NTRS)

1994-01-01

NASA's approach to continual improvement (CI) is a systems-oriented, agency-wide approach that builds on the past accomplishments of NASA Headquarters and its field installations and helps achieve NASA's vision, mission, and values. The NASA of the future will fully use the principles of continual improvement in every aspect of its operations. This NASA CI plan defines a systematic approach and a model for continual improvement throughout NASA, stressing systems integration and optimization. It demonstrates NASA's constancy of purpose for improvement - a consistent vision of NASA as a worldwide leader in top-quality science, technology, and management practices. The CI plan provides the rationale, structures, methods, and steps, and it defines NASA's short term (1-year) objectives for improvement. The CI plan presents the deployment strategies necessary for cascading the goals and objectives throughout the agency. It also provides guidance on implementing continual improvement with participation from top leadership and all levels of employees.

Endogenous patient responses and the consistency principle in cost-effectiveness analysis.

PubMed

Liu, Liqun; Rettenmaier, Andrew J; Saving, Thomas R

2012-01-01

In addition to incurring direct treatment costs and generating direct health benefits that improve longevity and/or health-related quality of life, medical interventions often have further or "unrelated" financial and health impacts, raising the issue of what costs and effects should be included in calculating the cost-effectiveness ratio of an intervention. The "consistency principle" in medical cost-effectiveness analysis (CEA) requires that one include both the cost and the utility benefit of a change (in medical expenditures, consumption, or leisure) caused by an intervention or neither of them. By distinguishing between exogenous changes directly brought about by an intervention and endogenous patient responses to the exogenous changes, and within a lifetime utility maximization framework, this article addresses 2 questions related to the consistency principle: 1) how to choose among alternative internally consistent exclusion/inclusion rules, and 2) what to do with survival consumption costs and earnings. It finds that, for an endogenous change, excluding or including both the cost and the utility benefit of the change does not alter cost-effectiveness results. Further, in agreement with the consistency principle, welfare maximization implies that consumption costs and earnings during the extended life directly caused by an intervention should be included in CEA.

[Main ways of improvements of the systems of medical rehabilitation of military servicemen after cardiovascular surgery].

PubMed

Iudin, V E; Klimko, V V; Shkarupa, O F; Guzenko, I E

2014-08-01

For better improvement of medical rehabilitation referred to effective restoration of functional status of servicemen after cardiovascular surgery it is necessary to introduce standards of medical rehabilitation at all stages of rehabilitation, syndrome-pathologic principle of grouping patients, multidisciplinary organisation of medical activity: cardiologist-physician, specialist of functional diagnostics, specialist of physical therapy, psychotherapist, physical therapeutic, surgeon and specialist of professional rehabilitation. Basic ways of improvement of the system of rehabilitation were organisational technologies of interaction during early and late stages of rehabilitation and persistent control of quality and effectiveness of rehabilitation. Optimization of organisation of late stage of hospitalisation allowed to reduce the average time of rehabilitation to 33,3% and at the same time to improve effectiveness of rehabilitation.

Improving physics education in radiology.

PubMed

Hendee, William R

2007-08-01

Concern is growing that the physics education of radiologists is flawed and that without knowledge of physics principles and applications, mastery of the technology of medical imaging is impaired. Furthermore, it is proposed that a mastery of imaging technology is necessary to perfect the clinical acumen of radiologists and to preserve the quality, safety, and cost-effectiveness of imaging procedures. These issues were the focus of a multiorganizational educational summit on physics education of radiologists held in January 2006 in Atlanta. Recommendations for improving the physics education and knowledge of radiologists that evolved from this summit are presented here, together with progress made to date on their fulfillment.

Market-Based Health Care in Specialty Surgery: Finding Patient-Centered Shared Value.

PubMed

Smith, Timothy R; Rambachan, Aksharananda; Cote, David; Cybulski, George; Laws, Edward R

2015-10-01

: The US health care system is struggling with rising costs, poor outcomes, waste, and inefficiency. The Patient Protection and Affordable Care Act represents a substantial effort to improve access and emphasizes value-based care. Value in health care has been defined as health outcomes for the patient per dollar spent. However, given the opacity of health outcomes and cost, the identification and quantification of patient-centered value is problematic. These problems are magnified by highly technical, specialized care (eg, neurosurgery). This is further complicated by potentially competing interests of the 5 major stakeholders in health care: patients, doctors, payers, hospitals, and manufacturers. These stakeholders are watching with great interest as health care in the United States moves toward a value-based system. Market principles can be harnessed to drive costs down, improve outcomes, and improve overall value to patients. However, there are many caveats to a market-based, value-driven system that must be identified and addressed. Many excellent neurosurgical efforts are already underway to nudge health care toward increased efficiency, decreased costs, and improved quality. Patient-centered shared value can provide a philosophical mooring for the development of health care policies that utilize market principles without losing sight of the ultimate goals of health care, to care for patients.

Clinical practice guideline development manual: A quality-driven approach for translating evidence into action

PubMed Central

Rosenfeld, Richard M.; Shiffman, Richard N.

2010-01-01

Background Guidelines translate best evidence into best practice. A well-crafted guideline promotes quality by reducing healthcare variations, improving diagnostic accuracy, promoting effective therapy, and discouraging ineffective – or potentially harmful – interventions. Despite a plethora of published guidelines, methodology is often poorly defined and varies greatly within and among organizations. Purpose This manual describes the principles and practices used successfully by the American Academy of Otolaryngology – Head and Neck Surgery to produce quality-driven, evidence-based guidelines using efficient and transparent methodology for action-ready recommendations with multi-disciplinary applicability. The development process, which allows moving from conception to completion in twelve months, emphasizes a logical sequence of key action statements supported by amplifying text, evidence profiles, and recommendation grades that link action to evidence. Conclusions As clinical practice guidelines become more prominent as a key metric of quality healthcare, organizations must develop efficient production strategies that balance rigor and pragmatism. Equally important, clinicians must become savvy in understanding what guidelines are – and are not – and how they are best utilized to improve care. The information in this manual should help clinicians and organizations achieve these goals. PMID:19464525

Sustainable improvement of animal health care by systematic quality risk management according to the HACCP concept.

PubMed

Noordhuizen, J P; Welpelo, H J

1996-12-01

This paper addresses the principles of the Hazard Analysis Critical Control Point (HACCP) concept as applied to animal health management strategy. Characteristics of the concept were analysed and compared with those of current animal health care strategies for disease risk identification and herd health management, insurance, and certification. HACCP is a hybrid strategy of quality control at both production process and product level. Animal health is considered a particular quality feature. We show that process control (expressed in terms of controlling both general and specific disease risk factors) and product control (expressed in terms of testing animals or animal products for specific disease agents) could form the basis for improving animal health. We conclude that HACCP provides ample opportunity for preventive health action and risk management at a relatively low cost in terms of labour, finance and documentation expenditure, at both the farm and sector level. Epidemiological field studies are currently needed to identify critical control points and to design HACCP procedures for livestock producers. In the long run, HACCP based animal health care can be further developed into a quality control systems approach to cover all aspects that are related, either directly or indirectly, to animal health.

MO-AB-206-02: Testing Gamma Cameras Based On TG177 WG Report

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

Halama, J.

2016-06-15

This education session will cover the physics and operation principles of gamma cameras and PET scanners. The first talk will focus on PET imaging. An overview of the principles of PET imaging will be provided, including positron decay physics, and the transition from 2D to 3D imaging. More recent advances in hardware and software will be discussed, such as time-of-flight imaging, and improvements in reconstruction algorithms that provide for options such as depth-of-interaction corrections. Quantitative applications of PET will be discussed, as well as the requirements for doing accurate quantitation. Relevant performance tests will also be described. Learning Objectives: Bemore » able to describe basic physics principles of PET and operation of PET scanners. Learn about recent advances in PET scanner hardware technology. Be able to describe advances in reconstruction techniques and improvements Be able to list relevant performance tests. The second talk will focus on gamma cameras. The Nuclear Medicine subcommittee has charged a task group (TG177) to develop a report on the current state of physics testing of gamma cameras, SPECT, and SPECT/CT systems. The report makes recommendations for performance tests to be done for routine quality assurance, annual physics testing, and acceptance tests, and identifies those needed satisfy the ACR accreditation program and The Joint Commission imaging standards. The report is also intended to be used as a manual with detailed instructions on how to perform tests under widely varying conditions. Learning Objectives: At the end of the presentation members of the audience will: Be familiar with the tests recommended for routine quality assurance, annual physics testing, and acceptance tests of gamma cameras for planar imaging. Be familiar with the tests recommended for routine quality assurance, annual physics testing, and acceptance tests of SPECT systems. Be familiar with the tests of a SPECT/CT system that include the CT images for SPECT reconstructions. Become knowledgeable of items to be included in annual acceptance testing reports including CT dosimetry and PACS monitor measurements. T. Turkington, GE Healthcare.« less

MO-AB-206-00: Nuclear Medicine Physics and Testing

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

NONE

This education session will cover the physics and operation principles of gamma cameras and PET scanners. The first talk will focus on PET imaging. An overview of the principles of PET imaging will be provided, including positron decay physics, and the transition from 2D to 3D imaging. More recent advances in hardware and software will be discussed, such as time-of-flight imaging, and improvements in reconstruction algorithms that provide for options such as depth-of-interaction corrections. Quantitative applications of PET will be discussed, as well as the requirements for doing accurate quantitation. Relevant performance tests will also be described. Learning Objectives: Bemore » able to describe basic physics principles of PET and operation of PET scanners. Learn about recent advances in PET scanner hardware technology. Be able to describe advances in reconstruction techniques and improvements Be able to list relevant performance tests. The second talk will focus on gamma cameras. The Nuclear Medicine subcommittee has charged a task group (TG177) to develop a report on the current state of physics testing of gamma cameras, SPECT, and SPECT/CT systems. The report makes recommendations for performance tests to be done for routine quality assurance, annual physics testing, and acceptance tests, and identifies those needed satisfy the ACR accreditation program and The Joint Commission imaging standards. The report is also intended to be used as a manual with detailed instructions on how to perform tests under widely varying conditions. Learning Objectives: At the end of the presentation members of the audience will: Be familiar with the tests recommended for routine quality assurance, annual physics testing, and acceptance tests of gamma cameras for planar imaging. Be familiar with the tests recommended for routine quality assurance, annual physics testing, and acceptance tests of SPECT systems. Be familiar with the tests of a SPECT/CT system that include the CT images for SPECT reconstructions. Become knowledgeable of items to be included in annual acceptance testing reports including CT dosimetry and PACS monitor measurements. T. Turkington, GE Healthcare.« less

Quality Management in U.S. High Schools: Evidence from the Field.

ERIC Educational Resources Information Center

Detert, James R.; Bauerly Kopel, Michelle E.; Mauriel, John J.; Jenni, Roger W.

2000-01-01

Reports on a longitudinal study examining implementation of a Quality Management reform based on Deming's seven principles. Interview and survey data from a national sample of purposefully chosen high schools show limited results as to teachers' effective use and institutionalization of TQM principles. The principal's role is critical. (Contains…

10 Principles for Building a High-Quality System of Assessments

ERIC Educational Resources Information Center

Jobs for the Future, 2018

2018-01-01

Many states and districts are working toward developing and implementing high-quality systems that align assessments with each other, and to college and career readiness, and a comprehensive set of higher-order thinking skills. In order to support states, districts, and communities in this, the following 10 principles as guidance and common…

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

ERIC Educational Resources Information Center

Waks, Shlomo; Frank, Moti

1999-01-01

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

Applying Toyota production system techniques for medication delivery: improving hospital safety and efficiency.

PubMed

Newell, Terry L; Steinmetz-Malato, Laura L; Van Dyke, Deborah L

2011-01-01

The inpatient medication delivery system used at a large regional acute care hospital in the Midwest had become antiquated and inefficient. The existing 24-hr medication cart-fill exchange process with delivery to the patients' bedside did not always provide ordered medications to the nursing units when they were needed. In 2007 the principles of the Toyota Production System (TPS) were applied to the system. Project objectives were to improve medication safety and reduce the time needed for nurses to retrieve patient medications. A multidisciplinary team was formed that included representatives from nursing, pharmacy, informatics, quality, and various operational support departments. Team members were educated and trained in the tools and techniques of TPS, and then designed and implemented a new pull system benchmarking the TPS Ideal State model. The newly installed process, providing just-in-time medication availability, has measurably improved delivery processes as well as patient safety and satisfaction. Other positive outcomes have included improved nursing satisfaction, reduced nursing wait time for delivered medications, and improved efficiency in the pharmacy. After a successful pilot on two nursing units, the system is being extended to the rest of the hospital. © 2010 National Association for Healthcare Quality.

Improving the Quality of Survivorship for Older Adults with Cancer

PubMed Central

Mohile, Supriya G.; Hurria, Arti; Cohen, Harvey J.; Rowland, Julia H.; Leach, Corinne R.; Arora, Neeraj K.; Canin, Beverly; Muss, Hyman; Magnuson, Allison; Flannery, Marie; Lowenstein, Lisa; Allore, Heather; Mustian, Karen; Demark-Wahnefried, Wendy; Extermann, Martine; Ferrell, Betty; Inouye, Sharon; Studenski, Stephanie; Dale, William

2016-01-01

In May 2015, the Cancer and Aging Research Group (CARG), in collaboration with the National Cancer Institute and the National Institute on Aging through a U13 grant, convened a conference to identify research priorities to help design and implement intervention studies to improve the quality of life and survivorship of older, frailer adults with cancer. Conference attendees included researchers with multidisciplinary expertise and advocates. It was concluded that future intervention trials for older adults with cancer should: 1) rigorously test interventions to prevent decline or improve health status, especially interventions focused on optimizing physical performance, nutritional status, and cognition while undergoing cancer treatment; 2) utilize standardized care plans based on geriatric assessment findings to guide targeted interventions; and 3) incorporate the principles of geriatrics into survivorship care plans. Also highlighted was the need to integrate the expertise of interdisciplinary team members into geriatric oncology research, improve funding mechanisms to support geriatric oncology research, and disseminate high-impact results to the research and clinical community. In conjunction with the prior two U13 meetings, this conference provides the framework for future research to improve the evidence base for the clinical care of older adults with cancer. PMID:27172129

The effects of prospective mate quality on investments in healthy body weight among single women.

PubMed

Harris, Matthew C; Cronin, Christopher J

2017-02-01

This paper examines how a single female's investment in healthy body weight is affected by the quality of single males in her marriage market. A principle concern in estimation is the presence of market-level unobserved heterogeneity that may be correlated with changes in single male quality, measured as earning potential. To address this concern, we employ a differencing strategy that normalizes the exercise behaviors of single women to those of their married counterparts. Our main results suggest that when potential mate quality in a marriage market decreases, single black women invest less in healthy body weight. For example, we find that a 10 percentage point increase in the proportion of low quality single black males leads to a 5-10% decrease in vigorous exercise taken by single black females. Results for single white women are qualitatively similar, but not consistent across specifications. These results highlight the relationship between male and female human capital acquisition that is driven by participation in the marriage market. Our results suggest that programs designed to improve the economic prospects of single males may yield positive externalities in the form of improved health behaviors, such as more exercise, particularly for single black females. Copyright © 2016 Elsevier B.V. All rights reserved.

The Applicability of Lean and Six Sigma Techniques to Clinical and Translational Research

PubMed Central

Schweikhart, Sharon A.; Dembe, Allard E

2010-01-01

Background Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside of the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma to improve the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the NIH Roadmap for Biomedical Research and the NIH Clinical and Translational Science Award (CTSA) program. Methods This article presents a description of the main principles, practices, and methodologies used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Results Examples are provided of Lean and Six Sigma applications that are being planned at a current CTSA site, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particularly translational research phases. Conclusions Lean and Six Sigma process improvement methodologies are well suited to help achieve NIH’s goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice. PMID:19730130

The applicability of Lean and Six Sigma techniques to clinical and translational research.

PubMed

Schweikhart, Sharon A; Dembe, Allard E

2009-10-01

Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma in improving the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the National Institutes of Health (NIH) Roadmap for Medical Research and the NIH's Clinical and Translational Science Award program. This article presents a description of the main principles, practices, and methods used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. Examples of Lean and Six Sigma applications that are being planned at a current Clinical and Translational Science Award site are provided, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particular translational research phases. Lean and Six Sigma process improvement methods are well suited to help achieve NIH's goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice.

Research in action: using positive deviance to improve quality of health care

PubMed Central

Bradley, Elizabeth H; Curry, Leslie A; Ramanadhan, Shoba; Rowe, Laura; Nembhard, Ingrid M; Krumholz, Harlan M

2009-01-01

Background Despite decades of efforts to improve quality of health care, poor performance persists in many aspects of care. Less than 1% of the enormous national investment in medical research is focused on improving health care delivery. Furthermore, when effective innovations in clinical care are discovered, uptake of these innovations is often delayed and incomplete. In this paper, we build on the established principle of 'positive deviance' to propose an approach to identifying practices that improve health care quality. Methods We synthesize existing literature on positive deviance, describe major alternative approaches, propose benefits and limitations of a positive deviance approach for research directed toward improving quality of health care, and describe an application of this approach in improving hospital care for patients with acute myocardial infarction. Results The positive deviance approach, as adapted for use in health care, presumes that the knowledge about 'what works' is available in existing organizations that demonstrate consistently exceptional performance. Steps in this approach: identify 'positive deviants,' i.e., organizations that consistently demonstrate exceptionally high performance in the area of interest (e.g., proper medication use, timeliness of care); study the organizations in-depth using qualitative methods to generate hypotheses about practices that allow organizations to achieve top performance; test hypotheses statistically in larger, representative samples of organizations; and work in partnership with key stakeholders, including potential adopters, to disseminate the evidence about newly characterized best practices. The approach is particularly appropriate in situations where organizations can be ranked reliably based on valid performance measures, where there is substantial natural variation in performance within an industry, when openness about practices to achieve exceptional performance exists, and where there is an engaged constituency to promote uptake of discovered practices. Conclusion The identification and examination of health care organizations that demonstrate positive deviance provides an opportunity to characterize and disseminate strategies for improving quality. PMID:19426507

TH-E-19A-01: Quality and Safety in Radiation Therapy

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

Ford, E; Ezzell, G; Miller, B

2014-06-15

Clinical radiotherapy data clearly demonstrate the link between the quality and safety of radiation treatments and the outcome for patients. The medical physicist plays an essential role in this process. To ensure the highest quality treatments, the medical physicist must understand and employ modern quality improvement techniques. This extends well beyond the duties traditionally associated with prescriptive QA measures. This session will review the current best practices for improving quality and safety in radiation therapy. General elements of quality management will be reviewed including: what makes a good quality management structure, the use of prospective risk analysis such as FMEA,more » and the use of incident learning. All of these practices are recommended in society-level documents and are incorporated into the new Practice Accreditation program developed by ASTRO. To be effective, however, these techniques must be practical in a resource-limited environment. This session will therefore focus on practical tools such as the newly-released radiation oncology incident learning system, RO-ILS, supported by AAPM and ASTRO. With these general constructs in mind, a case study will be presented of quality management in an SBRT service. An example FMEA risk assessment will be presented along with incident learning examples including root cause analysis. As the physicist's role as “quality officer” continues to evolve it will be essential to understand and employ the most effective techniques for quality improvement. This session will provide a concrete overview of the fundamentals in quality and safety. Learning Objectives: Recognize the essential elements of a good quality management system in radiotherapy. Understand the value of incident learning and the AAPM/ASTRO ROILS incident learning system. Appreciate failure mode and effects analysis as a risk assessment tool and its use in resource-limited environments. Understand the fundamental principles of good error proofing that extends beyond traditional prescriptive QA measures.« less

[Quality management and safety culture in medicine: context and concepts].

PubMed

Wischet, Werner; Eitzinger, Claudia

2009-01-01

The publication of the IOM report "To err is human: building a safer health system" in 1999 put spotlight on the primacy of the principle of primum non nocere and made patient safety a central topic of quality management. A key conclusion of the report was the need for a well-developed safety culture. While concepts of quality management have evolved along the lines of ISO and Total Quality Management over the last decades patient safety still has not got the same amount of attention (PubMed). Evidence from other safety-critical areas but also from the field of medicine itself suggests that an efficient culture of safety is a conditio sine qua non for the sustainable improvement of patient safety. Considering these arguments the present paper aims at emphasizing the importance of an efficient culture of safety for patient safety and quality management in healthcare. In addition, key instruments of safety culture as well as their limitations will be presented.

Integration of pharmacists into a patient-centered medical home.

PubMed

Scott, Mollie Ashe; Hitch, Bill; Ray, Lisa; Colvin, Gaye

2011-01-01

To define the joint principles of the patient-centered medical home (PCMH) and describe the integration of pharmacists into a PCMH. Family medicine residency training program in North Carolina from 2001 to 2011. Mountain Area Health Education Family Health Center is a family medicine residency training program that is part of the North Carolina Area Health Education Center system. The goal of the organization is to train and retain health care students and residents. The practice is recognized as a level III PCMH by the National Committee for Quality Assurance (NCQA) and seeks to provide quality, safe, patient-centered care according to the joint principles of PCMH. Pharmacists, nurses, nutritionists, care managers, Spanish translators, and behavioral medicine specialists work collaboratively with physicians to provide seamless, comprehensive care. The Department of Pharmacotherapy is embedded in the family medicine clinic. Three pharmacists and two pharmacy residents are involved in providing direct patient care services, ensuring access to community resources, assisting patients with transitions of care, providing interprofessional education, and participating in continuous quality improvement initiatives. The pharmacists serve as clinical pharmacist practitioners and provide medication therapy management services in a pharmacotherapy clinic, anticoagulation clinics, and an osteoporosis clinic and via an inpatient family medicine service. Multiple learners such as student pharmacists, pharmacy residents, and family medicine residents rotate through the various pharmacy clinics to learn about pharmacotherapeutic principles and the role of the pharmacist in PCMH. PCMH is a comprehensive, patient-centered, team-based approach to population management in the primary care setting. Pharmacists play a vital role in PCMH and make fundamental contributions to patient care across health care settings. Such innovations in the ambulatory care setting create a unique niche for pharmacists to use their skills.

Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer.

PubMed

Kim, Yeon Hee; Kim, Hwa Jung; Ahn, Seung Do; Seo, Yun Jeong; Kim, So Hee

2013-08-01

To investigate the effects of meditation on anxiety, depression, fatigue, and quality of life in women who are receiving radiation therapy for breast cancer. Randomized, non-program controlled, parallel intervention clinical trial. The ASAN Cancer Center located in Seoul, Korea. The subjects of this study included 102 female breast cancer patients who had undergone breast-conserving surgery; these female patients were randomized into equally assigned meditation control groups, with each group consisting of 51 patients. The test group received a total of 12 meditation therapy sessions during their 6-week radiation therapy period, and the control group underwent only a conventional radiation therapy. The tools used to evaluate the effects of meditation were Hospital Anxiety and Depression scale, Revised Piper Fatigue scale, and European Organization for Research and Treatment of Cancer-Quality of Life Core-30. The results were analyzed based on the principles of intention-to-treat analysis, and, as a corollary analysis, per-protocol analysis was conducted. The breast cancer patients who received meditation therapy compared with the non-intervention group saw improvements in reduction of anxiety (p=.032), fatigue (p=.030), and improvement in global quality of life (p=.028). Based on the results of this study, an affirmation can be made that meditation can be used as a non-invasive intervention treatment for improving fatigue, anxiety, quality of life, and emotional faculties of women with breast cancer. Copyright © 2013 Elsevier Ltd. All rights reserved.

Quality improvement in medical education: current state and future directions.

PubMed

Wong, Brian M; Levinson, Wendy; Shojania, Kaveh G

2012-01-01

During the last decade, there has been a drive to improve the quality of patient care and prevent the occurrence of avoidable errors. This review describes current efforts to teach or engage trainees in patient safety and quality improvement (QI), summarises progress to date, as well as successes and challenges, and lists our recommendations for the next steps that will shape the future of patient safety and QI in medical education. Trainees encounter patient safety and QI through three main groups of activity. First are formal curricula that teach concepts or methods intended to facilitate trainees' participation in QI activities. These curricula increase learner knowledge and may improve clinical processes, but demonstrate limited capacity to modify learner behaviours. Second are educational activities that impart specific skills related to safety or quality which are considered to represent core doctor competencies (e.g. effective patient handover). These are frequently taught effectively, but without emphasis on the general safety or quality principles that inform the relevant skills. Third are real-life QI initiatives that involve trainees as active or passive participants. These innovative approaches expose trainees to safety and quality by integrating QI activities into trainees' day-to-day work. However, this integration can be challenging and can sometimes result in tension with broader educational goals. To prepare the next generation of doctors to make meaningful contributions to the quality mission, we propose the following call to action. Firstly, a major effort to build faculty capacity, especially among teachers of QI, should be instigated. Secondly, accreditation standards and assessment methods, both during training and at end-of-training certification examinations, should explicitly target these competencies. Finally, and perhaps most importantly, we must refocus our attention at all levels of training and instil fundamental, collaborative, open-minded behaviours so that future clinicians are primed to promote a culture of safer, higher-quality care. © Blackwell Publishing Ltd 2012.

Reporting Quality of Randomized, Controlled Trials Evaluating Combined Chemoradiotherapy in Nasopharyngeal Carcinoma

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

Chen, Yu-Pei; Chen, Lei; Li, Wen-Fei

Purpose: To comprehensively assess the reporting quality of randomized, controlled trials (RCTs) in nasopharyngeal carcinoma (NPC), and to identify significant predictors of quality. Methods and Materials: Two investigators searched MEDLINE and EMBASE for RCTs published between January 1988 and December 2015 that assessed the effect of combined chemoradiotherapy for NPC. The overall quality of each report was assessed using a 28-point overall quality score (OQS) based on the 2010 Consolidated Standards of Reporting Trials (CONSORT) statement. To provide baseline data for further evaluation, we also investigated the reporting quality of certain important issues in detail, including key methodologic items (allocationmore » concealment, blinding, intention-to-treat principle), endpoints, follow-up, subgroup analyses, and adverse events. Results: We retrieved 24 relevant RCTs including 6591 patients. Median 2010 OQS was 15.5 (range, 10-24). Half of the items in the 2010 OQS were poorly reported in at least 40% of trials. Multivariable regression models revealed that publication after 2010 and high impact factor were significant predictors of improved 2010 OQS. Additionally, many issues that we consider significant were not reported adequately. Conclusions: Despite publication of the CONSORT statement more than a decade ago, overall reporting quality for RCTs in NPC was unsatisfactory. Additionally, substantial selectivity and heterogeneity exists in reporting of certain crucial issues. This survey provides the first prompt for NPC trial investigators to improve reporting quality according to the CONSORT statement; increased scrutiny and diligence by editors and peer reviewers is also required.« less

JPRS Report, Near East & South Asia

DTIC Science & Technology

1991-03-21

c m is was be I continue to believe that the left, as a principle, will stay thatgthentio alive, I certainly did not mean "this" left. strengthened...quality cannot get this foreign currency from the banks but who for local products will be improving and costs will be need it to receive treatment...punishment and will tie wages to produc- Indebtedness is undoubtedly an important and a serious tion and prices. It will also set forth a system by means

Lean Six Sigma Belt Certification Goals and Standing in TACOM Life Cycle Management Command

DTIC Science & Technology

2010-12-01

goes up must come down, what’s hot eventually cools off” ( Schonberger , 2008, p. 1). Industry was tiring of just-in-time and total quality control by...placard ( Schonberger , 2008). In the next paragraphs, we will explore the concept of Lean Six Sigma by looking at the histories and principles behind...20_1- 10_.pdf Schonberger , R. (2008). Best Practices in Lean Six Sigma Process Improvement, A Deeper Look. New Jersey: John Wiley & Sons, Inc

Well-being outcomes of chiropractic intervention for lower back pain: a systematic review.

PubMed

Parkinson, Lynne; Sibbritt, David; Bolton, Philip; van Rotterdam, Joan; Villadsen, Inger

2013-02-01

The usefulness of chiropractic for treatment of low back pain is a contentious issue. Chiropractors advocate holism and general well-being as a key principle on which they base their clinical practice, yet the quality of life, lifestyle, health and economic impacts of chiropractic intervention for back pain in adults have rarely been investigated. This article provides an overview of chiropractic principles and practices, together with the results of a systematic review of peer-reviewed publications between 2000 and 2010 retrieved from MEDLINE, CINAHL, EMBASE, AMED and Cochrane Database of Systematic Reviews. This review sought to determine the benefits of chiropractic treatment and care to well-being, and to what extent chiropractic treatment and care improve quality of life. Of 1,165 articles, 12 articles were retained, representing six studies (four randomised controlled trial, two observational) of varying quality. There was a high degree of inconsistency and lack of standardisation in measurement instruments and outcome measures. Three studies reported reduced use of other/extra treatments as a positive outcome; two studies reported a positive effect of chiropractic intervention on pain, and two studies reported a positive effect on disability. The six studies reviewed concentrated on the impact of chiropractic care on physical health and disability, rather than the wider holistic view which was the focus of this study. It is difficult, therefore, to defend any conclusion about the impact of chiropractic intervention on the quality of life, lifestyle, health and economic impact on chiropractic patients presenting with back pain.

Toward population management in an integrated care model.

PubMed

Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

2013-04-01

Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative.

Toward population management in an integrated care model.

PubMed

Maddux, Franklin W; McMurray, Stephen; Nissenson, Allen R

2013-01-01

Under the Patient Protection and Affordable Care Act of 2010, accountable care organizations (ACOs) will be the primary mechanism for achieving the dual goals of high-quality patient care at managed per capita costs. To achieve these goals in the newly emerging health care environment, the nephrology community must plan for and direct integrated delivery and coordination of renal care, focusing on population management. Even though the ESRD patient population is a complex group with comorbid conditions that may confound integration of care, the nephrology community has unique experience providing integrated care through ACO-like programs. Specifically, the recent ESRD Management Demonstration Project sponsored by the Centers for Medicare & Medicaid Services and the current ESRD Prospective Payment System with it Quality Incentive Program have demonstrated that integrated delivery of renal care can be accomplished in a manner that provides improved clinical outcomes with some financial margin of savings. Moving forward, integrated renal care will probably be linked to provider performance and quality outcomes measures, and clinical integration initiatives will share several common elements, namely performance-based payment models, coordination of communication via health care information technology, and development of best practices for care coordination and resource utilization. Integration initiatives must be designed to be measured and evaluated, and, consistent with principles of continuous quality improvement, each initiative will provide for iterative improvements of the initiative. © 2013 S. Karger AG, Basel.

Extended principle component analysis - a useful tool to understand processes governing water quality at catchment scales

NASA Astrophysics Data System (ADS)

Selle, B.; Schwientek, M.

2012-04-01

Water quality of ground and surface waters in catchments is typically driven by many complex and interacting processes. While small scale processes are often studied in great detail, their relevance and interplay at catchment scales remain often poorly understood. For many catchments, extensive monitoring data on water quality have been collected for different purposes. These heterogeneous data sets contain valuable information on catchment scale processes but are rarely analysed using integrated methods. Principle component analysis (PCA) has previously been applied to this kind of data sets. However, a detailed analysis of scores, which are an important result of a PCA, is often missing. Mathematically, PCA expresses measured variables on water quality, e.g. nitrate concentrations, as linear combination of independent, not directly observable key processes. These computed key processes are represented by principle components. Their scores are interpretable as process intensities which vary in space and time. Subsequently, scores can be correlated with other key variables and catchment characteristics, such as water travel times and land use that were not considered in PCA. This detailed analysis of scores represents an extension of the commonly applied PCA which could considerably improve the understanding of processes governing water quality at catchment scales. In this study, we investigated the 170 km2 Ammer catchment in SW Germany which is characterised by an above average proportion of agricultural (71%) and urban (17%) areas. The Ammer River is mainly fed by karstic springs. For PCA, we separately analysed concentrations from (a) surface waters of the Ammer River and its tributaries, (b) spring waters from the main aquifers and (c) deep groundwater from production wells. This analysis was extended by a detailed analysis of scores. We analysed measured concentrations on major ions and selected organic micropollutants. Additionally, redox-sensitive variables and environmental tracers indicating groundwater age were analysed for deep groundwater from production wells. For deep groundwater, we found that microbial turnover was stronger influenced by local availability of energy sources than by travel times of groundwater to the wells. Groundwater quality primarily reflected the input of pollutants determined by landuse, e.g. agrochemicals. We concluded that for water quality in the Ammer catchment, conservative mixing of waters with different origin is more important than reactive transport processes along the flow path.

Perceptual tools for quality-aware video networks

NASA Astrophysics Data System (ADS)

Bovik, A. C.

2014-01-01

Monitoring and controlling the quality of the viewing experience of videos transmitted over increasingly congested networks (especially wireless networks) is a pressing problem owing to rapid advances in video-centric mobile communication and display devices that are straining the capacity of the network infrastructure. New developments in automatic perceptual video quality models offer tools that have the potential to be used to perceptually optimize wireless video, leading to more efficient video data delivery and better received quality. In this talk I will review key perceptual principles that are, or could be used to create effective video quality prediction models, and leading quality prediction models that utilize these principles. The goal is to be able to monitor and perceptually optimize video networks by making them "quality-aware."

Assessment of an Internet-Delivered Interactive Approach to Introductory Astronomy for Non-Science Majors

ERIC Educational Resources Information Center

Slater, Timothy F.; Jones, Lauren V.

2004-01-01

This project explores the effectiveness of learner-centered education (LCE) principles and practices on student learning and attitudes in an online interactive introductory astronomy course for non-science majors by comparing a high-quality Internet-delivered course with a high-quality on-campus course, both of which are based on the principles of…

Quality of Life and its Measurement: Important Principles and Guidelines

ERIC Educational Resources Information Center

Verdugo, M. A.; Schalock, R. L.; Keith, K. D.; Stancliffe, R. J.

2005-01-01

Background: The importance of the valid assessment of quality of life (QOL) is heightened with the increased use of the QOL construct as a basis for policies and practices in the field of intellectual disability (ID). Method: This article discusses the principles that should guide the measurement process, the major interrogatories (i.e. who, what,…

External Quality Arrangements for the Review of Modern Apprenticeship Off-the-Job Training

ERIC Educational Resources Information Center

Education Scotland, 2015

2015-01-01

This publication provides a quality framework to provide a structure for external review of Modern Apprenticeship off-the-job training.? The indicators in this framework are arranged under three key principles, addressing five questions which Education Scotland is adopting for evaluation purposes. These are underpinned by a wider principle on the…

Tensions between materials and environmental quality.

PubMed

Carpenter, R A

1976-02-20

The tensions between availability of materials and quality of the environment will increase with economic growth and the appreciation of environmental values. These tensions can be relieved to an extent by internalizing the costs of environmental protection so that they are reflected in the price of materials. Economic incentives and disincentives, such as effluent fees, are receiving renewed attention (5, pp. 49-51). In addition, government regulation to protect the environment will, perhaps arbitrarily, affect the availability and use of materials. The report, Man, Materials, and Environment (5, p. 25), concluded that: A national materials policy should be based upon the principle that calculations of benefits and costs associated with the extraction, transport, processing, use, and disposal of materials should take full account of the value of common property resources and of any change in the value of common properties resulting from the impact of materials on the environment; and should support the principle that those responsible for impairment of the environment should bear the costs of damage or repair. These principles should become a commonplace element of property rights, legislation, and administrative practice at all levels of government. The difficulty of measuring benefits and costs should not delay adoption of these principles but suggests the need for continuous observation and experimentation. Environmental protection regulations will result in: (i) increased costs for many materials; (ii) disruptive changes in use of materials, due to environmental characteristics and revised cost effectiveness calculations; (iii) restrictions on the siting of processing and manufacturing installations; (iv) preemption of access and surface rights to some mineral bearing lands, particularly those that are federally controlled; (v) diversion of capital from new production facilities; and (vi) frustrating delays in decisions, such as those affecting leasing and plant siting. In return for these generally undesirable disruptions in the continued development and supply of materials, society will obtain: (i) improved quality of air and water; (ii) long-term protection of the natural ecosystems of which man is a part; (iii) more efficient allocation of natural resources on the basis of more accurate and complete accounting of costs; (iv) improved human health through decreased contamination of the environment with toxic substances; and (v) conservation of materials through a closing of the production, use, and disposal cycle. Ingenuity and a more complete understanding of the parts and interactions of the energy, materials, and environment system can do much to reduce the tensions in these conflicts and bring about equitable trade-offs among societal goals.

Availability of Care Concordant With Patient-centered Medical Home Principles Among Those With Chronic Conditions: Measuring Care Outcomes.

PubMed

Pourat, Nadereh; Charles, Shana A; Snyder, Sophie

2016-03-01

Care delivery redesign in the form of patient-centered medical home (PCMH) is considered as a potential solution to improve patient outcomes and reduce costs, particularly for patients with chronic conditions. But studies of prevalence or impact at the population level are rare. We aimed to assess whether desired outcomes indicating better care delivery and patient-centeredness were associated with receipt of care according to 3 important PCMH principles. We analyzed data from a representative population survey in California in 2009, focusing on a population with chronic condition who had a usual source of care. We used bivariate, logistic, and negative-binomial regressions. The indicators of PCMH concordant care included continuity of care (personal doctor), care coordination, and care management (individual treatment plan). Outcomes included flu shots, count of outpatient visits, any emergency department visit, timely provider communication, and confidence in self-care. We found that patients whose care was concordant with all 3 PCMH principles were more likely to receive flu shots, more outpatient care, and timely response from providers. Concordance with 2 principles led to some desired outcomes. Concordance with only 1 principle was not associated with desired outcomes. Patients who received care that met 3 key aspects of PCMH: coordination, continuity, and management, had better quality of care and more efficient use of the health care system.

Measuring the value of process improvement initiatives in a preoperative assessment center using time-driven activity-based costing.

PubMed

French, Katy E; Albright, Heidi W; Frenzel, John C; Incalcaterra, James R; Rubio, Augustin C; Jones, Jessica F; Feeley, Thomas W

2013-12-01

The value and impact of process improvement initiatives are difficult to quantify. We describe the use of time-driven activity-based costing (TDABC) in a clinical setting to quantify the value of process improvements in terms of cost, time and personnel resources. Difficulty in identifying and measuring the cost savings of process improvement initiatives in a Preoperative Assessment Center (PAC). Use TDABC to measure the value of process improvement initiatives that reduce the costs of performing a preoperative assessment while maintaining the quality of the assessment. Apply the principles of TDABC in a PAC to measure the value, from baseline, of two phases of performance improvement initiatives and determine the impact of each implementation in terms of cost, time and efficiency. Through two rounds of performance improvements, we quantified an overall reduction in time spent by patient and personnel of 33% that resulted in a 46% reduction in the costs of providing care in the center. The performance improvements resulted in a 17% decrease in the total number of full time equivalents (FTE's) needed to staff the center and a 19% increase in the numbers of patients assessed in the center. Quality of care, as assessed by the rate of cancellations on the day of surgery, was not adversely impacted by the process improvements. © 2013 Published by Elsevier Inc.

Population health management guiding principles to stimulate collaboration and improve pharmaceutical care.

PubMed

Steenkamer, Betty; Baan, Caroline; Putters, Kim; van Oers, Hans; Drewes, Hanneke

2018-04-09

Purpose A range of strategies to improve pharmaceutical care has been implemented by population health management (PHM) initiatives. However, which strategies generate the desired outcomes is largely unknown. The purpose of this paper is to identify guiding principles underlying collaborative strategies to improve pharmaceutical care and the contextual factors and mechanisms through which these principles operate. Design/methodology/approach The evaluation was informed by a realist methodology examining the links between PHM strategies, their outcomes and the contexts and mechanisms by which these strategies operate. Guiding principles were identified by grouping context-specific strategies with specific outcomes. Findings In total, ten guiding principles were identified: create agreement and commitment based on a long-term vision; foster cooperation and representation at the board level; use layered governance structures; create awareness at all levels; enable interpersonal links at all levels; create learning environments; organize shared responsibility; adjust financial strategies to market contexts; organize mutual gains; and align regional agreements with national policies and regulations. Contextual factors such as shared savings influenced the effectiveness of the guiding principles. Mechanisms by which these guiding principles operate were, for instance, fostering trust and creating a shared sense of the problem. Practical implications The guiding principles highlight how collaboration can be stimulated to improve pharmaceutical care while taking into account local constraints and possibilities. The interdependency of these principles necessitates effectuating them together in order to realize the best possible improvements and outcomes. Originality/value This is the first study using a realist approach to understand the guiding principles underlying collaboration to improve pharmaceutical care.

Viewing an ultra-brief chest compression only video improves some measures of bystander CPR performance and responsiveness at a mass gathering event.

PubMed

Beskind, Daniel L; Stolz, Uwe; Thiede, Rebecca; Hoyer, Riley; Robertson, Whitney; Brown, Jeffrey; Ludgate, Melissa; Tiutan, Timothy; Shane, Romy; McMorrow, Deven; Pleasants, Michael; Kern, Karl B; Panchal, Ashish R

2017-09-01

CPR training at mass gathering events is an important part of health initiatives to improve cardiac arrest survival. However, it is unclear whether training lay bystanders using an ultra-brief video at a mass gathering event improves CPR quality and responsiveness. To determine if showing a chest-compression only (CCO) Ultra-Brief Video (UBV) at a mass gathering event is effective in teaching lay bystanders CCO-CPR. Prospective control trial in adults (age >18) who attended either a women's University of Arizona or a men's Phoenix Suns basketball game. Participants were evaluated using a standardized cardiac arrest scenario with Laerdal Skillreporter™ mannequins. CPR responsiveness (calling 911, time to calling 911, starting compressions within two minutes) and quality (compression rate, depth, hands-off time) were assessed for participants and data collected at Baseline and Post-intervention. Different participants were tested before and after the exposure of the UBV. Data were analyzed via the intention to treat principle using logistic regression for binary outcomes and median regression for continuous outcomes, controlling for clustering by venue. A total of 96 people were consented (Baseline=45; Post intervention=51). CPR responsiveness post intervention improved with faster time to calling 911 (s) and time to starting compressions (sec). Likewise, CPR quality improved with deeper compressions and improved hands-off time. Showing a UBV at a mass gathering sporting event is associated with improved CPR responsiveness and performance for lay bystanders. This data provides further support for the use of mass media interventions. Copyright © 2017 Elsevier B.V. All rights reserved.

Dissemination and implementation sciences in pharmacy: A call to action for professional organizations.

PubMed

Seaton, Terry L

There is a substantial gap between the generation of new knowledge and its widespread incorporation into routine clinical practice, including the medication use process. Principles of dissemination and implementation sciences, if fully embraced by clinicians and researchers, have the potential of improving healthcare effectiveness, efficiency, quality, and safety. This commentary is a call to action for member-driven professional organizations in pharmacy to serve their members and the profession by proactively and strategically leading efforts to develop pharmacist's abilities to incorporate principles of dissemination and implementation sciences into their practice. Additionally, these organizations should provide meaningful support for dissemination and implementation research that hastens the adoption, promotes intervention fidelity, and demonstrates the scaling and sustaining of evidence-based practices to optimize patient care delivery and medication therapy outcomes. Copyright © 2017 Elsevier Inc. All rights reserved.

Comparison of the class and individual characteristics of Turkish 7.65 mm Browning/.32 Automatic caliber self-loading pistols with consecutive serial numbers.

PubMed

Sarıbey, Aylin Yalçin; Hannam, Abigail Grace

2013-01-01

Firearms identification is based on the fundamental principle that it is impossible to manufacture two identical items at the microscopic level. As firearm manufacturing technologies and quality assurance are improving, it is necessary to continually challenge this principle. In this study, two different makes of 7.65 mm Browning/.32 Automatic caliber self-loading pistols of Turkish manufacture were selected and examined. Ten pistols with consecutive serial numbers were examined and each fired 10 times. The fired cartridge cases were recovered for comparison purposes. It was found that for each make of pistol, the individual characteristics within the firing pin impression, ejector, and breech face marks of all 10 pistols were found to be significantly different. © 2012 American Academy of Forensic Sciences.

The Psychology and Neuroscience of Financial Decision Making.

PubMed

Frydman, Cary; Camerer, Colin F

2016-09-01

Financial decisions are among the most important life-shaping decisions that people make. We review facts about financial decisions and what cognitive and neural processes influence them. Because of cognitive constraints and a low average level of financial literacy, many household decisions violate sound financial principles. Households typically have underdiversified stock holdings and low retirement savings rates. Investors overextrapolate from past returns and trade too often. Even top corporate managers, who are typically highly educated, make decisions that are affected by overconfidence and personal history. Many of these behaviors can be explained by well-known principles from cognitive science. A boom in high-quality accumulated evidence-especially how practical, low-cost 'nudges' can improve financial decisions-is already giving clear guidance for balanced government regulation. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Foundations, Core Principles, Values, and Necessary Competencies of Interprofessional Team-Based Health Care.

PubMed

Vogt, H Bruce; Vogt, Jeremy J

2017-01-01

Health care reform has focused on improving health care delivery, quality, and patient safety. An interprofessional, team-based approach to health care is considered by many experts to be essential to meeting these goals. The evidence for this is growing. Core principles for team-based care and the interprofessional competencies necessary for a team to function effectively have been identified and can be taught. Resources for interprofessional education, which must begin at the health professions student level, are available to academic institutions, healthcare systems, and professional organizations to prepare students and current health care professionals for this cultural change. Models of successful collaborative practices exist in many forms and will continue to evolve as our expertise in best practices for interprofessional education and practice advance. Copyright© South Dakota State Medical Association.

A CNN based neurobiology inspired approach for retinal image quality assessment.

PubMed

Mahapatra, Dwarikanath; Roy, Pallab K; Sedai, Suman; Garnavi, Rahil

2016-08-01

Retinal image quality assessment (IQA) algorithms use different hand crafted features for training classifiers without considering the working of the human visual system (HVS) which plays an important role in IQA. We propose a convolutional neural network (CNN) based approach that determines image quality using the underlying principles behind the working of the HVS. CNNs provide a principled approach to feature learning and hence higher accuracy in decision making. Experimental results demonstrate the superior performance of our proposed algorithm over competing methods.

Harm reduction principles for healthcare settings.

PubMed

Hawk, Mary; Coulter, Robert W S; Egan, James E; Fisk, Stuart; Reuel Friedman, M; Tula, Monique; Kinsky, Suzanne

2017-10-24

Harm reduction refers to interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely. The vast majority of the harm reduction literature focuses on the harms of drug use and on specific harm reduction strategies, such as syringe exchange, rather than on the harm reduction philosophy as a whole. Given that a harm reduction approach can address other risk behaviors that often occur alongside drug use and that harm reduction principles have been applied to harms such as sex work, eating disorders, and tobacco use, a natural evolution of the harm reduction philosophy is to extend it to other health risk behaviors and to a broader healthcare audience. Building on the extant literature, we used data from in-depth qualitative interviews with 23 patients and 17 staff members from an HIV clinic in the USA to describe harm reduction principles for use in healthcare settings. We defined six principles of harm reduction and generalized them for use in healthcare settings with patients beyond those who use illicit substances. The principles include humanism, pragmatism, individualism, autonomy, incrementalism, and accountability without termination. For each of these principles, we present a definition, a description of how healthcare providers can deliver interventions informed by the principle, and examples of how each principle may be applied in the healthcare setting. This paper is one of the firsts to provide a comprehensive set of principles for universal harm reduction as a conceptual approach for healthcare provision. Applying harm reduction principles in healthcare settings may improve clinical care outcomes given that the quality of the provider-patient relationship is known to impact health outcomes and treatment adherence. Harm reduction can be a universal precaution applied to all individuals regardless of their disclosure of negative health behaviors, given that health behaviors are not binary or linear but operate along a continuum based on a variety of individual and social determinants.

Memorial Hermann: high reliability from board to bedside.

PubMed

Shabot, M Michael; Monroe, Douglas; Inurria, Juan; Garbade, Debbi; France, Anne-Claire

2013-06-01

In 2006 the Memorial Hermann Health System (MHHS), which includes 12 hospitals, began applying principles embraced by high reliability organizations (HROs). Three factors support its HRO journey: (1) aligned organizational structure with transparent management systems and compressed reporting processes; (2) Robust Process Improvement (RPI) with high-reliability interventions; and (3) cultural establishment, sustainment, and evolution. The Quality and Safety strategic plan contains three domains, each with a specific set of measures that provide goals for performance: (1) "Clinical Excellence;" (2) "Do No Harm;" and (3) "Saving Lives," as measured by the Serious Safety Event rate. MHHS uses a uniform approach to performance improvement--RPI, which includes Six Sigma, Lean, and change management, to solve difficult safety and quality problems. The 9 acute care hospitals provide multiple opportunities to integrate high-reliability interventions and best practices across MHHS. For example, MHHS partnered with the Joint Commission Center for Transforming Healthcare in its inaugural project to establish reliable hand hygiene behaviors, which improved MHHS's average hand hygiene compliance rate from 44% to 92% currently. Soon after compliance exceeded 85% at all 12 hospitals, the average rate of central line-associated bloodstream and ventilator-associated pneumonias decreased to essentially zero. MHHS's size and diversity require a disciplined approach to performance improvement and systemwide achievement of measurable success. The most significant cultural change at MHHS has been the expectation for 100% compliance with evidence-based quality measures and 0% incidence of patient harm.

Basic principles of stability.

PubMed

Egan, William; Schofield, Timothy

2009-11-01

An understanding of the principles of degradation, as well as the statistical tools for measuring product stability, is essential to management of product quality. Key to this is management of vaccine potency. Vaccine shelf life is best managed through determination of a minimum potency release requirement, which helps assure adequate potency throughout expiry. Use of statistical tools such a least squares regression analysis should be employed to model potency decay. The use of such tools provides incentive to properly design vaccine stability studies, while holding stability measurements to specification presents a disincentive for collecting valuable data. The laws of kinetics such as Arrhenius behavior help practitioners design effective accelerated stability programs, which can be utilized to manage stability after a process change. Design of stability studies should be carefully considered, with an eye to minimizing the variability of the stability parameter. In the case of measuring the degradation rate, testing at the beginning and the end of the study improves the precision of this estimate. Additional design considerations such as bracketing and matrixing improve the efficiency of stability evaluation of vaccines.

In Search of Effective Solutions to Curb Workplace Violence.

PubMed

Arnetz, Judith; Lipscomb, Jane; Ogaitis, Joanne

2017-04-01

Investigators have applied epidemiological principles to the study of workplace violence, producing results that offer intriguing information to hospitals struggling for a way forward on this issue. In a randomized, to hospitals struggling for a wary forward on this issue. In a randomized, controlled trial, the researchers found that a one-time, unit-based intervention can reduce the incidence of violent events, and that the approach offers some lasting effect over time. The intervention consisted of a 45-minute discussion with unit supervisors in which unit-specific data regarding violent incidents in their workplace were shared along with an array of improvement strategies. Unit supervisors then were directed to work with their teams to develop action plans to address violence, although they were free to adopt whatever solutions they deemed best. At six moths post-intervention, there was a clear reduction in the incident rate ratios of violent events on the intervention units as compared with control units that did not conduct an intervention. Experts note that the study demonstrates that an effective workplace violence intervention or program must be data-driven and based on principles of continuous quality improvement.

The methodological quality of systematic reviews of animal studies in dentistry.

PubMed

Faggion, C M; Listl, S; Giannakopoulos, N N

2012-05-01

Systematic reviews and meta-analyses of animal studies are important for improving estimates of the effects of treatment and for guiding future clinical studies on humans. The purpose of this systematic review was to assess the methodological quality of systematic reviews and meta-analyses of animal studies in dentistry through using a validated checklist. A literature search was conducted independently and in duplicate in the PubMed and LILACS databases. References in selected systematic reviews were assessed to identify other studies not captured by the electronic searches. The methodological quality of studies was assessed independently and in duplicate by using the AMSTAR checklist; the quality was scored as low, moderate, or high. The reviewers were calibrated before the assessment and agreement between them was assessed using Cohen's Kappa statistic. Of 444 studies retrieved, 54 systematic reviews were selected after full-text assessment. Agreement between the reviewers was regarded as excellent. Only two studies were scored as high quality; 17 and 35 studies were scored as medium and low quality, respectively. There is room for improvement of the methodological quality of systematic reviews of animal studies in dentistry. Checklists, such as AMSTAR, can guide researchers in planning and executing systematic reviews and meta-analyses. For determining the need for additional investigations in animals and in order to provide good data for potential application in human, such reviews should be based on animal experiments performed according to sound methodological principles. Copyright © 2011 Elsevier Ltd. All rights reserved.

The effect of errorless learning on quality of life in patients with Korsakoff’s syndrome

PubMed Central

Rensen, Yvonne CM; Egger, Jos IM; Westhoff, Josette; Walvoort, Serge JW; Kessels, Roy PC

2017-01-01

Background Errorless learning (EL) is a promising rehabilitation principle for (re)learning instrumental activities in patients with amnesia, including patients with Korsakoff’s syndrome (KS). Successfully (re)learning tasks might improve the sense of competence and independence, and subsequently the quality of life. Quality of life in patients with KS has received limited attention, and no studies have been conducted to experimentally examine the effect of EL on quality of life in patients in this patient group. Materials and methods The QUALIDEM, an observation scale for quality of life, was completed by professional nurses before and after EL training in a group of fifty-one patients with KS. This scale was also completed for a group of thirty-one control patients receiving care as usual but no EL training. Results Quality of life was significantly increased on eight of the nine subscales in the Korsakoff group who participated in an EL training. There was a trend toward a significant increase in “positive affect” (ie, the ninth subscale). In contrast, no changes over time were found on any of the subscales in the control group that did not participate in any EL training. Conclusion Despite severe memory impairments, patients with KS still have the potential to (partially) (re)learn tasks using EL. This potential should be exploited, as the successes of (re)-learning might improve the quality of life of Korsakoff patients in nursing homes. PMID:29225465

Adapting Evidence-based Interventions using a Common Theory, Practices, and Principles

PubMed Central

Rotheram-Borus, Mary Jane; Swendeman, Dallas; Becker, Kimberly D.

2013-01-01

Objective Hundreds of validated evidence-based intervention programs (EBIP) aim to improve families’ well-being, however, most are not broadly adopted. As an alternative diffusion strategy, we created wellness centers to reach families’ everyday lives with a prevention framework. Method At two wellness centers, one in a middle-class neighborhood and one in a low-income neighborhood, popular local activity leaders (instructors of martial arts, yoga, sports, music, dancing, zumba), and motivated parents were trained to be Family Mentors. Trainings focused on a framework which taught synthesized, foundational prevention science theory, practice elements, and principles, applied to specific content areas (parenting, social skills, and obesity). Family Mentors were then allowed to adapt scripts and activities based on their cultural experiences, but were closely monitored and supervised over time. The framework was implemented in a range of activities (summer camps, coaching) aimed at improving social, emotional, and behavioral outcomes. Results Successes and challenges are discussed for: 1) engaging parents and communities; 2) identifying and training Family Mentors to promote children and families’ well-being; and 3) gathering data for supervision, outcome evaluation, and continuous quality improvement (CQI). Conclusion To broadly diffuse prevention to families, far more experimentation is needed with alternative and engaging implementation strategies that are enhanced with knowledge harvested from researchers’ past 30 years of experience creating EBIP. One strategy is to train local parents and popular activity leaders in applying robust prevention science theory, common practice elements, and principles of EBIP. More systematic evaluation of such innovations is needed. PMID:24079747

The Federal Trade Commission, clinical integration, and the organization of physician practice.

PubMed

Casalino, Lawrence P

2006-06-01

This article examines Federal Trade Commission (FTC) policy--in particular, the agency's controversial 1996 statements on clinical integration--toward joint negotiations for nonrisk contracts with health plans by physicians organized into independent practice associations (IPAs) and (with hospitals) into physician-hospital organizations (PHOs). The article concludes that the policy is consistent with anti-trust principles, consistent with current thinking on the use of organized processes to improve medical care quality, specific enough to provide guidance to physicians wanting to integrate clinically, and general enough to encourage ongoing innovations in physician organization. The FTC should consider stronger sanctions for IPAs and PHOs whose clinical integration is nothing more than a sham intended to provide cover for joint negotiations, should give the benefit of the doubt to organizations whose clinical integration appears to be reasonably consonant with the statements, and should clarify several ambiguities in the statements. Health plans should facilitate IPA and PHO efforts to improve care by rewarding quality and efficiency and by providing clinically integrated organizations with claims information on individual patients. Though creating clinically integrated organizations is difficult and expensive, physicians should recognize that clinical integration can help them both to gain some negotiating leverage with health plans and to improve the quality of care for their patients.

Development of a quality assurance handbook to improve educational courses in Africa.

PubMed

Nabwera, Helen M; Purnell, Sue; Bates, Imelda

2008-12-18

The attainment of the Millennium Development Goals has been hampered by the lack of skilled and well-informed health care workers in many developing countries. The departure of health care workers from developing countries is one of the most important causes. One of the motivations for leaving is that developed countries have well-established health care systems that incorporate continuing medical education, which enables health care workers to develop their skills and knowledge base. This provision is lacking in many developing countries. The provision of higher-education programmes of good quality within developing countries therefore, contributes to building capacity of the health care workforce in these countries. The Liverpool School of Tropical Medicine is involved in delivering off-site higher educational programmes to health care workers in Africa. Our colleagues at one of these sites requested a guide to help them ensure that their professional development courses met international educational standards. We reviewed published literature that outlines the principles of quality assurance in higher education from various institutions worldwide. Using this information, we designed a handbook that outlines the quality assurance principles in a simple and practical way. This was intended to enable institutions, even in developing countries, to adapt these principles in accordance with their local resource capacity. We subsequently piloted this handbook at one of the sites in Ghana. The feedback from this aided the development of the handbook. The development of this handbook was participatory in nature. The handbook addresses six main themes that are the minimum requirements that a higher education course should incorporate to ensure that it meets internationally recognized standards. These include: recruitment and admissions, course design and delivery, student assessments, approval and review processes, support for students and staff training and welfare. It has been piloted in Ghana and the feedback was incorporated into the handbook. The handbook is currently available free of charge online and being used by various institutions across the world. We have had responses from individuals and institutions in Africa, Asia, North America and Europe. The principles outlined in the handbook provide a regulatory framework for locally establishing higher education courses of good quality that will contribute to enhancing the teaching and learning experience of students in courses in the developing world. This would contribute to providing a skilled and sustainable health care workforce that would reduce the need for health care workers to travel overseas in search of good higher education courses.

Stem cell bioprocessing: fundamentals and principles

PubMed Central

Placzek, Mark R.; Chung, I-Ming; Macedo, Hugo M.; Ismail, Siti; Mortera Blanco, Teresa; Lim, Mayasari; Min Cha, Jae; Fauzi, Iliana; Kang, Yunyi; Yeo, David C.L.; Yip Joan Ma, Chi; Polak, Julia M.; Panoskaltsis, Nicki; Mantalaris, Athanasios

2008-01-01

In recent years, the potential of stem cell research for tissue engineering-based therapies and regenerative medicine clinical applications has become well established. In 2006, Chung pioneered the first entire organ transplant using adult stem cells and a scaffold for clinical evaluation. With this a new milestone was achieved, with seven patients with myelomeningocele receiving stem cell-derived bladder transplants resulting in substantial improvements in their quality of life. While a bladder is a relatively simple organ, the breakthrough highlights the incredible benefits that can be gained from the cross-disciplinary nature of tissue engineering and regenerative medicine (TERM) that encompasses stem cell research and stem cell bioprocessing. Unquestionably, the development of bioprocess technologies for the transfer of the current laboratory-based practice of stem cell tissue culture to the clinic as therapeutics necessitates the application of engineering principles and practices to achieve control, reproducibility, automation, validation and safety of the process and the product. The successful translation will require contributions from fundamental research (from developmental biology to the ‘omics’ technologies and advances in immunology) and from existing industrial practice (biologics), especially on automation, quality assurance and regulation. The timely development, integration and execution of various components will be critical—failures of the past (such as in the commercialization of skin equivalents) on marketing, pricing, production and advertising should not be repeated. This review aims to address the principles required for successful stem cell bioprocessing so that they can be applied deftly to clinical applications. PMID:19033137

Stem cell bioprocessing: fundamentals and principles.

PubMed

Placzek, Mark R; Chung, I-Ming; Macedo, Hugo M; Ismail, Siti; Mortera Blanco, Teresa; Lim, Mayasari; Cha, Jae Min; Fauzi, Iliana; Kang, Yunyi; Yeo, David C L; Ma, Chi Yip Joan; Polak, Julia M; Panoskaltsis, Nicki; Mantalaris, Athanasios

2009-03-06

In recent years, the potential of stem cell research for tissue engineering-based therapies and regenerative medicine clinical applications has become well established. In 2006, Chung pioneered the first entire organ transplant using adult stem cells and a scaffold for clinical evaluation. With this a new milestone was achieved, with seven patients with myelomeningocele receiving stem cell-derived bladder transplants resulting in substantial improvements in their quality of life. While a bladder is a relatively simple organ, the breakthrough highlights the incredible benefits that can be gained from the cross-disciplinary nature of tissue engineering and regenerative medicine (TERM) that encompasses stem cell research and stem cell bioprocessing. Unquestionably, the development of bioprocess technologies for the transfer of the current laboratory-based practice of stem cell tissue culture to the clinic as therapeutics necessitates the application of engineering principles and practices to achieve control, reproducibility, automation, validation and safety of the process and the product. The successful translation will require contributions from fundamental research (from developmental biology to the 'omics' technologies and advances in immunology) and from existing industrial practice (biologics), especially on automation, quality assurance and regulation. The timely development, integration and execution of various components will be critical-failures of the past (such as in the commercialization of skin equivalents) on marketing, pricing, production and advertising should not be repeated. This review aims to address the principles required for successful stem cell bioprocessing so that they can be applied deftly to clinical applications.

'Governance of' and 'Governance by': implementing a clinical governance framework in an area mental health service.

PubMed

O'Connor, Nick; Paton, Michael

2008-04-01

A framework developed to promote the understanding and application of clinical governance principles in an area mental health service is described. The framework is operationalized through systems, processes, roles and responsibilities. The development of an explicit and operationalizable framework for clinical governance arose from the authors' experiences in leading and managing mental health services. There is a particular emphasis on improvement of quality of care and patient safety. The framework is informed by recent developments in thinking about clinical governance, including key documents from Australia and the United Kingdom. The operational nature of the framework allows for key components of clinical governance to be described explicitly, communicated effectively, and continually tested and improved. Further consideration and assessment of the value of differing approaches to this task are required. For example, a general, illustrative approach to raise clinician awareness can be contrasted with prescriptive and specified approaches which progressively encompass the many functions and processes of a mental health service. Mental health clinicians and managers can be guided by a framework that will ensure safe, high quality and continually improving processes of care.

Improving the quality of learning in science through optimization of lesson study for learning community

NASA Astrophysics Data System (ADS)

Setyaningsih, S.

2018-03-01

Lesson Study for Learning Community is one of lecturer profession building system through collaborative and continuous learning study based on the principles of openness, collegiality, and mutual learning to build learning community in order to form professional learning community. To achieve the above, we need a strategy and learning method with specific subscription technique. This paper provides a description of how the quality of learning in the field of science can be improved by implementing strategies and methods accordingly, namely by applying lesson study for learning community optimally. Initially this research was focused on the study of instructional techniques. Learning method used is learning model Contextual teaching and Learning (CTL) and model of Problem Based Learning (PBL). The results showed that there was a significant increase in competence, attitudes, and psychomotor in the four study programs that were modelled. Therefore, it can be concluded that the implementation of learning strategies in Lesson study for Learning Community is needed to be used to improve the competence, attitude and psychomotor of science students.

NDTAC Practice Guide: Quality Education Services Are Critical for Youth Involved with the Juvenile Justice and Child Welfare Systems

ERIC Educational Resources Information Center

Gonsoulin, Simon; Clark, Heather Griller; Rankin, Victoria E.

2015-01-01

This National Evaluation and Technical Assistance Center for the Education of Children and Youth Who are Neglected, Delinquent, or At-Risk (NDTAC) practice guide examines the principle that quality education services are critical for youth involved with the juvenile justice and child welfare systems. This principle asserts that, to address the…