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

ERIC Educational Resources Information Center

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

2013-01-01

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

How Would Programs Rate under California's Proposed Quality Rating and Improvement System? Evidence from Statewide and County Data on Early Care and Education Program Quality. Documented Briefing

ERIC Educational Resources Information Center

Karoly, Lynn A.; Zellman, Gail L.

2012-01-01

In 2010, the California Early Learning Quality Improvement System (CAEL QIS) Advisory Committee recommended a structure for a voluntary quality rating and improvement system (QRIS) that could apply to the state's 11,000 licensed centers and 36,600 licensed family child care homes (FCCHs). The proposed design consisted of an unweighted block system…

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

Using adapted quality-improvement approaches to strengthen community-based health systems and improve care in high HIV-burden sub-Saharan African countries.

PubMed

Horwood, Christiane M; Youngleson, Michele S; Moses, Edward; Stern, Amy F; Barker, Pierre M

2015-07-01

Achieving long-term retention in HIV care is an important challenge for HIV management and achieving elimination of mother-to-child transmission. Sustainable, affordable strategies are required to achieve this, including strengthening of community-based interventions. Deployment of community-based health workers (CHWs) can improve health outcomes but there is a need to identify systems to support and maintain high-quality performance. Quality-improvement strategies have been successfully implemented to improve quality and coverage of healthcare in facilities and could provide a framework to support community-based interventions. Four community-based quality-improvement projects from South Africa, Malawi and Mozambique are described. Community-based improvement teams linked to the facility-based health system participated in learning networks (modified Breakthrough Series), and used quality-improvement methods to improve process performance. Teams were guided by trained quality mentors who used local data to help nurses and CHWs identify gaps in service provision and test solutions. Learning network participants gathered at intervals to share progress and identify successful strategies for improvement. CHWs demonstrated understanding of quality-improvement concepts, tools and methods, and implemented quality-improvement projects successfully. Challenges of using quality-improvement approaches in community settings included adapting processes, particularly data reporting, to the education level and first language of community members. Quality-improvement techniques can be implemented by CHWs to improve outcomes in community settings but these approaches require adaptation and additional mentoring support to be successful. More research is required to establish the effectiveness of this approach on processes and outcomes of care.

Are university rankings useful to improve research? A systematic review.

PubMed

Vernon, Marlo M; Balas, E Andrew; Momani, Shaher

2018-01-01

Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and "luxury" indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance.

Driving photomask supplier quality through automation

NASA Astrophysics Data System (ADS)

Russell, Drew; Espenscheid, Andrew

2007-10-01

In 2005, Freescale Semiconductor's newly centralized mask data prep organization (MSO) initiated a project to develop an automated global quality validation system for photomasks delivered to Freescale Semiconductor fabs. The system handles Certificate of Conformance (CofC) quality metric collection, validation, reporting and an alert system for all photomasks shipped to Freescale fabs from all qualified global suppliers. The completed system automatically collects 30+ quality metrics for each photomask shipped. Other quality metrics are generated from the collected data and quality metric conformance is automatically validated to specifications or control limits with failure alerts emailed to fab photomask and mask data prep engineering. A quality data warehouse stores the data for future analysis, which is performed quarterly. The improved access to data provided by the system has improved Freescale engineers' ability to spot trends and opportunities for improvement with our suppliers' processes. This paper will review each phase of the project, current system capabilities and quality system benefits for both our photomask suppliers and Freescale.

Information Quality Evaluation of C2 Systems at Architecture Level

DTIC Science & Technology

2014-06-01

based on architecture models of C2 systems, which can help to identify key factors impacting information quality and improve the system capability at the stage of architecture design of C2 system....capability evaluation of C2 systems at architecture level becomes necessary and important for improving the system capability at the stage of architecture ... design . This paper proposes a method for information quality evaluation of C2 system at architecture level. First, the information quality model is

Financial incentives and measurement improved physicians' quality of care in the Philippines.

PubMed

Peabody, John; Shimkhada, Riti; Quimbo, Stella; Florentino, Jhiedon; Bacate, Marife; McCulloch, Charles E; Solon, Orville

2011-04-01

The merits of using financial incentives to improve clinical quality have much appeal, yet few studies have rigorously assessed the potential benefits. The uncertainty surrounding assessments of quality can lead to poor policy decisions, possibly resulting in increased cost with little or no quality improvement, or missed opportunities to improve care. We conducted an experiment involving physicians in thirty Philippine hospitals that overcomes many of the limitations of previous studies. We measured clinical performance and then examined whether modest bonuses equal to about 5 percent of a physician's salary, as well as system-level incentives that increased compensation to hospitals and across groups of physicians, led to improvements in the quality of care. We found that both the bonus and system-level incentives improved scores in a quality measurement system used in our study by ten percentage points. Our findings suggest that when careful measurement is combined with the types of incentives we studied, there may be a larger impact on quality than previously recognized.

Teaching Evaluation: A Critical Measure for Improving the Quality of Education

ERIC Educational Resources Information Center

Ji, Zhou

2009-01-01

In the coming period, the main task for China's higher education system is to improve the quality of education, and the key to improving the quality of education is to improve the quality of teaching. Teaching evaluations are a critical measure for improving the quality of teaching. The work of evaluating teaching at institutions of higher…

Staff Preparation, Reward, and Support: Are Quality Rating and Improvement Systems Addressing All of the Key Ingredients Necessary for Change? Policy Report

ERIC Educational Resources Information Center

Austin, Lea J. E.; Whitebook, Marcy; Connors, Maia; Darrah, Rory

2011-01-01

Reflecting the growing momentum in support of quality rating and improvement systems (QRISs) as a key strategy to improve early care and education quality, significant amounts of public dollars have been devoted to their development and implementation. In this brief, the authors report on their investigation of both quality rating and improvement…

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.

A review of national policies and strategies to improve quality of health care and patient safety: a case study from Lebanon and Jordan.

PubMed

El-Jardali, Fadi; Fadlallah, Racha

2017-08-16

Improving quality of care and patient safety practices can strengthen health care delivery systems, improve health sector performance, and accelerate attainment of health-related Sustainability Development Goals. Although quality improvement is now prominent on the health policy agendas of governments in low- and middle-income countries (LMICs), including countries of the Eastern Mediterranean Region (EMR), progress to date has not been optimal. The objective of this study is to comprehensively review existing quality improvement and patient safety policies and strategies in two selected countries of the EMR (Lebanon and Jordan) to determine the extent to which these have been institutionalized within existing health systems. We used a mixed methods approach that combined documentation review, stakeholder surveys and key informant interviews. Existing quality improvement and patient safety initiatives were assessed across five components of an analytical framework for assessing health care quality and patient safety: health systems context; national policies and legislation; organizations and institutions; methods, techniques and tools; and health care infrastructure and resources. Both Lebanon and Jordan have made important progress in terms of increased attention to quality and accreditation in national health plans and strategies, licensing requirements for health care professionals and organizations (albeit to varying extents), and investments in health information systems. A key deficiency in both countries is the absence of an explicit national policy for quality improvement and patient safety across the health system. Instead, there is a spread of several (disjointed) pieces of legal measures and national plans leading to fragmentation and lack of clear articulation of responsibilities across the entire continuum of care. Moreover, both countries lack national sets of standardized and applicable quality indicators for performance measurement and benchmarking. Importantly, incentive systems that link contractual agreement, regulations, accreditation, and performance indicators are underutilized in Lebanon and absent in Jordan. At the healthcare organizational level, there is a need to instill a culture of continuous quality improvement and promote professional training in quality improvement and patient safety. Study findings highlight the importance of aligning policies, organizations, methods, capacities and resources in order to institutionalize quality improvement and patient safety practices in health systems. Gaps and dysfunctions identified can help inform national deliberations and dialogues among key stakeholders in each study country. Findings can also inform future quality improvement efforts in the EMR and beyond, with a particular emphasis on LMICs.

How changing quality management influenced PGME accreditation: a focus on decentralization and quality improvement.

PubMed

Akdemir, Nesibe; Lombarts, Kiki M J M H; Paternotte, Emma; Schreuder, Bas; Scheele, Fedde

2017-06-02

Evaluating the quality of postgraduate medical education (PGME) programs through accreditation is common practice worldwide. Accreditation is shaped by educational quality and quality management. An appropriate accreditation design is important, as it may drive improvements in training. Moreover, accreditors determine whether a PGME program passes the assessment, which may have major consequences, such as starting, continuing or discontinuing PGME. However, there is limited evidence for the benefits of different choices in accreditation design. Therefore, this study aims to explain how changing views on educational quality and quality management have impacted the design of the PGME accreditation system in the Netherlands. To determine the historical development of the Dutch PGME accreditation system, we conducted a document analysis of accreditation documents spanning the past 50 years and a vision document outlining the future system. A template analysis technique was used to identify the main elements of the system. Four themes in the Dutch PGME accreditation system were identified: (1) objectives of accreditation, (2) PGME quality domains, (3) quality management approaches and (4) actors' responsibilities. Major shifts have taken place regarding decentralization, residency performance and physician practice outcomes, and quality improvement. Decentralization of the responsibilities of the accreditor was absent in 1966, but this has been slowly changing since 1999. In the future system, there will be nearly a maximum degree of decentralization. A focus on outcomes and quality improvement has been introduced in the current system. The number of formal documents striving for quality assurance has increased enormously over the past 50 years, which has led to increased bureaucracy. The future system needs to decrease the number of standards to focus on measurable outcomes and to strive for quality improvement. The challenge for accreditors is to find the right balance between trusting and controlling medical professionals. Their choices will be reflected in the accreditation design. The four themes could enhance international comparisons and encourage better choices in the design of accreditation systems.

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

ERIC Educational Resources Information Center

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

2014-01-01

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

Are university rankings useful to improve research? A systematic review

PubMed Central

Momani, Shaher

2018-01-01

Introduction Concerns about reproducibility and impact of research urge improvement initiatives. Current university ranking systems evaluate and compare universities on measures of academic and research performance. Although often useful for marketing purposes, the value of ranking systems when examining quality and outcomes is unclear. The purpose of this study was to evaluate usefulness of ranking systems and identify opportunities to support research quality and performance improvement. Methods A systematic review of university ranking systems was conducted to investigate research performance and academic quality measures. Eligibility requirements included: inclusion of at least 100 doctoral granting institutions, be currently produced on an ongoing basis and include both global and US universities, publish rank calculation methodology in English and independently calculate ranks. Ranking systems must also include some measures of research outcomes. Indicators were abstracted and contrasted with basic quality improvement requirements. Exploration of aggregation methods, validity of research and academic quality indicators, and suitability for quality improvement within ranking systems were also conducted. Results A total of 24 ranking systems were identified and 13 eligible ranking systems were evaluated. Six of the 13 rankings are 100% focused on research performance. For those reporting weighting, 76% of the total ranks are attributed to research indicators, with 24% attributed to academic or teaching quality. Seven systems rely on reputation surveys and/or faculty and alumni awards. Rankings influence academic choice yet research performance measures are the most weighted indicators. There are no generally accepted academic quality indicators in ranking systems. Discussion No single ranking system provides a comprehensive evaluation of research and academic quality. Utilizing a combined approach of the Leiden, Thomson Reuters Most Innovative Universities, and the SCImago ranking systems may provide institutions with a more effective feedback for research improvement. Rankings which extensively rely on subjective reputation and “luxury” indicators, such as award winning faculty or alumni who are high ranking executives, are not well suited for academic or research performance improvement initiatives. Future efforts should better explore measurement of the university research performance through comprehensive and standardized indicators. This paper could serve as a general literature citation when one or more of university ranking systems are used in efforts to improve academic prominence and research performance. PMID:29513762

Short and long term improvements in quality of chronic care delivery predict program sustainability.

PubMed

Cramm, Jane Murray; Nieboer, Anna Petra

2014-01-01

Empirical evidence on sustainability of programs that improve the quality of care delivery over time is lacking. Therefore, this study aims to identify the predictive role of short and long term improvements in quality of chronic care delivery on program sustainability. In this longitudinal study, professionals [2010 (T0): n=218, 55% response rate; 2011 (T1): n=300, 68% response rate; 2012 (T2): n=265, 63% response rate] from 22 Dutch disease-management programs completed surveys assessing quality of care and program sustainability. Our study findings indicated that quality of chronic care delivery improved significantly in the first 2 years after implementation of the disease-management programs. At T1, overall quality, self-management support, delivery system design, and integration of chronic care components, as well as health care delivery and clinical information systems and decision support, had improved. At T2, overall quality again improved significantly, as did community linkages, delivery system design, clinical information systems, decision support and integration of chronic care components, and self-management support. Multilevel regression analysis revealed that quality of chronic care delivery at T0 (p<0.001) and quality changes in the first (p<0.001) and second (p<0.01) years predicted program sustainability. In conclusion this study showed that disease-management programs based on the chronic care model improved the quality of chronic care delivery over time and that short and long term changes in the quality of chronic care delivery predicted the sustainability of the projects. Copyright © 2013 The Authors. Published by Elsevier Ltd.. All rights reserved.

42 CFR 480.143 - QIO involvement in shared health data systems.

Code of Federal Regulations, 2013 CFR

2013-10-01

... HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.143 QIO involvement in shared health data...

42 CFR 480.143 - QIO involvement in shared health data systems.

Code of Federal Regulations, 2012 CFR

2012-10-01

... HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.143 QIO involvement in shared health data...

42 CFR 480.143 - QIO involvement in shared health data systems.

Code of Federal Regulations, 2014 CFR

2014-10-01

... HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.143 QIO involvement in shared health data...

Building Citywide Systems for Quality: A Guide and Case Studies for Afterschool Leaders

ERIC Educational Resources Information Center

Yohalem, Nicole; Devaney, Elizabeth; Smith, Charles; Wilson-Ahlstrom, Alicia

2012-01-01

A quality improvement system (QIS) is an intentional effort to raise the quality of afterschool programming in an ongoing, organized fashion. There are a number of reasons the QIS is gaining popularity. The main reasons community leaders are drawn to improving quality is that they know that 1) higher quality programs will mean better experiences…

42 CFR 480.143 - QIO involvement in shared health data systems.

Code of Federal Regulations, 2011 CFR

2011-10-01

... HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.143 QIO involvement in shared health data...

42 CFR 480.143 - QIO involvement in shared health data systems.

Code of Federal Regulations, 2010 CFR

2010-10-01

... HUMAN SERVICES (CONTINUED) QUALITY IMPROVEMENT ORGANIZATIONS ACQUISITION, PROTECTION, AND DISCLOSURE OF QUALITY IMPROVEMENT ORGANIZATION REVIEW INFORMATION Utilization and Quality Control Quality Improvement Organizations (QIOs) Disclosure of Confidential Information § 480.143 QIO involvement in shared health data...

Strategies to improve the quality of life of persons post-stroke: protocol of a systematic review.

PubMed

Munce, Sarah E P; Perrier, Laure; Shin, Saeha; Adhihetty, Chamila; Pitzul, Kristen; Nelson, Michelle L A; Bayley, Mark T

2017-09-07

While many outcomes post-stroke (e.g., depression) have been previously investigated, there is no complete data on the impact of a variety of quality improvement strategies on the quality of life and physical and psychological well-being of individuals post-stroke. The current paper outlines a systematic review protocol on the impact of quality improvement strategies on quality of life as well as physical and psychological well-being of individuals with stroke. MEDLINE, CINAHL, EMBASE, and PsycINFO databases will be searched. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Only randomized controlled trials that report on the impact of quality improvement strategies on quality of life outcomes in people with stroke will be included. The secondary outcomes will be physical and psychological well-being. Quality improvement strategies include audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, (promotion of) self-management, patient reminder systems, and continuous quality improvement. Studies published since 2000 will be included to increase the relevancy of findings. Results will be grouped according to the target group of the varying quality improvement strategies (i.e., health system, health care professionals, or patients) and/or by any other noteworthy grouping variables, such as etiology of stroke or by sex. This systematic review will identify those quality improvement strategies aimed at the health system, health care professionals, and patients that impact the quality of life of individuals with stroke. Improving awareness and utilization of such strategies may enhance uptake of stroke best practices and reduce inappropriate health care utilization costs. PROSPERO, CRD42017064141.

A systematic review of human factors and ergonomics (HFE)-based healthcare system redesign for quality of care and patient safety.

PubMed

Xie, Anping; Carayon, Pascale

2015-01-01

Healthcare systems need to be redesigned to provide care that is safe, effective and efficient, and meets the multiple needs of patients. This systematic review examines how human factors and ergonomics (HFE) is applied to redesign healthcare work systems and processes and improve quality and safety of care. We identified 12 projects representing 23 studies and addressing different physical, cognitive and organisational HFE issues in a variety of healthcare systems and care settings. Some evidence exists for the effectiveness of HFE-based healthcare system redesign in improving process and outcome measures of quality and safety of care. We assessed risk of bias in 16 studies reporting the impact of HFE-based healthcare system redesign and found varying quality across studies. Future research should further assess the impact of HFE on quality and safety of care, and clearly define the mechanisms by which HFE-based system redesign can improve quality and safety of care.

Quality and Safety Education for Nurses (QSEN): The Key is Systems Thinking.

PubMed

Dolansky, Mary A; Moore, Shirley M

2013-09-30

Over a decade has passed since the Institute of Medicine's reports on the need to improve the American healthcare system, and yet only slight improvement in quality and safety has been reported. The Quality and Safety Education for Nurses (QSEN) initiative was developed to integrate quality and safety competencies into nursing education. The current challenge is for nurses to move beyond the application of QSEN competencies to individual patients and families and incorporate systems thinking in quality and safety education and healthcare delivery. This article provides a history of QSEN and proposes a framework in which systems thinking is a critical aspect in the application of the QSEN competencies. We provide examples of how using this framework expands nursing focus from individual care to care of the system and propose ways to teach and measure systems thinking. The conclusion calls for movement from personal effort and individual care to a focus on care of the system that will accelerate improvement of healthcare quality and safety.

FOCUS: Essential Elements of Quality for State-Funded Preschool Programs

ERIC Educational Resources Information Center

New Mexico Public Education Department, 2016

2016-01-01

The "FOCUS: Essential Elements of Quality, New Mexico's Tiered Quality Rating and Improvement System (TQRIS)," provides early childhood program personnel with the criteria, tools, and resources they need to improve the quality of their program. These quality improvements focus on children's growth, development, and learning--so that each…

Setting Quality Improvement Priorities for Women Receiving Systemic Therapy for Early-Stage Breast Cancer by Using Population-Level Administrative Data.

PubMed

Enright, Katherine A; Taback, Nathan; Powis, Melanie Lynn; Gonzalez, Alejandro; Yun, Lingsong; Sutradhar, Rinku; Trudeau, Maureen E; Booth, Christopher M; Krzyzanowska, Monika K

2017-10-01

Purpose Routine evaluation of quality measures (QMs) can drive improvement in cancer systems by highlighting gaps in care. Targeting quality improvement at QMs that demonstrate substantial variation has the potential to make the largest impact at the population level. We developed an approach that uses both variation in performance and number of patients affected by the QM to set priorities for improving the quality of systemic therapy for women with early-stage breast cancer (EBC). Patients and Methods Patients with EBC diagnosed from 2006 to 2010 in Ontario, Canada, were identified in the Ontario Cancer Registry and linked deterministically to multiple health care databases. Individual QMs within a panel of 15 QMs previously developed to assess the quality of systemic therapy across four domains (access, treatment delivery, toxicity, and safety) were ranked on interinstitutional variation in performance (using interquartile range) and the number of patients who were affected; then the two rankings were averaged for a summative priority ranking. Results We identified 28,427 patients with EBC who were treated at 84 institutions. The use of computerized physician electronic order entry for chemotherapy, emergency room visits or hospitalizations during chemotherapy, and timely receipt of chemotherapy were identified as the QMs that had the largest potential to improve quality of care at a system level within this cohort. Conclusion A simple ranking system based on interinstitutional variation in performance and patient volume can be used to identify high-priority areas for quality improvement from a population perspective. This approach is generalizable to other health care systems that use QMs to drive improvement.

Quality in-training initiative--a solution to the need for education in quality improvement: results from a survey of program directors.

PubMed

Kelz, Rachel R; Sellers, Morgan M; Reinke, Caroline E; Medbery, Rachel L; Morris, Jon; Ko, Clifford

2013-12-01

The Next Accreditation System and the Clinical Learning Environment Review Program will emphasize practice-based learning and improvement and systems-based practice. We present the results of a survey of general surgery program directors to characterize the current state of quality improvement in graduate surgical education and introduce the Quality In-Training Initiative (QITI). In 2012, a 20-item survey was distributed to 118 surgical residency program directors from ACS NSQIP-affiliated hospitals. The survey content was developed in collaboration with the QITI to identify program director opinions regarding education in practice-based learning and improvement and systems-based practice, to investigate the status of quality improvement education in their respective programs, and to quantify the extent of resident participation in quality improvement. There was a 57% response rate. Eighty-five percent of program directors (n = 57) reported that education in quality improvement is essential to future professional work in the field of surgery. Only 28% (n = 18) of programs reported that at least 50% of their residents track and analyze their patient outcomes, compare them with norms/benchmarks/published standards, and identify opportunities to make practice improvements. Program directors recognize the importance of quality improvement efforts in surgical practice. Subpar participation in basic practice-based learning and improvement activities at the resident level reflects the need for support of these educational goals. The QITI will facilitate programmatic compliance with goals for quality improvement education. Copyright © 2013 American College of Surgeons. All rights reserved.

Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project.

PubMed

Groene, Oliver; Klazinga, Niek; Wagner, Cordula; Arah, Onyebuchi A; Thompson, Andrew; Bruneau, Charles; Suñol, Rosa

2010-09-24

Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias. Products of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals.

Assessing the Validity of the Qualistar Early Learning Quality Rating and Improvement System as a Tool for Improving Child-Care Quality

ERIC Educational Resources Information Center

Zellman, Gail L.; Perlman, Michal; Le, Vi-Nhuan; Setodji, Claude Messan

2008-01-01

As a result of the generally low quality of child care in the United States and the increased emphasis on accountability in education policy, quality rating systems (QRSs) are proliferating in the child-care arena. QRSs assess child-care providers on multiple dimensions of quality and integrate these assessments into an easily understood summary…

Development and implementation of the Caribbean Laboratory Quality Management Systems Stepwise Improvement Process (LQMS-SIP) Towards Accreditation.

PubMed

Alemnji, George; Edghill, Lisa; Guevara, Giselle; Wallace-Sankarsingh, Sacha; Albalak, Rachel; Cognat, Sebastien; Nkengasong, John; Gabastou, Jean-Marc

2017-01-01

Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. We report the development of a stepwise process for quality systems improvement in the Caribbean Region. The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called 'Laboratory Quality Management System - Stepwise Improvement Process (LQMS-SIP) Towards Accreditation' to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement.

Do we need a national incident reporting system for medical imaging?

PubMed

Itri, Jason N; Krishnaraj, Arun

2012-05-01

The essential role of an incident reporting system as a tool to improve safety and reliability has been described in high-risk industries such as aviation and nuclear power, with anesthesia being the first medical specialty to successfully integrate incident reporting into a comprehensive quality improvement strategy. Establishing an incident reporting system for medical imaging that effectively captures system errors and drives improvement in the delivery of imaging services is a key component of developing and evaluating national quality improvement initiatives in radiology. Such a national incident reporting system would be most effective if implemented as one piece of a comprehensive quality improvement strategy designed to enhance knowledge about safety, identify and learn from errors, raise standards and expectations for improvement, and create safer systems through implementation of safe practices. The potential benefits of a national incident reporting system for medical imaging include reduced morbidity and mortality, improved patient and referring physician satisfaction, reduced health care expenses and medical liability costs, and improved radiologist satisfaction. The purposes of this article are to highlight the positive impact of external reporting systems, discuss how similar advancements in quality and safety can be achieved with an incident reporting system for medical imaging in the United States, and describe current efforts within the imaging community toward achieving this goal. Copyright © 2012 American College of Radiology. Published by Elsevier Inc. All rights reserved.

[Establishment of industry promotion technology system in Chinese medicine secondary exploitation based on "component structure theory"].

PubMed

Cheng, Xu-Dong; Feng, Liang; Zhang, Ming-Hua; Gu, Jun-Fei; Jia, Xiao-Bin

2014-10-01

The purpose of the secondary exploitation of Chinese medicine is to improve the quality of Chinese medicine products, enhance core competitiveness, for better use in clinical practice, and more effectively solve the patient suffering. Herbs, extraction, separation, refreshing, preparation and quality control are all involved in the industry promotion of Chinese medicine secondary exploitation of industrial production. The Chinese medicine quality improvement and industry promotion could be realized with the whole process of process optimization, quality control, overall processes improvement. Based on the "component structure theory", "multi-dimensional structure & process dynamic quality control system" and systematic and holistic character of Chinese medicine, impacts of whole process were discussed. Technology systems of Chinese medicine industry promotion was built to provide theoretical basis for improving the quality and efficacy of the secondary development of traditional Chinese medicine products.

Incentives for cooperation in quality improvement among hospitals--the impact of the reimbursement system.

PubMed

Kesteloot, K; Voet, N

1998-12-01

Up to now, few analytical models have studied the incentives for cooperation in quality improvements among hospitals. Only those dealing with reimbursement systems have shown that, from the point of view of individual or competing hospitals, retrospective reimbursement is more likely to encourage quality improvements than prospective financing, while the reverse holds for efficiency improvements. This paper studies the incentives to improve the quality of hospital care, in an analytical model, taking into account the possibility of cooperative agreements, price besides non-price (quality) competition and quality improvements that may simultaneously increase demand, increase or reduce costs and spill over to rival hospitals. In this setting quality improvement efforts rise with the rate of prospective reimbursement, while the impact of the rate of retrospective reimbursement is ambiguous, but likely to be negative for quality improvements that are highly cost-reducting and create large spillovers. Cooperation may lead to more or less quality improvement than non-cooperative conduct, depending on the magnitude of spillovers and the degree of product market competition, relative to the net effect of quality on profits and the share of costs that is reimbursed retrospectively. Finally, the stability of cooperative agreements, supported by grim trigger strategies, is shown to depend upon exactly the opposite interaction between these factors.

Title IV Quality Control Project, Stage II. Management Option II: Delivery System Quality Improvements.

ERIC Educational Resources Information Center

Advanced Technology, Inc., Reston, VA.

Stage Two of the Title IV Quality Control Project is an integrated study of quality in five related Federal financial aid programs for postsecondary students. Section 1 of the paper establishes a framework for defining quality improvements, in order to identify the types of changes that would tend to improve quality across all facets of the…

A case study of quality improvement methods for complex adaptive systems applied to an academic hepatology program.

PubMed

Fontanesi, John; Martinez, Anthony; Boyo, Toritsesan O; Gish, Robert

2015-01-01

Although demands for greater access to hepatology services that are less costly and achieve better outcomes have led to numerous quality improvement initiatives, traditional quality management methods may be inappropriate for hepatology. We empirically tested a model for conducting quality improvement in an academic hepatology program using methods developed to analyze and improve complex adaptive systems. We achieved a 25% increase in volume using 15% more clinical sessions with no change in staff or faculty FTEs, generating a positive margin of 50%. Wait times for next available appointments were reduced from five months to two weeks; unscheduled appointment slots dropped from 7% to less than 1%; "no-show" rates dropped to less than 10%; Press-Ganey scores increased to the 100th percentile. We conclude that framing hepatology as a complex adaptive system may improve our understanding of the complex, interdependent actions required to improve quality of care, patient satisfaction, and cost-effectiveness.

[Organizational capacity for continuous improvement of health services].

PubMed

Saturno-Hernández, Pedro J; Hernández-Avila, Mauricio; Magaña-Valladares, Laura; Garcia-Saisó, Sebastián; Vertiz-Ramírez, José de Jesús

2015-01-01

While the Mexican health system has achieved significant progress, as reflected in the growing improvement in population health, heterogeneity in the quality of services and its impact on health in different population groups is still a challenge. The costs or poor quality represent about 20 to 40% of the health system's expenditure. We need to develop organizational capacity to implement quality management systems in order to identify, evaluate, prevent and eventually overcome the health system's challenges. A competency-based comprehensive strategy for training human resources is proposed including undergraduate and graduate education as well as continuing education, which will contribute to improve the quality function at the various levels of responsibility in the health system. The proposed strategy responds to the context of the Mexican health system, but it could be adapted to other systems and contexts.

Educational Information Quantization for Improving Content Quality in Learning Management Systems

ERIC Educational Resources Information Center

Rybanov, Alexander Aleksandrovich

2014-01-01

The article offers the educational information quantization method for improving content quality in Learning Management Systems. The paper considers questions concerning analysis of quality of quantized presentation of educational information, based on quantitative text parameters: average frequencies of parts of speech, used in the text; formal…

Information technology as a tool to improve the quality of American Indian health care.

PubMed

Sequist, Thomas D; Cullen, Theresa; Ayanian, John Z

2005-12-01

The American Indian/Alaska Native population experiences a disproportionate burden of disease across a spectrum of conditions. While the recent National Healthcare Disparities Report highlighted differences in quality of care among racial and ethnic groups, there was only very limited information available for American Indians. The Indian Health Service (IHS) is currently enhancing its information systems to improve the measurement of health care quality as well as to support quality improvement initiatives. We summarize current knowledge regarding health care quality for American Indians, highlighting the variation in reported measures in the existing literature. We then discuss how the IHS is using information systems to produce standardized performance measures and present future directions for improving American Indian health care quality.

A quality improvement approach to capacity building in low- and middle-income countries.

PubMed

Bardfield, Joshua; Agins, Bruce; Akiyama, Matthew; Basenero, Apollo; Luphala, Patience; Kaindjee-Tjituka, Francina; Natanael, Salomo; Hamunime, Ndapewa

2015-07-01

To describe the HEALTHQUAL framework consisting of the following three components: performance measurement, quality improvement and the quality management program, representing an adaptive approach to building capacity in national quality management programs in low and middle-income countries. We present a case study from Namibia illustrating how this approach is adapted to country context. HEALTHQUAL partners with Ministries of Health to build knowledge and expertise in modern improvement methods, including data collection, analysis and reporting, process analysis and the use of data to implement quality improvement projects that aim to improve systems and processes of care. Clinical performance measures are selected in each country by the Ministry of Health on the basis of national guidelines. Patient records are sampled using a standardized statistical table to achieve a minimum confidence interval of 90%, with a spread of ±8% in participating facilities. Data are routinely reviewed to identify gaps in patient care, and aggregated to produce facility mean scores that are trended over time. A formal organizational assessment is conducted at facility and national levels to review the implementation progress. Aggregate mean rates of performance for 10 of 11 indicators of HIV care improved for adult HIV-positive patients between 2008 and 2013. Quality improvement is an approach to capacity building and health systems strengthening that offers adaptive methodology. Synergistic implementation of elements of a national quality program can lead to improvements in care, in parallel with systematic capacity development for measurement, improvement and quality management throughout the healthcare delivery system.

Mechanisms of deterioration of nutrients. [improved quality of freeze-dried foods

NASA Technical Reports Server (NTRS)

Karel, M.; Flink, J. M.

1978-01-01

Methods for improving the quality of freeze-dried foods were investigated. Areas discussed include: (1) microstructure of freeze-dried systems, (2) structural changes in freeze-dried systems, (3) artificial food matrices, and (4) osmotic preconcentration to yield improved freeze-dried products.

An analysis of total quality management in Aeronautical Systems Division

NASA Astrophysics Data System (ADS)

Caudle, Mark D.

1991-09-01

This study investigated the major schools of thought on various aspects of quality management and quality improvement. Areas covered included definitions of waste and quality, views on the cost of quality, tools and techniques used for quality improvement, and management philosophies and frameworks for continuous improvement. In addition, this study analyzed the structure and training content of the current Total Quality Management program at Aeronautical Systems Division (ASD). Pre- and post-test surveys on employee attitudes toward organizational effectiveness were analyzed from the Advanced Cruise Missile System Program Office (SPO), the F-15 SPO, and the ASD Deputy Chief of Staff for Human Resources (ASD/DP). Data was supplemented with semi-structured, personal interviews with ASD personnel involved in TQM. Survey analysis showed that the ACM SPO significantly improved, ASD/DP significantly digressed, and the F-15 SPO remained basically consistent. This led to the conclusion that ASD allows too much flexibility in the implementation of TQM in the three-letter organizations.

Cost-effectiveness of an electronic clinical decision support system for improving quality of antenatal and childbirth care in rural Tanzania: an intervention study.

PubMed

Saronga, Happiness Pius; Duysburgh, Els; Massawe, Siriel; Dalaba, Maxwell Ayindenaba; Wangwe, Peter; Sukums, Felix; Leshabari, Melkizedeck; Blank, Antje; Sauerborn, Rainer; Loukanova, Svetla

2017-08-07

QUALMAT project aimed at improving quality of maternal and newborn care in selected health care facilities in three African countries. An electronic clinical decision support system was implemented to support providers comply with established standards in antenatal and childbirth care. Given that health care resources are limited and interventions differ in their potential impact on health and costs (efficiency), this study aimed at assessing cost-effectiveness of the system in Tanzania. This was a quantitative pre- and post- intervention study involving 6 health centres in rural Tanzania. Cost information was collected from health provider's perspective. Outcome information was collected through observation of the process of maternal care. Incremental cost-effectiveness ratios for antenatal and childbirth care were calculated with testing of four models where the system was compared to the conventional paper-based approach to care. One-way sensitivity analysis was conducted to determine whether changes in process quality score and cost would impact on cost-effectiveness ratios. Economic cost of implementation was 167,318 USD, equivalent to 27,886 USD per health center and 43 USD per contact. The system improved antenatal process quality by 4.5% and childbirth care process quality by 23.3% however these improvements were not statistically significant. Base-case incremental cost-effectiveness ratios of the system were 2469 USD and 338 USD per 1% change in process quality for antenatal and childbirth care respectively. Cost-effectiveness of the system was sensitive to assumptions made on costs and outcomes. Although the system managed to marginally improve individual process quality variables, it did not have significant improvement effect on the overall process quality of care in the short-term. A longer duration of usage of the electronic clinical decision support system and retention of staff are critical to the efficiency of the system and can reduce the invested resources. Realization of gains from the system requires effective implementation and an enabling healthcare system. Registered clinical trial at www.clinicaltrials.gov ( NCT01409824 ). Registered May 2009.

A conceptual persistent healthcare quality improvement process for software development management.

PubMed

Lin, Jen-Chiun; Su, Mei-Ju; Cheng, Po-Hsun; Weng, Yung-Chien; Chen, Sao-Jie; Lai, Jin-Shin; Lai, Feipei

2007-01-01

This paper illustrates a sustained conceptual service quality improvement process for the management of software development within a healthcare enterprise. Our proposed process is revised from Niland's healthcare quality information system (HQIS). This process includes functions to survey the satisfaction of system functions, describe the operation bylaws on-line, and provide on-demand training. To achieve these goals, we integrate five information systems in National Taiwan University Hospital, including healthcare information systems, health quality information system, requirement management system, executive information system, and digital learning system, to form a full Deming cycle. A preliminary user satisfaction survey showed that our outpatient information system scored an average of 71.31 in 2006.

A framework for considering business models.

PubMed

Anderson, James G

2003-01-01

Information technology (IT) such as computerized physician order entry, computer-based decision support and alerting systems, and electronic prescribing can reduce medical errors and improve the quality of health care. However, the business value of these systems is frequently questioned. At present a number of barriers exist to realizing the potential of IT to improve quality of care. Some of these barriers are: the ineffectiveness of existing error reporting systems, low investment in IT infrastructure, legal impediments to reforms, and the difficulty in demonstrating a sufficient return on investment to justify expenditures for quality improvement. This paper provides an overview of these issues, a framework for considering business models, and examples of successful implementations of IT to improve quality of patient care.

The six critical attributes of the next generation of quality management software systems.

PubMed

Clark, Kathleen

2011-07-01

Driven by both the need to meet regulatory requirements and a genuine desire to drive improved quality, quality management systems encompassing standard operating procedure, corrective and preventative actions and related processes have existed for many years, both in paper and electronic form. The impact of quality management systems on 'actual' quality, however, is often reported as far less than desired. A quality management software system that moves beyond formal forms-driven processes to include a true closed loop design, manage disparate processes across the enterprise, provide support for collaborative processes and deliver insight into the overall state of control has the potential to close the gap between simply accomplishing regulatory compliance and delivering measurable improvements in quality and efficiency.

Development and implementation of the Caribbean Laboratory Quality Management Systems Stepwise Improvement Process (LQMS-SIP) Towards Accreditation

PubMed Central

Alemnji, George; Edghill, Lisa; Wallace-Sankarsingh, Sacha; Albalak, Rachel; Cognat, Sebastien; Nkengasong, John; Gabastou, Jean-Marc

2017-01-01

Background Implementing quality management systems and accrediting laboratories in the Caribbean has been a challenge. Objectives We report the development of a stepwise process for quality systems improvement in the Caribbean Region. Methods The Caribbean Laboratory Stakeholders met under a joint Pan American Health Organization/US Centers for Disease Control and Prevention initiative and developed a user-friendly framework called ‘Laboratory Quality Management System – Stepwise Improvement Process (LQMS-SIP) Towards Accreditation’ to support countries in strengthening laboratory services through a stepwise approach toward fulfilling the ISO 15189: 2012 requirements. Results This approach consists of a three-tiered framework. Tier 1 represents the minimum requirements corresponding to the mandatory criteria for obtaining a licence from the Ministry of Health of the participating country. The next two tiers are quality improvement milestones that are achieved through the implementation of specific quality management system requirements. Laboratories that meet the requirements of the three tiers will be encouraged to apply for accreditation. The Caribbean Regional Organisation for Standards and Quality hosts the LQMS-SIP Secretariat and will work with countries, including the Ministry of Health and stakeholders, including laboratory staff, to coordinate and implement LQMS-SIP activities. The Caribbean Public Health Agency will coordinate and advocate for the LQMS-SIP implementation. Conclusion This article presents the Caribbean LQMS-SIP framework and describes how it will be implemented among various countries in the region to achieve quality improvement. PMID:28879149

Public health laboratory quality management in a developing country.

PubMed

Wangkahat, Khwanjai; Nookhai, Somboon; Pobkeeree, Vallerut

2012-01-01

The article aims to give an overview of the system of public health laboratory quality management in Thailand and to produce a strengths, weaknesses, opportunities and threats (SWOT) analysis that is relevant to public health laboratories in the country. The systems for managing laboratory quality that are currently employed were described in the first component. The second component was a SWOT analysis, which used the opinions of laboratory professionals to identify any areas that could be improved to meet quality management systems. Various quality management systems were identified and the number of laboratories that met both international and national quality management requirements was different. The SWOT analysis found the opportunities and strengths factors offered the best chance to improve laboratory quality management in the country. The results are based on observations and brainstorming with medical laboratory professionals who can assist laboratories in accomplishing quality management. The factors derived from the analysis can help improve laboratory quality management in the country. This paper provides viewpoints and evidence-based approaches for the development of best possible practice of services in public health laboratories.

Improving the Quality of Patient Care Utilizing Tracer Methodology

DTIC Science & Technology

2011-01-25

Sharing Knowledge: Achieving Breakthrough Performance 2011 Military Health System Conference Improving the Quality of Patient Care Utilizing Tracer...Methodology 25 Jan 2011 Leslie Atkins, RN 1 Military Health System Conference T e Quadruple Aim Working Together, Achieving Success USA MEDDAC...25 JAN 2011 2. REPORT TYPE 3. DATES COVERED 00-00-2011 to 00-00-2011 4. TITLE AND SUBTITLE Improving the Quality of Patient Care Utilizing

A New Tool for Quality: The Internal Audit.

PubMed

Haycock, Camille; Schandl, Annette

As health care systems aspire to improve the quality and value for the consumers they serve, quality outcomes must be at the forefront of this value equation. As organizations implement evidence-based practices, electronic records to standardize processes, and quality improvement initiatives, many tactics are deployed to accelerate improvement and care outcomes. This article describes how one organization utilized a formal clinical audit process to identify gaps and/or barriers that may be contributing to underperforming measures and outcomes. This partnership between quality and audit can be a powerful tool and produce insights that can be scaled across a large health care system.

The network of Shanghai Stroke Service System (4S): A public health-care web-based database using automatic extraction of electronic medical records.

PubMed

Dong, Yi; Fang, Kun; Wang, Xin; Chen, Shengdi; Liu, Xueyuan; Zhao, Yuwu; Guan, Yangtai; Cai, Dingfang; Li, Gang; Liu, Jianmin; Liu, Jianren; Zhuang, Jianhua; Wang, Panshi; Chen, Xin; Shen, Haipeng; Wang, David Z; Xian, Ying; Feng, Wuwei; Campbell, Bruce Cv; Parsons, Mark; Dong, Qiang

2018-07-01

Background Several stroke outcome and quality control projects have demonstrated the success in stroke care quality improvement through structured process. However, Chinese health-care systems are challenged with its overwhelming numbers of patients, limited resources, and large regional disparities. Aim To improve quality of stroke care to address regional disparities through process improvement. Method and design The Shanghai Stroke Service System (4S) is established as a regional network for stroke care quality improvement in the Shanghai metropolitan area. The 4S registry uses a web-based database that automatically extracts data from structured electronic medical records. Site-specific education and training program will be designed and administrated according to their baseline characteristics. Both acute reperfusion therapies including thrombectomy and thrombolysis in the acute phase and subsequent care were measured and monitored with feedback. Primary outcome is to evaluate the differences in quality metrics between baseline characteristics (including rate of thrombolysis in acute stroke and key performance indicators in secondary prevention) and post-intervention. Conclusions The 4S system is a regional stroke network that monitors the ongoing stroke care quality in Shanghai. This project will provide the opportunity to evaluate the spectrum of acute stroke care and design quality improvement processes for better stroke care. A regional stroke network model for quality improvement will be explored and might be expanded to other large cities in China. Clinical Trial Registration-URL http://www.clinicaltrials.gov . Unique identifier: NCT02735226.

Implementation and quality assessment of a pharmacy services call center for outpatient pharmacies and specialty pharmacy services in an academic health system.

PubMed

Rim, Matthew H; Thomas, Karen C; Chandramouli, Jane; Barrus, Stephanie A; Nickman, Nancy A

2018-05-15

The implementation and quality assessment of a pharmacy services call center (PSCC) for outpatient pharmacies and specialty pharmacy services within an academic health system are described. Prolonged wait times in outpatient pharmacies or hold times on the phone affect the ability of pharmacies to capture and retain prescriptions. To support outpatient pharmacy operations and improve quality, a PSCC was developed to centralize handling of all outpatient and specialty pharmacy calls. The purpose of the PSCC was to improve the quality of pharmacy telephone services by (1) decreasing the call abandonment rate, (2) improving the speed of answer, (3) increasing first-call resolution, (4) centralizing all specialty pharmacy and prior authorization calls, (5) increasing labor efficiency and pharmacy capacities, (6) implementing a quality evaluation program, and (7) improving workplace satisfaction and retention of outpatient pharmacy staff. The PSCC centralized pharmacy calls from 9 pharmacy locations, 2 outpatient clinics, and a specialty pharmacy. Since implementation, the PSCC has achieved and maintained program goals, including improved abandonment rate, speed of answer, and first-call resolution. A centralized 24-7 support line for specialty pharmacy patients was also successfully established. A quality calibration program was implemented to ensure service quality and excellent patient experience. Additional ongoing evaluations measure the impact of the PSCC on improving workplace satisfaction and retention of outpatient pharmacy staff. The design and implementation of the PSCC have significantly improved the health system's patient experiences, efficiency, and quality. Copyright © 2018 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

How to Begin a Quality Improvement Project.

PubMed

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

2016-05-06

Quality improvement involves a combined effort among health care staff and stakeholders to diagnose and treat problems in the health care system. However, health care professionals often lack training in quality improvement methods, which makes it challenging to participate in improvement efforts. This article familiarizes health care professionals with how to begin a quality improvement project. The initial steps involve forming an improvement team that possesses expertise in the quality of care problem, leadership, and change management. Stakeholder mapping and analysis are useful tools at this stage, and these are reviewed to help identify individuals who might have a vested interest in the project. Physician engagement is a particularly important component of project success, and the knowledge that patients/caregivers can offer as members of a quality improvement team should not be overlooked. After a team is formed, an improvement framework helps to organize the scientific process of system change. Common quality improvement frameworks include Six Sigma, Lean, and the Model for Improvement. These models are contrasted, with a focus on the Model for Improvement, because it is widely used and applicable to a variety of quality of care problems without advanced training. It involves three steps: setting aims to focus improvement, choosing a balanced set of measures to determine if improvement occurs, and testing new ideas to change the current process. These new ideas are evaluated using Plan-Do-Study-Act cycles, where knowledge is gained by testing changes and reflecting on their effect. To show the real world utility of the quality improvement methods discussed, they are applied to a hypothetical quality improvement initiative that aims to promote home dialysis (home hemodialysis and peritoneal dialysis). This provides an example that kidney health care professionals can use to begin their own quality improvement projects. Copyright © 2016 by the American Society of Nephrology.

How to Begin a Quality Improvement Project

PubMed Central

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

2016-01-01

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

Fit for purpose quality management system for military forensic exploitation.

PubMed

Wilson, Lauren Elizabeth; Gahan, Michelle Elizabeth; Robertson, James; Lennard, Chris

2018-03-01

In a previous publication we described a systems approach to forensic science applied in the military domain. The forensic science 'system of systems' describes forensic science as a sub-system in the larger criminal justice, law enforcement, intelligence, and military systems, with quality management being an important supporting system. Quality management systems help to ensure that organisations achieve their objective and continually improve their capability. Components of forensic science quality management systems can include standardisation of processes, accreditation of facilities to national/international standards, and certification of personnel. A fit for purpose quality management system should be balanced to allow organisations to meet objectives, provide continuous improvement; mitigate risk; and impart a positive quality culture. Considerable attention over the last decades has been given to the need for forensic science quality management systems to meet criminal justice and law enforcement objectives. More recently, the need for the forensic quality management systems to meet forensic intelligence objectives has been considered. This paper, for the first time, discusses the need for a fit for purpose quality management system for military forensic exploitation. Crown Copyright © 2018. Published by Elsevier B.V. All rights reserved.

75 FR 61413 - Notice of Availability of Biotechnology Quality Management System Audit Standard and Evaluation...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-10-05

...] Notice of Availability of Biotechnology Quality Management System Audit Standard and Evaluation of... Biotechnology Quality Management System Program (BQMS Program) to assist regulated entities in achieving and... customized biotechnology quality management system (BQMS) to improve their management of domestic research...

Multivariate Analyses of Quality Metrics for Crystal Structures in the PDB Archive.

PubMed

Shao, Chenghua; Yang, Huanwang; Westbrook, John D; Young, Jasmine Y; Zardecki, Christine; Burley, Stephen K

2017-03-07

Following deployment of an augmented validation system by the Worldwide Protein Data Bank (wwPDB) partnership, the quality of crystal structures entering the PDB has improved. Of significance are improvements in quality measures now prominently displayed in the wwPDB validation report. Comparisons of PDB depositions made before and after introduction of the new reporting system show improvements in quality measures relating to pairwise atom-atom clashes, side-chain torsion angle rotamers, and local agreement between the atomic coordinate structure model and experimental electron density data. These improvements are largely independent of resolution limit and sample molecular weight. No significant improvement in the quality of associated ligands was observed. Principal component analysis revealed that structure quality could be summarized with three measures (Rfree, real-space R factor Z score, and a combined molecular geometry quality metric), which can in turn be reduced to a single overall quality metric readily interpretable by all PDB archive users. Copyright © 2017 Elsevier Ltd. All rights reserved.

Improving Professional Development System through Quality Assurance Practices in the Universities of Pakistan

ERIC Educational Resources Information Center

Shabbir, Muhammad; Khalid, M. Ibrahim; Bakhsh, Khuda; Mohsin, Muhammad Naeem; Rasool, Shafqat; Mohsin, M. Saleem

2016-01-01

The rationalization of this research was to investigate about improving professional development system through Quality Assurance Practices (QAP) in the Universities of Pakistan pertaining to the opinions of students, teachers and Directors of Quality Enhancement Cells (QECs) and to differentiate the ideas of students, teachers and Directors of…

Quality Rating and Improvement Systems and Children's Cognitive Development

ERIC Educational Resources Information Center

Jeon, Lieny; Buettner, Cynthia K.

2015-01-01

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

Do Health Care Delivery System Reforms Improve Value? The Jury Is Still Out.

PubMed

Korenstein, Deborah; Duan, Kevin; Diaz, Manuel J; Ahn, Rosa; Keyhani, Salomeh

2016-01-01

Widespread restructuring of health delivery systems is underway in the United States to reduce costs and improve the quality of health care. To describe studies evaluating the impact of system-level interventions (incentives and delivery structures) on the value of US health care, defined as the balance between quality and cost. We identified articles in PubMed (2003 to July 2014) using keywords identified through an iterative process, with reference and author tracking. We searched tables of contents of relevant journals from August 2014 through 11 August 2015 to update our sample. We included prospective or retrospective studies of system-level changes, with a control, reporting both quality and either cost or utilization of resources. Data about study design, study quality, and outcomes was extracted by one reviewer and checked by a second. Thirty reports of 28 interventions were included. Interventions included patient-centered medical home implementations (n=12), pay-for-performance programs (n=10), and mixed interventions (n=6); no other intervention types were identified. Most reports (n=19) described both cost and utilization outcomes. Quality, cost, and utilization outcomes varied widely; many improvements were small and process outcomes predominated. Improved value (improved quality with stable or lower cost/utilization or stable quality with lower cost/utilization) was seen in 23 reports; 1 showed decreased value, and 6 showed unchanged, unclear, or mixed results.Study limitations included variability among specific endpoints reported, inconsistent methodologies, and lack of full adjustment in some observational trials. Lack of standardized MeSH terms was also a challenge in the search. On balance, the literature suggests that health system reforms can improve value. However, this finding is tempered by the varying outcomes evaluated across studies with little documented improvement in outcome quality measures. Standardized measures of value would facilitate assessment of the impact of interventions across studies and better estimates of the broad impact of system change.

Incompetent Teachers or Dysfunctional Systems?

ERIC Educational Resources Information Center

Futernick, Ken

2010-01-01

Calls to fire the lowest-performing teachers are widespread, but such actions are not likely to improve teacher quality. Instead, educators should focus on improving the education system that can prevent even good teachers from providing high-quality teaching. To improve the teaching environment, educators and policy makers need to better…

Infrastructure for Large-Scale Quality-Improvement Projects: Early Lessons from North Carolina Improving Performance in Practice

ERIC Educational Resources Information Center

Newton, Warren P.; Lefebvre, Ann; Donahue, Katrina E.; Bacon, Thomas; Dobson, Allen

2010-01-01

Introduction: Little is known regarding how to accomplish large-scale health care improvement. Our goal is to improve the quality of chronic disease care in all primary care practices throughout North Carolina. Methods: Methods for improvement include (1) common quality measures and shared data system; (2) rapid cycle improvement principles; (3)…

Quality improvement: the nurse's role.

PubMed

Moran, M J; Johnson, J E

1992-06-01

Continuous quality improvement is a concept which includes: Quality assurance--the provision of services that meet an appropriate standard. Problem resolution--including all departments involved in the issue at hand. Quality improvement--a continuous process involving all levels of the organization working together across departmental lines to produce better services for health care clients. Deming (1982b) and others have espoused total system reform to achieve quality improvement--not merely altering the current system, but radically changing it. It must be assumed that those who provide services at the staff level are acting in good faith and are not willfully failing to do what is correct (Berwick, 1991). Those who perform direct services are in an excellent position to identify the need for change in service delivery processes. Based on this premise, the staff nurse--who is at the heart of the system--is the best person to assess the status of health care services and to work toward improving the processes by which these services are provided to clients in the health care setting. The nurse manager must structure the work setting to facilitate the staff nurse's ability to undertake constructive action for improving care. The use of quality circles, quality councils, or quality improvement forums to facilitate the coordination of quality improvement efforts is an effective way to achieve success. The QA coordinator assists departments in documenting that the quality improvement efforts are effective across all departments of the organization, and aggregates data to demonstrate that they meet the requirements of external regulatory agencies, insurers, and professional standards. The nurse executive provides the vision and secures the necessary resources to ensure that the organization's quality improvement efforts are successful. By inspiring and empowering the staff in their efforts to improve the process by which health care is provided, nurse managers participate in reshaping the health care environment. The professional nurse plays a vital role in the quality improvement of health care services. However, nurses cannot make these improvements in a vacuum; they must include other professionals and ancillary personnel in their efforts. Total quality commitment must include all levels of an organization's structure. Quality patient care services will be achieved as the result of positive interactions among departments working together to build a dynamic mechanism that continuously improves the processes and outcomes of health care services.

Quality management, a directive approach to patient safety.

PubMed

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

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

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Technical Appendix. Publication #2016-07B

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Executive Summary. Publication #2016-07A

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Program Design Appendix. Publication #2016-07C

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). The SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

Improving Quality for Child Care Centers in Greater Philadelphia: An Evaluation of Success by 6®. Final Report. Publication #2016-07

ERIC Educational Resources Information Center

Warner-Richter, Mallory; Lowe, Claire; Tout, Kathryn; Epstein, Dale; Li, Weilin

2016-01-01

The Success By 6® (SB6) initiative is designed to support early care and education centers in improving and sustaining quality in Pennsylvania's Keystone STARS Quality Rating and Improvement System (QRIS). This SB6 evaluation report examines implementation and outcomes. The findings have implications for SB6 continous quality improvement process…

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

PubMed

Palmersheim, T M

1999-12-01

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

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.

The Effects of Accountability Incentives in Early Childhood Education. CEPA Working Paper No. 17-10

ERIC Educational Resources Information Center

Bassok, Daphna; Dee, Thomas S.; Latham, Scott

2017-01-01

In an effort to enhance the quality of early childhood education (ECE) at scale, nearly all U.S. states have recently adopted Quality Rating and Improvement Systems (QRIS). These accountability systems give providers and parents information on program quality and create both reputational and financial incentives for program improvement. However,…

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

ERIC Educational Resources Information Center

Gardner, John Wallace

2012-01-01

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

Importance of relationship quality in the success of data warehouse systems

NASA Astrophysics Data System (ADS)

Almabhouh, Alaaeddin; Saleh, Abdul; Ahmad, Azizah

2011-10-01

Increased organizational dependence on data warehouse (DW) systems drives management attention towards improving DW systems success. However, the successful implementation rate of DW systems is low and many firms did not achieve intended goals. A recent studies show that improves and evaluates DW success is one of the top concerns facing IT/DW executives. Existing information system (IS) research has studied DW success more from information quality and system quality. Researchers argue in this study that we should also take the relationship quality, which has significant research and practical implications in that it connects to IS success directly. As our first attempt, this study, referring to both IS and marketing literature, examines how communication, coordination, cooperation, commitment, and trust can be achieved to some degrees by high quality relationships between DW parties.

Single dose systemic acetaminophen to improve patient reported quality of recovery after ambulatory segmental mastectomy: A prospective, randomized, double-blinded, placebo controlled, clinical trial.

PubMed

De Oliveira, Gildasio S; Rodes, Meghan E; Bialek, Jane; Kendall, Mark C; McCarthy, Robert J

2017-11-15

Few systemic drug interventions are efficacious to improve patient reported quality of recovery after ambulatory surgery. We aimed to evaluate whether a single dose systemic acetaminophen improve quality of recovery in female patients undergoing ambulatory breast surgery. We hypothesized that patients receiving a single dose systemic acetaminophen at the end of the surgical procedure would have a better global quality of postsurgical recovery compared to the ones receiving saline. The study was a prospective randomized double blinded, placebo controlled, clinical trial. Healthy female subjects were randomized to receive 1 g single dose systemic acetaminophen at the end of the surgery or the same volume of saline. The primary outcome was the Quality of Recovery 40 (QOR-40) questionnaire at 24 hours after surgery. Other data collected included opioid consumption and pain scores. Data were analyzed using group t tests and the Wilcoxon exact test. The association between opioid consumption and quality of recovery was evaluated using Spearman rho. P < .05 was used to reject the null hypothesis for the primary outcome. Seventy subjects were randomized and sixty-five completed the study. Patients' baseline characteristics and surgical factors were similar between the study groups. There was a clinically significant difference in the global QoR-40 scores between the acetaminophen and the saline groups, median (IQR) of 189 (183 to 194) and 183 (175 to 190), respectively, P = .01. In addition, there was an inverse relationship (Spearman's rho= -0.33) between oral opioid consumption at home (oral morphine equivalents) and 24 hour postoperative quality of recovery, P = .007. A single dose of systemic acetaminophen improves patient reported quality of recovery after ambulatory breast surgery. The use of systemic acetaminophen is an efficacious strategy to improve patient perceived quality of postsurgical recovery and analgesic outcomes after hospital discharge for ambulatory breast surgery. © 2017 Wiley Periodicals, Inc.

The influence of context on the effectiveness of hospital quality improvement strategies: a review of systematic reviews.

PubMed

Kringos, Dionne S; Sunol, Rosa; Wagner, Cordula; Mannion, Russell; Michel, Philippe; Klazinga, Niek S; Groene, Oliver

2015-07-22

It is now widely accepted that the mixed effect and success rates of strategies to improve quality and safety in health care are in part due to the different contexts in which the interventions are planned and implemented. The objectives of this study were to (i) describe the reporting of contextual factors in the literature on the effectiveness of quality improvement strategies, (ii) assess the relationship between effectiveness and contextual factors, and (iii) analyse the importance of contextual factors. We conducted an umbrella review of systematic reviews searching the following databases: PubMed, Cochrane Database of Systematic Reviews, Embase and CINAHL. The search focused on quality improvement strategies included in the Cochrane Effective Practice and Organisation of Care Group taxonomy. We extracted data on quality improvement effectiveness and context factors. The latter were categorized according to the Model for Understanding Success in Quality tool. We included 56 systematic reviews in this study of which only 35 described contextual factors related with the effectiveness of quality improvement interventions. The most frequently reported contextual factors were: quality improvement team (n = 12), quality improvement support and capacity (n = 11), organization (n = 9), micro-system (n = 8), and external environment (n = 4). Overall, context factors were poorly reported. Where they were reported, they seem to explain differences in quality improvement effectiveness; however, publication bias may contribute to the observed differences. Contextual factors may influence the effectiveness of quality improvement interventions, in particular at the level of the clinical micro-system. Future research on the implementation and effectiveness of quality improvement interventions should emphasize formative evaluation to elicit information on context factors and report on them in a more systematic way in order to better appreciate their relative importance.

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.

Quality of care: measuring a neglected driver of improved health

PubMed Central

Kruk, Margaret E

2017-01-01

Abstract The quality of care provided by health systems contributes towards efforts to reach sustainable development goal 3 on health and well-being. There is growing evidence that the impact of health interventions is undermined by poor quality of care in lower-income countries. Quality of care will also be crucial to the success of universal health coverage initiatives; citizens unhappy with the quality and scope of covered services are unlikely to support public financing of health care. Moreover, an ethical impetus exists to ensure that all people, including the poorest, obtain a minimum quality standard of care that is effective for improving health. However, the measurement of quality today in low- and middle-income countries is inadequate to the task. Health information systems provide incomplete and often unreliable data, and facility surveys collect too many indicators of uncertain utility, focus on a limited number of services and are quickly out of date. Existing measures poorly capture the process of care and the patient experience. Patient outcomes that are sensitive to health-care practices, a mainstay of quality assessment in high-income countries, are rarely collected. We propose six policy recommendations to improve quality-of-care measurement and amplify its policy impact: (i) redouble efforts to improve and institutionalize civil registration and vital statistics systems; (ii) reform facility surveys and strengthen routine information systems; (iii) innovate new quality measures for low-resource contexts; (iv) get the patient perspective on quality; (v) invest in national quality data; and (vi) translate quality evidence for policy impact. PMID:28603313

Cardiopulmonary resuscitation quality: [corrected] improving cardiac resuscitation outcomes both inside and outside the hospital: a consensus statement from the American Heart Association.

PubMed

Meaney, Peter A; Bobrow, Bentley J; Mancini, Mary E; Christenson, Jim; de Caen, Allan R; Bhanji, Farhan; Abella, Benjamin S; Kleinman, Monica E; Edelson, Dana P; Berg, Robert A; Aufderheide, Tom P; Menon, Venu; Leary, Marion

2013-07-23

The "2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care" increased the focus on methods to ensure that high-quality cardiopulmonary resuscitation (CPR) is performed in all resuscitation attempts. There are 5 critical components of high-quality CPR: minimize interruptions in chest compressions, provide compressions of adequate rate and depth, avoid leaning between compressions, and avoid excessive ventilation. Although it is clear that high-quality CPR is the primary component in influencing survival from cardiac arrest, there is considerable variation in monitoring, implementation, and quality improvement. As such, CPR quality varies widely between systems and locations. Victims often do not receive high-quality CPR because of provider ambiguity in prioritization of resuscitative efforts during an arrest. This ambiguity also impedes the development of optimal systems of care to increase survival from cardiac arrest. This consensus statement addresses the following key areas of CPR quality for the trained rescuer: metrics of CPR performance; monitoring, feedback, and integration of the patient's response to CPR; team-level logistics to ensure performance of high-quality CPR; and continuous quality improvement on provider, team, and systems levels. Clear definitions of metrics and methods to consistently deliver and improve the quality of CPR will narrow the gap between resuscitation science and the victims, both in and out of the hospital, and lay the foundation for further improvements in the future.

ACHS Quality Awards 2000. Quality is the way we do business.

PubMed

Cruickshank, N; Bullock, J

2001-01-01

Hollywood Private Hospital recognized that the use of quality management processes can achieve numerous benefits; however, for this to occur quality must be regarded as normal business practice rather than a separate programme. Therefore, the means of ensuring a quality service must be embedded in the strategic plans of both the organization and individual departments. The Hollywood Private Hospital Executive committed the organization to this approach further building on the 'core values' of the hospital by: integrating quality into the Strategic Planning of the organization; integrating risk management into the existing quality system; further embedding of the core values into the culture of the organisation; introducing systems thinking into the organization; taking a process improvement approach to improving quality; involving staff in Quality Action Teams and utilizing the Evaluation and Quality Improvement Programme as the management framework to co-ordinate all the above.

42 CFR 441.585 - Quality assurance system.

Code of Federal Regulations, 2012 CFR

2012-10-01

... provides information about the provisions of quality improvement and assurance to each individual receiving... 42 Public Health 4 2012-10-01 2012-10-01 false Quality assurance system. 441.585 Section 441.585...) § 441.585 Quality assurance system. (a) States must establish and maintain a comprehensive, continuous...

Rheumatologists' perception of systemic lupus erythematosus quality indicators: significant interest and perceived barriers.

PubMed

Casey, Carolyn; Chung, Cecilia P; Crofford, Leslie J; Barnado, April

2017-01-01

Differences in quality of care may contribute to health disparities in systemic lupus erythematosus (SLE). Studies show low physician adherence rates to the SLE quality indicators but do not assess physician perception of SLE quality indicators or quality improvement. Using a cross-sectional survey of rheumatologists in the southeastern USA, we assessed the perception and involvement of rheumatologists in quality improvement and the SLE quality indicators. Using electronic mail, an online survey of 32 questions was delivered to 568 rheumatologists. With a response rate of 19% (n = 106), the majority of participants were male, Caucasian, with over 20 years of experience, and seeing adult patients in an academic setting. Participants had a positive perception toward quality improvement (81%) with a majority responding that the SLE quality indicators would significantly impact quality of care (54%). While 66% of respondents were familiar with the SLE quality indicators, only 18% of respondents reported using them in everyday practice. The most commonly reported barrier to involvement in quality improvement and the SLE quality indicators was time. Rheumatologists had a positive perception of the SLE quality indicators and agreed that use of the quality indicators could improve quality of care in SLE; however, they identified time as a barrier to implementation. Future studies should investigate methods to increase use of the SLE quality indicators.

Validation of Quality Rating and Improvement Systems for Early Care and Education and School-Age Care. Research-to-Policy, Research-to-Practice Brief. OPRE 2012-29

ERIC Educational Resources Information Center

Zellman, Gail L.; Fiene, Richard

2012-01-01

Quality Rating and Improvement Systems (QRIS) for early care and education and school age care programs are designed to collect information about quality and to use that information to produce program-level ratings, which are the foundation of a QRIS. The ratings are intended to make program quality transparent for parents and other stakeholders…

Enhancement of digital radiography image quality using a convolutional neural network.

PubMed

Sun, Yuewen; Li, Litao; Cong, Peng; Wang, Zhentao; Guo, Xiaojing

2017-01-01

Digital radiography system is widely used for noninvasive security check and medical imaging examination. However, the system has a limitation of lower image quality in spatial resolution and signal to noise ratio. In this study, we explored whether the image quality acquired by the digital radiography system can be improved with a modified convolutional neural network to generate high-resolution images with reduced noise from the original low-quality images. The experiment evaluated on a test dataset, which contains 5 X-ray images, showed that the proposed method outperformed the traditional methods (i.e., bicubic interpolation and 3D block-matching approach) as measured by peak signal to noise ratio (PSNR) about 1.3 dB while kept highly efficient processing time within one second. Experimental results demonstrated that a residual to residual (RTR) convolutional neural network remarkably improved the image quality of object structural details by increasing the image resolution and reducing image noise. Thus, this study indicated that applying this RTR convolutional neural network system was useful to improve image quality acquired by the digital radiography system.

Improving data quality across 3 sub-Saharan African countries using the Consolidated Framework for Implementation Research (CFIR): results from the African Health Initiative.

PubMed

Gimbel, Sarah; Mwanza, Moses; Nisingizwe, Marie Paul; Michel, Cathy; Hirschhorn, Lisa

2017-12-21

High-quality data are critical to inform, monitor and manage health programs. Over the seven-year African Health Initiative of the Doris Duke Charitable Foundation, three of the five Population Health Implementation and Training (PHIT) partnership projects in Mozambique, Rwanda, and Zambia introduced strategies to improve the quality and evaluation of routinely-collected data at the primary health care level, and stimulate its use in evidence-based decision-making. Using the Consolidated Framework for Implementation Research (CFIR) as a guide, this paper: 1) describes and categorizes data quality assessment and improvement activities of the projects, and 2) identifies core intervention components and implementation strategy adaptations introduced to improve data quality in each setting. The CFIR was adapted through a qualitative theme reduction process involving discussions with key informants from each project, who identified two domains and ten constructs most relevant to the study aim of describing and comparing each country's data quality assessment approach and implementation process. Data were collected on each project's data quality improvement strategies, activities implemented, and results via a semi-structured questionnaire with closed and open-ended items administered to health management information systems leads in each country, with complementary data abstraction from project reports. Across the three projects, intervention components that aligned with user priorities and government systems were perceived to be relatively advantageous, and more readily adapted and adopted. Activities that both assessed and improved data quality (including data quality assessments, mentorship and supportive supervision, establishment and/or strengthening of electronic medical record systems), received higher ranking scores from respondents. Our findings suggest that, at a minimum, successful data quality improvement efforts should include routine audits linked to ongoing, on-the-job mentoring at the point of service. This pairing of interventions engages health workers in data collection, cleaning, and analysis of real-world data, and thus provides important skills building with on-site mentoring. The effect of these core components is strengthened by performance review meetings that unify multiple health system levels (provincial, district, facility, and community) to assess data quality, highlight areas of weakness, and plan improvements.

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.

Measuring quality progress

NASA Astrophysics Data System (ADS)

Lambert, Larry D.

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

Measuring quality progress

NASA Technical Reports Server (NTRS)

Lambert, Larry D.

1992-01-01

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

Measuring and improving the quality of mental health care: a global perspective

PubMed Central

Kilbourne, Amy M.; Beck, Kathryn; Spaeth‐Rublee, Brigitta; Ramanuj, Parashar; O'Brien, Robert W.; Tomoyasu, Naomi; Pincus, Harold Alan

2018-01-01

Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology‐based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient‐centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement‐based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems. PMID:29352529

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

NASA Technical Reports Server (NTRS)

Antelman, Albert

1991-01-01

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

Improving the quality of cancer care in America through health information technology.

PubMed

Feeley, Thomas W; Sledge, George W; Levit, Laura; Ganz, Patricia A

2014-01-01

A recent report from the Institute of Medicine titled Delivering High-Quality Cancer Care: Charting a New Course for a System in Crisis, identifies improvement in information technology (IT) as essential to improving the quality of cancer care in America. The report calls for implementation of a learning healthcare IT system: a system that supports patient-clinician interactions by providing patients and clinicians with the information and tools necessary to make well informed medical decisions and to support quality measurement and improvement. While some elements needed for a learning healthcare system are already in place for cancer, they are incompletely implemented, have functional deficiencies, and are not integrated in a way that creates a true learning healthcare system. To achieve the goal of a learning cancer care delivery system, clinicians, professional organizations, government, and the IT industry will have to partner, develop, and incentivize participation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Expert database system for quality control

NASA Astrophysics Data System (ADS)

Wang, Anne J.; Li, Zhi-Cheng

1993-09-01

There are more competitors today. Markets are not homogeneous they are fragmented into increasingly focused niches requiring greater flexibility in the product mix shorter manufacturing production runs and above allhigher quality. In this paper the author identified a real-time expert system as a way to improve plantwide quality management. The quality control expert database system (QCEDS) by integrating knowledge of experts in operations quality management and computer systems use all information relevant to quality managementfacts as well as rulesto determine if a product meets quality standards. Keywords: expert system quality control data base

Complex adaptive systems: a tool for interpreting responses and behaviours.

PubMed

Ellis, Beverley

2011-01-01

Quality improvement is a priority for health services worldwide. There are many barriers to implementing change at the locality level and misinterpreting responses and behaviours can effectively block change. Electronic health records will influence the means by which knowledge and information are generated and sustained among those operating quality improvement programmes. To explain how complex adaptive system (CAS) theory provides a useful tool and new insight into the responses and behaviours that relate to quality improvement programmes in primary care enabled by informatics. Case studies in two English localities who participated in the implementation and development of quality improvement programmes. The research strategy included purposefully sampled case studies, conducted within a social constructionist ontological perspective. Responses and behaviours of quality improvement programmes in the two localities include both positive and negative influences associated with a networked model of governance. Pressures of time, resources and workload are common issues, along with the need for education and training about capturing, coding, recording and sharing information held within electronic health records to support various information requirements. Primary care informatics enables information symmetry among those operating quality improvement programmes by making some aspects of care explicit, allowing consensus about quality improvement priorities and implementable solutions.

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

Asan medical information system for healthcare quality improvement.

PubMed

Ryu, Hyeon Jeong; Kim, Woo Sung; Lee, Jae Ho; Min, Sung Woo; Kim, Sun Ja; Lee, Yong Su; Lee, Young Ha; Nam, Sang Woo; Eo, Gi Seung; Seo, Sook Gyoung; Nam, Mi Hyun

2010-09-01

This purpose of this paper is to introduce the status of the Asan Medical Center (AMC) medical information system with respect to healthcare quality improvement. Asan Medical Information System (AMIS) is projected to become a completely electronic and digital information hospital. AMIS has played a role in improving the health care quality based on the following measures: safety, effectiveness, patient-centeredness, timeliness, efficiency, privacy, and security. AMIS CONSISTED OF SEVERAL DISTINCTIVE SYSTEMS: order communication system, electronic medical record, picture archiving communication system, clinical research information system, data warehouse, enterprise resource planning, IT service management system, and disaster recovery system. The most distinctive features of AMIS were the high alert-medication recognition & management system, the integrated and severity stratified alert system, the integrated patient monitoring system, the perioperative diabetic care monitoring and support system, and the clinical indicator management system. AMIS provides IT services for AMC, 7 affiliated hospitals and over 5,000 partners clinics, and was developed to improve healthcare services. The current challenge of AMIS is standard and interoperability. A global health IT strategy is needed to get through the current challenges and to provide new services as needed.

Increased Use of No-till Cropping Systems Improves Stream Ecosystem Quality

NASA Astrophysics Data System (ADS)

Yates, A. G.; Bailey, R. C.; Schwindt, J. A.

2005-05-01

Release of sediments to streams from tilled lands has been a significant stressor to streams in agro-ecosystems for decades and has been shown to impact aquatic biota in a variety of ways. To limit soil erosion from cultivated lands, conservation tillage techniques, including the use of no-till systems, have been developed and widely adopted throughout the region. However, there haves been no tests of the effects of no-till systems on stream quality at a watershed scale. We measured habitat and water quality and sampled the benthic macroinvertebrate (BMI) and fish communities in 32 small (100-1400 ha) subwatersheds along a gradient of the proportion of land under no-till cropping systems to determine relationships between the use of no-till and stream quality. Our results demonstrate that with increasing proportions of no-till, habitat scores improve, the quantities of sediment and sediment associated stressors in the water decline, the BMI community exhibits reduced dominance by Oligocheata and Sphaeriidae, as well as improved Family Biotic Index (FBI) scores, and fish species richness increases. We concluded that increased use of no-till cropping systems by farmers does contribute to improved quality of streams in agro-ecosystems.

ISO9000 and the quality management system in the digital hospital.

PubMed

Liu, Yalan; Yao, Bin; Zhang, Zigang

2002-01-01

ISO9000 quality management system (ISO9000QMS) emphasize on the customer-oriented, managers' leadership and all staff's joining, adopt the process method and system management, spread the taking facts as a basis to make decision and improve consistently, and establish win-win relation with the suppliers. So, the digital hospital can adopt the ISO9000QMS. In order to establish the ISO9000QMS, the digital hospital should: (1) Design integrally, including analyzing the operation procedure, clarifying the job duties, setting up the spreading team and setting the quality policy and objectives: (2) Learning the ISO9000 quality standards; (3) Drawing up the documents, including the quality manual, program files and operation guiding files; (4) Training according the documents; (5) Executing the quality standard, including the service quality auditing, quality record auditing and quality system auditing; (6) Improving continually. With the establishment of ISO900QMS, the digital hospital can appraise more accurately, analyze quality matters statistically and avoid the interference of artificial factors.

Quality Improvement Awards and Vocational Education Assessment. ERIC Digest No. 182.

ERIC Educational Resources Information Center

Brown, Bettina Lankard

Quality system awards offer blueprints for assessing quality in vocational education as well as in business and industry. The three most prestigious awards recognizing quality improvement in business and industry are the Malcolm Baldrige Quality Award, Deming Application Prize, and ISO 9000 Registration. When comparing standards for the quality…

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.

Remote Sensing Image Quality Assessment Experiment with Post-Processing

NASA Astrophysics Data System (ADS)

Jiang, W.; Chen, S.; Wang, X.; Huang, Q.; Shi, H.; Man, Y.

2018-04-01

This paper briefly describes the post-processing influence assessment experiment, the experiment includes three steps: the physical simulation, image processing, and image quality assessment. The physical simulation models sampled imaging system in laboratory, the imaging system parameters are tested, the digital image serving as image processing input are produced by this imaging system with the same imaging system parameters. The gathered optical sampled images with the tested imaging parameters are processed by 3 digital image processes, including calibration pre-processing, lossy compression with different compression ratio and image post-processing with different core. Image quality assessment method used is just noticeable difference (JND) subject assessment based on ISO20462, through subject assessment of the gathered and processing images, the influence of different imaging parameters and post-processing to image quality can be found. The six JND subject assessment experimental data can be validated each other. Main conclusions include: image post-processing can improve image quality; image post-processing can improve image quality even with lossy compression, image quality with higher compression ratio improves less than lower ratio; with our image post-processing method, image quality is better, when camera MTF being within a small range.

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

PubMed

Myette, Thomas L

2008-04-01

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

Using mobile technology to improve healthcare service quality.

PubMed

Chao, Chia Chen; Jen, Wen Yuan; Li, Yu-Chuan; Chi, Y P; Chen, Chang-I; Feng, Chen Chjeh

2005-01-01

Improving healthcare service quality for illness of treatment, illness prevention and patient service is difficult for most hospitals because the hospitals are lack adequate resources and labor. In order to provide better healthcare service quality for patients, mobile technology can be used to manage healthcare in a way that provides the optimal healthcare service for patients. Pursuing utilization of mobile technology for better patient service, Taipei Medical University Municipal W. F. Teaching Hospital has implemented a mobile healthcare service (m-HS) system to increase healthcare service quality. The m-HS system improves the quality of medical care as well as healthcare service. The m-HS is a multi-functional healthcare management agent, meets the mobile tendency of the present society. This study seeks to discuss the m-HS architecture and workflow processes. We believe the m-HS does have the potential to improve healthcare service quality. Finally, the conclusions and suggestions for the m-HS are given.

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

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

PubMed

Eisner, Reinhold; Patel, Rakeshkumar

2017-04-20

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

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.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004-2012.

PubMed

Hamel, Donald J; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T; Okonkwo, Prosper; Kanki, Phyllis J

From 2004-2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President's Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings.

Validation Studies for Early Learning and Care Quality Rating and Improvement Systems: A Review of the Literature. Working Paper WR-1051-DOEL

ERIC Educational Resources Information Center

Karoly, Lynn A.

2014-01-01

Care Quality Rating and Improvement Systems (QRISs) have advanced and matured, a number of states and localities have undertaken evaluations to validate the systems. Such efforts stem from the desire to ensure that the system is designed and operating in the ways envisioned when the system was established. Given that a central component in a QRIS…

23 CFR 500.102 - Policy.

Code of Federal Regulations, 2012 CFR

2012-04-01

... increasing pressure to balance their budgets and, at the same time, respond to public demands for quality... life-cycle cost. The primary outcome of transportation management systems is improved system...)(1) and 23 U.S.C. 134(a)); congestion mitigation and air quality improvement program funds for those...

23 CFR 500.102 - Policy.

Code of Federal Regulations, 2011 CFR

2011-04-01

... increasing pressure to balance their budgets and, at the same time, respond to public demands for quality... life-cycle cost. The primary outcome of transportation management systems is improved system...)(1) and 23 U.S.C. 134(a)); congestion mitigation and air quality improvement program funds for those...

Webinar: Clean Air in the Classroom: Improve Air Quality, Extend HVAC System Life with Preventive Maintenance

EPA Pesticide Factsheets

A page to register to view the May 17, 2018, webinar in the IAQ Knowledge-to-Action Professional Training Webinar Series: Clean Air in the Classroom: Improve Air Quality, Extend HVAC System Life with Preventive Maintenance

23 CFR 500.102 - Policy.

Code of Federal Regulations, 2010 CFR

2010-04-01

... increasing pressure to balance their budgets and, at the same time, respond to public demands for quality... life-cycle cost. The primary outcome of transportation management systems is improved system...)(1) and 23 U.S.C. 134(a)); congestion mitigation and air quality improvement program funds for those...

Unsatisfactory Performance: How California's K-12 Education System Protects Mediocrity and How Teacher Quality Can Be Improved.

ERIC Educational Resources Information Center

Dawson, Thomas C.; Billingsley, K. Lloyd

This study examines the quality of California's K-12 education, discussing how the system protects mediocrity and how to improve educational quality in the state. It explains that what most ails the teaching force is that excellent teachers are not rewarded for superior work, and failing teachers are rarely held accountable for poor performance.…

Standards-Based Assessments in the Classroom: A Feasible Approach to Improving the Quality of Students' Learning

ERIC Educational Resources Information Center

Sharma, Priyanka

2015-01-01

In the new millennium, the Indian education system has experienced a major shift and the issue of the quality of education has taken centre stage in policy discussion fora. Globally, assessment has become an important means of improving the quality of education, both at the systemic level and at the level of individual students. It necessitates…

Quality improvement in basic histotechnology: the lean approach.

PubMed

Clark, David

2016-01-01

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

A Blueprint for Early Care and Education Quality Improvement Initiatives. Publication #2015-07

ERIC Educational Resources Information Center

Tout, Kathryn; Epstein, Dale; Soli, Meg; Lowe, Claire

2015-01-01

As Quality Rating and Improvement Systems (QRIS) continue to launch and mature across states, questions emerge from stakeholders about how to design and implement effective quality improvement (QI) initiatives that accompany a QRIS. Funders, policymakers, and program developers with limited resources are looking to invest in activities that will…

Guide for Improving NRS Data Quality: Procedures for Data Collection and Training.

ERIC Educational Resources Information Center

Condelli, Larry; Castillo, Laura; Seburn, Mary; Deveaux, Jon

This guide for improving the quality of National Reporting System for Adult Education (NRS) data through improved data collection and training is intended for local providers and state administrators. Chapter 1 explains the guide's purpose, contents, and use and defines the following components of data quality: objectivity; integrity;…

Innovating for quality and value: Utilizing national quality improvement programs to identify opportunities for responsible surgical innovation.

PubMed

Woo, Russell K; Skarsgard, Erik D

2015-06-01

Innovation in surgical techniques, technology, and care processes are essential for improving the care and outcomes of surgical patients, including children. The time and cost associated with surgical innovation can be significant, and unless it leads to improvements in outcome at equivalent or lower costs, it adds little or no value from the perspective of the patients, and decreases the overall resources available to our already financially constrained healthcare system. The emergence of a safety and quality mandate in surgery, and the development of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) allow needs-based surgical care innovation which leads to value-based improvement in care. In addition to general and procedure-specific clinical outcomes, surgeons should consider the measurement of quality from the patients' perspective. To this end, the integration of validated Patient Reported Outcome Measures (PROMs) into actionable, benchmarked institutional outcomes reporting has the potential to facilitate quality improvement in process, treatment and technology that optimizes value for our patients and health system. Copyright © 2015 Elsevier Inc. All rights reserved.

Winter wheat quality monitoring and forecasting system based on remote sensing and environmental factors

NASA Astrophysics Data System (ADS)

Haiyang, Yu; Yanmei, Liu; Guijun, Yang; Xiaodong, Yang; Dong, Ren; Chenwei, Nie

2014-03-01

To achieve dynamic winter wheat quality monitoring and forecasting in larger scale regions, the objective of this study was to design and develop a winter wheat quality monitoring and forecasting system by using a remote sensing index and environmental factors. The winter wheat quality trend was forecasted before the harvest and quality was monitored after the harvest, respectively. The traditional quality-vegetation index from remote sensing monitoring and forecasting models were improved. Combining with latitude information, the vegetation index was used to estimate agronomy parameters which were related with winter wheat quality in the early stages for forecasting the quality trend. A combination of rainfall in May, temperature in May, illumination at later May, the soil available nitrogen content and other environmental factors established the quality monitoring model. Compared with a simple quality-vegetation index, the remote sensing monitoring and forecasting model used in this system get greatly improved accuracy. Winter wheat quality was monitored and forecasted based on the above models, and this system was completed based on WebGIS technology. Finally, in 2010 the operation process of winter wheat quality monitoring system was presented in Beijing, the monitoring and forecasting results was outputted as thematic maps.

Quality of the ophthalmological service to outpatients of the public and private healthcare systems.

PubMed

Hercos, Benigno Vicente Santos; Berezovsky, Adriana

2017-01-01

To compare perceptions of the quality of ophthalmological services offered to outpatients from the public healthcare system to those from the private healthcare system, and to determine which measures are seen as necessary and a priority for improving the quality of care. This was a prospective observational study on 200 patients, 101 and 99 of whom were from the public and private healthcare systems, respectively. All patients underwent an ophthalmological examination at an ophthalmology hospital in Belo Horizonte, Minas Gerais, Brazil. Personal interviews were conducted using two structured questionnaires adapted from the modified SERVQUAL scale. Overall, patients from the private healthcare system were significantly more dissatisfied than those from the public healthcare system. In both systems, reliability was considered to be the most important determinant of quality, and it presented the highest level of dissatisfaction. Satisfaction with the public healthcare system was significantly greater than that with the private healthcare system in terms of the tangibles, reliability, responsiveness, and assurance determinants of the SERVQUAL scale. Institutions must plan, execute, evaluate, and monitor measures that seek to improve the overall patient satisfaction with the quality of services provided, particularly in the private healthcare system, and special attention must be paid to reliability in both healthcare systems. The identification and monitoring of the quality of healthcare services through the periodic use of the SERVQUAL scale may provide healthcare managers with information so that they can identify, plan, and monitor necessary and priority measures. This could be a key strategy for improving the quality of outpatient health services in the public and private systems.

The Clinical Nurse Leader--new nursing role with global implications.

PubMed

Baernholdt, M; Cottingham, S

2011-03-01

This paper describes the development of the Clinical Nurse Leader (CNL ©) role and education, the CNL's impact and potential to improve quality globally. The need for clinical nurse leadership to improve the quality of health care systems while controlling costs is recognized in reports internationally. In the USA, a new nursing role, the CNL, was developed in response to such reports. CNLs are master's level nurse graduates (although not necessarily recruited from a nursing background) with the skills and knowledge to create change within complex systems and improve outcomes while they remain direct care providers. This innovative role can be adapted worldwide to improve the quality of health care systems. © 2010 The Authors. International Nursing Review © 2010 International Council of Nurses.

Subjective evaluation of two stereoscopic imaging systems exploiting visual attention to improve 3D quality of experience

NASA Astrophysics Data System (ADS)

Hanhart, Philippe; Ebrahimi, Touradj

2014-03-01

Crosstalk and vergence-accommodation rivalry negatively impact the quality of experience (QoE) provided by stereoscopic displays. However, exploiting visual attention and adapting the 3D rendering process on the fly can reduce these drawbacks. In this paper, we propose and evaluate two different approaches that exploit visual attention to improve 3D QoE on stereoscopic displays: an offline system, which uses a saliency map to predict gaze position, and an online system, which uses a remote eye tracking system to measure real time gaze positions. The gaze points were used in conjunction with the disparity map to extract the disparity of the object-of-interest. Horizontal image translation was performed to bring the fixated object on the screen plane. The user preference between standard 3D mode and the two proposed systems was evaluated through a subjective evaluation. Results show that exploiting visual attention significantly improves image quality and visual comfort, with a slight advantage for real time gaze determination. Depth quality is also improved, but the difference is not significant.

Quality management in health care: a 20-year journey.

PubMed

Ruiz, Ulises

2004-01-01

In this article, the total quality programme in the Spanish healthcare system (1986-1992) and the subsequent quality improvement steps that have led to definition and implementation of such an integrated framework, seeking a quality management system and patient safety, are discussed.

A Novel and Intelligent Home Monitoring System for Care Support of Elders with Cognitive Impairment.

PubMed

Lazarou, Ioulietta; Karakostas, Anastasios; Stavropoulos, Thanos G; Tsompanidis, Theodoros; Meditskos, Georgios; Kompatsiaris, Ioannis; Tsolaki, Magda

2016-10-18

Assistive technology, in the form of a smart home environment, is employed to support people with dementia. To propose a system for continuous and objective remote monitoring of problematic daily living activity areas and design personalized interventions based on system feedback and clinical observations for improving cognitive function and health-related quality of life. The assistive technology of the proposed system, including wearable, sleep, object motion, presence, and utility usage sensors, was methodically deployed at four different home installations of people with cognitive impairment. Detection of sleep patterns, physical activity, and activities of daily living, based on the collected sensor data and analytics, was available at all times through comprehensive data visualization solutions. Combined with clinical observation, targeted psychosocial interventions were introduced to enhance the participants' quality of life and improve their cognitive functions and daily functionality. Meanwhile, participants and their caregivers were able to visualize a reduced set of information tailored to their needs. Overall, paired-sample t-test analysis of monitored qualities revealed improvement for all participants in neuropsychological assessment. Moreover, improvement was detected from the beginning to the end of the trial, in physical condition and in the domains of sleep. Detecting abnormalities via the system, for example in sleep quality, such as REM sleep, has proved to be critical to assess current status, drive interventions, and evaluate improvements in a reliable manner. It has been proved that the proposed system is suitable to support clinicians to reliably drive and evaluate clinical interventions toward quality of life improvement of people with cognitive impairment.

Quality Management Systems Implementation Compared With Organizational Maturity in Hospital.

PubMed

Moradi, Tayebeh; Jafari, Mehdi; Maleki, Mohammad Reza; Naghdi, Seyran; Ghiasvand, Hesam

2015-07-27

A quality management system can provide a framework for continuous improvement in order to increase the probability of customers and other stakeholders' satisfaction. The test maturity model helps organizations to assess the degree of maturity in implementing effective and sustained quality management systems; plan based on the current realities of the organization and prioritize their improvement programs. We aim to investigate and compare the level of organizational maturity in hospitals with the status of quality management systems implementation. This analytical cross sectional study was conducted among hospital administrators and quality experts working in hospitals with over 200 beds located in Tehran. In the first step, 32 hospitals were selected and then 96 employees working in the selected hospitals were studied. The data were gathered using the implementation checklist of quality management systems and the organization maturity questionnaire derived from ISO 10014. The content validity was calculated using Lawshe method and the reliability was estimated using test - retest method and calculation of Cronbach's alpha coefficient. The descriptive and inferential statistics were used to analyze the data using SPSS 18 software. According to the table, the mean score of organizational maturity among hospitals in the first stage of quality management systems implementation was equal to those in the third stage and hypothesis was rejected (p-value = 0.093). In general, there is no significant difference in the organizational maturity between the first and third level hospitals (in terms of implementation of quality management systems). Overall, the findings of the study show that there is no significant difference in the organizational maturity between the hospitals in different levels of the quality management systems implementation and in fact, the maturity of the organizations cannot be attributed to the implementation of such systems. As a result, hospitals should make changes in the quantity and quality of quality management systems in an effort to increase organizational maturity, whereby they improve the hospital efficiency and productivity.

Quality Management Systems Implementation Compared With Organizational Maturity in Hospital

PubMed Central

Moradi, Tayebeh; Jafari, Mehdi; Maleki, Mohammad Reza; Naghdi, Seyran; Ghiyasvand, Hesam

2016-01-01

Background: A quality management system can provide a framework for continuous improvement in order to increase the probability of customers and other stakeholders’ satisfaction. The test maturity model helps organizations to assess the degree of maturity in implementing effective and sustained quality management systems; plan based on the current realities of the organization and prioritize their improvement programs. Objectives: We aim to investigate and compare the level of organizational maturity in hospitals with the status of quality management systems implementation. Materials and Methods: This analytical cross sectional study was conducted among hospital administrators and quality experts working in hospitals with over 200 beds located in Tehran. In the first step, 32 hospitals were selected and then 96 employees working in the selected hospitals were studied. The data were gathered using the implementation checklist of quality management systems and the organization maturity questionnaire derived from ISO 10014. The content validity was calculated using Lawshe method and the reliability was estimated using test - retest method and calculation of Cronbach's alpha coefficient. The descriptive and inferential statistics were used to analyze the data using SPSS 18 software. Results: According to the table, the mean score of organizational maturity among hospitals in the first stage of quality management systems implementation was equal to those in the third stage and hypothesis was rejected (p-value = 0.093). In general, there is no significant difference in the organizational maturity between the first and third level hospitals (in terms of implementation of quality management systems). Conclusions: Overall, the findings of the study show that there is no significant difference in the organizational maturity between the hospitals in different levels of the quality management systems implementation and in fact, the maturity of the organizations cannot be attributed to the implementation of such systems. As a result, hospitals should make changes in the quantity and quality of quality management systems in an effort to increase organizational maturity, whereby they improve the hospital efficiency and productivity. PMID:26493411

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

PubMed Central

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

2015-01-01

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

Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives.

PubMed

Chelico, John D; Wilcox, Adam B; Vawdrey, David K; Kuperman, Gilad J

2016-01-01

Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across multiple disparate sources. We created a virtual data warehouse at NewYork Presbyterian Hospital that allowed us to bring together data from several source systems throughout the organization. We also created a framework to match the maturity of a data request in the quality improvement life cycle to proper tools needed for each request. As projects progress in the Define, Measure, Analyze, Improve, Control stages of quality improvement, there is a proper matching of resources the data needs at each step. We describe the analysis and design creating a robust model for applying clinical data warehousing to quality improvement.

Designing a Clinical Data Warehouse Architecture to Support Quality Improvement Initiatives

PubMed Central

Chelico, John D.; Wilcox, Adam B.; Vawdrey, David K.; Kuperman, Gilad J.

2016-01-01

Clinical data warehouses, initially directed towards clinical research or financial analyses, are evolving to support quality improvement efforts, and must now address the quality improvement life cycle. In addition, data that are needed for quality improvement often do not reside in a single database, requiring easier methods to query data across multiple disparate sources. We created a virtual data warehouse at NewYork Presbyterian Hospital that allowed us to bring together data from several source systems throughout the organization. We also created a framework to match the maturity of a data request in the quality improvement life cycle to proper tools needed for each request. As projects progress in the Define, Measure, Analyze, Improve, Control stages of quality improvement, there is a proper matching of resources the data needs at each step. We describe the analysis and design creating a robust model for applying clinical data warehousing to quality improvement. PMID:28269833

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.

Pilot Study Evaluating a Practice-Based Learning and Improvement Curriculum Focusing on the Development of System-Level Quality Improvement Skills

PubMed Central

Tomolo, Anne M; Lawrence, Renée H; Watts, Brook; Augustine, Sarah; Aron, David C; Singh, Mamta K

2011-01-01

Background We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. Methods We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. Results The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Conclusion Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills. PMID:22379523

Pilot study evaluating a practice-based learning and improvement curriculum focusing on the development of system-level quality improvement skills.

PubMed

Tomolo, Anne M; Lawrence, Renée H; Watts, Brook; Augustine, Sarah; Aron, David C; Singh, Mamta K

2011-03-01

We developed a practice-based learning and improvement (PBLI) curriculum to address important gaps in components of content and experiential learning activities through didactics and participation in systems-level quality improvement projects that focus on making changes in health care processes. We evaluated the impact of our curriculum on resident PBLI knowledge, self-efficacy, and application skills. A quasi-experimental design assessed the impact of a curriculum (PBLI quality improvement systems compared with non-PBLI) on internal medicine residents' learning during a 4-week ambulatory block. We measured application skills, self-efficacy, and knowledge by using the Systems Quality Improvement Training and Assessment Tool. Exit evaluations assessed time invested and experiences related to the team projects and suggestions for improving the curriculum. The 2 groups showed differences in change scores. Relative to the comparison group, residents in the PBLI curriculum demonstrated a significant increase in the belief about their ability to implement a continuous quality improvement project (P  =  .020), comfort level in developing data collection plans (P  =  .010), and total knowledge scores (P < .001), after adjusting for prior PBLI experience. Participants in the PBLI curriculum also demonstrated significant improvement in providing a more complete aim statement for a proposed project after adjusting for prior PBLI experience (P  =  .001). Exit evaluations were completed by 96% of PBLI curriculum participants who reported high satisfaction with team performance. Residents in our curriculum showed gains in areas fundamental for PBLI competency. The observed improvements were related to fundamental quality improvement knowledge, with limited gain in application skills. This suggests that while heading in the right direction, we need to conceptualize and structure PBLI training in a way that integrates it throughout the residency program and fosters the application of this knowledge and these skills.

Grouped comparisons of sleep quality for new and personal bedding systems.

PubMed

Jacobson, Bert H; Wallace, Tia J; Smith, Doug B; Kolb, Tanner

2008-03-01

The purpose of this study was to compare sleep comfort and quality between personal and new bedding systems. A convenience sample (women, n=33; men, n=29) with no clinical history of disturbed sleep participated in the study. Subjects recorded back and shoulder pain, sleep quality, comfort, and efficiency for 28 days each in their personal beds (pre) and in new medium-firm bedding systems (post). Repeated measures ANOVAs revealed significant improvement between pre- and post-test means for all dependent variables. Furthermore, reduction of pain and stiffness and improvement of sleep comfort and quality became more prominent over time. No significant differences were found for the groupings of age, weight, height, or body mass index. It was found that for the cheapest category of beds, lower back pain was significantly (p<0.01) more prominent than for the medium and higher priced beds. Average bed age was 9.5yrs. It was concluded that new bedding systems can significantly improve selected sleep variables and that continuous sleep quality may be dependent on timely replacement of bedding systems.

Are hospital quality improvement and public accountability compatible?

PubMed

Panzer, R J

1994-07-01

The goals of public accountability and quality improvement are compatible in theory but not necessarily in practice. Both concepts emphasize the customer. However, those working toward these two goals design systems with quite different roles and relationships between the providers and consumers of health care. Superficial interactions obstruct meaningful dialogue about how to build a better system meeting both sets of goals. Current practices of public accountability and quality improvement have fundamentally different paradigms concerning the roles and responsibilities of those who provide and those who consume health care. There are at least three ways to improve the current relationship between public accountability and quality improvement. First, optimizing the design and performance of each effort would be an improvement since the goals are highly compatible. Neither ideal currently meets its own expectations, creating distrust among the proponents of each when reality falls short. Second, the two efforts could be coordinated through joint community-level planning and sharing. Finally and optimally, the two concepts could be made part of the same community-level cooperative system, an approach that offers the greatest opportunity for achieving shared goals.

Quality improvement to guide the new health system.

PubMed

Merry, M D

2001-03-01

While there are many areas, such as intensive care treatment and pain management, where great gains in quality improvement can be made, the greatest strides will come as the leaders and trustees in health care organizations begin to create "the industrial revolution" in their organizations by creating cultures of quality. Stephen Shortell recommends the following list of things board members can do to improve quality in their organizations.

Student laboratory reports: an approach to improving feedback and quality

NASA Astrophysics Data System (ADS)

Ellingsen, Pål Gunnar; Støvneng, Jon Andreas

2018-05-01

We present an ongoing effort in improving the quality of laboratory reports written by first and second year physics students. The effort involves a new approach where students are given the opportunity to submit reports at intermediate deadlines, receive feedback, and then resubmit for the final deadline. In combination with a differential grading system, instead of pass/fail, the improved feedback results in higher quality reports. Improvement in the quality of the reports is visible through the grade statistics.

Study of college library appealing information system: A case of Longyan University

NASA Astrophysics Data System (ADS)

Liao, Jin-Hui

2014-10-01

The complaints from the readers at university libraries mainly focus on the aspects of service attitude, quality of service, reading environment, the management system, etc. Librarians should realize that reader complaints can actually promote the role of the library service and communicate with readers who complain in a friendly manner. In addition, the Longyan University library should establish an internal management system, improve library hardware facilities, improve the quality of librarians and optimize the knowledge structure of librarians, so as to improve the quality of the service for readers and reduce complaints. Based on this point, we have designed an appealing information system in cryptography machine basis, to provide readers online, remote and anonymous complaint functions.

Gaining customer knowledge: obtaining and using customer judgments for hospitalwide quality improvement.

PubMed

Nelson, E C; Caldwell, C; Quinn, D; Rose, R

1991-03-01

Customer knowledge is an essential feature of hospitalwide quality improvement. All systems and processes have customers. The aim is to use customer knowledge and voice of the customer measurement to plan, design, improve, and monitor these systems and processes continuously. In this way, the hospital stands the best chance of meeting customers' needs and, hopefully, delivering services that are so outstanding that customers will be surprised and delighted. There are many methods, both soft and hard, that can be used to increase customer knowledge. One useful strategy is to use a family of quality measures that reflect the voice of the customer. These measures can generate practical and powerful customer knowledge information that is essential to performing strategic planning, deploying quality policy, designing new services, finding targets for improvements, and monitoring those continuous improvements based on customers' judgments.

[Integrated Quality Management System (IQMS): a model for improving the quality of reproductive health care in rural Kenya].

PubMed

Herrler, Claudia; Bramesfeld, Anke; Brodowski, Marc; Prytherch, Helen; Marx, Irmgard; Nafula, Maureen; Richter-Aairijoki, Heide; Musyoka, Lucy; Marx, Michael; Szecsenyi, Joachim

2015-01-01

To develop a model aiming to improve the quality of services for reproductive health care in rural Kenya and designed to measure the quality of reproductive health services in such a way that allows these services to identify measures for improving their performance. The Integrated Quality Management System (IQMS) was developed on the basis of a pre-existing and validated model for quality promotion, namely the European Practice Assessment (EPA). The methodology for quality assessment and feedback of assessment results to the service teams was adopted from the EPA model. Quality assessment methodology included data assessment through staff, patient surveys and service visitation. Quality is assessed by indicators, and so indicators had to be developed that were appropriate for assessing reproductive health care in rural Kenya. A search of the Kenyan and international literature was conducted to identify potential indicators. These were then rated for their relevance and clarity by a panel of Kenyan experts. 260 indicators were rated as relevant and assigned to 29 quality dimensions and 5 domains. The implementation of IQMS in ten facilities showed that IQMS is a feasible model for assessing the quality of reproductive health services in rural Kenya. IQMS enables these services to identify quality improvement targets and necessary improvement measures. Both strengths and limitations of IQMS will be discussed. Copyright © 2015. Published by Elsevier GmbH.

[Recommendations for the evaluation and follow-up of the continuous quality improvement].

PubMed

Maurellet-Evrard, S; Daunizeau, A

2013-06-01

Continual improvement of the quality in a medical laboratory is based on the implementation of tools for systematically evaluate the quality management system and its ability to meet the objectives defined. Monitoring through audit and management review, addressing complaints and nonconformities and performing client satisfaction survey are the key for the continual improvement.

Data Use "Multi-State" Spotlight: Using Data Fidelity Tools to Improve Data Quality. Transforming State Systems to Improve Outcomes for Children with Disabilities

ERIC Educational Resources Information Center

Ruedel, Kristin; Nelson, Gena; Bailey, Tessie

2018-01-01

To evaluate interim progress toward the State-identified Measurable Result (SIMR), states require access to high-quality data from local education agencies (LEAs) and early intervention service providers. In a review of 2017 Phase III State Systemic Improvement Plans (SSIP), 43 Part C states noted limitations or concerns related to data and…

[Animal drugs quality status and reason analysis].

PubMed

Ding, Qing; Qiu, Ya-jing; Fang, Ke-hui; Hu, Hao-bin; Wu, Yue

2015-11-01

In order to reaction the quality present situation, problems on the current quality of animal sources of drugs are summed up by using test data analysis, literature search and marketing research. This paper can also help the improvement of the quality management, the revision of the relevant department policy system and the improvement of standards.

Executing Quality: A Grounded Theory of Child Care Quality Improvement Engagement Process in Pennsylvania

ERIC Educational Resources Information Center

Critchosin, Heather

2014-01-01

Executing Quality describes the perceived process experienced by participants while engaging in Keystone Standards, Training, Assistance, Resources, and Support (Keystone STARS) quality rating improvement system (QRIS). The purpose of this qualitative inquiry was to understand the process of Keystone STARS engagement in order to generate a…

Telemedicine-based system for quality management and peer review in radiology.

PubMed

Morozov, Sergey; Guseva, Ekaterina; Ledikhova, Natalya; Vladzymyrskyy, Anton; Safronov, Dmitry

2018-06-01

Quality assurance is the key component of modern radiology. A telemedicine-based quality assurance system helps to overcome the "scoring" approach and makes the quality control more accessible and objective. A concept for quality assurance in radiology is developed. Its realization is a set of strategies, actions, and tools. The latter is based on telemedicine-based peer review of 23,199 computed tomography (CT) and magnetic resonance imaging (MRI) images. The conception of the system for quality management in radiology represents a chain of actions: "discrepancies evaluation - routine support - quality improvement activity - discrepancies evaluation". It is realized by an audit methodology, telemedicine, elearning, and other technologies. After a year of systemic telemedicine-based peer reviews, the authors have estimated that clinically significant discrepancies were detected in 6% of all cases, while clinically insignificant ones were found in 19% of cases. Most often, problems appear in musculoskeletal records; 80% of the examinations have diagnostic or technical imperfections. The presence of routine telemedicine support and personalized elearning allowed improving the diagnostics quality. The level of discrepancies has decreased significantly (p < 0.05). The telemedicine-based peer review system allows improving radiology departments' network effectiveness. • "Scoring" approach to radiologists' performance assessment must be changed. • Telemedicine peer review and personalized elearning significantly decrease the number of discrepancies. • Teleradiology allows linking all primary-level hospitals to a common peer review network.

Context in Quality of Care: Improving Teamwork and Resilience.

PubMed

Tawfik, Daniel S; Sexton, John Bryan; Adair, Kathryn C; Kaplan, Heather C; Profit, Jochen

2017-09-01

Quality improvement in health care is an ongoing challenge. Consideration of the context of the health care system is of paramount importance. Staff resilience and teamwork climate are key aspects of context that drive quality. Teamwork climate is dynamic, with well-established tools available to improve teamwork for specific tasks or global applications. Similarly, burnout and resilience can be modified with interventions such as cultivating gratitude, positivity, and awe. A growing body of literature has shown that teamwork and burnout relate to quality of care, with improved teamwork and decreased burnout expected to produce improved patient quality and safety. Copyright © 2017 Elsevier Inc. All rights reserved.

Building laboratory capacity to support HIV care in Nigeria: Harvard/APIN PEPFAR, 2004–2012

PubMed Central

Hamel, Donald J.; Sankalé, Jean-Louis; Samuels, Jay Osi; Sarr, Abdoulaye D.; Chaplin, Beth; Ofuche, Eke; Meloni, Seema T.; Okonkwo, Prosper; Kanki, Phyllis J.

2015-01-01

Introduction From 2004–2012, the Harvard/AIDS Prevention Initiative in Nigeria, funded through the US President’s Emergency Plan for AIDS Relief programme, scaled up HIV care and treatment services in Nigeria. We describe the methodologies and collaborative processes developed to improve laboratory capacity significantly in a resource-limited setting. These methods were implemented at 35 clinic and laboratory locations. Methods Systems were established and modified to optimise numerous laboratory processes. These included strategies for clinic selection and management, equipment and reagent procurement, supply chains, laboratory renovations, equipment maintenance, electronic data management, quality development programmes and trainings. Results Over the eight-year programme, laboratories supported 160 000 patients receiving HIV care in Nigeria, delivering over 2.5 million test results, including regular viral load quantitation. External quality assurance systems were established for CD4+ cell count enumeration, blood chemistries and viral load monitoring. Laboratory equipment platforms were improved and standardised and use of point-of-care analysers was expanded. Laboratory training workshops supported laboratories toward increasing staff skills and improving overall quality. Participation in a World Health Organisation-led African laboratory quality improvement system resulted in significant gains in quality measures at five laboratories. Conclusions Targeted implementation of laboratory development processes, during simultaneous scale-up of HIV treatment programmes in a resource-limited setting, can elicit meaningful gains in laboratory quality and capacity. Systems to improve the physical laboratory environment, develop laboratory staff, create improvements to reduce costs and increase quality are available for future health and laboratory strengthening programmes. We hope that the strategies employed may inform and encourage the development of other laboratories in resource-limited settings. PMID:26900573

[Certification of an ambulatory gastroenterologic service fulfilling ISO Law 9001--criteria and national guidelines of the Gastroenterologic Association].

PubMed

Birkner, B

2000-09-01

The objectives of certification and accreditation are the deployment and examination of quality improvement measures in health care services. The quality management system of the ISO 9001 is created to install measures and tools leading to assured and improved quality in health care. Only some experiences with certification fulfilling ISO 9001 criteria exist in the German health care system. Evidence-based clinical guidelines can serve as references for the development of standards in quality measurement. Only little data exists on the implementation strategy of guidelines and evaluation, respectively. A pilot quality management system in consistence with ISO 9001 criteria was developed for ambulatory, gastroenterological services. National guidelines of the German Society of Gastroenterology and Metabolism and the recommendations of the German Association of Physicians for quality assurance of gastrointestinal endoscopy were included in the documentation and internal auditing. This pilot quality management system is suitable for the first steps in the introduction of quality management in ambulatory health care. This system shows validity for accreditation and certification of gastrointestinal health care units as well.

Quality Management and Key Performance Indicators in Oncologic Esophageal Surgery.

PubMed

Gockel, Ines; Ahlbrand, Constantin Johannes; Arras, Michael; Schreiber, Elke Maria; Lang, Hauke

2015-12-01

Ranking systems and comparisons of quality and performance indicators will be of increasing relevance for complex "high-risk" procedures such as esophageal cancer surgery. The identification of evidence-based standards relevant for key performance indicators in esophageal surgery is essential for establishing monitoring systems and furthermore a requirement to enhance treatment quality. In the course of this review, we analyze the key performance indicators case volume, radicality of resection, and postoperative morbidity and mortality, leading to continuous quality improvement. Ranking systems established on this basis will gain increased relevance in highly complex procedures within the national and international comparison and furthermore improve the treatment of patients with esophageal carcinoma.

A supply chain model to improve the beef quality distribution using investment analysis: A case study

NASA Astrophysics Data System (ADS)

Lupita, Alessandra; Rangkuti, Sabrina Heriza; Sutopo, Wahyudi; Hisjam, Muh.

2017-11-01

There are significant differences related to the quality and price of the beef commodity in traditional market and modern market in Indonesia. Those are caused by very different treatments of the commodity. The different treatments are in the slaughter lines, the transportation from the abattoir to the outlet, the display system, and the control system. If the problem is not solved by the Government, the gap will result a great loss of the consumer regarding to the quality and sustainability of traditional traders business because of the declining interest in purchasing beef in the traditional markets. This article aims to improve the quality of beef in traditional markets. This study proposed A Supply Chain Model that involves the schemes of investment and government incentive for improving the distribution system. The supply chain model is can be formulated using the Mix Integer Linear Programming (MILP) and solved using the IBM®ILOG®CPLEX software. The results show that the proposed model can be used to determine the priority of programs for improving the quality and sustainability business of traditional beef merchants. By using the models, The Government can make a decision to consider incentives for improving the condition.

Creating Quality Schools.

ERIC Educational Resources Information Center

American Association of School Administrators, Arlington, VA.

This booklet presents information on how total quality management can be applied to school systems to create educational improvement. Total quality management offers education a systemic approach and a new set of assessment tools. Chapter 1 provides a definition and historical overview of total quality management. Chapter 2 views the school…

The ReACH Collaborative--improving quality home care.

PubMed

Boyce, Patricia Simino; Pace, Karen B; Lauder, Bonnie; Solomon, Debra A

2007-08-01

Research on quality of care has shown that vigorous leadership, clear goals, and compatible incentive systems are critical factors in influencing successful change (Institute of Medicine, 2001). Quality improvement is a complex process, and clinical quality improvement applications are more likely to be effective in organizations that are ready for change and have strong leaders, who are committed to creating and reinforcing a work environment that supports quality goals (Shortell, 1998). Key leadership roles include providing clear and sustained direction, articulating a coherent set of values and incentives to guide group and individual activities, aligning and integrating improvement efforts into organizational priorities, obtaining or freeing up resources to implement improvement activities, and creating a culture of "continuous improvement" that encourages and rewards the pursuit and achievement of shared quality aims (Institute of Medicine, 2001, 70-71). In summary, home health care is a significant and growing sector of the health care system that provides care to millions of vulnerable patients. There seems little doubt that home health agencies want to focus on quality of care issues and provide optimal care to home-based patients. Furthermore, there is a growing awareness of the value for adapting innovative, effective models for improving the culture of home care practice. This awareness stems from the notion that some agencies see quality improvement activities as a way for them to distinguish themselves not only to regulators and customers, but also to meet the cultural and transformational needs to remain viable in a constantly evolving and competitive health care industry.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria: Successes and Challenges.

PubMed

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System-AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement ( t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities.

[Financial incentives for quality improvement].

PubMed

Belicza, Eva; Evetovits, Tamás

2010-05-01

Policy makers and payers of health care services devote increasing attention to improve quality of services by incentivising health care providers. These--so called--pay for performance (P4P) programmes have so far been introduced in few countries only and evidence on their effectiveness is still scarce. Therefore we do not know yet which instruments of these programmes are most effective and efficient in improving quality. The P4P systems implemented so far in primary care and in integrated delivery systems use indicators for measurement of performance and the basis for rewards. These indicators are mostly process indicators, but there are some outcome indicators as well. The desired quality improvement effects are most likely to be achieved with programmes that provide seizable financial rewards and cover the extra cost of quality improvement efforts as well. Administration of the programme has to be fully transparent and clear to all involved. It has to be based on scientific evidence and supported with sufficient dedicated funding. Conducting pilot studies is a precondition for large scale implementation.

The Health Quality and Safety Commission: making good health care better.

PubMed

Shuker, Carl; Bohm, Gillian; Bramley, Dale; Frost, Shelley; Galler, David; Hamblin, Richard; Henderson, Robert; Jansen, Peter; Martin, Geraint; Orsborn, Karen; Penny, Anthea; Wilson, Janice; Merry, Alan F

2015-01-30

New Zealand has one of the best value health care systems in the world, but as a proportion of GDP our spending on health care has increased every year since 1999. Further, there are issues of quality and safety in our system we must address, including rates of adverse events. The Health Quality and Safety Commission was formed in 2010 as a crown agent to influence, encourage, guide and support improvement in health care practice in New Zealand. The New Zealand Triple Aim has been defined as: improved quality, safety and experience of care; improved health and equity for all populations; and best value for public health system resources. The Commission is pursuing the Triple Aim via two fundamental objectives: doing the right thing by providing care supported by the best evidence available, focused on what matters to each individual patient, and doing the right thing right, first time, by making sure health care is safe and of the highest quality possible. Improvement efforts must be supported by robust but economical measurements. New Zealand has a strong culture of quality, so the Commission's role is to work with our colleagues to make good health care better.

COMPUTERIZED NEEDS-ORIENTED QUALITY MEASUREMENT EVALUATION SYSTEM (CONQUEST)

EPA Science Inventory

CONQUEST is an easy-to-use quality improvement software tool that uses a common structure and language to help users identity, understand, compare, evaluate, and select among 1,200 clinical performance measures that can be used to assess and improve quality of care. CONQUEST's in...

Feasibility of encoding the Institute for Clinical Systems Improvement Depression Guideline using the Omaha System.

PubMed

Monsen, Karen A; Neely, Claire; Oftedahl, Gary; Kerr, Madeleine J; Pietruszewski, Pam; Farri, Oladimeji

2012-08-01

Evidence-based clinical guidelines are being developed to bridge the gap between research and practice with the goals of improving health care quality and population health. However, disseminating, implementing, and ensuring ongoing use of clinical guidelines in practice settings is challenging. The purpose of this study was to demonstrate the feasibility of encoding evidence-based clinical guidelines using the Omaha System. Clinical documentation with Omaha System-encoded guidelines generates individualized, meaningful data suitable for program evaluation and health care quality research. The use of encoded guidelines within the electronic health record has potential to reinforce use of guidelines, and thus improve health care quality and population health. Research using Omaha System data generated by clinicians has potential to discover new knowledge related to guideline use and effectiveness. Copyright © 2012 Elsevier Inc. All rights reserved.

Unisys' experience in software quality and productivity management of an existing system

NASA Technical Reports Server (NTRS)

Munson, John B.

1988-01-01

A summary of Quality Improvement techniques, implementation, and results in the maintenance, management, and modification of large software systems for the Space Shuttle Program's ground-based systems is provided.

Independent Evaluation of California's Race to the Top: Early Learning Challenge Quality Rating and Improvement System. Half-Term Report

ERIC Educational Resources Information Center

Hawkinson, Laura E.; Quick, Heather E.; Muenchow, Susan; Anthony, Jennifer; Weinberg, Emily; Holod, Aleksandra; Parrish, Deborah; Meakin, John; Lee, Dong Hoon; Tarrant, Kate; Cannon, Jill S.; Zellman, Gail L.; Karoly, Lynn A.

2015-01-01

The first step in the Validity and Reliability Study summarizes the history and purpose of California's quality rating and improvement system (QRIS), reviews findings from other QRIS evaluation studies, and describes the approach to validating the system in California. The majority of this report focuses on providing context for the California…

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.

Seven Strategies for Improving the Quality and Efficiency of the Education System. Notes, Comments... No. 192 = Sept strategies visant a ameliorer la qualite et l'efficacite du systeme d'education.

ERIC Educational Resources Information Center

Schiefelbein, Ernesto

Seven strategies for improving the quality and efficiency of educational system in Latin American are delineated within the context of background information on the coverage and efficiency of school systems from 1970 to 1980, technical and institutional limitations to educational progress, and an estimate of the impact of the strategies.…

Technology as an Instrument to Improve Quality, Accountability, and Reflection in Academic Medicine

ERIC Educational Resources Information Center

Wilkes, Michael S.; Howell, Lydia

2006-01-01

Objective: This article describes two complementary technology systems used in academic medicine to 1) improve the quality of learning and teaching, and 2) describe the barriers and obstacles encountered in implementing these systems. Method: The literature was integrated with in-depth, case-based experience with technology related to student…

South Carolina Case Study: Building a Student-Level Longitudinal Data System

ERIC Educational Resources Information Center

Kugle, Cherry; Smith, Nancy

2007-01-01

The Data Quality Campaign is a national, collaborative effort to encourage and support state policymakers to improve the collection, availability and use of high-quality education data and to implement state longitudinal data systems to improve student achievement. The campaign aims to provide tools and resources that will assist state development…

Mechanisms of deterioration of nutrients. [of freeze dried foods

NASA Technical Reports Server (NTRS)

Karel, M.; Flink, J. M.

1976-01-01

Methods which produce freeze dried foods of improved quality were examined with emphasis on storage stability. Specific topics discussed include: microstructure of freeze dried systems, investigation of structural changes in freeze dried systems, artificial food matrices, osmotic preconcentration to yield improved quality freeze dried fruits, and storage stability of osmotically preconcentrated freeze dried fruits.

Louisiana Case Study: Building a Student-Level Longitudinal Data System

ERIC Educational Resources Information Center

Kugle, Cherry; Smith, Nancy

2008-01-01

The Data Quality Campaign is a national, collaborative effort to encourage and support state policymakers to improve the collection, availability and use of high-quality education data and to implement state longitudinal data systems to improve student achievement. The campaign aims to provide tools and resources that will assist state development…

Enhancing the primary care team to provide redesigned care: the roles of practice facilitators and care managers.

PubMed

Taylor, Erin Fries; Machta, Rachel M; Meyers, David S; Genevro, Janice; Peikes, Deborah N

2013-01-01

Efforts to redesign primary care require multiple supports. Two potential members of the primary care team-practice facilitator and care manager-can play important but distinct roles in redesigning and improving care delivery. Facilitators, also known as quality improvement coaches, assist practices with coordinating their quality improvement activities and help build capacity for those activities-reflecting a systems-level approach to improving quality, safety, and implementation of evidence-based practices. Care managers provide direct patient care by coordinating care and helping patients navigate the system, improving access for patients, and communicating across the care team. These complementary roles aim to help primary care practices deliver coordinated, accessible, comprehensive, and patient-centered care.

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

PubMed

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

2015-10-01

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

Low Quality of Basic Caregiving Environments in Child Care: Actual Reality or Artifact of Scoring?

ERIC Educational Resources Information Center

Norris, Deborah J.; Guss, Shannon

2016-01-01

Quality Rating Improvement Systems (QRIS) frequently include the Infant-Toddler Environment Rating Scale-Revised (ITERS-R) as part of rating and improving child care quality. However, studies utilizing the ITERS-R consistently report low quality, especially for basic caregiving items. This research examined whether the low scores reflected the…

Establishment and outcomes of a model primary care pharmacy service system.

PubMed

Carmichael, Jannet M; Alvarez, Autumn; Chaput, Ryan; DiMaggio, Jennifer; Magallon, Heather; Mambourg, Scott

2004-03-01

The establishment and outcomes of a model primary care pharmacy service system are described. A primary care pharmacy practice model was established at a government health care facility in March 1996. The original objective was to establish a primary pharmacy practice model that would demonstrate improved patient outcomes and maximize the pharmacist's contributions to drug therapy. Since its inception, many improvements have been realized and supported by advanced computer and automated systems, expanded disease state management practices, and unique practitioner and administrative support. Many outcomes studies have been performed on the pharmacist-initiated and -managed clinics, leading to improved patient care and conveying the quality-conscious and cost-effective role pharmacists can play as independent practitioners in this environment. These activities demonstrate cutting-edge leadership in health-system pharmacy. Redesign has been used to improve consistent access to a medication expert and has significantly improved the quality of patient care while easing physicians' workload without increasing health care costs. A system using pharmacists as independent practitioners to promote primary care has achieved high-quality and cost-effective patient care.

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

PubMed

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

2015-04-21

To examine the effectiveness of the quality management programme--European Practice Assessment--in primary care in Switzerland. Longitudinal study with three points of measurement. Primary care practices in Switzerland. In total, 45 of 91 primary care practices completed European Practice Assessment three times. The interval between each assessment was around 36 months. A variance analyses for repeated measurements were performed for all 129 quality indicators from the domains: 'infrastructure', 'information', 'finance', and 'quality and safety' to examine changes over time. Significant improvements were found in three of four domains: 'quality and safety' (F=22.81, p<0.01), 'information' (F=27.901, p<0.01) and 'finance' (F=4.073, p<0.02). The 129 quality indicators showed a significant improvement within the three points of measurement (F=33.864, p<0.01). The European Practice Assessment for primary care practices thus provides a functioning quality management programme, focusing on the sustainable improvement of structural and organisational aspects to promote high quality of primary care. The implementation of a quality management system which also includes a continuous improvement process would give added value to provide good care. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Quality improvement in the use of medications through a drug use evaluation service.

PubMed

Stevenson, J G; Bakst, C M; Zaran, F K; Rybak, M J; Smolarek, R T; Alexander, M R

1992-10-01

Continuous quality improvement methods have the potential to improve processes that cross several disciplines. The medication system is one in which coordination of activities between physicians, pharmacists, and nurses is essential for optimal therapy to occur. DUE services can play an important role in helping to ensure that patients receive high-quality pharmaceutical care. It is necessary for pharmacy managers to review the structure, goals, and outcomes of their DUE programs to ensure that they are consistent with a philosophy of continuous improvement in the quality of drug therapy.

Reduced nutrient pollution in a rural stream following septic tank upgrade and installation of runoff retention measures.

PubMed

Ockenden, M C; Quinton, J N; Favaretto, N; Deasy, C; Surridge, B

2014-07-01

Surface water quality in the UK and much of Western Europe has improved in recent decades, in response to better point source controls and the regulation of fertilizer, manure and slurry use. However, diffuse sources of pollution, such as leaching or runoff of nutrients from agricultural fields, and micro-point sources including farmyards, manure heaps and septic tank sewerage systems, particularly systems without soil adsorption beds, are now hypothesised to contribute a significant proportion of the nutrients delivered to surface watercourses. Tackling such sources in an integrated manner is vital, if improvements in freshwater quality are to continue. In this research, we consider the combined effect of constructing small field wetlands and improving a septic tank system on stream water quality within an agricultural catchment in Cumbria, UK. Water quality in the ditch-wetland system was monitored by manual sampling at fortnightly intervals (April-October 2011 and February-October 2012), with the septic tank improvement taking place in February 2012. Reductions in nutrient concentrations were observed through the catchment, by up to 60% when considering total phosphorus (TP) entering and leaving a wetland with a long residence time. Average fluxes of TP, soluble reactive phosphorus (SRP) and ammonium-N (NH4-N) at the head of the ditch system in 2011 (before septic tank improvement) compared to 2012 (after septic tank improvement) were reduced by 28%, 9% and 37% respectively. However, TP concentration data continue to show a clear dilution with increasing flow, indicating that the system remained point source dominated even after the septic tank improvement.

Manufacturing Bms/Iso System Review

NASA Technical Reports Server (NTRS)

Gomez, Yazmin

2004-01-01

The Quality Management System (QMS) is one that recognizes the need to continuously change and improve an organization s products and services as determined by system feedback, and corresponding management decisions. The purpose of a Quality Management System is to minimize quality variability of an organization's products and services. The optimal Quality Management System balances the need for an organization to maintain flexibility in the products and services it provides with the need for providing the appropriate level of discipline and control over the processes used to provide them. The goal of a Quality Management System is to ensure the quality of the products and services while consistently (through minimizing quality variability) meeting or exceeding customer expectations. The GRC Business Management System (BMS) is the foundation of the Center's ISO 9001:2000 registered quality system. ISO 9001 is a quality system model developed by the International Organization for Standardization. BMS supports and promote the Glenn Research Center Quality Policy and wants to ensure the customer satisfaction while also meeting quality standards. My assignment during this summer is to examine the manufacturing processes used to develop research hardware, which in most cases are one of a kind hardware, made with non conventional equipment and materials. During this process of observation I will make a determination, based on my observations of the hardware development processes the best way to meet customer requirements and at the same time achieve the GRC quality standards. The purpose of my task is to review the manufacturing processes identifying opportunities in which to optimize the efficiency of the processes and establish a plan for implementation and continuous improvement.

Designing and implementing a trust-wide quality assurance programme.

PubMed

Coope, Sally-Ann

2018-04-02

Derbyshire Community Health Services (DCHS) NHS Foundation Trust provides a wide range of community-based health services. After the Care Quality Commission (CQC) found gaps in the trust's assurance process, its board decided to develop a method of continuous quality improvements that could be used as a basis for the trust's quality assurance system. The trust adapted and built on an acute model so it was suitable for community services. The final assurance system, Quality Always, has four elements: the clinical assessment and accreditation scheme; leadership development; 'champions' within clinical teams to support and promote the scheme; and dashboards to record and monitor progress. A system to recognise and reward achievement was essential for success. Quality Always has resulted in better care quality, an improved CQC rating, a sense of achievement among staff, the development of support networks, learning (especially among support staff) and good practice being shared.

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.

Assessment of Clinical Risk Management System in Hospitals: An Approach for Quality Improvement

PubMed Central

Farokhzadian, Jamileh; Nayeri, Nahid Dehghan; Borhani, Fariba

2015-01-01

Background: Clinical risks have created major problems in healthcare system such as serious adverse effects on patient safety and enhancing the financial burden for the healthcare. Thus, clinical risk management (CRM) system has been introduced for improving the quality and safety of services to health care. The aim of this study was to assess the status of CRM in the hospitals. Methods: A cross-sectional study was conducted on 200 nursing staff from three teaching hospitals affiliated with the Kerman University of Medical Sciences in southeast of Iran. Data were collected from the participants using questionnaire and observational checklist in quality improvement offices and selected wards. The data were analyzed using SPSS version 20. Results: Almost, 57% of persons participated in at least one of training sessions on CRM. The status of CRM system was rated from weak to moderate (2.93±0.72- 3.18±0.66). Among the six domains of CRM system, the highest mean belonged to domain the monitoring of analysis, evaluation and risk control (3.18±0.72); the lowest mean belonged to domain the staff’s knowledge, recognition and understanding of CRM (2.93±0.66). There were no integrated electronic systems for recording and analyzing clinical risks and incidents in the hospitals. Conclusion: Attempts have been made to establish CRM through improvement quality approach such as clinical governance and accreditation, but not enough, however, health care should move toward quality improvement and safe practice through the effective integration of CRM in organizational process. PMID:26156927

Blueprint for action: steps toward a high-quality, high-value maternity care system.

PubMed

Angood, Peter B; Armstrong, Elizabeth Mitchell; Ashton, Diane; Burstin, Helen; Corry, Maureen P; Delbanco, Suzanne F; Fildes, Barbara; Fox, Daniel M; Gluck, Paul A; Gullo, Sue Leavitt; Howes, Joanne; Jolivet, R Rima; Laube, Douglas W; Lynne, Donna; Main, Elliott; Markus, Anne Rossier; Mayberry, Linda; Mitchell, Lynn V; Ness, Debra L; Nuzum, Rachel; Quinlan, Jeffrey D; Sakala, Carol; Salganicoff, Alina

2010-01-01

Childbirth Connection hosted a 90th Anniversary national policy symposium, Transforming Maternity Care: A High Value Proposition, on April 3, 2009, in Washington, DC. Over 100 leaders from across the range of stakeholder perspectives were actively engaged in the symposium work to improve the quality and value of U.S. maternity care through broad system improvement. A multi-disciplinary symposium steering committee guided the strategy from its inception and contributed to every phase of the project. The "Blueprint for Action: Steps Toward a High Quality, High Value Maternity Care System", issued by the Transforming Maternity Care Symposium Steering Committee, answers the fundamental question, "Who needs to do what, to, for, and with whom to improve the quality of maternity care over the next five years?" Five stakeholder workgroups collaborated to propose actionable strategies in 11 critical focus areas for moving expeditiously toward the realization of the long term "2020 Vision for a High Quality, High Value Maternity Care System", also published in this issue. Following the symposium these workgroup reports and recommendations were synthesized into the current blueprint. For each critical focus area, the "Blueprint for Action" presents a brief problem statement, a set of system goals for improvement in that area, and major recommendations with proposed action steps to achieve them. This process created a clear sightline to action that if enacted could improve the structure, process, experiences of care, and outcomes of the maternity care system in ways that when anchored in the culture can indeed transform maternity care. Copyright 2010 Jacobs Institute of Women

The impact of SLMTA in improving laboratory quality systems in the Caribbean Region.

PubMed

Guevara, Giselle; Gordon, Floris; Irving, Yvette; Whyms, Ismae; Parris, Keith; Beckles, Songee; Maruta, Talkmore; Ndlovu, Nqobile; Albalak, Rachel; Alemnji, George

Past efforts to improve laboratory quality systems and to achieve accreditation for better patient care in the Caribbean Region have been slow. To describe the impact of the Strengthening of Laboratory Management Toward Accreditation (SLMTA) training programme and mentorship amongst five clinical laboratories in the Caribbean after 18 months. Five national reference laboratories from four countries participated in the SLMTA programme that incorporated classroom teaching and implementation of improvement projects. Mentors were assigned to the laboratories to guide trainees on their improvement projects and to assist in the development of Quality Management Systems (QMS). Audits were conducted at baseline, six months, exit (at 12 months) and post-SLMTA (at 18 months) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist to measure changes in implementation of the QMS during the period. At the end of each audit, a comprehensive implementation plan was developed in order to address gaps. Baseline audit scores ranged from 19% to 52%, corresponding to 0 stars on the SLIPTA five-star scale. After 18 months, one laboratory reached four stars, two reached three stars and two reached two stars. There was a corresponding decrease in nonconformities and development of over 100 management and technical standard operating procedures in each of the five laboratories. The tremendous improvement in these five Caribbean laboratories shows that SLMTA coupled with mentorship is an effective, user-friendly, flexible and customisable approach to the implementation of laboratory QMS. It is recommended that other laboratories in the region consider using the SLMTA training programme as they engage in quality systems improvement and preparation for accreditation.

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.

Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the “Technology to Systems Gap”

PubMed Central

Benoit, Daphne; Zhou, Xi K.; Pape, Jean W.; Peeling, Rosanna W.; Fitzgerald, Daniel W.; Mate, Kedar S.

2013-01-01

Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches. PMID:26316955

Rapid-Testing Technology and Systems Improvement for the Elimination of Congenital Syphilis in Haiti: Overcoming the "Technology to Systems Gap".

PubMed

Severe, Linda; Benoit, Daphne; Zhou, Xi K; Pape, Jean W; Peeling, Rosanna W; Fitzgerald, Daniel W; Mate, Kedar S

2013-01-01

Background. Despite the availability of rapid diagnostic tests and inexpensive treatment for pregnant women, maternal-child syphilis transmission remains a leading cause of perinatal morbidity and mortality in developing countries. In Haiti, more than 3000 babies are born with congenital syphilis annually. Methods and Findings. From 2007 to 2011, we used a sequential time series, multi-intervention study design in fourteen clinics throughout Haiti to improve syphilis testing and treatment in pregnancy. The two primary interventions were the introduction of a rapid point-of-care syphilis test and systems strengthening based on quality improvement (QI) methods. Syphilis testing increased from 91.5% prediagnostic test to 95.9% after (P < 0.001) and further increased to 96.8% (P < 0.001) after the QI intervention. Despite high rates of testing across all time periods, syphilis treatment lagged behind and only increased from 70.3% to 74.7% after the introduction of rapid tests (P = 0.27), but it improved significantly from 70.2% to 84.3% (P < 0.001) after the systems strengthening QI intervention. Conclusion. Both point-of-care diagnostic testing and health systems-based quality improvement interventions can improve the delivery of specific evidence-based healthcare interventions to prevent congenital syphilis at scale in Haiti. Improved treatment rates for syphilis were seen only after the use of systems-based quality improvement approaches.

Why do electricity policy and competitive markets fail to use advanced PV systems to improve distribution power quality?

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

McHenry, Mark P.; Johnson, Jay; Hightower, Mike

The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG) exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the networkmore » characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. As a result, we discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.« less

Why do electricity policy and competitive markets fail to use advanced PV systems to improve distribution power quality?

DOE PAGES

McHenry, Mark P.; Johnson, Jay; Hightower, Mike

2016-01-01

The increasing pressure for network operators to meet distribution network power quality standards with increasing peak loads, renewable energy targets, and advances in automated distributed power electronics and communications is forcing policy-makers to understand new means to distribute costs and benefits within electricity markets. Discussions surrounding how distributed generation (DG) exhibits active voltage regulation and power factor/reactive power control and other power quality capabilities are complicated by uncertainties of baseline local distribution network power quality and to whom and how costs and benefits of improved electricity infrastructure will be allocated. DG providing ancillary services that dynamically respond to the networkmore » characteristics could lead to major network improvements. With proper market structures renewable energy systems could greatly improve power quality on distribution systems with nearly no additional cost to the grid operators. Renewable DG does have variability challenges, though this issue can be overcome with energy storage, forecasting, and advanced inverter functionality. This paper presents real data from a large-scale grid-connected PV array with large-scale storage and explores effective mitigation measures for PV system variability. As a result, we discuss useful inverter technical knowledge for policy-makers to mitigate ongoing inflation of electricity network tariff components by new DG interconnection requirements or electricity markets which value power quality and control.« less

Impact of Quality Improvement Educational Interventions on Documented Adherence to Quality Measures for Adults with Crohn's Disease.

PubMed

Greene, Laurence; Sapir, Tamar; Moreo, Kathleen; Carter, Jeffrey D; Patel, Barry; Higgins, Peter D R

2015-09-01

In recent years, leading organizations in inflammatory bowel disease (IBD) have developed quality measures for the care of adults with Crohn's disease or ulcerative colitis. We used chart audits to assess the impact of quality improvement educational activities on documented adherence to Physician Quality Reporting System measures for IBD. Twenty community-based gastroenterologists were recruited to participate in baseline chart audits (n = 200), a series of 4 accredited educational activities with feedback, and follow-up chart audits (n = 200). Trained abstractors reviewed randomly selected charts of adults with moderate or severe Crohn's disease. The charts were retrospectively abstracted for physicians' documented performance of the 2013 Physician Quality Reporting System IBD quality measures. We compared the physicians' baseline and posteducation rates of documented adherence with 10 of these measures. In a secondary analysis, we compared preeducation with posteducation difference scores of low-performing physicians, those whose baseline documentation rates were in the lowest quartile, and the rest of the cohort. At baseline, documentation of mean provider-level adherence to the 10 quality measures ranged from 3% to 98% (grand mean = 35.8%). In the overall analysis, baseline and posteducation rates of documented adherence did not differ significantly for any of the measures. However, for 4 measures, preeducation to posteducation difference scores were significantly greater among low performers than physicians in the highest 3 quartiles. The results of this preliminary pragmatic study indicate that quality improvement education affords the potential to improve adherence to Physician Quality Reporting System quality measures for IBD among low-performing gastroenterologists.

Crossing the quality chasm in resource-limited settings.

PubMed

Maru, Duncan Smith-Rohrberg; Andrews, Jason; Schwarz, Dan; Schwarz, Ryan; Acharya, Bibhav; Ramaiya, Astha; Karelas, Gregory; Rajbhandari, Ruma; Mate, Kedar; Shilpakar, Sona

2012-11-30

Over the last decade, extensive scientific and policy innovations have begun to reduce the "quality chasm"--the gulf between best practices and actual implementation that exists in resource-rich medical settings. While limited data exist, this chasm is likely to be equally acute and deadly in resource-limited areas. While health systems have begun to be scaled up in impoverished areas, scale-up is just the foundation necessary to deliver effective healthcare to the poor. This perspective piece describes a vision for a global quality improvement movement in resource-limited areas. The following action items are a first step toward achieving this vision: 1) revise global health investment mechanisms to value quality; 2) enhance human resources for improving health systems quality; 3) scale up data capacity; 4) deepen community accountability and engagement initiatives; 5) implement evidence-based quality improvement programs; 6) develop an implementation science research agenda.

Quality, risk management and governance in mental health: an overview.

PubMed

Callaly, Tom; Arya, Dinesh; Minas, Harry

2005-03-01

To consider the origin, current emphasis and relevance of the concepts of quality, risk management and clinical governance in mental health. Increasingly, health service boards and management teams are required to give attention to clinical governance rather than corporate governance alone. Clinical governance is a unifying quality concept that aims to produce a structure and systems to assure and improve the quality of clinical services by promoting an integrated and organization-wide approach towards continuous quality improvement. Many psychiatrists will find the reduction in clinical autonomy, the need to consider the welfare of the whole population as well as the individual patient for whom they are responsible, and the requirement that they play a part in a complex systems approach to quality improvement to be a challenge. Avoiding or ignoring this challenge will potentially lead to conflict with modern management approaches and increased loss of influence on future developments in mental health services.

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

ERIC Educational Resources Information Center

Aluri, Rao

1993-01-01

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

Healthcare quality measurement in orthopaedic surgery: current state of the art.

PubMed

Auerbach, Andrew

2009-10-01

Improving quality of care in arthroplasty is of increasing importance to payors, hospitals, surgeons, and patients. Efforts to compel improvement have traditionally focused measurement and reporting of data describing structural factors, care processes (or 'quality measures'), and clinical outcomes. Reporting structural measures (eg, surgical case volume) has been used with varying degrees of success. Care process measures, exemplified by initiatives such as the Surgical Care Improvement Project measures, are chosen based on the strength of randomized trial evidence linking the process to improved outcomes. However, evidence linking improved performance on Surgical Care Improvement Project measures with improved outcomes is limited. Outcome measures in surgery are of increasing importance as an approach to compel care improvement with prominent examples represented by the National Surgical Quality Improvement Project. Although outcomes-focused approaches are often costly, when linked to active benchmarking and collaborative activities, they may improve care broadly. Moreover, implementation of computerized data systems collecting information formerly collected on paper only will facilitate benchmarking. In the end, care will only be improved if these data are used to define methods for innovating care systems that deliver better outcomes at lower or equivalent costs.

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.

Managing the System of Higher Education: Competition or Collaboration?

ERIC Educational Resources Information Center

Maguad, Ben A.

2018-01-01

The systems view of quality postulates that product or service quality comes as the result of interactions between various components that comprise a production process. In view of this, most problems in the organization, like an institution of higher education, can be attributed to the system. To be effective, any quality improvement initiative…

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

ERIC Educational Resources Information Center

Iskandar

2017-01-01

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

77 FR 42679 - National Pollutant Discharge Elimination System (NPDES) Concentrated Animal Feeding Operation...

Federal Register 2010, 2011, 2012, 2013, 2014

2012-07-20

.... SUMMARY: On October 21, 2011, the EPA proposed a rulemaking to improve and restore water quality by... comments on improving water quality by promoting environmental stewardship and compliance rather than... from CAFOs to support the EPA in meeting its water quality protection responsibilities under the CWA...

Shell Creek Summers

ERIC Educational Resources Information Center

Seier, Mark; Goedeken, Suzy

2005-01-01

In 2002 Shell Creek Watershed Improvement Group turned to the Newman Grove Public Schools' science department to help educate the public on water quality in the watershed and to establish a monitoring system that would be used to improve surface and groundwater quality in the creek's watershed. Nebraska Department of Environmental Quality provided…

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

ERIC Educational Resources Information Center

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

2011-01-01

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

Assessing the evidence of Six Sigma and Lean in the health care industry.

PubMed

DelliFraine, Jami L; Langabeer, James R; Nembhard, Ingrid M

2010-01-01

Popular quality improvement tools such as Six Sigma and Lean Systems (SS/L) claim to provide health care managers the opportunity to improve health care quality on the basis of sound methodology and data. However, it is unclear whether these 2 quality improvement tools actually improve health care quality. The authors conducted a comprehensive literature review to assess the empirical evidence relating SS/L to improved clinical outcomes, processes of care, and financial performance of health care organizations. The authors identified 177 articles on SS/L published in the last 10 years. However, only 34 of them reported any outcomes of the SS/L projects studied, and less than one-third of these articles included statistical analyses to test for significant changes in outcomes. This review demonstrates that there are significant gaps in the SS/L health care quality improvement literature and very weak evidence that SS/L improve health care quality.

Quality Rating and Improvement System (QRIS) Validation Study Designs. CEELO FastFacts

ERIC Educational Resources Information Center

Schilder, D.

2013-01-01

In this "Fast Facts," a state has received Race to the Top Early Learning Challenge funds and is seeking information to inform the design of the Quality Rating and Improvement System (QRIS) validation study. The Center on Enhancing Early Learning Outcomes (CEELO) responds that according to Resnick (2012), validation of a QRIS is an…

Integrating Quality Improvement Education into the Nephrology Curricular Milestones Framework and the Clinical Learning Environment Review

PubMed Central

Prince, Lisa K.; Little, Dustin J.; Schexneider, Katherine I.

2017-01-01

The Accreditation Council for Graduate Medical Education requires that trainees show progressive milestone attainment in the practice–based learning and systems–based practice competencies. As part of the Clinical Learning Environment Review, sponsoring hospitals must educate trainees in health care quality improvement, provide them with specialty–specific quality data, and ensure trainee participation in quality improvement activities and committees. Subspecialty–specific quality improvement curricula in nephrology training programs have not been reported, although considerable curricular and assessment material exists for specialty residencies, including tools for assessing trainee and faculty competence. Nephrology–specific didactic material exists to assist nephrology fellows and faculty mentors in designing and implementing quality improvement projects. Nephrology is notable among internal medicine subspecialties for the emphasis placed on adherence to quality thresholds—specifically for chronic RRT shown by the Centers for Medicare and Medicaid Services Quality Incentive Program. We have developed a nephrology-specific curriculum that meets Accreditation Council for Graduate Medical Education and Clinical Learning Environment Review requirements, acknowledges regulatory quality improvement requirements, integrates with ongoing divisional quality improvement activities, and has improved clinical care and the training program. In addition to didactic training in quality improvement, we track trainee compliance with Kidney Disease Improving Global Outcomes CKD and ESRD quality indicators (emphasizing Quality Improvement Program indicators), and fellows collaborate on a yearly multidisciplinary quality improvement project. Over the past 6 years, each fellowship class has, on the basis of a successful quality improvement project, shown milestone achievement in Systems-Based Practice and Practice-Based Learning. Fellow quality improvement projects have improved nephrology clinical care within the institution and introduced new educational and assessment tools to the training program. All have been opportunities for quality improvement scholarship. The curriculum prepares fellows to apply quality improvement principals in independent clinical practice—while showing milestone advancement and divisional compliance with Clinical Learning Environment Review requirements. PMID:28174318

Leadership and Quality Management: An Analysis of Three Key Features of the Greek Education System

ERIC Educational Resources Information Center

Saiti, Anna

2012-01-01

Purpose: This paper aims to investigate whether educational leadership in Greece implements the values of total quality management and contributes to the improvement of the educational process, and to offer proposals for a framework of total quality management that would contribute to an improvement in the overall quality of the education process.…

A Quality System for Education: Using Quality and Productivity Techniques To Save Our Schools.

ERIC Educational Resources Information Center

Spanbauer, Stanley J.; Hillman, Jo

This book provides a case study of the implementation of a quality improvement model to improve educational services at Fox Valley Technical College (FVTC), in Appleton, Wisconsin. Chapter 1 describes the early stages of the implementation of the quality processes at FVTC. Chapter 2 discusses the role of the chief administrator as mentor and…

Enabling nutrient security and sustainability through systems research.

PubMed

Kaput, Jim; Kussmann, Martin; Mendoza, Yery; Le Coutre, Ronit; Cooper, Karen; Roulin, Anne

2015-05-01

Human and companion animal health depends upon nutritional quality of foods. Seed varieties, seasonal and local growing conditions, transportation, food processing, and storage, and local food customs can influence the nutrient content of food. A new and intensive area of investigation is emerging that recognizes many factors in these agri-food systems that influence the maintenance of nutrient quality which is fundamental to ensure nutrient security for world populations. Modeling how these systems function requires data from different sectors including agricultural, environmental, social, and economic, but also must incorporate basic nutrition and other biomedical sciences. Improving the agri-food system through advances in pre- and post-harvest processing methods, biofortification, or fortifying processed foods will aid in targeting nutrition for populations and individuals. The challenge to maintain and improve nutrient quality is magnified by the need to produce food locally and globally in a sustainable and consumer-acceptable manner for current and future populations. An unmet requirement for assessing how to improve nutrient quality, however, is the basic knowledge of how to define health. That is, health cannot be maintained or improved by altering nutrient quality without an adequate definition of what health means for individuals and populations. Defining and measuring health therefore becomes a critical objective for basic nutritional and other biomedical sciences.

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

PubMed

Nix, Kathryn A; O'Shea, John S

2015-06-01

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

Quality-Focused Management.

ERIC Educational Resources Information Center

Needham, Robbie Lee

1993-01-01

Presents the quality-focused management (QFM) system and explains the departure QFM makes from established community college management practices. Describes the system's self-directed teams engaged in a continuous improvement process driven by customer demand and long-term commitment to quality and cost control. (13 references.) (MAB)

COMMUNITY MULTISCALE AIR QUALITY MODELING SYSTEM (ONE ATMOSPHERE)

EPA Science Inventory

This task supports ORD's strategy by providing responsive technical support of EPA's mission and provides credible state of the art air quality models and guidance. This research effort is to develop and improve the Community Multiscale Air Quality (CMAQ) modeling system, a mu...

Longitudinal analysis on the development of hospital quality management systems in the Netherlands.

PubMed

Dückers, Michel; Makai, Peter; Vos, Leti; Groenewegen, Peter; Wagner, Cordula

2009-10-01

Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a multi-layered organizational development programme based on quality improvement collaboratives. The objective is to answer the question as to whether these changes were accompanied by a further development of hospital quality management systems and to what extent did the development within the multi-layered programme hospitals differ from that in other hospitals. Longitudinal data were collected in 1995, 2000, 2005 and 2007 using a validated questionnaire. Descriptive analyses and multi-level modelling were applied to test whether: (1) quality management system development stages in hospitals differ over time, (2) development stages and trends differ between hospitals participating or not participating in the multi-layered programme and (3) hospital size has an effect on development stage. Dutch hospital sector between 1995 and 2007. Hospital organizations. Changes through time. Quality management system development stage. Since 1995, hospital quality management systems have reached higher development levels. Programme participants have developed their quality management system more rapidly than have non-participants. However, this effect is confounded by hospital size. Study results suggest that the combination of policy measures at macro level was accompanied by an increase in hospital size and the further development of quality management systems. Hospitals are entering the stage of systematic quality improvement.

Development and implementation of a quality improvement curriculum for child neurology residents: lessons learned.

PubMed

Maski, Kiran P; Loddenkemper, Tobias; An, Sookee; Allred, Elizabeth N; Urion, David K; Leviton, Alan

2014-05-01

Quality improvement is a major component of the Accreditation Council for Graduate Medical Education core competencies required of all medical trainees. Currently, neither the Neurology Residency Review Committee nor the Accreditation Council for Graduate Medical Education defines the process by which this competency should be taught and assessed. We developed a quality improvement curriculum that provides mentorship for resident quality improvement projects and is clinically relevant to pediatric neurologists. Before and after implementation of the quality improvement curriculum, a 14-item survey assessed resident comfort with quality improvement project skills and attitudes about implementation of quality improvement in clinical practice using a 5-point Likert scale. We used the Kruskal-Wallis and Fisher exact tests to evaluate pre to post changes. Residents' gained confidence in their abilities to identify measures (P = 0.02) and perform root cause analysis (P = 0.02). Overall, 73% of residents were satisfied or very satisfied with the quality improvement curriculum. Our child neurology quality improvement curriculum was well accepted by trainees. We report the details of this curriculum and its impact on residents and discuss its potential to meet the Accreditation Council for Graduate Medical Education's Next Accreditation System requirements. Published by Elsevier Inc.

Quality control and assurance in hematopoietic stem cell transplantation data registries in Japan and other countries.

PubMed

Kuwatsuka, Yachiyo

2016-01-01

Observational studies from national and international registries with large volumes of patients are commonly performed to identify superior strategies for hematopoietic stem cell transplantation. Major international and national stem cell transplant registries collect outcome data using electronic data capture systems, and a systematic study support process has been developed. Statistical support for studies is available from some major international registries, and international and national registries also mutually collaborate to promote stem cell transplant outcome studies and transplant-related activities. Transplant registries additionally take measures to improve data quality to further improve the quality of outcome studies by utilizing data capture systems and manual data management. Data auditing can potentially even further improve data quality; however, human and budgetary resources can be limiting factors in system construction and audits of the Japanese transplant registry are not currently performed.

Cause-and-effect mapping of critical events.

PubMed

Graves, Krisanne; Simmons, Debora; Galley, Mark D

2010-06-01

Health care errors are routinely reported in the scientific and public press and have become a major concern for most Americans. In learning to identify and analyze errors health care can develop some of the skills of a learning organization, including the concept of systems thinking. Modern experts in improving quality have been working in other high-risk industries since the 1920s making structured organizational changes through various frameworks for quality methods including continuous quality improvement and total quality management. When using these tools, it is important to understand systems thinking and the concept of processes within organization. Within these frameworks of improvement, several tools can be used in the analysis of errors. This article introduces a robust tool with a broad analytical view consistent with systems thinking, called CauseMapping (ThinkReliability, Houston, TX, USA), which can be used to systematically analyze the process and the problem at the same time. Copyright 2010 Elsevier Inc. All rights reserved.

Kaiser Permanente's performance improvement system, Part 1: From benchmarking to executing on strategic priorities.

PubMed

Schilling, Lisa; Chase, Alide; Kehrli, Sommer; Liu, Amy Y; Stiefel, Matt; Brentari, Ruth

2010-11-01

By 2004, senior leaders at Kaiser Permanente, the largest not-for-profit health plan in the United States, recognizing variations across service areas in quality, safety, service, and efficiency, began developing a performance improvement (PI) system to realizing best-in-class quality performance across all 35 medical centers. MEASURING SYSTEMWIDE PERFORMANCE: In 2005, a Web-based data dashboard, "Big Q," which tracks the performance of each medical center and service area against external benchmarks and internal goals, was created. PLANNING FOR PI AND BENCHMARKING PERFORMANCE: In 2006, Kaiser Permanente national and regional continued planning the PI system, and in 2007, quality, medical group, operations, and information technology leaders benchmarked five high-performing organizations to identify capabilities required to achieve consistent best-in-class organizational performance. THE PI SYSTEM: The PI system addresses the six capabilities: leadership priority setting, a systems approach to improvement, measurement capability, a learning organization, improvement capacity, and a culture of improvement. PI "deep experts" (mentors) consult with national, regional, and local leaders, and more than 500 improvement advisors are trained to manage portfolios of 90-120 day improvement initiatives at medical centers. Between the second quarter of 2008 and the first quarter of 2009, performance across all Kaiser Permanente medical centers improved on the Big Q metrics. The lessons learned in implementing and sustaining PI as it becomes fully integrated into all levels of Kaiser Permanente can be generalized to other health care systems, hospitals, and other health care organizations.

Evaluating the impact of AMDAR data quality control in China on the short-range convection forecasts using the WRF model

NASA Astrophysics Data System (ADS)

Wang, Xiaofeng; Jiang, Qin; Zhang, Lei

2016-04-01

A quality control system for the Aircraft Meteorological Data Relay (AMDAR) data has been implemented in China. This system is an extension to the AMDAR quality control system used at the US National Centers for Environmental Prediction. We present a study in which the characteristics of each AMDAR data quality type were examined and the impact of the AMDAR data quality system on short-range convective weather forecasts using the WRF model was investigated. The main results obtained from this study are as follows. (1) The hourly rejection rate of AMDAR data during 2014 was 5.79%, and most of the rejections happened in Near Duplicate Check. (2) There was a significant diurnal variation for both quantity and quality of AMDAR data. Duplicated reports increased with the increase of data quantity, while suspicious and disorderly reports decreased with the increase of data quantity. (3) The characteristics of the data quality were different in each model layer, with the quality problems occurring mainly at the surface as well as at the height where the power or the flight mode of the aircraft underwent adjustment. (4) Assimilating the AMDAR data improved the forecast accuracy, particularly over the region where strong convection occurred. (5) Significant improvements made by assimilating AMDAR data were found after six hours into the model forecast. The conclusion from this study is that the newly implemented AMDAR data quality system can help improve the accuracy of short-range convection forecasts using the WRF model.

System-Level Action Required for Wide-Scale Improvement in Quality of Primary Health Care: Synthesis of Feedback from an Interactive Process to Promote Dissemination and Use of Aggregated Quality of Care Data.

PubMed

Bailie, Jodie; Laycock, Alison; Matthews, Veronica; Bailie, Ross

2016-01-01

There is an enduring gap between recommended practice and care that is actually delivered; and there is wide variation between primary health care (PHC) centers in delivery of care. Where aspects of care are not being done well across a range of PHC centers, this is likely due to inadequacies in the broader system. This paper aims to describe stakeholders' perceptions of the barriers and enablers to addressing gaps in Australian Aboriginal and Torres Strait Islander chronic illness care and child health, and to identify key drivers for improvement. This paper draws on data collected as part of a large-scale continuous quality improvement project in Australian Indigenous PHC settings. We undertook a qualitative assessment of stakeholder feedback on the main barriers and enablers to addressing gaps in care for Aboriginal and Torres Strait Islander children and in chronic illness care. Themes on barriers and enablers were further analyzed to develop a "driver diagram," an improvement tool used to locate barriers and enablers within causal pathways (as primary and secondary drivers), enabling them to be targeted by tailored interventions. We identified 5 primary drivers and 11 secondary drivers of high-quality care, and associated strategies that have potential for wide-scale implementation to address barriers and enablers for improving care. Perceived barriers to addressing gaps in care included both health system and staff attributes. Primary drivers were: staff capability to deliver high-quality care; availability and use of clinical information systems and decision support tools; embedding of quality improvement processes and data-driven decision-making; appropriate and effective recruitment and retention of staff; and community capacity, engagement and mobilization for health. Suggested strategies included mechanisms for increasing clinical supervision and support, staff retention, reorientation of service delivery, use of information systems and community health literacy. The findings identify areas of focus for development of barrier-driven, tailored interventions to improve health outcomes. They reinforce the importance of system-level action to improve health center performance and health outcomes, and of developing strategies to address system-wide challenges that can be adapted to local contexts.

Report of the international workshop on quality control of monthly climate data

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

Not Available

1993-12-31

The National Climatic Data Center (NCDC), the US Department of Energy`s Carbon Dioxide Information Analysis Center, and the World Meteorological Organization (WMO) cosponsored an international quality control workshop for monthly climate data, October 5--6, 1993, at NCDC. About 40 scientists from around the world participated. The purpose of the meeting was to discuss and compare various quality control methods and to draft recommendations concerning the most successful systems. The near-term goal to improve quality control of CLIMAT messages for the NCDC/WMO publication Monthly Climatic Data for the World was sucessfully met. An electronic bulletin board was established to post errorsmore » and corrections. Improved communications among Global Telecommunication System hubs will be implemented. Advanced quality control algorithms were discussed and improvements were suggested. Further data exchanges were arranged.« less

Flying qualities - A costly lapse in flight-control design

NASA Technical Reports Server (NTRS)

Berry, D. T.

1982-01-01

Generic problems in advanced aircraft with advanced control systems which suffer from control sensitivity, sluggish response, and pilot-induced oscillation tendencies are examined, with a view to improving techniques for eliminating the problems in the design phase. Results of two NASA and NASA/AIAA workshops reached a consensus that flying qualities criteria do not match control system development, control system designers are not relying on past experience in their field, ground-based simulation is relied on too heavily, and communications between flying qualities and control systems engineers need improvement. A summation is offered in that hardware and software have outstripped the pilot's capacity to use the capabilities which new aircraft offer. The flying qualities data base is stressed to be dynamic, and continually redefining the man/machine relationships.

Quality Improvement Initiatives in Inflammatory Bowel Disease.

PubMed

Berry, Sameer K; Siegel, Corey A; Melmed, Gil Y

2017-08-01

This article serves as an overview of several quality improvement initiatives in inflammatory bowel disease (IBD). IBD is associated with significant variation in care, suggesting poor quality of care. There have been several efforts to improve the quality of care for patients with IBD. Quality improvement (QI) initiatives in IBD are intended to be patient-centric, improve outcomes for individuals and populations, and reduce costs-all consistent with "the triple aim" put forth by the Institute for Healthcare Improvement (IHI). Current QI initiatives include the development of quality measure sets to standardize processes and outcomes, learning health systems to foster collaborative improvement, and patient-centered medical homes specific to patients with IBD in shared risk models of care. Some of these programs have demonstrated early success in improving patient outcomes, reducing costs, improving patient satisfaction, and facilitating patient engagement. However, further studies are needed to evaluate and compare the effects of these programs over time on clinical outcomes in order to demonstrate long-term value and sustainability.

[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.

Developing a multidisciplinary robotic surgery quality assessment program.

PubMed

Gonsenhauser, Iahn; Abaza, Ronney; Mekhjian, Hagop; Moffatt-Bruce, Susan D

2012-01-01

The objective of this study was to test the feasibility of a novel quality-improvement (QI) program designed to incorporate multiple robotic surgical sub-specialties in one health care system. A robotic surgery quality assessment program was developed by The Ohio State University College of Medicine (OSUMC) in conjunction with The Ohio State University Medical Center Quality Improvement and Operations Department. A retrospective review of cases was performed using data interrogated from the OSUMC Information Warehouse from January 2007 through August 2009. Robotic surgery cases (n=2200) were assessed for operative times, length of stay (LOS), conversions, returns to surgery, readmissions and cancellations as potential quality indicators. An actionable and reproducible framework for the quality measurement and assessment of a multidisciplinary and interdepartmental robotic surgery program was successfully completed demonstrating areas for improvement opportunities. This report supports that standard quality indicators can be applied to multiple specialties within a health care system to develop a useful quality tracking and assessment tool in the highly specialized area of robotic surgery. © 2012 National Association for Healthcare Quality.

Practical Approaches to Quality Improvement for Radiologists.

PubMed

Kelly, Aine Marie; Cronin, Paul

2015-10-01

Continuous quality improvement is a fundamental attribute of high-performing health care systems. Quality improvement is an essential component of health care, with the current emphasis on adding value. It is also a regulatory requirement, with reimbursements increasingly being linked to practice performance metrics. Practice quality improvement efforts must be demonstrated for credentialing purposes and for certification of radiologists in practice. Continuous quality improvement must occur for radiologists to remain competitive in an increasingly diverse health care market. This review provides an introduction to the main approaches available to undertake practice quality improvement, which will be useful for busy radiologists. Quality improvement plays multiple roles in radiology services, including ensuring and improving patient safety, providing a framework for implementing and improving processes to increase efficiency and reduce waste, analyzing and depicting performance data, monitoring performance and implementing change, enabling personnel assessment and development through continued education, and optimizing customer service and patient outcomes. The quality improvement approaches and underlying principles overlap, which is not surprising given that they all align with good patient care. The application of these principles to radiology practices not only benefits patients but also enhances practice performance through promotion of teamwork and achievement of goals. © RSNA, 2015.

42 CFR 441.585 - Quality assurance system.

Code of Federal Regulations, 2013 CFR

2013-10-01

... 42 Public Health 4 2013-10-01 2013-10-01 false Quality assurance system. 441.585 Section 441.585 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... provides information about the provisions of quality improvement and assurance to each individual receiving...

42 CFR 441.585 - Quality assurance system.

Code of Federal Regulations, 2014 CFR

2014-10-01

... 42 Public Health 4 2014-10-01 2014-10-01 false Quality assurance system. 441.585 Section 441.585 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... provides information about the provisions of quality improvement and assurance to each individual receiving...

[Quality improvement potential in the pharmaceutical industry].

PubMed

Nusser, Michael

2007-01-01

The performance of the German pharmaceutical industry, future challenges and obstacles to quality improvement are assessed from a systems-of-innovation perspective, using appropriate innovation indicators. The current close-to-market performance indicators paint an unfavourable picture. Early R&D indicators (e.g., publications, patents), however, reveal a positive trend. A lot of obstacles to quality improvements are identified with respect to knowledge base, knowledge/technology transfer, industrial R&D processes, capital markets, market attractiveness and both regulatory and political framework conditions. On this basis, recommendations will finally be derived to improve quality in the pharmaceutical industry.

[Management systems of the quality of health care in Quebec hospitals].

PubMed

François, P

2001-03-31

The aim of this study was to take stock of the development of quality management systems in the Quebec health care services. The study relied on semi-guided interviews and on a documentary analysis. It concerned the structure and the activity of quality management in 4 Montreal university hospitals as well as on outside organizations dealing with quality of care. Quality management of the health care services is dealt with by council on health care accreditation and regional health and social services agencies. In hospitals, the quality of services is managed by structures created by the administration council and the top management: the piloting committee, the head of quality assurance, the executive committees and the multidisciplinary team or self-evaluation of the hospital, and development of plans for improvement. Other activities are management of complaints, users satisfaction evaluation and follow-up of indicators. This system of quality management of services is currently expanding. This change of paradigm leads to accepting the view of services users and to change quality management methods. Those methods have evolved from normative approach to a continuous quality improvement approach.

Do Standard Measures of Preschool Quality Used in Statewide Policy Predict School Readiness?

ERIC Educational Resources Information Center

Sabol, Terri J.; Pianta, Robert C.

2014-01-01

In the majority of states using Quality Rating and Improvement Systems (QRIS) to improve children's school readiness, the Early Childhood Environmental Rating Scale-Revised (ECERS-R) is a core assessment of preschool program quality and is central to QRIS metrics and incentive structures. The present study utilizes nationally representative data…

Home-based pulmonary rehabilitation improves clinical features and systemic inflammation in chronic obstructive pulmonary disease patients.

PubMed

do Nascimento, Eloisa Sanches Pereira; Sampaio, Luciana Maria Malosá; Peixoto-Souza, Fabiana Sobral; Dias, Fernanda Dultra; Gomes, Evelim Leal Freitas Dantas; Greiffo, Flavia Regina; Ligeiro de Oliveira, Ana Paula; Stirbulov, Roberto; Vieira, Rodolfo Paula; Costa, Dirceu

2015-01-01

Chronic obstructive pulmonary disease (COPD) is a respiratory disease characterized by chronic airflow limitation that leads beyond the pulmonary changes to important systemic effects. COPD is characterized by pulmonary and systemic inflammation. However, increases in the levels of inflammatory cytokines in plasma are found even when the disease is stable. Pulmonary rehabilitation improves physical exercise capacity and quality of life and decreases dyspnea. The aim of this study was to evaluate whether a home-based pulmonary rehabilitation (HBPR) program improves exercise tolerance in COPD patients, as well as health-related quality of life and systemic inflammation. This prospective study was conducted at the Laboratory of Functional Respiratory Evaluation, Nove de Julho University, São Paulo, Brazil. After anamnesis, patients were subjected to evaluations of health-related quality of life and dyspnea, spirometry, respiratory muscle strength, upper limbs incremental test, incremental shuttle walk test, and blood test for quantification of systemic inflammatory markers (interleukin [IL]-6 and IL-8). At the end of the evaluations, patients received a booklet containing the physical exercises to be performed at home, three times per week for 8 consecutive weeks. Around 25 patients were enrolled, and 14 completed the pre- and post-HBPR ratings. There was a significant increase in the walked distance and the maximal inspiratory pressure, improvements on two components from the health-related quality-of-life questionnaire, and a decrease in plasma IL-8 levels after the intervention. The HBPR is an important and viable alternative to pulmonary rehabilitation for the treatment of patients with COPD; it improves exercise tolerance, inspiratory muscle strength, quality of life, and systemic inflammation in COPD patients.

Lick sodium laser guide star: performance during the 1998 LGS observing campaign

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

Bauman, B; Friedman, H; Gavel, D T

1999-07-19

The performance of a sodium laser guide star adaptive optics system depends crucially on the characteristics of the laser guide star in the sodium layer. System performance is quite sensitive to sodium layer spot radiance, that is, return per unit sterradian on the sky, hence we have been working to improve projected beam quality via improvements to the laser and changes to the launched beam format. The laser amplifier was reconfigured to a ''bounce-beam'' geometry, which considerably improves wavefront quality and allows a larger round instead of square launch beam aperture. The smaller beacon makes it easier to block themore » unwanted Rayleigh light and improves the accuracy of Hartmann sensor wavefront measurements in the A0 system. We present measurements of the beam quality and of the resulting sodium beacon and compare to similar measurements from last year.« less

Access to Quality Early Childhood Care and Education. Background Paper for the Quality Child Care Think Tank. Draft.

ERIC Educational Resources Information Center

Brandon, Richard N.; Smith, Diana

This background paper discusses the current system of child care finance in Washington State and analyzes options for improvement. It describes prominent characteristics of the early childhood care and education system, findings relating program quality to staff/child ratios and staff educational levels, characteristics of quality, parent…

Clinical Trials Infrastructure as a Quality Improvement Intervention in Low- and Middle-Income Countries.

PubMed

Denburg, Avram; Rodriguez-Galindo, Carlos; Joffe, Steven

2016-06-01

Mounting evidence suggests that participation in clinical trials confers neither advantage nor disadvantage on those enrolled. Narrow focus on the question of a "trial effect," however, distracts from a broader mechanism by which patients may benefit from ongoing clinical research. We hypothesize that the existence of clinical trials infrastructure-the organizational culture, systems, and expertise that develop as a product of sustained participation in cooperative clinical trials research-may function as a quality improvement lever, improving the quality of care and outcomes of all patients within an institution or region independent of their individual participation in trials. We further contend that this "infrastructure effect" can yield particular benefits for patients in low- and middle-income countries (LMICs). The hypothesis of an infrastructure effect as a quality improvement intervention, if correct, justifies enhanced research capacity in LMIC as a pillar of health system development.

A Two-State Study of Family Child Care Engagement in Quality Rating and Improvement Systems: A Mixed-Methods Analysis

ERIC Educational Resources Information Center

Hallam, Rena; Hooper, Alison; Bargreen, Kaitlin; Buell, Martha; Han, Myae

2017-01-01

Research Findings: The current study is a mixed-methods investigation of family child care provider participation in voluntary Quality Rating and Improvement Systems (QRIS) in 2 states. Study 1 is an analysis of matched QRIS and child care licensing administrative data extracted from both states in May, 2014. Poverty and population density…

Federal Aviation Administration weather program to improve aviation safety

NASA Technical Reports Server (NTRS)

Wedan, R. W.

1983-01-01

The implementation of the National Airspace System (NAS) will improve safety services to aviation. These services include collision avoidance, improved landing systems and better weather data acquisition and dissemination. The program to improve the quality of weather information includes the following: Radar Remote Weather Display System; Flight Service Automation System; Automatic Weather Observation System; Center Weather Processor, and Next Generation Weather Radar Development.

The impact of SLMTA in improving laboratory quality systems in the Caribbean Region

PubMed Central

Gordon, Floris; Irving, Yvette; Whyms, Ismae; Parris, Keith; Beckles, Songee; Maruta, Talkmore; Ndlovu, Nqobile; Albalak, Rachel; Alemnji, George

2014-01-01

Background Past efforts to improve laboratory quality systems and to achieve accreditation for better patient care in the Caribbean Region have been slow. Objective To describe the impact of the Strengthening of Laboratory Management Toward Accreditation (SLMTA) training programme and mentorship amongst five clinical laboratories in the Caribbean after 18 months. Method Five national reference laboratories from four countries participated in the SLMTA programme that incorporated classroom teaching and implementation of improvement projects. Mentors were assigned to the laboratories to guide trainees on their improvement projects and to assist in the development of Quality Management Systems (QMS). Audits were conducted at baseline, six months, exit (at 12 months) and post-SLMTA (at 18 months) using the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) checklist to measure changes in implementation of the QMS during the period. At the end of each audit, a comprehensive implementation plan was developed in order to address gaps. Results Baseline audit scores ranged from 19% to 52%, corresponding to 0 stars on the SLIPTA five-star scale. After 18 months, one laboratory reached four stars, two reached three stars and two reached two stars. There was a corresponding decrease in nonconformities and development of over 100 management and technical standard operating procedures in each of the five laboratories. Conclusion The tremendous improvement in these five Caribbean laboratories shows that SLMTA coupled with mentorship is an effective, user-friendly, flexible and customisable approach to the implementation of laboratory QMS. It is recommended that other laboratories in the region consider using the SLMTA training programme as they engage in quality systems improvement and preparation for accreditation. PMID:27066396

Project officer's perspective: quality assurance as a management tool.

PubMed

Heiby, J

1993-06-01

Advances in the management of health programs in less developed countries (LDC) have not kept pace with the progress of the technology used. The US Agency for International Development mandated the Quality Assurance Project (QAP) to provide quality improvement technical assistance to primary health care systems in LDCs while developing appropriate quality assurance (QA) strategies. The quality of health care in recent years in the US and Europe focused on the introduction of management techniques developed for industry into health systems. The experience of the QAP and its predecessor, the PRICOR Project, shows that quality improvement techniques facilitate measurement of quality of care. A recently developed WHO model for the management of the sick child provides scientifically based standards for actual care. Since 1988, outside investigators measuring how LDC clinicians perform have revealed serious deficiencies in quality compared with the program's own standards. This prompted developed of new QA management initiatives: 1) communicating standards clearly to the program staff; 2) actively monitoring actual performance corresponds to these standards; and 3) taking action to improve performance. QA means that managers are expected to monitor service delivery, undertake problem solving, and set specific targets for quality improvement. Quality improvement methods strengthen supervision as supervisors can objectively assess health worker performance. QA strengthens the management functions that support service delivery, e.g., training, records management, finance, logistics, and supervision. Attention to quality can contribute to improved health worker motivation and effective incentive programs by recognition for a job well done and opportunities for learning new skills. These standards can also address patient satisfaction. QA challenges managers to aim for the optimal level of care attainable.

Smart information system for gachon university gil hospital.

PubMed

Park, Dong Kyun; Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-03-01

In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future.

Smart Information System for Gachon University Gil Hospital

PubMed Central

Jung, Eun Young; Jeong, Byung Hui; Moon, Byung Chan; Kang, Hyung Wook; Tchah, Hann; Han, Gi Seong; Cheng, Woo Sung; Lee, Young Ho

2012-01-01

Objectives In this research, the hospital information system of Gachon University Gil hospital is introduced and a future strategy for hospital information systems is proposed. Methods This research introduces the development conditions of hospital information system at Gachon University Gil hospital, information about the development of the enterprise resource planning (ERP), a medical service process improvement system, and the personal health record (PHR) system. Results The medical service process and work efficiency were improved through the medical service process improvement system, which is the most common hospital information system at Gachon University Gil hospital and which includes an emergency medical service system, an online evaluation system and a round support system. Conclusions Gachon University Gil hospital developed medical service improvement systems to increase work efficiency of medical team and optimized the systems to prove the availability of high-quality medical services for patients and their families. The PHR-based personalized health care solution is under development and will provide higher quality medical service for more patients in the future. PMID:22509476

Leveraging Health Information Technology to Improve Quality in Federal Healthcare.

PubMed

Weigel, Fred K; Switaj, Timothy L; Hamilton, Jessica

2015-01-01

Healthcare delivery in America is extremely complex because it is comprised of a fragmented and nonsystematic mix of stakeholders, components, and processes. Within the US healthcare structure, the federal healthcare system is poised to lead American medicine in leveraging health information technology to improve the quality of healthcare. We posit that through developing, adopting, and refining health information technology, the federal healthcare system has the potential to transform federal healthcare quality by managing the complexities associated with healthcare delivery. Although federal mandates have spurred the widespread use of electronic health records, other beneficial technologies have yet to be adopted in federal healthcare settings. The use of health information technology is fundamental in providing the highest quality, safest healthcare possible. In addition, health information technology is valuable in achieving the Agency for Healthcare Research and Quality's implementation goals. We conducted a comprehensive literature search using the Google Scholar, PubMed, and Cochrane databases to identify an initial list of articles. Through a thorough review of the titles and abstracts, we identified 42 articles as having relevance to health information technology and quality. Through our exclusion criteria of currency of the article, citation frequency, applicability to the federal health system, and quality of research supporting conclusions, we refined the list to 11 references from which we performed our analysis. The literature shows that the use of computerized physician order entry has significantly increased accurate medication dosage and decreased medication errors. The use of clinical decision support systems have significantly increased physician adherence to guidelines, although there is little evidence that indicates any significant correlation to patient outcomes. Research shows that interoperability and usability are continuing challenges for implementation. The Veterans Administration is the only entity within the federal health system that has published research on the use of health information technology to improve quality. The federal healthcare system has existing systems in place with computerized physician order entry systems and clinical decision support systems, but these should be advanced. Particular focus and attention should be placed on data mining capabilities, integrating the electronic health record across all aspects of care, using the electronic health record to improve quality at the point of care, and developing interoperable and usable health information technology.

A Quality Improvement System to Manage Feeding Assistance Care in Assisted-Living.

PubMed

Simmons, Sandra F; Coelho, Chris S; Sandler, Andrew; Schnelle, John F

2018-03-01

To describe a feasible quality improvement system to manage feeding assistance care processes in an assisted living facility (ALF) that provides dementia care and the use of these data to maintain the quality of daily care provision and prevent unintentional weight loss. Supervisory ALF staff used a standardized observational protocol to assess feeding assistance care quality during and between meals for 12 consecutive months for 53 residents receiving dementia care. Direct care staff received feedback about the quality of assistance and consistency of between-meal snack delivery for residents with low meal intake and/or weight loss. On average, 78.4% of the ALF residents consumed more than one-half of each served meal and/or received staff assistance during meals to promote consumption over the 12 months. An average of 79.7% of the residents were offered snacks between meals twice per day. The prevalence of unintentional weight loss averaged 1.3% across 12 months. A quality improvement system resulted in sustained levels of mealtime feeding assistance and between-meal snack delivery and a low prevalence of weight loss among ALF residents receiving dementia care. Given that many ALF residents receiving dementia care are likely to be at risk for low oral intake and unintentional weight loss, ALFs should implement a quality improvement system similar to that described in this project, despite the absence of regulations to do so. Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Motion-base simulator results of advanced supersonic transport handling qualities with active controls

NASA Technical Reports Server (NTRS)

Feather, J. B.; Joshi, D. S.

1981-01-01

Handling qualities of the unaugmented advanced supersonic transport (AST) are deficient in the low-speed, landing approach regime. Consequently, improvement in handling with active control augmentation systems has been achieved using implicit model-following techniques. Extensive fixed-based simulator evaluations were used to validate these systems prior to tests with full motion and visual capabilities on a six-axis motion-base simulator (MBS). These tests compared the handling qualities of the unaugmented AST with several augmented configurations to ascertain the effectiveness of these systems. Cooper-Harper ratings, tracking errors, and control activity data from the MBS tests have been analyzed statistically. The results show the fully augmented AST handling qualities have been improved to an acceptable level.

Toward an evidence-based system for innovation support for implementing innovations with quality: tools, training, technical assistance, and quality assurance/quality improvement.

PubMed

Wandersman, Abraham; Chien, Victoria H; Katz, Jason

2012-12-01

An individual or organization that sets out to implement an innovation (e.g., a new technology, program, or policy) generally requires support. In the Interactive Systems Framework for Dissemination and Implementation, a Support System should work with Delivery Systems (national, state and/or local entities such as health and human service organizations, community-based organizations, schools) to enhance their capacity for quality implementation of innovations. The literature on the Support System [corrected] has been underresearched and under-developedThis article begins to conceptualize theory, research, and action for an evidence-based system for innovation support (EBSIS). EBSIS describes key priorities for strengthening the science and practice of support. The major goal of EBSIS is to enhance the research and practice of support in order to build capacity in the Delivery System for implementing innovations with quality, and thereby, help the Delivery System achieve outcomes. EBSIS is guided by a logic model that includes four key support components: tools, training, technical assistance, and quality assurance/quality improvement. EBSIS uses the Getting To Outcomes approach to accountability to aid the identification and synthesis of concepts, tools, and evidence for support. We conclude with some discussion of the current status of EBSIS and possible next steps, including the development of collaborative researcher-practitioner-funder-consumer partnerships to accelerate accumulation of knowledge on the Support System.

Performance Measurement and Target-Setting in California's Safety Net Health Systems.

PubMed

Hemmat, Shirin; Schillinger, Dean; Lyles, Courtney; Ackerman, Sara; Gourley, Gato; Vittinghoff, Eric; Handley, Margaret; Sarkar, Urmimala

Health policies encourage implementing quality measurement with performance targets. The 2010-2015 California Medicaid waiver mandated quality measurement and reporting. In 2013, California safety net hospitals participating in the waiver set a voluntary performance target (the 90th percentile for Medicare preferred provider organization plans) for mammography screening and cholesterol control in diabetes. They did not reach the target, and the difference-in-differences analysis suggested that there was no difference for mammography ( P = .39) and low-density lipoprotein control ( P = .11) performance compared to measures for which no statewide quality improvement initiative existed. California's Medicaid waiver was associated with improved performance on a number of metrics, but this performance was not attributable to target setting on specific health conditions. Performance may have improved because of secular trends or systems improvements related to waiver funding. Relying on condition-specific targets to measure performance may underestimate improvements and disadvantage certain health systems. Achieving ambitious targets likely requires sustained fiscal, management, and workforce investments.

[Quality management in a clinical research facility: Evaluation of changes in quality in-house figures and the appraisal of in-house quality indicators].

PubMed

Aden, Bile; Allekotte, Silke; Mösges, Ralph

2016-12-01

For long-term maintenance and improvement of quality within a clinical research institute, the implementation and certification of a quality management system is suitable. Due to the implemented quality management system according to the still valid DIN EN ISO 9001:2008 desired quality objectives are achieved effectively. The evaluation of quality scores and the appraisal of in-house quality indicators make an important contribution in this regard. In order to achieve this and draw quality assurance conclusions, quality indicators as sensible and sensitive as possible are developed. For this, own key objectives, the retrospective evaluation of quality scores, a prospective follow-up and also discussions establish the basis. In the in-house clinical research institute the measures introduced by the quality management led to higher efficiency in work processes, improved staff skills, higher customer satisfaction and overall to more successful outcomes in relation to the self-defined key objectives. Copyright © 2016. Published by Elsevier GmbH.

How to improve vital sign data quality for use in clinical decision support systems? A qualitative study in nine Swedish emergency departments.

PubMed

Skyttberg, Niclas; Vicente, Joana; Chen, Rong; Blomqvist, Hans; Koch, Sabine

2016-06-04

Vital sign data are important for clinical decision making in emergency care. Clinical Decision Support Systems (CDSS) have been advocated to increase patient safety and quality of care. However, the efficiency of CDSS depends on the quality of the underlying vital sign data. Therefore, possible factors affecting vital sign data quality need to be understood. This study aims to explore the factors affecting vital sign data quality in Swedish emergency departments and to determine in how far clinicians perceive vital sign data to be fit for use in clinical decision support systems. A further aim of the study is to provide recommendations on how to improve vital sign data quality in emergency departments. Semi-structured interviews were conducted with sixteen physicians and nurses from nine hospitals and vital sign documentation templates were collected and analysed. Follow-up interviews and process observations were done at three of the hospitals to verify the results. Content analysis with constant comparison of the data was used to analyse and categorize the collected data. Factors related to care process and information technology were perceived to affect vital sign data quality. Despite electronic health records (EHRs) being available in all hospitals, these were not always used for vital sign documentation. Only four out of nine sites had a completely digitalized vital sign documentation flow and paper-based triage records were perceived to provide a better mobile workflow support than EHRs. Observed documentation practices resulted in low currency, completeness, and interoperability of the vital signs. To improve vital sign data quality, we propose to standardize the care process, improve the digital documentation support, provide workflow support, ensure interoperability and perform quality control. Vital sign data quality in Swedish emergency departments is currently not fit for use by CDSS. To address both technical and organisational challenges, we propose five steps for vital sign data quality improvement to be implemented in emergency care settings.

Clinical Information Systems - From Yesterday to Tomorrow.

PubMed

Gardner, R M

2016-06-30

To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author's personal experience with developing the HELP system were also used. There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years.

Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions.

PubMed

Bowen, Michael E; Bhat, Deepa; Fish, Jason; Moran, Brett; Howell-Stampley, Temple; Kirk, Lynne; Persell, Stephen D; Halm, Ethan A

Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before-after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.

Controlled dehydration improves the diffraction quality of two RNA crystals.

PubMed

Park, HaJeung; Tran, Tuan; Lee, Jun Hyuck; Park, Hyun; Disney, Matthew D

2016-11-03

Post-crystallization dehydration methods, applying either vapor diffusion or humidity control devices, have been widely used to improve the diffraction quality of protein crystals. Despite the fact that RNA crystals tend to diffract poorly, there is a dearth of reports on the application of dehydration methods to improve the diffraction quality of RNA crystals. We use dehydration techniques with a Free Mounting System (FMS, a humidity control device) to recover the poor diffraction quality of RNA crystals. These approaches were applied to RNA constructs that model various RNA-mediated repeat expansion disorders. The method we describe herein could serve as a general tool to improve diffraction quality of RNA crystals to facilitate structure determinations.

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…

Parameters of Higher Education Quality Assessment System at Universities

ERIC Educational Resources Information Center

Savickiene, Izabela

2005-01-01

The article analyses the system of institutional quality assessment at universities and lays foundation to its functional, morphological and processual parameters. It also presents the concept of the system and discusses the distribution of systems into groups, defines information, accountability, improvement and benchmarking functions of higher…

Evidence-based emergency medicine. Creating a system to facilitate translation of evidence into standardized clinical practice: a preliminary report.

PubMed

Wright, Stewart W; Trott, Alexander; Lindsell, Christopher J; Smith, Carol; Gibler, W Brian

2008-01-01

The Institute of Medicine, through its landmark report concerning errors in medicine, suggests that standardization of practice through systematic development and implementation of evidence-based clinical pathways is an effective way of reducing errors in emergency systems. The specialty of emergency medicine is well positioned to develop a complete system of innovative quality improvement, incorporating best practice guidelines with performance measures and practitioner feedback mechanisms to reduce errors and therefore improve quality of care. This article reviews the construction, ongoing development, and initial impact of such a system at a large, urban, university teaching hospital and at 2 affiliated community hospitals. The Committee for Procedural Quality and Evidence-Based Practice was formed within the Department of Emergency Medicine to establish evidence-based guidelines for nursing and provider care. The committee measures the effect of such guidelines, along with other quality measures, through pre- and postguideline patient care medical record audits. These measures are fed back to the providers in a provider-specific, peer-matched "scorecard." The Committee for Procedural Quality and Evidence-Based Practice affects practice and performance within our department. Multiple physician and nursing guidelines have been developed and put into use. Using asthma as an example, time to first nebulizer treatment and time to disposition from the emergency department decreased. Initial therapeutic agent changed and documentation improved. A comprehensive, guideline-driven, evidence-based approach to clinical practice is feasible within the structure of a department of emergency medicine. High-level departmental support with dedicated personnel is necessary for the success of such a system. Internet site development (available at http://www.CPQE.com) for product storage has proven valuable. Patient care has been improved in several ways; however, consistent and complete change in provider behavior remains elusive. Physician scorecards may play a role in altering these phenomena. Emergency medicine can play a leadership role in the development of quality improvement, error reduction, and pay-for-performance systems.

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

PubMed

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

2012-12-01

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

Improving the quality of healthcare for children: implementing the results of the AHSR research agenda conference.

PubMed Central

Halfon, N; Schuster, M; Valentine, W; McGlynn, E

1998-01-01

OBJECTIVE: To describe the rationale, development, content, and results of the AHSR-sponsored conference on developing a research agenda focused on improving the quality of care for children. DATA SOURCES AND METHODS: Planning documents, background papers, and conference proceedings. PRINCIPAL FINDINGS: The conference developed the research agenda focused on (1) monitoring the health of children; (2) evaluating the efficacy and effectiveness of health services for children; (3) assessing the quality of healthcare provided to children; (4) improving the quality of healthcare within health systems; (5) assessing the performance of community systems for children; (6) exploring the impact of different financial incentives on the provision of pediatric healthcare; and (7) developing and disseminating clinical practice guidelines and other information to physicians, families, and consumers. Specific issues and research questions in each area are also presented. Strategies for implementing the research agenda are presented and include: (1) expanding the child health services research workforce; (2) developing child healthcare quality improvement research centers; (3) conducting research in specific high-priority areas; (4) focusing research on improving the health of vulnerable populations; (5) improving child health data and collection systems at the national level; (6) developing better community health monitoring for children; (7) building and supporting research networks and a consortium of research users; and (8) developing a coordinated interagency federal effort to advance this agenda and to provide accountability for its completion. CONCLUSION: The proposed research agenda should be a national priority so that all Americans can be assured that children are receiving the best quality of care that the United States can provide. PMID:9776945

Health service changes to address diabetes in pregnancy in a complex setting: perspectives of health professionals.

PubMed

Kirkham, R; Boyle, J A; Whitbread, C; Dowden, M; Connors, C; Corpus, S; McCarthy, L; Oats, J; McIntyre, H D; Moore, E; O'Dea, K; Brown, A; Maple-Brown, L

2017-08-03

Australian Aboriginal and Torres Strait Islander women have high rates of gestational and pre-existing type 2 diabetes in pregnancy. The Northern Territory (NT) Diabetes in Pregnancy Partnership was established to enhance systems and services to improve health outcomes. It has three arms: a clinical register, developing models of care and a longitudinal birth cohort. This study used a process evaluation to report on health professional's perceptions of models of care and related quality improvement activities since the implementation of the Partnership. Changes to models of care were documented according to goals and aims of the Partnership and reviewed annually by the Partnership Steering group. A 'systems assessment tool' was used to guide six focus groups (49 healthcare professionals). Transcripts were coded and analysed according to pre-identified themes of orientation and guidelines, education, communication, logistics and access, and information technology. Key improvements since implementation of the Partnership include: health professional relationships, communication and education; and integration of quality improvement activities. Focus groups with 49 health professionals provided in depth information about how these activities have impacted their practice and models of care for diabetes in pregnancy. Co-ordination of care was reported to have improved, however it was also identified as an opportunity for further development. Recommendations included a central care coordinator, better integration of information technology systems and ongoing comprehensive quality improvement processes. The Partnership has facilitated quality improvement through supporting the development of improved systems that enhance models of care. Persisting challenges exist for delivering care to a high risk population however improvements in formal processes and structures, as demonstrated in this work thus far, play an important role in work towards improving health outcomes.

Increasing reliability of APACHE II scores in a medical-surgical intensive care unit: a quality improvement study.

PubMed

Donahoe, Laura; McDonald, Ellen; Kho, Michelle E; Maclennan, Margaret; Stratford, Paul W; Cook, Deborah J

2009-01-01

Given their clinical, research, and administrative purposes, scores on the Acute Physiology and Chronic Health Evaluation (APACHE) II should be reliable, whether calculated by health care personnel or a clinical information system. To determine reliability of APACHE II scores calculated by a clinical information system and by health care personnel before and after a multifaceted quality improvement intervention. APACHE II scores of 37 consecutive patients admitted to a closed, 15-bed, university-affiliated intensive care unit were collected by a research coordinator, a database clerk, and a clinical information system. After a quality improvement intervention focused on health care personnel and the clinical information system, the same methods were used to collect data on 32 consecutive patients. The research coordinator and the clerk did not know each other's scores or the information system's score. The data analyst did not know the source of the scores until analysis was complete. APACHE II scores obtained by the clerk and the research coordinator were highly reliable (intraclass correlation coefficient, 0.88 before vs 0.80 after intervention; P = .25). No significant changes were detected after the intervention; however, compared with scores of the research coordinator, the overall reliability of APACHE II scores calculated by the clinical information system improved (intraclass correlation coefficient, 0.24 before intervention vs 0.91 after intervention, P < .001). After completion of a quality improvement intervention, health care personnel and a computerized clinical information system calculated sufficiently reliable APACHE II scores for clinical, research, and administrative purposes.

Framing quality improvement tools and techniques in healthcare the case of improvement leaders' guides.

PubMed

Millar, Ross

2013-01-01

The purpose of this paper is to present a study of how quality improvement tools and techniques are framed within healthcare settings. The paper employs an interpretive approach to understand how quality improvement tools and techniques are mobilised and legitimated. It does so using a case study of the NHS Modernisation Agency Improvement Leaders' Guides in England. Improvement Leaders' Guides were framed within a service improvement approach encouraging the use of quality improvement tools and techniques within healthcare settings. Their use formed part of enacting tools and techniques across different contexts. Whilst this enactment was believed to support the mobilisation of tools and techniques, the experience also illustrated the challenges in distributing such approaches. The paper provides an important contribution in furthering our understanding of framing the "social act" of quality improvement. Given the ongoing emphasis on quality improvement in health systems and the persistent challenges involved, it also provides important information for healthcare leaders globally in seeking to develop, implement or modify similar tools and distribute leadership within health and social care settings.

The Definition and Measurement of Evaluation Quality as a Management Tool.

ERIC Educational Resources Information Center

Chelimsky, Eleanor

1983-01-01

Evaluation management requires a system for measuring, improving, and accounting for quality. The Institute for Program Evaluation in the United States General Accounting Office is developing such a system. (Author)

Developing and implementing a computerized nursing quality control system in a tertiary general medical center in Israel.

PubMed

Kagan, Ilya; Cohen, Rachel; Fish, Miri; Mezare, Henia Perry

2014-01-01

This article describes the development and implementation of the Nursing Quality Indicators Scale and a quality control system for hospital nursing care, which allows universal access to all external and internal audit results, thus ensuring complete data transparency. Standardized indicators make departments' performance comparable. Key to the new system is nurses' self-audit and responsibility for making quality improvements at the ward level.

Quality of health care in the US managed care system: comparing and highlighting successful states.

PubMed

Guo, Kristina L

2008-01-01

This paper aims to examine the issue of quality of care in the US managed care system and to compare state-level policies and programs. Specifically, it aims to describe five states which are making the most quality of care improvements. This study examines the literature to identify states' care quality rankings. Additionally, five state case studies are presented to illustrate various programs approach to quality. The paper finds that some states are better than others in their strategies to enhance quality of care. California, Florida, Maryland, Minnesota and Rhode Island are considered among the best. Thus, their programs are described. From a research perspective the study brings a renewed focus on various methods in which states invest to improve residents' quality of care. From a practical standpoint, since quality of care is an important topic and interesting to all stakeholders in health care--policymakers, consumers, providers, and payers--readers can use the study's results to compare states' strategies and develop new ways to increase quality. This study's value lies in the way it helps states to compare their performance over time and against other states as they make improvements to enhance quality.

Incorporating metacognition into morbidity and mortality rounds: The next frontier in quality improvement.

PubMed

Katz, David; Detsky, Allan S

2016-02-01

This Perspective proposes the introduction of metacognition (thinking about thinking) into the existing format of hospital-based morbidity and mortality rounds. It is placed in the context of historical movements to advance quality improvement by expanding the spectrum of the causes of medical error from systems-based issues to flawed human decision-making capabilities. We suggest that the current approach that focuses on systems-based issues can be improved by exploiting the opportunities to educate physicians about predictable errors committed by reliance on cognitive heuristics. In addition, because the field of educating clinicians about cognitive heuristics has shown mixed results, this proposal represents fertile ground for further research. Educating clinicians about cognitive heuristics may improve metacognition and perhaps be the next frontier in quality improvement. © 2015 Society of Hospital Medicine.

Improving organizational climate for quality and quality of care: does membership in a collaborative help?

PubMed

Nembhard, Ingrid M; Northrup, Veronika; Shaller, Dale; Cleary, Paul D

2012-11-01

The lack of quality-oriented organizational climates is partly responsible for deficiencies in patient-centered care and poor quality more broadly. To improve their quality-oriented climates, several organizations have joined quality improvement collaboratives. The effectiveness of this approach is unknown. To evaluate the impact of collaborative membership on organizational climate for quality and service quality. Twenty-one clinics, 4 of which participated in a collaborative sponsored by the Institute for Clinical Systems Improvement. Pre-post design. Preassessments occurred 2 months before the collaborative began in January 2009. Postassessments of service quality and climate occurred about 6 months and 1 year, respectively, after the collaborative ended in January 2010. We surveyed clinic employees (eg, physicians, nurses, receptionists, etc.) about the organizational climate and patients about service quality. Prioritization of quality care, high-quality staff relationships, and open communication as indicators of quality-oriented climate and timeliness of care, staff helpfulness, doctor-patient communication, rating of doctor, and willingness to recommend doctor's office as indicators of service quality. There was no significant effect of collaborative membership on quality-oriented climate and mixed effects on service quality. Doctors' ratings improved significantly more in intervention clinics than in control clinics, staff helpfulness improved less, and timeliness of care declined more. Ratings of doctor-patient communication and willingness to recommend doctor were not significantly different between intervention and comparison clinics. Membership in the collaborative provided no significant advantage for improving quality-oriented climate and had equivocal effects on service quality.

Continuous Improvement and Employee Engagement, Part 2: Design, Implementation, and Outcomes of a Daily Management System.

PubMed

Maurer, Marsha; Browall, Pamela; Phelan, Cynthia; Sanchez, Sandra; Sulmonte, Kimberlyann; Wandel, Jane; Wang, Allison

2018-04-01

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or work flow and to address them on a daily basis. Through a DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 2 describes the implementation and outcomes of the program.

Building a Culture of Continuous Improvement and Employee Engagement Using a Daily Management System Part 1: Overview.

PubMed

Maurer, Marsha; Canacari, Elena; Eng, Kimberly; Foley, Jane; Phelan, Cynthia; Sulmonte, Kimberlyann; Wandel, Jane

2018-03-01

A daily management system (DMS) can be used to implement continuous quality improvement and advance employee engagement. It can empower staff to identify problems in the care environment that impact quality or workflow and to address them on a daily basis. Through DMS, improvement becomes the work of everyone, every day. The authors of this 2-part series describe their work to develop a DMS. Part 1 describes the background and organizing framework of the program.

Lighting recommendations for the Social Security Administration Frank Hagel Federal Building in Richmond CA

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

Rubinstein, Francis M.

Specific recommendations are made to improve the lighting quality and energy efficiency of the lighting system at the Social Security Administration Frank Hagel Building in Richmond, CA. The main recommendation is to replace the recessed fluorescent lighting system in the general office area with indirect lighting. Indirect lighting will improve lighting quality, will provide an energy efficient solution and will be about the same cost as the direct lighting system originally proposed.

The Strengths and Weaknesses of Total Quality Management in Higher Education.

ERIC Educational Resources Information Center

Hazzard, Terry

This paper defines Total Quality Management (TQM), discusses its origins, and identifies its strengths and weaknesses as they apply to higher education. The paper defines TQM as a philosophy of organizations that defines quality and improves organizational performance and administrative systems. The system originated from statistical quality…

Deploying advanced public transportation systems in Birmingham

DOT National Transportation Integrated Search

2003-08-01

Advanced Public Transportation Systems (APTS) technologies have been deployed by many urban transit systems in order to improve efficiency, reduce operating costs, and improve service quality. The majority of : these deployments, however, have been i...

From Board to Bedside: How the Application of Financial Structures to Safety and Quality Can Drive Accountability in a Large Health Care System.

PubMed

Austin, J Matthew; Demski, Renee; Callender, Tiffany; Lee, K H Ken; Hoffman, Ann; Allen, Lisa; Radke, Deborah A; Kim, Yungjin; Werthman, Ronald J; Peterson, Ronald R; Pronovost, Peter J

2017-04-01

As the health care system in the United States places greater emphasis on the public reporting of quality and safety data and its use to determine payment, provider organizations must implement structures that ensure discipline and rigor regarding these data. An academic health system, as part of a performance management system, applied four key components of a financial reporting structure to support the goal of top-to-bottom accountability for improving quality and safety. The four components implemented by Johns Hopkins Medicine were governance, accountability, reporting of consolidated quality performance statements, and auditing. Governance is provided by the health system's Patient Safety and Quality Board Committee, which reviews goals and strategy for patient safety and quality, reviews quarterly performance for each entity, and holds organizational leaders accountable for performance. An accountability plan includes escalating levels of review corresponding to the number of months an entity misses the defined performance target for a measure. A consolidated quality statement helps inform the Patient Safety and Quality Board Committee and leadership on key quality and safety issues. An audit evaluates the efficiency and effectiveness of processes for data collection, validation, and storage, as to ensure the accuracy and completeness of quality measure reporting. If hospitals and health systems truly want to prioritize improvements in safety and quality, they will need to create a performance management system that ensures data validity and supports performance accountability. Without valid data, it is difficult to know whether a performance gap is due to data quality or clinical quality. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

Register-Recall Systems: Tools for Chronic Disease Management in General Practice.

PubMed

Georgiou, Andrew; Burns, Joan; Penn, Danielle; Infante, Fernando; Harris, Mark

2004-09-01

The Divisions Diabetes and Cardiovascular Disease Quality Improvement Project (DDCQIP) is a national project that aims to promote quality improvement initiatives among Divisions of General Practice. DDCQIP has investigated the growth of Division-based diabetes and cardiovascular disease register-recall systems and the role they play in promoting evidence-based structured care within general practice. In the period 2000-2002, an increase in the number of GPs using register-recall systems and the rise in the number of active registered patients have made it possible to monitor quality of care and health outcome indicators, and contributed to the growth of a Division-based population health program.

QRIS and Inclusion: Do State QRIS Standards Support the Learning Needs of All Children? CEELO FastFact

ERIC Educational Resources Information Center

Horowitz, Michelle; Squires, Jim

2014-01-01

As the country quickly builds its efforts to enhance quality in early education and care classrooms, states are implementing Quality Rating and Improvement Systems (QRIS) to recognize and improve the quality of programs. QRIS also provides technical support and increased financial benefits for participating programs to attain higher levels of…

Building High-Performing and Improving Education Systems: Teachers. Review

ERIC Educational Resources Information Center

Slater, Liz

2013-01-01

There is overwhelming evidence that teachers have the most effect on pupil outcomes (closely followed by the quality of leadership). The Organisation for Economic Co-Operation and Development (OECD) concluded that: (1) teachers were central to school improvement; (2) in order to improve the quality and fairness of education, teachers had to be…

Implementation and results of an integrated data quality assurance protocol in a randomized controlled trial in Uttar Pradesh, India.

PubMed

Gass, Jonathon D; Misra, Anamika; Yadav, Mahendra Nath Singh; Sana, Fatima; Singh, Chetna; Mankar, Anup; Neal, Brandon J; Fisher-Bowman, Jennifer; Maisonneuve, Jenny; Delaney, Megan Marx; Kumar, Krishan; Singh, Vinay Pratap; Sharma, Narender; Gawande, Atul; Semrau, Katherine; Hirschhorn, Lisa R

2017-09-07

There are few published standards or methodological guidelines for integrating Data Quality Assurance (DQA) protocols into large-scale health systems research trials, especially in resource-limited settings. The BetterBirth Trial is a matched-pair, cluster-randomized controlled trial (RCT) of the BetterBirth Program, which seeks to improve quality of facility-based deliveries and reduce 7-day maternal and neonatal mortality and maternal morbidity in Uttar Pradesh, India. In the trial, over 6300 deliveries were observed and over 153,000 mother-baby pairs across 120 study sites were followed to assess health outcomes. We designed and implemented a robust and integrated DQA system to sustain high-quality data throughout the trial. We designed the Data Quality Monitoring and Improvement System (DQMIS) to reinforce six dimensions of data quality: accuracy, reliability, timeliness, completeness, precision, and integrity. The DQMIS was comprised of five functional components: 1) a monitoring and evaluation team to support the system; 2) a DQA protocol, including data collection audits and targets, rapid data feedback, and supportive supervision; 3) training; 4) standard operating procedures for data collection; and 5) an electronic data collection and reporting system. Routine audits by supervisors included double data entry, simultaneous delivery observations, and review of recorded calls to patients. Data feedback reports identified errors automatically, facilitating supportive supervision through a continuous quality improvement model. The five functional components of the DQMIS successfully reinforced data reliability, timeliness, completeness, precision, and integrity. The DQMIS also resulted in 98.33% accuracy across all data collection activities in the trial. All data collection activities demonstrated improvement in accuracy throughout implementation. Data collectors demonstrated a statistically significant (p = 0.0004) increase in accuracy throughout consecutive audits. The DQMIS was successful, despite an increase from 20 to 130 data collectors. In the absence of widely disseminated data quality methods and standards for large RCT interventions in limited-resource settings, we developed an integrated DQA system, combining auditing, rapid data feedback, and supportive supervision, which ensured high-quality data and could serve as a model for future health systems research trials. Future efforts should focus on standardization of DQA processes for health systems research. ClinicalTrials.gov identifier, NCT02148952 . Registered on 13 February 2014.

Race to the Top--Early Learning Challenge (RTT-ELC): Descriptive Study of Tiered Quality Rating and Improvement Systems (TQRIS). Master Data Collection Protocol

ERIC Educational Resources Information Center

Mathematica Policy Research, Inc., 2015

2015-01-01

This master data collection protocol describes the data that Mathematica collected for the Race to the Top-Early Learning Challenge Study of Tiered Quality Rating and Improvement Systems. This study was conducted for the Department of Education's Institute of Education Sciences. The data were collected from reviews of applications, documents, and…

Quality Rating Improvement System "for" Early Care "and" Education: Development, Implementation, Evaluation and Learning

ERIC Educational Resources Information Center

Shen, Jianping; Ma, Xin

2013-01-01

Quality Rating Improvement System (QRIS) has gained national momentum. The authors first present a national scene of QRIS and then use Children's Services Council of Palm Beach County as a case study to illustrate a number of things. First, they look at the logic model behind the QRIS. Next, they review the design and implementation of the QRIS in…

A Quality Improvement Customer Service Process and CSS [Customer Service System]. Burlington County College Employee Development Series, Volumes I & II.

ERIC Educational Resources Information Center

Burlington County Coll., Pemberton, NJ.

Prepared for use by staff in development workshops at Burlington County College (BCC), in New Jersey, this handbook offers college-wide guidelines for improving the quality of service provided to internal and external customers, and reviews key elements of BCC's Customer Service System (CSS), a computerized method of recording and following-up on…

Control by quality: proposition of a typology.

PubMed

Pujo, P; Pillet, M

The application of Quality tools and methods in industrial management has always had a fundamental impact on the control of production. It influences the behavior of the actors concerned, while introducing the necessary notions and formalizations, especially for production systems with little or no automation, which constitute a large part of the industrial activity. Several quality approaches are applied in the workshop and are implemented at the level of the control. In this paper, the authors present a typology of the various approaches that have successively influenced control, such as statistical process control, quality assurance, and continuous improvement. First the authors present a parallel between production control and quality organizational structure. They note the duality between control, which is aimed at increasing productivity, and quality, which aims to satisfy the needs of the customer. They also note the hierarchical organizational structure of these two systems of management with, at each level, the notion of a feedback loop. This notion is fundamental to any kind of decision making. The paper is organized around the operational, tactical, and strategic levels, by describing for each level the main methods and tools for control by quality. The overview of these tools and methods starts at the operational level, with the Statistical Process Control, the Taguchi technique, and the "six sigma" approach. On the tactical level, we find a quality system approach, with a documented description of the procedures introduced in the firm. The management system can refer here to Quality Assurance, Total Productive Maintenance, or Management by Total Quality. The formalization through procedures of the rules of decision governing the process control enhances the validity of these rules. This leads to the enhancement of their reliability and to their consolidation. All this counterbalances the human, intrinsically fluctuating, behavior of the control operators. Strategic control by quality is then detailed, and the two main approaches, the continuous improvement approach and the proactive improvement approach, are introduced. Finally, the authors observe that at each of the three levels, the continuous process improvement, which is a component of Total Quality, becomes an essential preoccupation for the control. Ultimately, the recursive utilization of the Deming cycle remains the best practice for the control by quality.

Country Immunization Information System Assessments - Kenya, 2015 and Ghana, 2016.

PubMed

Scott, Colleen; Clarke, Kristie E N; Grevendonk, Jan; Dolan, Samantha B; Ahmed, Hussein Osman; Kamau, Peter; Ademba, Peter Aswani; Osadebe, Lynda; Bonsu, George; Opare, Joseph; Diamenu, Stanley; Amenuvegbe, Gregory; Quaye, Pamela; Osei-Sarpong, Fred; Abotsi, Francis; Ankrah, Joseph Dwomor; MacNeil, Adam

2017-11-10

The collection, analysis, and use of data to measure and improve immunization program performance are priorities for the World Health Organization (WHO), global partners, and national immunization programs (NIPs). High quality data are essential for evidence-based decision-making to support successful NIPs. Consistent recording and reporting practices, optimal access to and use of health information systems, and rigorous interpretation and use of data for decision-making are characteristics of high-quality immunization information systems. In 2015 and 2016, immunization information system assessments (IISAs) were conducted in Kenya and Ghana using a new WHO and CDC assessment methodology designed to identify root causes of immunization data quality problems and facilitate development of plans for improvement. Data quality challenges common to both countries included low confidence in facility-level target population data (Kenya = 50%, Ghana = 53%) and poor data concordance between child registers and facility tally sheets (Kenya = 0%, Ghana = 3%). In Kenya, systemic challenges included limited supportive supervision and lack of resources to access electronic reporting systems; in Ghana, challenges included a poorly defined subdistrict administrative level. Data quality improvement plans (DQIPs) based on assessment findings are being implemented in both countries. IISAs can help countries identify and address root causes of poor immunization data to provide a stronger evidence base for future investments in immunization programs.

Morbidity and Mortality Conference: Its Purpose Reclaimed and Grounded in Theory.

PubMed

Gregor, Alexander; Taylor, David

2016-01-01

The morbidity and mortality conference (MMC) remains a central activity within the departments of our academic healthcare institutions. It is deeply rooted in the premise that we can learn from our mistakes, thereby improving the care we provide. Recent advances in our understanding of medical error and quality improvement have challenged the value of traditional models of MMC. As a result the purpose of MMC has become clouded and ill-defined: Is it an educational conference that promotes mastery of clinical acumen, or is it a venue to drive quality improvement by addressing systems-based issues in delivering care? Or can it serve both purposes? Review of the history of MMC, the literature, and critical application of education theory demonstrates the source of the confusion and the challenges in viewing it through the exclusive lens of either education or quality improvement. Application of experiential learning theory helps resolve this discord showing how the conference facilitates the development of clinical mastery while informing quality improvement programs about important and relevant systems-based issues. Building on this, we present a model for MMC involving five essential elements: case-based involving an adverse patient event, anonymity for participants, expert guided critical analysis, reframing understanding of the case presentation and related systems-based factors, and projection to practice change. This model builds on previously described models, is grounded in the literature, and helps clarify its role from both the educational and the quality improvement perspectives.

Quality improvement in hospitals: how much does it reduce healthcare costs?

PubMed

Jones, S B

1995-01-01

The philosophy of W.E. Deming suggests that continuous quality improvement efforts, when properly applied, ultimately will lead to financial dividends and will help ensure business longevity. Reducing hospital charges can be exciting for the participants and can provide an impetus for expanding quality improvement efforts. Americans, however, tend to demand almost instant gratification and have limited patience for longer-term results. This factor, coupled with minimal knowledge of actual operational costs and inaccurate charge accounting systems, may lead hospital managers to misinterpret the potential net long-term effects of their quality improvement efforts. In the approaching environment of capitated reimbursement, such mistakes may have serious consequences.

MEDNET: A Multi-State Policymaker/Researcher Collaboration to Improve Prescribing Practices

PubMed Central

Finnerty, Molly; Neese-Todd, Sheree; Bilder, Scott; Olfson, Mark; Crystal, Stephen

2015-01-01

States face new federal requirements to monitor psychotropic prescribing practices for children and adults in Medicaid. Effective use of quality measurement and quality improvement strategies hold the promise of improved outcomes for public mental health systems. The Medicaid/Mental Health Network for Evidence Based Treatment (MEDNET) is an AHRQ funded multi-state Medicaid quality collaborative with the Rutgers University Center for Health Services Research on Pharmacotherapy, Chronic Disease Management, and Outcomes. We review the development, infrastructure, challenges, and early evidence of success of this public-academic partnership, the first multi-state Medicaid quality improvement collaborative to focus on psychotropic medications. PMID:25756882

Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care

PubMed Central

2013-01-01

Background The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. Methods The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether ‘FQHCs’ HIT capacity’ is associated with the outcome measures. Results The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). Conclusions Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care. PMID:23363660

Health information technology capacity at federally qualified health centers: a mechanism for improving quality of care.

PubMed

Frimpong, Jemima A; Jackson, Bradford E; Stewart, LaShonda M; Singh, Karan P; Rivers, Patrick A; Bae, Sejong

2013-01-31

The adoption of health information technology has been recommended as a viable mechanism for improving quality of care and patient health outcomes. However, the capacity of health information technology (i.e., availability and use of multiple and advanced functionalities), particularly in federally qualified health centers (FQHCs) on improving quality of care is not well understood. We examined associations between health information technology (HIT) capacity at FQHCs and quality of care, measured by the receipt of discharge summary, frequency of patients receiving reminders/notifications for preventive care/follow-up care, and timely appointment for specialty care. The analyses used 2009 data from the National Survey of Federally Qualified Health Centers. The study included 776 of the FQHCs that participated in the survey. We examined the extent of HIT use and tested the hypothesis that level of HIT capacity is associated with quality of care. Multivariable logistic regressions, reporting unadjusted and adjusted odds ratios, were used to examine whether 'FQHCs' HIT capacity' is associated with the outcome measures. The results showed a positive association between health information technology capacity and quality of care. FQHCs with higher HIT capacity were significantly more likely to have improved quality of care, measured by the receipt of discharge summaries (OR=1.43; CI=1.01, 2.40), the use of a patient notification system for preventive and follow-up care (OR=1.74; CI=1.23, 2.45), and timely appointment for specialty care (OR=1.77; CI=1.24, 2.53). Our findings highlight the promise of HIT in improving quality of care, particularly for vulnerable populations who seek care at FQHCs. The results also show that FQHCs may not be maximizing the benefits of HIT. Efforts to implement HIT must include strategies that facilitate the implementation of comprehensive and advanced functionalities, as well as promote meaningful use of these systems. Further examination of the role of health information systems in clinical decision-making and improvements in patient outcomes are needed to better understand the benefits of HIT in improving overall quality of care.

Integrated delivery systems: the cure for fragmentation.

PubMed

Enthoven, Alain C

2009-12-01

Our healthcare system is fragmented, with a misalignment of incentives, or lack of coordination, that spawns inefficient allocation of resources. Fragmentation adversely impacts quality, cost, and outcomes. Eliminating waste from unnecessary, unsafe care is crucial for improving quality and reducing costs--and making the system financially sustainable. Many believe this can be achieved through greater integration of healthcare delivery, more specifically via integrated delivery systems (IDSs). An IDS is an organized, coordinated, and collaborative network that links various healthcare providers to provide a coordinated, vertical continuum of services to a particular patient population or community. It is also accountable, both clinically and fiscally, for the clinical outcomes and health status of the population or community served, and has systems in place to manage and improve them. The marketplace already contains numerous styles and degrees of integration, ranging from Kaiser Permanente-style full integration, to more loosely organized individual practice associations, to public-private partnerships. Evidence suggests that IDSs can improve healthcare quality, improve outcomes, and reduce costs--especially for patients with complex needs--if properly implemented and coordinated. No single approach or public policy will fix the fragmented healthcare system, but IDSs represent an important step in the right direction.

Evaluation of Knowledge Development in a Healthcare Setting

NASA Astrophysics Data System (ADS)

Schaffer, Scott P.

Healthcare organizations worldwide have recently increased efforts to improve performance, quality, and knowledge transfer using information and communication technologies. Evaluation of the effectiveness and quality of such efforts is challenging. A macro and micro-level system evaluation conducted with a 14000 member US hospital administrative services organization examined the appropriateness of a blended face-to-face and technology-enabled performance improvement and knowledge development system. Furthermore, a successful team or microsystem in a high performing hospital was studied in-depth. Several types of data methods including interview, observation, and questionnaire were used to address evaluation questions within a knowledge development framework created for the study. Results of this preliminary study focus on how this organization attempted to organize clinical improvement efforts around quality and performance improvement processes supported by networked technologies.

The Productive Ward Program™: A Two-Year Implementation Impact Review Using a Longitudinal Multilevel Study.

PubMed

Van Bogaert, Peter; Van Heusden, Danny; Verspuy, Martijn; Wouters, Kristien; Slootmans, Stijn; Van der Straeten, Johnny; Van Aken, Paul; White, Mark

2017-03-01

Aim To investigate the impact of the quality improvement program "Productive Ward - Releasing Time to Care™" using nurses' and midwives' reports of practice environment, burnout, quality of care, job outcomes, as well as workload, decision latitude, social capital, and engagement. Background Despite the requirement for health systems to improve quality and the proliferation of quality improvement programs designed for healthcare, the empirical evidence supporting large-scale quality improvement programs impacting patient satisfaction, staff engagement, and quality care remains sparse. Method A longitudinal study was performed in a large 600-bed acute care university hospital at two measurement intervals for nurse practice environment, burnout, and quality of care and job outcomes and three measurement intervals for workload, decision latitude, social capital, and engagement between June 2011 and November 2014. Results Positive results were identified in practice environment, decision latitude, and social capital. Less favorable results were identified in relation to perceived workload, emotional exhaustion. and vigor. Moreover, measures of quality of care and job satisfaction were reported less favorably. Conclusion This study highlights the need to further understand how to implement large-scale quality improvement programs so that they integrate with daily practices and promote "quality improvement" as "business as usual."

The clinical nurse specialist: leadership in quality improvement.

PubMed

Finkelman, Anita

2013-01-01

Healthcare delivery is in a crisis, requiring improvement. How to improve and who should assume more leadership are not clear. At the same time, the nursing profession struggles with a weak education system, graduating students who require major support for an extended time. There is also confusion related to nursing roles, particularly with nurses who have a graduate degree. The Institute of Medicine has published a series of reports about the healthcare system and need for improvement and describes a structure for improvement. The clinical nurse specialist is particularly suited to assume a major role in nursing leadership to guide staff and the healthcare system to better ensure improved care. There is great need to communicate that the clinical nurse specialist can and should assume this role. This will require a review and development of more quality improvement content and experiences in clinical nurse specialist educational programs, but much of the content is already in programs. The clinical nurse specialist works in systems, impacts systems, works with staff, and can thus reach more patients with improvement approaches.

Establishment, Present Condition, and Developmental Direction of the New Korean Healthcare Accreditation System

PubMed Central

Chang, Hoo-Sun

2012-01-01

On July 23rd, 2010 a revised medical law (Article 58) was passed to change existing evaluation system of medical institutions to an accreditation system. The new healthcare accreditation system was introduced to encourage medical institutions to work voluntarily and continuously to improve patient safety and medical service quality. Changes regarding the healthcare accreditation system included the establishment of an accreditation agency, the voluntary participation of medical institutions, accreditation standards centering on the treatment process and patient safety, tracing methodology, and the announcement of comprehensive results concerning accreditation. Despite varying views on the healthcare accreditation system, including some that are critical, it is meaningful that the voluntary nature of the system acknowledges that the medical institutions must be active agents in improving medical service quality. Healthcare quality is not improved instantaneously, but instead gradually through continuous communication within the clinical field. For this accreditation system to be successful, followings are essential: the accreditation agency becomes financially independent and is managed efficiently, the autonomy and regulation surrounding the system are balanced, the professionalism of the system is ensured, and the medical field plays an active role in the operation of the system. PMID:22661873

A review of portal screen-film technology and five radiologists' evaluations of some existing products.

PubMed

Walker, M A; Steinheimer, D N; Weir, V A; Homco, L D; Green, R W; Morris, E L; Hess, M E

1999-01-01

Portal radiographs, radiographs made to document the accuracy of radiotherapy treatment fields, are typically of poor image contrast. Recently, a new portal film and screened-cassette system was marketed, the Kodak EC-L system, with the claim of greatly improved image contrast. This new EC-L system was tested on a canine cadaver exposed to Cobalt-60 teletherapy gamma radiation, and image quality was compared to earlier marketed Kodak portal film products. The EC-L system was found to provide portal images of improved contrast/quality.

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care

PubMed Central

Percival, Nikki; O’Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers. PMID:27066470

Improving Health Promotion Using Quality Improvement Techniques in Australian Indigenous Primary Health Care.

PubMed

Percival, Nikki; O'Donoghue, Lynette; Lin, Vivian; Tsey, Komla; Bailie, Ross Stewart

2016-01-01

Although some areas of clinical health care are becoming adept at implementing continuous quality improvement (CQI) projects, there has been limited experimentation of CQI in health promotion. In this study, we examined the impact of a CQI intervention on health promotion in four Australian Indigenous primary health care centers. Our study objectives were to (a) describe the scope and quality of health promotion activities, (b) describe the status of health center system support for health promotion activities, and (c) introduce a CQI intervention and examine the impact on health promotion activities and health centers systems over 2 years. Baseline assessments showed suboptimal health center systems support for health promotion and significant evidence-practice gaps. After two annual CQI cycles, there were improvements in staff understanding of health promotion and systems for planning and documenting health promotion activities had been introduced. Actions to improve best practice health promotion, such as community engagement and intersectoral partnerships, were inhibited by the way health center systems were organized, predominately to support clinical and curative services. These findings suggest that CQI can improve the delivery of evidence-based health promotion by engaging front line health practitioners in decision-making processes about the design/redesign of health center systems to support the delivery of best practice health promotion. However, further and sustained improvements in health promotion will require broader engagement of management, senior staff, and members of the local community to address organizational and policy level barriers.

Documenting quality improvement and patient safety efforts: the quality portfolio. A statement from the academic hospitalist taskforce.

PubMed

Taylor, Benjamin B; Parekh, Vikas; Estrada, Carlos A; Schleyer, Anneliese; Sharpe, Bradley

2014-01-01

Physicians increasingly investigate, work, and teach to improve the quality of care and safety of care delivery. The Society of General Internal Medicine Academic Hospitalist Task Force sought to develop a practical tool, the quality portfolio, to systematically document quality and safety achievements. The quality portfolio was vetted with internal and external stakeholders including national leaders in academic medicine. The portfolio was refined for implementation to include an outlined framework, detailed instructions for use and an example to guide users. The portfolio has eight categories including: (1) a faculty narrative, (2) leadership and administrative activities, (3) project activities, (4) education and curricula, (5) research and scholarship, (6) honors, awards, and recognition, (7) training and certification, and (8) an appendix. The authors offer this comprehensive, yet practical tool as a method to document quality and safety activities. It is relevant for physicians across disciplines and institutions and may be useful as a standalone document or as an adjunct to traditional promotion documents. As the Next Accreditation System is implemented, academic medical centers will require faculty who can teach and implement the systems-based practice requirements. The quality portfolio is a method to document quality improvement and safety activities.

Improving Papanicolaou test quality and reducing medical errors by using Toyota production system methods.

PubMed

Raab, Stephen S; Andrew-Jaja, Carey; Condel, Jennifer L; Dabbs, David J

2006-01-01

The objective of the study was to determine whether the Toyota production system process improves Papanicolaou test quality and patient safety. An 8-month nonconcurrent cohort study that included 464 case and 639 control women who had a Papanicolaou test was performed. Office workflow was redesigned using Toyota production system methods by introducing a 1-by-1 continuous flow process. We measured the frequency of Papanicolaou tests without a transformation zone component, follow-up and Bethesda System diagnostic frequency of atypical squamous cells of undetermined significance, and diagnostic error frequency. After the intervention, the percentage of Papanicolaou tests lacking a transformation zone component decreased from 9.9% to 4.7% (P = .001). The percentage of Papanicolaou tests with a diagnosis of atypical squamous cells of undetermined significance decreased from 7.8% to 3.9% (P = .007). The frequency of error per correlating cytologic-histologic specimen pair decreased from 9.52% to 7.84%. The introduction of the Toyota production system process resulted in improved Papanicolaou test quality.

A Framework and Improvements of the Korea Cloud Services Certification System.

PubMed

Jeon, Hangoo; Seo, Kwang-Kyu

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed.

A Framework and Improvements of the Korea Cloud Services Certification System

PubMed Central

Jeon, Hangoo

2015-01-01

Cloud computing service is an evolving paradigm that affects a large part of the ICT industry and provides new opportunities for ICT service providers such as the deployment of new business models and the realization of economies of scale by increasing efficiency of resource utilization. However, despite benefits of cloud services, there are some obstacles to adopt such as lack of assessing and comparing the service quality of cloud services regarding availability, security, and reliability. In order to adopt the successful cloud service and activate it, it is necessary to establish the cloud service certification system to ensure service quality and performance of cloud services. This paper proposes a framework and improvements of the Korea certification system of cloud service. In order to develop it, the critical issues related to service quality, performance, and certification of cloud service are identified and the systematic framework for the certification system of cloud services and service provider domains are developed. Improvements of the developed Korea certification system of cloud services are also proposed. PMID:26125049

The potential for intelligent decision support systems to improve the quality and consistency of medication reviews.

PubMed

Bindoff, I; Stafford, A; Peterson, G; Kang, B H; Tenni, P

2012-08-01

Drug-related problems (DRPs) are of serious concern worldwide, particularly for the elderly who often take many medications simultaneously. Medication reviews have been demonstrated to improve medication usage, leading to reductions in DRPs and potential savings in healthcare costs. However, medication reviews are not always of a consistently high standard, and there is often room for improvement in the quality of their findings. Our aim was to produce computerized intelligent decision support software that can improve the consistency and quality of medication review reports, by helping to ensure that DRPs relevant to a patient are overlooked less frequently. A system that largely achieved this goal was previously published, but refinements have been made. This paper examines the results of both the earlier and newer systems. Two prototype multiple-classification ripple-down rules medication review systems were built, the second being a refinement of the first. Each of the systems was trained incrementally using a human medication review expert. The resultant knowledge bases were analysed and compared, showing factors such as accuracy, time taken to train, and potential errors avoided. The two systems performed well, achieving accuracies of approximately 80% and 90%, after being trained on only a small number of cases (126 and 244 cases, respectively). Through analysis of the available data, it was estimated that without the system intervening, the expert training the first prototype would have missed approximately 36% of potentially relevant DRPs, and the second 43%. However, the system appeared to prevent the majority of these potential expert errors by correctly identifying the DRPs for them, leaving only an estimated 8% error rate for the first expert and 4% for the second. These intelligent decision support systems have shown a clear potential to substantially improve the quality and consistency of medication reviews, which should in turn translate into improved medication usage if they were implemented into routine use. © 2011 Blackwell Publishing Ltd.

Software Design Improvements. Part 2; Software Quality and the Design and Inspection Process

NASA Technical Reports Server (NTRS)

Lalli, Vincent R.; Packard, Michael H.; Ziemianski, Tom

1997-01-01

The application of assurance engineering techniques improves the duration of failure-free performance of software. The totality of features and characteristics of a software product are what determine its ability to satisfy customer needs. Software in safety-critical systems is very important to NASA. We follow the System Safety Working Groups definition for system safety software as: 'The optimization of system safety in the design, development, use and maintenance of software and its integration with safety-critical systems in an operational environment. 'If it is not safe, say so' has become our motto. This paper goes over methods that have been used by NASA to make software design improvements by focusing on software quality and the design and inspection process.

Introduction of Transplant Registry Unified Management Program 2 (TRUMP2): scripts for TRUMP data analyses, part I (variables other than HLA-related data).

PubMed

Atsuta, Yoshiko

2016-01-01

Collection and analysis of information on diseases and post-transplant courses of allogeneic hematopoietic stem cell transplant recipients have played important roles in improving therapeutic outcomes in hematopoietic stem cell transplantation. Efficient, high-quality data collection systems are essential. The introduction of the Second-Generation Transplant Registry Unified Management Program (TRUMP2) is intended to improve data quality and more efficient data management. The TRUMP2 system will also expand possible uses of data, as it is capable of building a more complex relational database. The construction of an accessible data utilization system for adequate data utilization by researchers would promote greater research activity. Study approval and management processes and authorship guidelines also need to be organized within this context. Quality control of processes for data manipulation and analysis will also affect study outcomes. Shared scripts have been introduced to define variables according to standard definitions for quality control and improving efficiency of registry studies using TRUMP data.

Scaling up Evidence-based Practices for Children and Families in New York State: Towards Evidence-based Policies on Implementation for State Mental Health Systems

PubMed Central

Hoagwood, Kimberly Eaton; Olin, S. Serene; Horwitz, Sarah; McKay, Mary; Cleek, Andrew; Gleacher, Alissa; Lewandowski, Eric; Nadeem, Erum; Acri, Mary; Chor, Ka Ho Brian; Kuppinger, Anne; Burton, Geraldine; Weiss, Dara; Frank, Samantha; Finnerty, Molly; Bradbury, Donna M.; Woodlock, Kristin M.; Hogan, Michael

2014-01-01

Dissemination of innovations is widely considered the sine qua non for system improvement. At least two dozen states are rolling-out evidence-based mental health practices targeted at children and families using trainings, consultations, webinars, and learning collaboratives to improve quality and outcomes. In New York State (NYS) a group of researchers, policy-makers, providers and family support specialists have worked in partnership since 2002 to redesign and evaluate the children’s mental health system. Five system strategies driven by empirically-based practices and organized within a state-supported infrastructure have been used in the child and family service system with over 2,000 providers: (a) business practices; (b) use of health information technologies in quality improvement; (c) specific clinical interventions targeted at common childhood disorders; (d) parent activation; and (e) quality indicator development. The NYS system has provided a laboratory for naturalistic experiments. We describe these initiatives, key findings and challenges, lessons learned for scaling, and implications for creating evidence-based implementation policies in state systems. PMID:24460518

Benchmarking and audit of breast units improves quality of care

PubMed Central

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

2013-01-01

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

Performance Evaluation of UPQC under Nonlinear Unbalanced Load Conditions Using Synchronous Reference Frame Based Control

NASA Astrophysics Data System (ADS)

Kota, Venkata Reddy; Vinnakoti, Sudheer

2017-12-01

Today, maintaining Power Quality (PQ) is very important in the growing competent world. With new equipments and devices, new challenges are also being put before power system operators. Unified Power Quality Conditioner (UPQC) is proposed to mitigate many power quality problems and to improve the performance of the power system. In this paper, an UPQC with Fuzzy Logic controller for capacitor voltage balancing is proposed in Synchronous Reference Frame (SRF) based control with Modified Phased Locked Loop (MPLL). The proposed controller with SRF-MPLL based control is tested under non-linear and unbalanced load conditions. The system is developed in Matlab/Simulink and its performance is analyzed under various conditions like non-linear, unbalanced load and polluted supply voltage including voltage sag/swells. Active and reactive power flow in the system, power factor and %THD of voltages and currents before and after compensation are also analyzed in this work. Results prove the applicability of the proposed scheme for power quality improvement. It is observed that the fuzzy controller gives better performance than PI controller with faster capacitor voltage balancing and also improves the dynamic performance of the system.

Implementing a user-driven online quality improvement toolkit for cancer care.

PubMed

Luck, Jeff; York, Laura S; Bowman, Candice; Gale, Randall C; Smith, Nina; Asch, Steven M

2015-05-01

Peer-to-peer collaboration within integrated health systems requires a mechanism for sharing quality improvement lessons. The Veterans Health Administration (VA) developed online compendia of tools linked to specific cancer quality indicators. We evaluated awareness and use of the toolkits, variation across facilities, impact of social marketing, and factors influencing toolkit use. A diffusion of innovations conceptual framework guided the collection of user activity data from the Toolkit Series SharePoint site and an online survey of potential Lung Cancer Care Toolkit users. The VA Toolkit Series site had 5,088 unique visitors in its first 22 months; 5% of users accounted for 40% of page views. Social marketing communications were correlated with site usage. Of survey respondents (n = 355), 54% had visited the site, of whom 24% downloaded at least one tool. Respondents' awareness of the lung cancer quality performance of their facility, and facility participation in quality improvement collaboratives, were positively associated with Toolkit Series site use. Facility-level lung cancer tool implementation varied widely across tool types. The VA Toolkit Series achieved widespread use and a high degree of user engagement, although use varied widely across facilities. The most active users were aware of and active in cancer care quality improvement. Toolkit use seemed to be reinforced by other quality improvement activities. A combination of user-driven tool creation and centralized toolkit development seemed to be effective for leveraging health information technology to spread disease-specific quality improvement tools within an integrated health care system. Copyright © 2015 by American Society of Clinical Oncology.

SafeCare: An Innovative Approach for Improving Quality Through Standards, Benchmarking, and Improvement in Low- and Middle- Income Countries.

PubMed

Johnson, Michael C; Schellekens, Onno; Stewart, Jacqui; van Ostenberg, Paul; de Wit, Tobias Rinke; Spieker, Nicole

2016-08-01

In low- and middle-income countries (LMICs), patients often have limited access to high-quality care because of a shortage of facilities and human resources, inefficiency of resource allocation, and limited health insurance. SafeCare was developed to provide innovative health care standards; surveyor training; a grading system for quality of care; a quality improvement process that is broken down into achievable, measurable steps to facilitate incremental improvement; and a private sector-supported health financing model. Three organizations-PharmAccess Foundation, Joint Commission International, and the Council for Health Service Accreditation of Southern Africa-launched SafeCare in 2011 as a formal partnership. Five SafeCare levels of improvement are allocated on the basis of an algorithm that incorporates both the overall score and weighted criteria, so that certain high-risk criteria need to be in place before a facility can move to the next SafeCare certification level. A customized quality improvement plan based on the SafeCare assessment results lists the specific, measurable activities that should be undertaken to address gaps in quality found during the initial assessment and to meet the nextlevel SafeCare certificate. The standards have been implemented in more than 800 primary and secondary facilities by qualified local surveyors, in partnership with various local public and private partner organizations, in six sub-Saharan African countries (Ghana, Kenya, Nigeria, Namibia, Tanzania, and Zambia). Expanding access to care and improving health care quality in LMICs will require a coordinated effort between institutions and other stakeholders. SafeCare's standards and assessment methodology can help build trust between stakeholders and lay the foundation for country-led quality monitoring systems.

Improving the Performance of Three-Mirror Imaging Systems with Freeform Optics

NASA Technical Reports Server (NTRS)

Howard, Joseph M.; Wolbach, Steven

2013-01-01

The image quality improvement for three-mirror systems by Freeform Optics is surveyed over various f-number and field specifications. Starting with the Korsch solution, we increase the surface shape degrees of freedom and record the improvements.

Mentorship and coaching to support strengthening healthcare systems: lessons learned across the five Population Health Implementation and Training partnership projects in sub-Saharan Africa.

PubMed

Manzi, Anatole; Hirschhorn, Lisa R; Sherr, Kenneth; Chirwa, Cindy; Baynes, Colin; Awoonor-Williams, John Koku

2017-12-21

Despite global efforts to increase health workforce capacity through training and guidelines, challenges remain in bridging the gap between knowledge and quality clinical practice and addressing health system deficiencies preventing health workers from providing high quality care. In many developing countries, supervision activities focus on data collection, auditing and report completion rather than catalyzing learning and supporting system quality improvement. To address this gap, mentorship and coaching interventions were implemented in projects in five African countries (Ghana, Mozambique, Rwanda, Tanzania, and Zambia) as components of health systems strengthening (HSS) strategies funded through the Doris Duke Charitable Foundation's African Health Initiative. We report on lessons learned from a cross-country evaluation. The evaluation was designed based on a conceptual model derived from the project-specific interventions. Semi-structured interviews were administered to key informants to capture data in six categories: 1) mentorship and coaching goals, 2) selection and training of mentors and coaches, 3) integration with the existing systems, 4) monitoring and evaluation, 5) reported outcomes, and 6) challenges and successes. A review of project-published articles and technical reports from the individual projects supplemented interview information. Although there was heterogeneity in the approaches to mentorship and coaching and targeted areas of the country projects, all led to improvements in core health system areas, including quality of clinical care, data-driven decision making, leadership and accountability, and staff satisfaction. Adaptation of approaches to reflect local context encouraged their adoption and improved their effectiveness and sustainability. We found that incorporating mentorship and coaching activities into HSS strategies was associated with improvements in quality of care and health systems, and mentorship and coaching represents an important component of HSS activities designed to improve not just coverage, but even further effective coverage, in achieving Universal Health Care.

An Architecture for Continuous Data Quality Monitoring in Medical Centers.

PubMed

Endler, Gregor; Schwab, Peter K; Wahl, Andreas M; Tenschert, Johannes; Lenz, Richard

2015-01-01

In the medical domain, data quality is very important. Since requirements and data change frequently, continuous and sustainable monitoring and improvement of data quality is necessary. Working together with managers of medical centers, we developed an architecture for a data quality monitoring system. The architecture enables domain experts to adapt the system during runtime to match their specifications using a built-in rule system. It also allows arbitrarily complex analyses to be integrated into the monitoring cycle. We evaluate our architecture by matching its components to the well-known data quality methodology TDQM.

Enhanced road weather forecasting : Clarus regional demonstrations.

DOT National Transportation Integrated Search

2011-01-01

The quality of road weather forecasts has major impacts on users of surface transportation systems and managers of those systems. Improving the quality involves the ability to provide accurate, route-specific road weather information (e.g., timing an...

Aerospace technology and hospital systems

NASA Technical Reports Server (NTRS)

1972-01-01

The use of aerospace medical techniques to improve the quality of earth health care systems is discussed. Data are focused on physiological measurements and monitoring, medical information management, clean room technology, and reliability and quality assurance for hospital equipment.

Consumer response to a report card comparing healthcare systems.

PubMed

Braun, Barbara L; Kind, Elizabeth A; Fowles, Jinnet B; Suarez, Walter G

2002-06-01

Report cards to date have focused on quality of care in health plans rather than within healthcare delivery systems. The purpose of this study was to evaluate consumer response to the first healthcare system-level report card. Qualitative assessment of consumer response. We conducted 5 focus groups of community members to evaluate consumer response to the report card; 2 included community club members, 3 included community-dwelling retired persons. Discussions were audiotaped and transcribed; comments were categorized by topic area from the script, and common themes identified. Focus group participants, in general, were unaware of the current emphasis on medical quality improvement initiatives. However, they believed that the opinion that the descriptive clinic information and patient survey data contained in the report card would be most useful mainly for choosing a healthcare system if they were dissatisfied with current medical care, if their healthcare options changed, or if they were in poor health. Personal experience was considered a more trustworthy measure of healthcare quality than were patient survey results. Trustworthiness was perceived to be higher if the report card sponsor was not affiliated with the healthcare systems being evaluated. Participants also believed care system administrators should use the data to enact positive clinic-level and physician-level changes. Healthcare consumers appreciated the attention to patient experiences and supported healthcare quality improvement initiatives. Report cards were considered important for choosing a healthcare system in certain circumstances and for guiding quality improvement efforts at all levels.

[Certified quality management according to DIN ISO 9001 in a radiology department at a university hospital: measurable changes in academic quality indicators?].

PubMed

Lorenzen, J; Habermann, C; Utler, C; Grzyska, U; Weber, C; Adam, G; Koops, A

2009-10-01

To evaluate the changes in academic quality indicators after implementation of a quality management system according to DIN ISO 9001:2000. After implementation and certification of a quality management system, the actual state based on quality indicators from the fields of student teaching, research, continuing education and the satisfaction of referring physician was determined. After implementation of an action plan for the individual areas, the temporal changes in the ratios were documented in the follow-up. The evaluation of teaching performance obtained by questionnaire among the students of the radiology course showed a steady increase in satisfaction (mean value 2003: 2.7; 2007: 3.9). In the field of research an increase in scientific output was achieved based on the number of an internal publication score (2002: 99 points; 2006: 509). Repeated opinion surveys among our referring physicians found improvements in indicators for the appointment of investigations, consulting service and waiting times for the investigation, while the waiting times for internal transport service did not improve. Exemplary measurements of the success of the advanced training of the staff demonstrated the need for continuing education for quality improvement. The evaluation of quality indicators showed over time a measurable positive impact on processes of a radiological University Hospital after implementation of a QM system according to DIN ISO 9001:2000. Georg Thieme Verlag KG Stuttgart-New York.

Factors Influencing Team Performance in a Continuous Quality Improvement Process in the Wisconsin Technical College System

ERIC Educational Resources Information Center

Pietz, Victoria Lynn

2014-01-01

Continuous Quality Improvement (CQI) programs are growing in popularity in higher education settings and a key component is the use of work groups, which require active employee involvement. The problem addressed in this research was the lack of employee engagement in the Quality Review Process (QRP), which is a statewide CQI model developed by…

Quality drying of hardwood lumber : guidebook -- checklist

Treesearch

R. S. Boone; M. R. Milota; J. D. Danielson; D. W. Huber

The IMPROVE Lumber Drying Program is intended to increase awareness of the lumber drying system as a critical component in the manufacture of quality lumber. One objective of the program is to provide easy-to-use tools that a kiln operator can use to maintain an efficient kiln operation and therefore improve lumber drying quality. This report is one component of the...

Quality drying in a hardwood lumber predryer : guidebook--checklist

Treesearch

E. M. Wengert; R. S. Boone

The IMPROVE Lumber Drying Program is intended to increase awareness of the lumber drying system as a critical component in the manufacture of quality lumber. One objective of the program is to provide easy-to-use tools that a kiln/predryer operator can use to maintain an efficient drying operation and therefore improve lumber drying quality. This report is one...

Office of Student Financial Aid Quality Improvement Program: Design and Implementation Plan.

ERIC Educational Resources Information Center

Advanced Technology, Inc., Reston, VA.

The purpose and direction of the quality improvement program of the U.S. Department of Education's Office of Student Financial Aid (OSFA) are described. The improvement program was designed to develop a systematic approach to identify, measure, and correct errors in the student aid delivery system. Information is provided on the general approach…

Using TQM to Improve the Quality of Race/Ethnicity Reporting. AIR 1995 Annual Forum Paper.

ERIC Educational Resources Information Center

Matier, Michael W.; Larson, Oscar W., III

Total quality management (TQM) was employed to improve the collection, storage, and use of racial/ethnic information at Cornell University. The initiative began with the task of standardizing ethnic codes across a number of university systems. The project to improve race/ethnicity reporting was undertaken by a team representing various university…

The Practice of a Quality Assurance System in Open and Distance Learning: A Case Study at Universitas Terbuka Indonesia (The Indonesia Open University)

ERIC Educational Resources Information Center

Belawati, Tian; Zuhairi, Amin

2007-01-01

Quality assurance for distance higher education is one of the main concerns among institutions and stakeholders today. This paper examines the experiences of Universitas Terbuka (UT), which has initiated and implemented an innovative strategy of quality assurance (QA) for continuous improvement. The credo of the UT quality assurance system is…

Effective interventions on service quality improvement in a physiotherapy clinic.

PubMed

Gharibi, Farid; Tabrizi, JafarSadegh; Eteraf Oskouei, MirAli; AsghariJafarabadi, Mohammad

2014-01-01

Service quality is considered as a main domain of quality associ-ated with non-clinical aspect of healthcare. This study aimed to survey and im-proves service quality of delivered care in the Physiotherapy Clinic affiliated with the Tabriz University of Medical Sciences, Tabriz, Iran. A quasi experimental interventional study was conducted in the Physiotherapy Clinic, 2010-2011. Data were collected using a validated and reli-able researcher made questionnaire with participation of 324 patients and their coadjutors. The study questionnaire consisted of 7 questions about demographic factors and 38 questions for eleven aspects of service quality. Data were then analyzed using paired samples t-test by SPSS16. In the pre intervention phase, six aspects of service quality including choice of provider, safety, prevention and early detection, dignity, autonomy and availability achieved non-acceptable scores. Following interventions, all aspects of the service quality improved and also total service quality score improved from 8.58 to 9.83 (P<0.001). Service quality can be improved by problem implementation of appropriate interventions. The acquired results can be used in health system fields to create respectful environments for healthcare customers.

Identifying Continuous Quality Improvement Priorities in Maternal, Infant, and Early Childhood Home Visiting.

PubMed

Preskitt, Julie; Fifolt, Matthew; Ginter, Peter M; Rucks, Andrew; Wingate, Martha S

2016-01-01

The purpose of this article was to describe a methodology to identify continuous quality improvement (CQI) priorities for one state's Maternal, Infant, and Early Childhood Home Visiting program from among the 40 required constructs associated with 6 program benchmarks. The authors discuss how the methodology provided consensus on system CQI quality measure priorities and describe variation among the 3 service delivery models used within the state. Q-sort methodology was used by home visiting (HV) service delivery providers (home visitors) to prioritize HV quality measures for the overall state HV system as well as their service delivery model. There was general consensus overall and among the service delivery models on CQI quality measure priorities, although some variation was observed. Measures associated with Maternal, Infant, and Early Childhood Home Visiting benchmark 1, Improved Maternal and Newborn Health, and benchmark 3, Improvement in School Readiness and Achievement, were the highest ranked. The Q-sort exercise allowed home visitors an opportunity to examine priorities within their service delivery model as well as for the overall First Teacher HV system. Participants engaged in meaningful discussions regarding how and why they selected specific quality measures and developed a greater awareness and understanding of a systems approach to HV within the state. The Q-sort methodology presented in this article can easily be replicated by other states to identify CQI priorities at the local and state levels and can be used effectively in states that use a single HV service delivery model or those that implement multiple evidence-based models for HV service delivery.

Improving Elementary School Quality Through the Use of a Social-Emotional and Character Development Program: A Matched-Pair, Cluster-Randomized, Controlled Trial in Hawai’i

PubMed Central

Snyder, Frank J.; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac J.; Flay, Brian R.

2012-01-01

BACKGROUND School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai’i trial included 20 racially/ethnically diverse schools and was conducted from 2002–2003 through 2005–2006. METHODS School-level archival data, collected by the Hawai’i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models. RESULTS Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. CONCLUSIONS School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change. PMID:22142170

Improving elementary school quality through the use of a social-emotional and character development program: a matched-pair, cluster-randomized, controlled trial in Hawai'i.

PubMed

Snyder, Frank J; Vuchinich, Samuel; Acock, Alan; Washburn, Isaac J; Flay, Brian R

2012-01-01

School safety and quality affect student learning and success. This study examined the effects of a comprehensive elementary school-wide social-emotional and character education program, Positive Action, on teacher, parent, and student perceptions of school safety and quality utilizing a matched-pair, cluster-randomized, controlled design. The Positive Action Hawai'i trial included 20 racially/ethnically diverse schools and was conducted from 2002-2003 through 2005-2006. School-level archival data, collected by the Hawai'i Department of Education, were used to examine program effects at 1-year post-trial. Teacher, parent, and student data were analyzed to examine indicators of school quality such as student safety and well-being, involvement, and satisfaction, as well as overall school quality. Matched-paired t-tests were used for the primary analysis, and sensitivity analyses included permutation tests and random-intercept growth curve models. Analyses comparing change from baseline to 1-year post-trial revealed that intervention schools demonstrated significantly improved school quality compared to control schools, with 21%, 13%, and 16% better overall school quality scores as reported by teachers, parents, and students, respectively. Teacher, parent, and student reports on individual school-quality indicators showed improvement in student safety and well-being, involvement, satisfaction, quality student support, focused and sustained action, standards-based learning, professionalism and system capacity, and coordinated team work. Teacher reports also showed an improvement in the responsiveness of the system. School quality was substantially improved, providing evidence that a school-wide social-emotional and character education program can enhance school quality and facilitate whole-school change. © 2011, American School Health Association.

Cost benefit of investment on quality in pharmaceutical manufacturing: WHO GMP pre- and post-certification of a Nigerian pharmaceutical manufacturer.

PubMed

Anyakora, Chimezie; Ekwunife, Obinna; Alozie, Faith; Esuga, Mopa; Ukwuru, Jonathan; Onya, Steve; Nwokike, Jude

2017-09-18

Pharmaceutical companies in Africa need to invest in both facilities and quality management systems to achieve good manufacturing practice (GMP) compliance. Compliance to international GMP standards is important to the attainment of World Health Organization (WHO) prequalification. However, most of the local pharmaceutical manufacturing companies may be deterred from investing in quality because of many reasons, ranging from financial constraints to technical capacity. This paper primarily evaluates benefits against the cost of investing in GMP, using a Nigerian pharmaceutical company, Chi Pharmaceuticals Limited, as a case study. This paper also discusses how to drive more local manufacturers to invest in quality to attain GMP compliance; and proffers practical recommendations for local manufacturers who would want to invest in quality to meet ethical and regulatory obligations. The cost benefit of improving the quality of Chi Pharmaceuticals Limited's facilities and system to attain WHO GMP certification for the production of zinc sulfate 20-mg dispersible tablets was calculated by dividing the annual benefits derived from quality improvement interventions by the annual costs of implementing quality improvement interventions, referred to as a benefit-cost ratio (BCR). Cost benefit of obtaining WHO GMP certification for the production of zinc sulfate 20-mg dispersible tablets was 5.3 (95% confidence interval of 5.0-5.5). Investment in quality improvement intervention is cost-beneficial for local manufacturing companies. Governments and regulators in African countries should support pharmaceutical companies striving to invest in quality. Collaboration of local manufacturing companies with global companies will further improve quality. Local pharmaceutical companies should be encouraged to key into development opportunities available for pharmaceutical companies in Africa.

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

PubMed

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

1994-01-01

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

Nursing informatics, outcomes, and quality improvement.

PubMed

Charters, Kathleen G

2003-08-01

Nursing informatics actively supports nursing by providing standard language systems, databases, decision support, readily accessible research results, and technology assessments. Through normalized datasets spanning an entire enterprise or other large demographic, nursing informatics tools support improvement of healthcare by answering questions about patient outcomes and quality improvement on an enterprise scale, and by providing documentation for business process definition, business process engineering, and strategic planning. Nursing informatics tools provide a way for advanced practice nurses to examine their practice and the effect of their actions on patient outcomes. Analysis of patient outcomes may lead to initiatives for quality improvement. Supported by nursing informatics tools, successful advance practice nurses leverage their quality improvement initiatives against the enterprise strategic plan to gain leadership support and resources.

Clinical Information Systems – From Yesterday to Tomorrow

PubMed Central

2016-01-01

Summary Objectives To review the history of clinical information systems over the past twenty-five years and project anticipated changes to those systems over the next twenty-five years. Methods Over 250 Medline references about clinical information systems, quality of patient care, and patient safety were reviewed. Books, Web resources, and the author’s personal experience with developing the HELP system were also used. Results There have been dramatic improvements in the use and acceptance of clinical computing systems and Electronic Health Records (EHRs), especially in the United States. Although there are still challenges with the implementation of such systems, the rate of progress has been remarkable. Over the next twenty-five years, there will remain many important opportunities and challenges. These opportunities include understanding complex clinical computing issues that must be studied, understood and optimized. Dramatic improvements in quality of care and patient safety must be anticipated as a result of the use of clinical information systems. These improvements will result from a closer involvement of clinical informaticians in the optimization of patient care processes. Conclusions Clinical information systems and computerized clinical decision support have made contributions to medicine in the past. Therefore, by using better medical knowledge, optimized clinical information systems, and computerized clinical decision, we will enable dramatic improvements in both the quality and safety of patient care in the next twenty-five years. PMID:27362589

Key interventions and quality indicators for quality improvement of STEMI care: a RAND Delphi survey.

PubMed

Aeyels, Daan; Sinnaeve, Peter R; Claeys, Marc J; Gevaert, Sofie; Schoors, Danny; Sermeus, Walter; Panella, Massimiliano; Coeckelberghs, Ellen; Bruyneel, Luk; Vanhaecht, Kris

2017-12-13

Identification, selection and validation of key interventions and quality indicators for improvement of in hospital quality of care for ST-elevated myocardial infarction (STEMI) patients. A structured literature review was followed by a RAND Delphi Survey. A purposively selected multidisciplinary expert panel of cardiologists, nurse managers and quality managers selected and validated key interventions and quality indicators prior for quality improvement for STEMI. First, 34 experts (76% response rate) individually assessed the appropriateness of items to quality improvement on a nine point Likert scale. Twenty-seven key interventions, 16 quality indicators at patient level and 27 quality indicators at STEMI care programme level were selected. Eighteen additional items were suggested. Experts received personal feedback, benchmarking their score with group results (response rate, mean, median and content validity index). Consequently, 32 experts (71% response rate) openly discussed items with an item-content validity index above 75%. By consensus, the expert panel validated a final set of 25 key interventions, 13 quality indicators at patient level and 20 quality indicators at care programme level prior for improvement of in hospital care for STEMI. A structured literature review and multidisciplinary expertise was combined to validate a set of key interventions and quality indicators prior for improvement of care for STEMI. The results allow researchers and hospital staff to evaluate and support quality improvement interventions in a large cohort within the context of a health care system.

Patient Safety Reporting Systems: Sustained Quality Improvement Using a Multidisciplinary Team and “Good Catch” Awards

PubMed Central

Herzer, Kurt R.; Mirrer, Meredith; Xie, Yanjun; Steppan, Jochen; Li, Matthew; Jung, Clinton; Cover, Renee; Doyle, Peter A.; Mark, Lynette J.

2014-01-01

Background Since 1999, hospitals have made substantial commitments to healthcare quality and patient safety through individual initiatives of executive leadership involvement in quality, investments in safety culture, education and training for medical students and residents in quality and safety, the creation of patient safety committees, and implementation of patient safety reporting systems. Cohesive quality and safety approaches have become comprehensive programs to identify and mitigate hazards that could harm patients. This article moves to the next level with an intense refocusing of attention on one of the individual components of a comprehensive program--the patient safety reporting system—with a goal of maximized usefulness of the reports and long-term sustainability of quality improvements arising from them. Methods A six-phase framework was developed to deal with patient safety hazards: identify, report, analyze, mitigate, reward, and follow up. Unique features of this process included a multidisciplinary team to review reports, mitigate hazards, educate and empower providers, recognize the identifying/reporting individuals or groups with “Good Catch” awards, and follow up to determine if quality improvements were sustained over time. Results To date, 29 patient safety hazards have gone through this process with “Good Catch” awards being granted at our institution. These awards were presented at various times over the past 4 years since the process began in 2008. Follow-up revealed that 86% of the associated quality improvements have been sustained over time since the awards were given. We present the details of two of these “Good Catch” awards: vials of heparin with an unusually high concentration of the drug that posed a potential overdose hazard and a rapid infusion device that resisted practitioner control. Conclusion A multidisciplinary team's analysis and mitigation of hazards identified in a patient safety reporting system, positive recognition with a “Good Catch” award, education of practitioners, and long-term follow-up resulted in an outcome of sustained quality improvement initiatives. PMID:22946251

Development of an in-house hospital information system in a hospital in Pakistan.

PubMed

Sultan, Faisal; Aziz, Muhammad Tahir; Khokhar, Idrees; Qadri, Hussain; Abbas, Manzar; Mukhtar, Amir; Manzoor, Waqar; Yusuf, Muhammed Aasim

2014-03-01

To review our experience of development and implementation of an electronic hospital information system, its costs and return on investment as well as incorporation of some key quality standards. Cost and saving trends of the project were calculated using different tools including project expense, cost saving through cessation of printing radiology films and paper. Net present value with payback period was utilized to evaluate the efficiency of the health information systems. Qualitative improvements in different healthcare functions were also analyzed. The total saving of the project was approximately US$ 5.1 million with net saving of US$ 3.5 million for the period from 2001 to 2011. The net present value of the project is US$ 3.2 million with a payback period of 3.4 years. Electronic hospital information systems and health records hold the potential to be useful tools for quality improvement and error reduction. Adoption of such systems, however, has been slow and erratic, worldwide. Utilizing the concept of net present value, development of such a system may be financially viable for some institutions. Instead of simply replacing paper, these systems may also be used to improve information management and improve quality of patient care. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Audit filters for improving processes of care and clinical outcomes in trauma systems.

PubMed

Evans, Christopher; Howes, Daniel; Pickett, William; Dagnone, Luigi

2009-10-07

Traumatic injuries represent a considerable public health burden with significant personal and societal costs. The care of the severely injured patient in a trauma system progresses along a continuum that includes numerous interventions being provided by a multidisciplinary group of healthcare personnel. Despite the recent emphasis on quality of care in medicine, there has been little research to direct trauma clinicians and administrators on how optimally to monitor and improve upon the quality of care delivered within a trauma system. Audit filters are one mechanism for improving quality of care and are defined as specific clinical processes or outcomes of care that, when they occur, represent unfavorable deviations from an established norm and which prompt review and feedback. Although audit filters are widely utilized for performance improvement in trauma systems they have not been subjected to systematic review of their effectiveness. To determine the effectiveness of using audit filters for improving processes of care and clinical outcomes in trauma systems. Our search strategy included an electronic search of the Cochrane Injuries Group Specialized Register, the Cochrane EPOC Group Specialized Register, CENTRAL (The Cochrane Library 2008, Issue 4), MEDLINE, PubMed, EMBASE, CINAHL, and ISI Web of Science: (SCI-EXPANDED and CPCI-S). We handsearched the Journal of Trauma, Injury, Annals of Emergency Medicine, Academic Emergency Medicine, and Injury Prevention. We searched two clinical trial registries: 1) The World Health Organization International Clinical Trials Registry Platform and, 2) Clinical Trials.gov. We also contacted content experts for further articles. The most recent electronic search was completed in December 2008 and the handsearch was completed up to February 2009. We searched for randomized controlled trials, controlled clinical trials, controlled before-and-after studies, and interrupted time series studies that used audit filters as an intervention for improving processes of care, morbidity, or mortality for severely injured patients. Two authors independently screened the search results, applied inclusion criteria, and extracted data. There were no studies identified that met the inclusion criteria for this review. We were unable to identify any studies of sufficient methodological quality to draw conclusions regarding the effectiveness of audit filters as a performance improvement intervention in trauma systems. Future research using rigorous study designs should focus on the relative effectiveness of audit filters in comparison to alternative quality improvement strategies at improving processes of care, functional outcomes, and mortality for injured patients.

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.

Protocol for the evaluation of a quality-based pay for performance scheme in Liberia.

PubMed

Bawo, Luke; Leonard, Kenneth L; Mohammed, Rianna

2015-01-13

Improving the quality of care at hospitals is a key next step in rebuilding Liberia's health system. In order to improve the efficiency, effectiveness, and quality of care at the secondary hospital level, the country is developing a system to upgrade health worker skills and competencies, and shifting towards improved provider accountability for results, including a Graduate Medical Residency Program (GMRP) and provider accountability for improvements in quality through performance-based financing (PBF) at the hospital level. This document outlines the protocol for the impact evaluation of the hospital improvement program. The evaluation will provide an estimate of the impact of the project and investigate the mechanism for success in a way that can provide general lessons about the quality of health care in low-income countries. The evaluation aims 1) to provide the best possible estimate of program impact and 2) to quantitatively describe the changes that took place within facilities as a result of the program. In particular, the impact evaluation focuses on the changes in human resources within the hospitals. As such, we use a three-period intensive evaluation of treated and matched comparison hospitals to see how services change in treated hospitals as well as a continuous data collection effort to track the activities of individual health workers within treated hospitals. We are particularly interested in understanding how facilities met quality targets. Did they bring in new health workers with higher qualifications? Did they improve the knowledge or competence of their existing staff? Did they improve the availability of medicines and equipment so that the capacities of existing health workers were improved? Did they address the motivation of health workers so that individuals with the same competence and capacity were able to provide higher quality? And, if they did improve quality, did patients notice?

Ensuring Quality Cancer Care: A Follow-Up Review of the Institute of Medicine’s Ten Recommendations for Improving the Quality of Cancer Care in America

PubMed Central

Spinks, Tracy; Albright, Heidi W.; Feeley, Thomas W.; Walters, Ron; Burke, Thomas W.; Aloia, Thomas; Bruera, Eduardo; Buzdar, Aman; Foxhall, Lewis; Hui, David; Summers, Barbara; Rodriguez, Alma; DuBois, Raymond; Shine, Kenneth I.

2011-01-01

Responding to growing concerns regarding the safety, quality, and efficacy of cancer care in the United States, the Institute of Medicine (IOM) of the National Academy of Sciences commissioned a comprehensive review of cancer care delivery in the US healthcare system in the late 1990s. The National Cancer Policy Board (NCPB), a twenty-member board with broad representation, performed this review. In its review, the NCPB focused on the state of cancer care delivery at that time, its shortcomings, and ways to measure and improve the quality of cancer care. The NCPB described an ideal cancer care system, where patients would have equitable access to coordinated, guideline-based care and novel therapies throughout the course of their disease. In 1999, the IOM published the results of this review in its influential report, Ensuring Quality Cancer Care. This report outlined ten recommendations, which, when implemented, would: 1) improve the quality of cancer care; 2) increase our understanding of quality cancer care; and, 3) reduce or eliminate access barriers to quality cancer care. Despite the fervor generated by this report, there are lingering doubts regarding the safety and quality of cancer care in the United States today. Increased awareness of medical errors and barriers to quality care, coupled with escalating healthcare costs, has prompted national efforts to reform the healthcare system. These efforts by healthcare providers and policymakers should bridge the gap between the ideal state described in Ensuring Quality Cancer Care and the current state of cancer care in the United States. PMID:22045610

Measuring quality in maternal-newborn care: developing a clinical dashboard.

PubMed

Sprague, Ann E; Dunn, Sandra I; Fell, Deshayne B; Harrold, Joann; Walker, Mark C; Kelly, Sherrie; Smith, Graeme N

2013-01-01

Pregnancy, birth, and the early newborn period are times of high use of health care services. As well as opportunities for providing quality care, there are potential missed opportunities for health promotion, safety issues, and increased costs for the individual and the system when quality is not well defined or measured. There has been a need to identify key performance indicators (KPIs) to measure quality care within the provincial maternal-newborn system. We also wanted to provide automated audit and feedback about these KPIs to support quality improvement initiatives in a large Canadian province with approximately 140 000 births per year. We therefore worked to develop a maternal-newborn dashboard to increase awareness about selected KPIs and to inform and support hospitals and care providers about areas for quality improvement. We mapped maternal-newborn data elements to a quality domain framework, sought feedback via survey for the relevance and feasibility of change, and examined current data and the literature to assist in setting provincial benchmarks. Six clinical performance indicators of maternal-newborn quality care were identified and evidence-informed benchmarks were set. A maternal-newborn dashboard with "drill down" capacity for detailed analysis to enhance audit and feedback is now available for implementation. While audit and feedback does not guarantee individuals or institutions will make practice changes and move towards quality improvement, it is an important first step. Practice change and quality improvement will not occur without an awareness of the issues.

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).

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

PubMed

Shamsuddin Alaraki, Mohammad

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi hospitals. It appears that the most important contributing factors to the successful implementation of QI in Saudi hospitals are proper human resources utilization and effective quality management. Through careful planning, change management, proper utilization of human resources, supportive quality information systems, focus on processes and systems, structural support, and an organizational culture that is compatible with QI philosophy, Saudi hospitals will be more capable in achieving sustained measureable improvements in the quality and safety of patient care.

The Business of Art Education: A Fairytale Adventure

ERIC Educational Resources Information Center

Buda, Sharon; Fedorenko, Jan; Sheridan, Mary A.

2012-01-01

School reform initiatives designed to improve school quality require strong leadership, strategic planning, data analysis, and systemized performance accountability. Utilizing school reforms includes rethinking curriculum and instruction to improve quality and promote equality, restructuring school operations with a focus on both the students and…

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.

Interrupted Time Series Versus Statistical Process Control in Quality Improvement Projects.

PubMed

Andersson Hagiwara, Magnus; Andersson Gäre, Boel; Elg, Mattias

2016-01-01

To measure the effect of quality improvement interventions, it is appropriate to use analysis methods that measure data over time. Examples of such methods include statistical process control analysis and interrupted time series with segmented regression analysis. This article compares the use of statistical process control analysis and interrupted time series with segmented regression analysis for evaluating the longitudinal effects of quality improvement interventions, using an example study on an evaluation of a computerized decision support system.

The role of quality measurement in a competitive marketplace.

PubMed

Epstein, A M

1996-01-01

Quality measurement is not a new idea. However, in recent years, several new trends have gained prominence: greater interest in publicly reported information on quality of care, access to care, and patient satisfaction; an increased focus on health plans and integrated systems of care rather than on institutional providers and practitioners as the unit of observation; wide adoption of the techniques of continuous quality improvement within the health care sector; increased use of clinical practice guidelines to improve care for a broad range of medical conditions; incorporation of computer technology into the clinical setting; and greater appreciation for health outcomes as a measure of quality of care. This chapter first reviews the changes in the medical landscape that have seeded these trends and the distinction between quality assurance and quality improvement. It then focuses on public policy concerns, in particular on the emergence of publicly disseminated information about quality of care, now often called "quality report cards." The major prototypes of these reports developed to date, the responses to quality reporting by different members of the delivery system, and the major criticisms of this approach are reviewed. The chapter concludes by predicting probable developments and the strategies most likely to move health care forward in a productive direction.

Technology and outcomes assessment in lung transplantation.

PubMed

Yusen, Roger D

2009-01-15

Lung transplantation offers the hope of prolonged survival and significant improvement in quality of life to patients that have advanced lung diseases. However, the medical literature lacks strong positive evidence and shows conflicting information regarding survival and quality of life outcomes related to lung transplantation. Decisions about the use of lung transplantation require an assessment of trade-offs: do the potential health and quality of life benefits outweigh the potential risks and harms? No amount of theoretical reasoning can resolve this question; empiric data are needed. Rational analyses of these trade-offs require valid measurements of the benefits and harms to the patients in all relevant domains that affect survival and quality of life. Lung transplant systems and registries mainly focus outcomes assessment on patient survival on the waiting list and after transplantation. Improved analytic approaches allow comparisons of the survival effects of lung transplantation versus continued waiting. Lung transplant entities do not routinely collect quality of life data. However, the medical community and the public want to know how lung transplantation affects quality of life. Given the huge stakes for the patients, the providers, and the healthcare systems, key stakeholders need to further support quality of life assessment in patients with advanced lung disease that enter into the lung transplant systems. Studies of lung transplantation and its related technologies should assess patients with tools that integrate both survival and quality of life information. Higher quality information obtained will lead to improved knowledge and more informed decision making.

Intensive care unit quality improvement: a "how-to" guide for the interdisciplinary team.

PubMed

Curtis, J Randall; Cook, Deborah J; Wall, Richard J; Angus, Derek C; Bion, Julian; Kacmarek, Robert; Kane-Gill, Sandra L; Kirchhoff, Karin T; Levy, Mitchell; Mitchell, Pamela H; Moreno, Rui; Pronovost, Peter; Puntillo, Kathleen

2006-01-01

Quality improvement is an important activity for all members of the interdisciplinary critical care team. Although an increasing number of resources are available to guide clinicians, quality improvement activities can be overwhelming. Therefore, the Society of Critical Care Medicine charged this Outcomes Task Force with creating a "how-to" guide that focuses on critical care, summarizes key concepts, and outlines a practical approach to the development, implementation, evaluation, and maintenance of an interdisciplinary quality improvement program in the intensive care unit. The task force met in person twice and by conference call twice to write this document. We also conducted a literature search on "quality improvement" and "critical care or intensive care" and searched online for additional resources. DATA SYNTHESIS AND OVERVIEW: We present an overview of quality improvement in the intensive care unit setting and then describe the following steps for initiating or improving an interdisciplinary critical care quality improvement program: a) identify local motivation, support teamwork, and develop strong leadership; b) prioritize potential projects and choose the first target; c) operationalize the measures, build support for the project, and develop a business plan; d) perform an environmental scan to better understand the problem, potential barriers, opportunities, and resources for the project; e) create a data collection system that accurately measures baseline performance and future improvements; f) create a data reporting system that allows clinicians and others to understand the problem; g) introduce effective strategies to change clinician behavior. In addition, we identify four steps for evaluating and maintaining this program: a) determine whether the target is changing with periodic data collection; b) modify behavior change strategies to improve or sustain improvements; c) focus on interdisciplinary collaboration; and d) develop and sustain support from the hospital leadership. We also identify a number of online resources to complement this overview. This Society of Critical Care Medicine Task Force report provides an overview for clinicians interested in developing or improving a quality improvement program using a step-wise approach. Success depends not only on committed interdisciplinary work that is incremental and continuous but also on strong leadership. Further research is needed to refine the methods and identify the most cost-effective means of improving the quality of health care received by critically ill patients and their families.

Water Quality Improvement through Reductions of Pollutant Loads on Small Scale of Bioretention System

NASA Astrophysics Data System (ADS)

Elyza Muha, Norshafa; Mohd Sidek, Lariyah; Jajarmizadeh, Milad

2016-03-01

Bioretention system is introduced as an important topic namely Urban Storm Water Management Manual for Malaysia (MSMA) by the Department of Irrigation and Drainage Malaysia (DID) in May 2012. The main objective of this paper is to evaluate the performance of water quality for small scale bioretention system under tropical climate via MUSIC model. Two bioretention systems 1 and 2 are observed based on the difference media depth. The result of bioretention system is compared with a reference model which has infrastructure with Urban Stormwater Improvement Conceptualisation (MUSIC) for pollutants load reduction and water quality results. Assessment of results via MUSIC software indicates a significant percentage of reduction for Total Suspended Solid (TSS), Total Phosphorus (TP) and Total Nitrogen (TN). The prediction of pollutant reduction via using MUSIC has the harmony for requirement in MSMA. TSS pollutant reduction is more than 80%, while for TP and TN more than 50%. The outcome of this study can be helpful for improvement of the existing MSMA guidelines for application of bioretention systems in Malaysia.

A well-designed online transfusion reaction reporting system improves the estimation of transfusion reaction incidence and quality of care in transfusion practice.

PubMed

Yeh, Su-Peng; Chang, Ci-Wen; Chen, Ju-Chuan; Yeh, Wan-Chen; Chen, Pei-Chi; Chuang, Su-Jung; Lin, Chiou-Ping; Hsu, Ling-Nu; Chen, Han-Mih; Lu, Jang-Jih; Peng, Ching-Tien

2011-12-01

Recognizing and reporting a transfusion reaction is important in transfusion practice. However, the actual incidence of transfusion reactions is frequently underestimated. We designed an online transfusion reaction reporting system for nurses who take care of transfusion recipients. The common management before and after transfusion and the 18 most common transfusion reactions were itemized as tick boxes. We found the overall documented incidence of transfusion reaction increased dramatically, from 0.21% to 0.61% per unit of blood, after we started using an online reporting system. Overall, 94% (30/32) of nurses took only 1 week to become familiar with the new system, and 88% (28/32) considered the new system helpful in improving the quality of clinical transfusion care. By using an intranet connection, blood bank physicians can also identify patients who are having a reaction and provide appropriate recommendations immediately. A well-designed online reporting system may improve the ability to estimate the incidence of transfusion reactions and the quality of transfusion care.

Connecting Medical Records: An Evaluation of Benefits and Challenges for Primary Care Practices.

PubMed

Compeau, Deborah Ruth; Terry, Amanda

2017-06-30

Implementation of systems to support health information sharing has lagged other areas of healthcare IT, yet offers a strong possibility for benefit.  Clinical acceptance is a key limiting factor in health IT adoption. To assess the benefits and challenges experienced by clinicians using a custom-developed health information exchange system, and to show how perceptions of benefits and challenges influence perceptions of productivity and care-related outcomes. We used a mixed methods design with two phases. First, we conducted interviews with stakeholders who were familiar with the health information exchange system to inform the development of a measure of benefits and challenges of the use of this system. Second, using this measure we conducted a survey of current and former users of the health information exchange system using a modified Dillman method. 105 current and former users completed the survey. The results showed information quality, ease of completing tasks and clinical process improvement as key benefits that reduced workload and improved patient care.  Challenges related to system reliability, quality of reports and service quality increased workload and decreased impact on care, though the effect of the challenges was smaller than that of the benefits.  Even very limited health information exchange capabilities can improve outcomes for primary care users.  Improving perceptions of benefits may be even more important the removing challenges to use, though it is likely that a threshold of quality must be achieved for this to be true.

Technical Note: Comparison of first- and second-generation photon-counting slit-scanning tomosynthesis systems.

PubMed

Berggren, Karl; Cederström, Björn; Lundqvist, Mats; Fredenberg, Erik

2018-02-01

Digital breast tomosynthesis (DBT) is an emerging tool for breast-cancer screening and diagnostics. The purpose of this study is to present a second-generation photon-counting slit-scanning DBT system and compare it to the first-generation system in terms of geometry and image quality. The study presents the first image-quality measurements on the second-generation system. The geometry of the new system is based on a combined rotational and linear motion, in contrast to a purely rotational scan motion in the first generation. In addition, the calibration routines have been updated. Image quality was measured in the center of the image field in terms of in-slice modulation transfer function (MTF), artifact spread function (ASF), and in-slice detective quantum efficiency (DQE). Images were acquired using a W/Al 29 kVp spectrum at 13 mAs with 2 mm Al additional filtration and reconstructed using simple back-projection. The in-slice 50% MTF was improved in the chest-mammilla direction, going from 3.2 to 3.5 lp/mm, and the zero-frequency DQE increased from 0.71 to 0.77. The MTF and ASF were otherwise found to be on par for the two systems. The new system has reduced in-slice variation of the tomographic angle. The new geometry is less curved, which reduces in-slice tomographic-angle variation, and increases the maximum compression height, making the system accessible for a larger population. The improvements in MTF and DQE were attributed to the updated calibration procedures. We conclude that the second-generation system maintains the key features of the photon-counting system while maintaining or improving image quality and improving the maximum compression height. © 2017 American Association of Physicists in Medicine.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes.

PubMed

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10-20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally.

Continuous Quality Improvement and Comprehensive Primary Health Care: A Systems Framework to Improve Service Quality and Health Outcomes

PubMed Central

McCalman, Janya; Bailie, Ross; Bainbridge, Roxanne; McPhail-Bell, Karen; Percival, Nikki; Askew, Deborah; Fagan, Ruth; Tsey, Komla

2018-01-01

Continuous quality improvement (CQI) processes for improving clinical care and health outcomes have been implemented by primary health-care services, with resultant health-care impacts. But only 10–20% of gain in health outcomes is contributed by health-care services; a much larger share is determined by social and cultural factors. This perspective paper argues that health care and health outcomes can be enhanced through applying CQI as a systems approach to comprehensive primary health care. Referring to the Aboriginal and Torres Strait Islander Australian context as an example, the authors provide a systems framework that includes strategies and conditions to facilitate evidence-based and local decision making by primary health-care services. The framework describes the integration of CQI vertically to improve linkages with governments and community members and horizontally with other sectors to influence the social and cultural determinants of health. Further, government and primary health-care service investment is required to support and extend integration and evaluation of CQI efforts vertically and horizontally. PMID:29623271

Four Pillars for Improving the Quality of Safety-Critical Software-Reliant Systems

DTIC Science & Technology

2013-04-01

Studies of safety-critical software-reliant systems developed using the current practices of build-then-test show that requirements and architecture ... design defects make up approximately 70% of all defects, many system level related to operational quality attributes, and 80% of these defects are

ThedaCare's business performance system: sustaining continuous daily improvement through hospital management in a lean environment.

PubMed

Barnas, Kim

2011-09-01

For 2003-2008, ThedaCare, a community health system in Wisconsin, achieved significant improvements in quality and the elimination of waste through the development of an improvement system, which included Value Stream analysis, rapid improvement events, and projects applied to specific processes. However, to meet its continuous daily improvement goals, particularly the goal of increasing productivity by 10% annually, ThedaCare needed to change the way its managers and leaders (in its hospital division) conduct and manage their daily work. Accordingly, it developed its Business Performance System (BPS) to achieve and sustain continuous daily improvement. BUILDING THE BPS: ThedaCare devised a multipart pilot project, consisting of "learning to see" and then, "problem solving." On completion of the 15-week alpha phase (6 units) in July 2009, the BPS was spread to the beta pilot (12 units; September 2009-January 2010) and then to cohort 3 (10 units; September 2010-January 2011). Each alpha unit improved performance on (1) the key driver metric of increasing productivity from 2008 to year-end 2009 (by 1%-11%) and (2) its respective safety/ quality drivers over the respective 2008 baselines. For 2010, improvements across the alpha, beta, and cohort 3 units were found for 11 of the 14 safety/quality drivers-85% of the 11 customer satisfaction drivers, 83% of 6 people engagement drivers; and 48% of 23 financial stewardship drivers. The tools developed for the BPS have enabled teams to see, prioritize, and pursue continuous daily improvement opportunities. Unit leaders now have a structured management reporting system to reduce variation in their management styles. Leaders all now follow leadership standard work, and their daily work is now consistently aligned with the hospital and system strategy.

The measurement of quality of care in the Veterans Health Administration.

PubMed

Halpern, J

1996-03-01

The Veterans Health Administration (VHA) is committed to continual refinement of its system of quality measurement. The VHA organizational structure for quality measurement has three levels. At the national level, the Associate Chief Medical Director for Quality Management provides leadership, sets policy, furnishes measurement tools, develops and distributes measures of quality, and delivers educational programs. At the intermediate level, VHA has four regional offices with staff responsible for reviewing risk management data, investigating quality problems, and ensuring compliance with accreditation requirements. At the hospital level, staff reporting directly to the chief of staff or the hospital director are responsible for implementing VHA quality management policy. The Veterans Health Administration's philosophy of quality measurement recognizes the agency's moral imperative to provide America's veterans with care that meets accepted standards. Because the repair of faulty systems is more efficient than the identification of poor performers, VHA has integrated the techniques of total quality into a multifaceted improvement program that also includes the accreditation program and traditional quality assurance activities. VHA monitors its performance by maintaining adverse incident databases, conducting patient satisfaction surveys, contracting for external peer review of 50,000 records per year, and comparing process and outcome rates internally and when possible with external benchmarks. The near-term objectives of VHA include providing medical centers with a quality matrix that will permit local development of quality indicators, construction of a report card for VHA's customers, and implementing the Malcolm W. Baldrige system for quality improvement as the road map for systemwide continuous improvement. Other goals include providing greater access to data, creating a patient-centered database, providing real-time clinical decision support, and expanding the databases.

Use of the quality management system "JACIE" and outcome after hematopoietic stem cell transplantation.

PubMed

Gratwohl, Alois; Brand, Ronald; McGrath, Eoin; van Biezen, Anja; Sureda, Anna; Ljungman, Per; Baldomero, Helen; Chabannon, Christian; Apperley, Jane

2014-05-01

Competent authorities, healthcare payers and hospitals devote increasing resources to quality management systems but scientific analyses searching for an impact of these systems on clinical outcome remain scarce. Earlier data indicated a stepwise improvement in outcome after allogeneic hematopoietic stem cell transplantation with each phase of the accreditation process for the quality management system "JACIE". We therefore tested the hypothesis that working towards and achieving "JACIE" accreditation would accelerate improvement in outcome over calendar time. Overall mortality of the entire cohort of 107,904 patients who had a transplant (41,623 allogeneic, 39%; 66,281 autologous, 61%) between 1999 and 2006 decreased over the 14-year observation period by a factor of 0.63 per 10 years (hazard ratio: 0.63; 0.58-0.69). Considering "JACIE"-accredited centers as those with programs having achieved accreditation by November 2012, at the latest, this improvement was significantly faster in "JACIE"-accredited centers than in non-accredited centers (approximately 5.3% per year for 49,459 patients versus approximately 3.5% per year for 58,445 patients, respectively; hazard ratio: 0.83; 0.71-0.97). As a result, relapse-free survival (hazard ratio 0.85; 0.75-0.95) and overall survival (hazard ratio 0.86; 0.76-0.98) were significantly higher at 72 months for those patients transplanted in the 162 "JACIE"-accredited centers. No significant effects were observed after autologous transplants (hazard ratio 1.06; 0.99-1.13). Hence, working towards implementation of a quality management system triggers a dynamic process associated with a steeper reduction in mortality over the years and a significantly improved survival after allogeneic stem cell transplantation. Our data support the use of a quality management system for complex medical procedures.

Designing a Large-Scale Multilevel Improvement Initiative: The Improving Performance in Practice Program

ERIC Educational Resources Information Center

Margolis, Peter A.; DeWalt, Darren A.; Simon, Janet E.; Horowitz, Sheldon; Scoville, Richard; Kahn, Norman; Perelman, Robert; Bagley, Bruce; Miles, Paul

2010-01-01

Improving Performance in Practice (IPIP) is a large system intervention designed to align efforts and motivate the creation of a tiered system of improvement at the national, state, practice, and patient levels, assisting primary-care physicians and their practice teams to assess and measurably improve the quality of care for chronic illness and…

Training And Supervision Did Not Meaningfully Improve Quality Of Care For Pregnant Women Or Sick Children In Sub-Saharan Africa.

PubMed

Leslie, Hannah H; Gage, Anna; Nsona, Humphreys; Hirschhorn, Lisa R; Kruk, Margaret E

2016-09-01

In-service training courses and supportive supervision of health workers are among the most common interventions to improve the quality of health care in low- and middle-income countries. Despite extensive investment from donors, evaluations of the long-term effect of these two interventions are scarce. We used nationally representative surveys of health systems in seven countries in sub-Saharan Africa to examine the association of in-service training and supervision with provider quality in antenatal and sick child care. The results of our analysis showed that observed quality of care was poor, with fewer than half of evidence-based actions completed by health workers, on average. In-service training and supervision were associated with quality of sick child care; they were associated with quality of antenatal care only when provided jointly. All associations were modest-at most, improvements related to interventions were equivalent to 2 additional provider actions out of the 18-40 actions expected per visit. In-service training and supportive supervision as delivered were not sufficient to meaningfully improve the quality of care in these countries. Greater attention to the quality of health professional education and national health system performance will be required to provide the standard of health care that patients deserve. Project HOPE—The People-to-People Health Foundation, Inc.

Integration of HIV care into maternal health services: a crucial change required in improving quality of obstetric care in countries with high HIV prevalence.

PubMed

Madzimbamuto, Farai D; Ray, Sunanda; Mogobe, Keitshokile D

2013-06-10

The failure to reduce preventable maternal deaths represents a violation of women's right to life, health, non-discrimination and equality. Maternal deaths result from weaknesses in health systems: inadequate financing of services, poor information systems, inefficient logistics management and most important, the lack of investment in the most valuable resource, the human resource of health workers. Inadequate senior leadership, poor communication and low staff morale are cited repeatedly in explaining low quality of healthcare. Vertical programmes undermine other service areas by creating competition for scarce skilled staff, separate reporting systems and duplication of training and tasks. Confidential enquiries and other quality-improvement activities have identified underlying causes of maternal deaths, but depend on the health system to respond with remedies. Instead of separate vertical programmes for management of HIV, tuberculosis, and reproductive health, integration of care and joint management of pregnancy and HIV would be more effective. Addressing health system failures that lead to each woman's death would have a wider impact on improving the quality of care provided in the health service as a whole. More could be achieved if existing resources were used more effectively. The challenge for African countries is how to get into practice interventions known from research to be effective in improving quality of care. Advocacy and commitment to saving women's lives are crucial elements for campaigns to influence governments and policy -makers to act on the findings of these enquiries. Health professional training curricula should be updated to include perspectives on patients' rights, communication skills, and integrated approaches, while using adult learning methods and problem-solving techniques. In countries with high rates of Human Immunodeficiency Virus (HIV), indirect causes of maternal deaths from HIV-associated infections now exceed direct causes of hemorrhage, hypertension and sepsis. Advocacy for all pregnant HIV-positive women to be on anti-retroviral therapy must extend to improvements in the quality of service offered, better organised obstetric services and integration of clinical HIV care into maternity services. Improved communication and specialist support to peripheral facilities can be facilitated through advances in technology such as mobile phones.

From community-based pilot testing to region-wide systems change: lessons from a local quality improvement collaborative.

PubMed

Keyser, Donna J; Pincus, Harold Alan

2010-01-01

A community-based collaborative conducted a 2-year pilot study to inform efforts for improving maternal and child health care practice and policy in Allegheny County, Pennsylvania. (1) To test whether three small-scale versions of an evidence-based, systems improvement approach would be workable in local community settings and (2) to identify specific policy/infrastructure reforms for sustaining improvements. A mixed methods approach was used, including quantitative performance measurement supplemented with qualitative data about factors related to outcomes of interest, as well as key stakeholder interviews and a literature review/Internet search. Quantitative performance results varied; qualitative data revealed critical factors for the success and failure of the practices tested. Policy/infrastructure recommendations were developed to address specific practice barriers. This information was important for designing a region-wide quality improvement initiative focused on maternal depression. The processes and outcomes provide valuable insights for other communities interested in conducting similar quality improvement initiatives.

Testing the Effectiveness of a Quality Assurance System: The Example of Hong Kong

ERIC Educational Resources Information Center

Lim, David

2009-01-01

Operating a quality assurance system in tertiary education is the rule rather than the exception, because of the belief that it will improve quality. However, proving this is not easy. This study examines three ways of providing the evidence: the a "priori" method, the stepwise backtracking method, and the external evaluation method. The…

Student Perceptions of Service Quality in a Multi-Campus Higher Education System in Spain

ERIC Educational Resources Information Center

Gallifa, Josep; Batalle, Pere

2010-01-01

Purpose: This paper aims to present an in-depth case study with student perceptions of service quality, discussing the relevance of these perceptions for the important issue of quality improvement in higher education. Design/methodology/approach: The paper presents institutional research carried out in a multi-campus system in Spain made up of…

The Quest for Quality: How YoungStar Is Affecting Child Care in Milwaukee County

ERIC Educational Resources Information Center

Mueller, Betsy; Peterangelo, Joe; Henken, Rob

2016-01-01

The State of Wisconsin's YoungStar system was created by the Legislature and Governor in 2010 to "drive quality improvement in child care throughout the state." YoungStar uses a five-star system to rate child care providers based on several measures of quality, including staff education levels, learning environment, business methods, and…

Academics' Perceptions of the Impact of Internal Quality Assurance on Teaching and Learning

ERIC Educational Resources Information Center

Tavares, Orlanda; Sin, Cristina; Videira, Pedro; Amaral, Alberto

2017-01-01

Internal quality assurance systems are expected to improve the institutions' core mission of teaching and learning. Using data gathered through an online survey, distributed in 2014/2015, to the teaching staff of all Portuguese private and public higher education institutions, this paper examines the impact of internal quality assurance systems on…

Improving benchmarking by using an explicit framework for the development of composite indicators: an example using pediatric quality of care

PubMed Central

2010-01-01

Background The measurement of healthcare provider performance is becoming more widespread. Physicians have been guarded about performance measurement, in part because the methodology for comparative measurement of care quality is underdeveloped. Comprehensive quality improvement will require comprehensive measurement, implying the aggregation of multiple quality metrics into composite indicators. Objective To present a conceptual framework to develop comprehensive, robust, and transparent composite indicators of pediatric care quality, and to highlight aspects specific to quality measurement in children. Methods We reviewed the scientific literature on composite indicator development, health systems, and quality measurement in the pediatric healthcare setting. Frameworks were selected for explicitness and applicability to a hospital-based measurement system. Results We synthesized various frameworks into a comprehensive model for the development of composite indicators of quality of care. Among its key premises, the model proposes identifying structural, process, and outcome metrics for each of the Institute of Medicine's six domains of quality (safety, effectiveness, efficiency, patient-centeredness, timeliness, and equity) and presents a step-by-step framework for embedding the quality of care measurement model into composite indicator development. Conclusions The framework presented offers researchers an explicit path to composite indicator development. Without a scientifically robust and comprehensive approach to measurement of the quality of healthcare, performance measurement will ultimately fail to achieve its quality improvement goals. PMID:20181129

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

A.S. Larin; V.V. Demenko; V.L. Voitanik

In recent Giprokoks designs for the reconstruction of coke-sorting systems, high-productivity vibrational-inertial screens have been employed. This permits single-stage screening and reduction in capital and especially operating expenditures, without loss of coke quality. In two-stage screening, >80 mm coke (for foundry needs) is additionally separated, with significant improvement in quality of the metallurgical coke (25-80 mm). New designs for the reconstruction of coke-sorting systems employ mechanical treatment of the coke outside the furnace, which offers new scope for stabilization of coke quality and permits considerable improvement in mechanical strength and granulometric composition of the coke by mechanical crushing.

[Should disease management be feared? (1): hospital care].

PubMed

Gaspoz, J M; Rutschmann, O

2005-11-23

The goals of disease management are: (1) an integrated health care delivery system; (2) knowledge-based care; (3) elaborate information systems; (4) continuous quality improvement. In-hospital disease management and, more specifically, critical pathways, establish standardized care plans, set goals and time actions to reach these goals. They can reduce variations in practice patterns and resource utilization without compromising quality of care. Such strategies participate to quality improvement programs in hospitals when they involve and empower all actors of a given process of care, are not imposed from outside, and use sound and rigorous development and evaluation methods.

Innovative strategies for a successful SLMTA country programme: The Rwanda story

PubMed Central

Sebasirimu, Sabin; Gatabazi, John B.; Ruzindana, Emmanuel; Kayobotsi, Claver; Linde, Mary K.; Mazarati, Jean B.; Ntagwabira, Edouard; Serumondo, Janvier; Dahourou, Georges A.; Gatei, Wangeci; Muvunyi, Claude M.

2014-01-01

Background In 2009, to improve the performance of laboratories and strengthen healthcare systems, the World Health Organization Regional Office for Africa (WHO AFRO) and partners launched two initiatives: a laboratory quality improvement programme called Strengthening Laboratory Management Toward Accreditation (SLMTA), and what is now called the Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA). Objectives This study describes the achievements of Rwandan laboratories four years after the introduction of SLMTA in the country, using the SLIPTA scoring system to measure laboratory progress. Methods Three cohorts of five laboratories each were enrolled in the SLMTA programme in 2010, 2011 and 2013. The cohorts used SLMTA workshops, improvement projects, mentorship and quarterly performance-based financing incentives to accelerate laboratory quality improvement. Baseline, exit and follow-up audits were conducted over a two-year period from the time of enrolment. Audit scores were used to categorise laboratory quality on a scale of zero (< 55%) to five (95% – 100%) stars. Results At baseline, 14 of the 15 laboratories received zero stars with the remaining laboratory receiving a two-star rating. At exit, five laboratories received one star, six received two stars and four received three stars. At the follow-up audit conducted in the first two cohorts approximately one year after exit, one laboratory scored two stars, five laboratories earned three stars and four laboratories, including the National Reference Laboratory, achieved four stars. Conclusion Rwandan laboratories enrolled in SLMTA showed improvement in quality management systems. Sustaining the gains and further expansion of the SLMTA programme to meet country targets will require continued programme strengthening. PMID:29043189

A concept paper: using the outcomes of common surgical conditions as quality metrics to benchmark district surgical services in South Africa as part of a systematic quality improvement programme.

PubMed

Clarke, Damian L; Kong, Victor Y; Handley, Jonathan; Aldous, Colleen

2013-07-31

The fourth, fifth and sixth Millennium Development Goals relate directly to improving global healthcare and health outcomes. The focus is to improve global health outcomes by reducing maternal and childhood mortality and the burden of infectious diseases such as HIV/AIDS, tuberculosis and malaria. Specific targets and time frames have been set for these diseases. There is, however, no specific mention of surgically treated diseases in these goals, reflecting a bias that is slowly changing with emerging consensus that surgical care is an integral part of primary healthcare systems in the developing world. The disparities between the developed and developing world in terms of wealth and social indicators are reflected in disparities in access to surgical care. Health administrators must develop plans and strategies to reduce these disparities. However, any strategic plan that addresses deficits in healthcare must have a system of metrics, which benchmark the current quality of care so that specific improvement targets may be set.This concept paper outlines the role of surgical services in a primary healthcare system, highlights the ongoing disparities in access to surgical care and outcomes of surgical care, discusses the importance of a systems-based approach to healthcare and quality improvement, and reviews the current state of surgical care at district hospitals in South Africa. Finally, it proposes that the results from a recently published study on acute appendicitis, as well as data from a number of other common surgical conditions, can provide measurable outcomes across a healthcare system and so act as an indicator for judging improvements in surgical care. This would provide a framework for the introduction of collection of these outcomes as a routine epidemiological health policy tool.

The Perfect Process Storm: Integration of CMMI, Agile, and Lean Six Sigma

DTIC Science & Technology

2012-12-01

struggled over the past few decades with a blizzard of process improvement methodologies such as Total Quality Manage- ment (TQM), Kaizen , JIT...the Japanese Kaizen system, targeting quality, effort, employee involvement, willingness to change, communication, and elimina- tion of waste in...blizzard of process improvement methodologies such as Total Quality Management (TQM), Kaizen , JIT Production, and Re-Engineering. These operations are

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

ERIC Educational Resources Information Center

Kaufman, Roger

2000-01-01

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

Improving the Quality of the Supply-Demand-Match in Vocational Education and Training by Anticipation and "Matching Policy"

ERIC Educational Resources Information Center

Lassnigg, Lorenz

2008-01-01

This article discusses the implications of a framework to improve matching supply and demand in VET by a policy to improve quality by using anticipation and foresight approaches. Analysis of the Austrian anticipation system identified some basic aspects such as policy. The analysis focused on two issues: the observation and measurement of…

Examining Ratings on the VAL-ED Evaluation Instrument of Principals to Improve Instructional Leadership Practices

ERIC Educational Resources Information Center

Babin, Erin Pevey

2017-01-01

The biggest challenge facing American public schools today is increasing student achievement, and this depends on the educational system's ability to improve the quality of instruction. Principals play a key role in improving the quality of instruction on their campus through the instructional leadership practices they engage in on a daily basis.…

Design Research with Educational Systems: Investigating and Supporting Improvements in the Quality of Mathematics Teaching and Learning at Scale

ERIC Educational Resources Information Center

Cobb, Paul; Jackson, Kara; Smith, Thomas; Sorum, Michael; Henrick, Erin

2013-01-01

This chapter describes a partnership with four urban districts that aimed to develop an empirically grounded theory of action for improving the quality of mathematics instruction at scale. Each year, we conducted a data collection, analysis, and feedback cycle in each district that involved documenting the district's improvement strategies,…

Making Quality Happen: How Training Can Turn Strategy into Real Improvement. The Jossey-Bass Management Series.

ERIC Educational Resources Information Center

Cocheu, Ted

This book, written by an organizational development director and consultant in the fields of quality improvement, management, and design of training systems to Fortune 500 clients, offers a six-step improvement strategy and a six-phase training curriculum that can be adapted to the needs of companies in various fields. Seven chapters present ideas…

Improving Performance through Knowledge Translation in the Veterans Health Administration

ERIC Educational Resources Information Center

Francis, Joseph; Perlin, Jonathan B.

2006-01-01

The Veterans Health Administration (VA) provides a case study for linking performance measurement, information technology, and aligned research efforts to facilitate quality improvement in a large, complex health system. Dialogue between clinical researchers and VA leaders occurs through structured activities (e.g., the Quality Enhancement…

Distance-Learning, ADHD Quality Improvement in Primary Care: A Cluster-Randomized Trial.

PubMed

Fiks, Alexander G; Mayne, Stephanie L; Michel, Jeremy J; Miller, Jeffrey; Abraham, Manju; Suh, Andrew; Jawad, Abbas F; Guevara, James P; Grundmeier, Robert W; Blum, Nathan J; Power, Thomas J

2017-10-01

To evaluate a distance-learning, quality improvement intervention to improve pediatric primary care provider use of attention-deficit/hyperactivity disorder (ADHD) rating scales. Primary care practices were cluster randomized to a 3-part distance-learning, quality improvement intervention (web-based education, collaborative consultation with ADHD experts, and performance feedback reports/calls), qualifying for Maintenance of Certification (MOC) Part IV credit, or wait-list control. We compared changes relative to a baseline period in rating scale use by study arm using logistic regression clustered by practice (primary analysis) and examined effect modification by level of clinician participation. An electronic health record-linked system for gathering ADHD rating scales from parents and teachers was implemented before the intervention period at all sites. Rating scale use was ascertained by manual chart review. One hundred five clinicians at 19 sites participated. Differences between arms were not significant. From the baseline to intervention period and after implementation of the electronic system, clinicians in both study arms were significantly more likely to administer and receive parent and teacher rating scales. Among intervention clinicians, those who participated in at least 1 feedback call or qualified for MOC credit were more likely to give parents rating scales with differences of 14.2 (95% confidence interval [CI], 0.6-27.7) and 18.8 (95% CI, 1.9-35.7) percentage points, respectively. A 3-part clinician-focused distance-learning, quality improvement intervention did not improve rating scale use. Complementary strategies that support workflows and more fully engage clinicians may be needed to bolster care. Electronic systems that gather rating scales may help achieve this goal. Index terms: ADHD, primary care, quality improvement, clinical decision support.

UPMC Prescription for Wellness: A Quality Improvement Case Study for Supporting Patient Engagement and Health Behavior Change.

PubMed

Maners, Rebecca J; Bakow, Eric; Parkinson, Michael D; Fischer, Gary S; Camp, Geoffrey R

Addressing patient health and care behaviors that underlie much of chronic disease continues to challenge providers, medical practices, health systems, and insurers. Improving health and care as described by the Quadruple Aim requires innovation at the front lines of clinical care: the doctor-patient interaction and office practice. This article describes the use of Lean Six Sigma in a quality improvement (QI) effort to design an effective and scalable method for physicians to prescribe health coaching for healthy behaviors in a primary care medical home within a large integrated delivery and financing system. Building on the national Agency for Healthcare Research and Quality and Robert Wood Johnson Foundation-funded Prescription for Health multisite demonstration, this QI case study provides important lessons for transforming patient-physician-practice support systems to better address lifestyle and care management challenges critical to producing better outcomes.

Data That Drive: Closing the Loop in the Learning Hospital System

PubMed Central

Liu, Vincent X.; Morehouse, John W.; Baker, Jennifer M.; Greene, John D.; Kipnis, Patricia; Escobar, Gabriel J.

2017-01-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson—sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system—to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. PMID:27805797

Upgrades to the NOAA/NESDIS automated Cloud-Motion Vector system

NASA Technical Reports Server (NTRS)

Nieman, Steve; Menzel, W. Paul; Hayden, Christopher M.; Wanzong, Steve; Velden, Christopher S.

1993-01-01

The latest version of the automated cloud motion vector software has yielded significant improvements in the quality of the GOES cloud-drift winds produced operationally by NESDIS. Cloud motion vectors resulting from the automated system are now equal or superior in quality to those which had the benefit of manual quality control a few years ago. The single most important factor in this improvement has been the upgraded auto-editor. Improved tracer selection procedures eliminate targets in difficult regions and allow a higher target density and therefore enhanced coverage in areas of interest. The incorporation of the H2O-intercept height assignment method allows an adequate representation of the heights of semi-transparent clouds in the absence of a CO2-absorption channel. Finally, GOES-8 water-vapor motion winds resulting from the automated system are superior to any done previously by NESDIS and should now be considered as an operational product.

Understanding patient safety performance and educational needs using the 'Safety-II' approach for complex systems.

PubMed

McNab, Duncan; Bowie, Paul; Morrison, Jill; Ross, Alastair

2016-11-01

Participation in projects to improve patient safety is a key component of general practice (GP) specialty training, appraisal and revalidation. Patient safety training priorities for GPs at all career stages are described in the Royal College of General Practitioners' curriculum. Current methods that are taught and employed to improve safety often use a 'find-and-fix' approach to identify components of a system (including humans) where performance could be improved. However, the complex interactions and inter-dependence between components in healthcare systems mean that cause and effect are not always linked in a predictable manner. The Safety-II approach has been proposed as a new way to understand how safety is achieved in complex systems that may improve quality and safety initiatives and enhance GP and trainee curriculum coverage. Safety-II aims to maximise the number of events with a successful outcome by exploring everyday work. Work-as-done often differs from work-as-imagined in protocols and guidelines and various ways to achieve success, dependent on work conditions, may be possible. Traditional approaches to improve the quality and safety of care often aim to constrain variability but understanding and managing variability may be a more beneficial approach. The application of a Safety-II approach to incident investigation, quality improvement projects, prospective analysis of risk in systems and performance indicators may offer improved insight into system performance leading to more effective change. The way forward may be to combine the Safety-II approach with 'traditional' methods to enhance patient safety training, outcomes and curriculum coverage.

Some Dimensions of Data Quality in Statistical Systems

DOT National Transportation Integrated Search

1997-07-01

An important objective of a statistical data system is to enable users of the data to recommend (an organizations to take) rational action for solving problems or for improving quality of service of manufactured product. With this view in mind, this ...

Advances in traffic data collection and management : white paper.

DOT National Transportation Integrated Search

2003-01-31

This white paper identifies innovative approaches for improving data quality through Quality Control. Quality Control emphasizes good data by ensuring selection of the most accurate detector then optimizing detector system performance. This is contra...

Data that drive: Closing the loop in the learning hospital system.

PubMed

Liu, Vincent X; Morehouse, John W; Baker, Jennifer M; Greene, John D; Kipnis, Patricia; Escobar, Gabriel J

2016-11-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Critical maternal health knowledge gaps in low- and middle-income countries for the post-2015 era.

PubMed

Kendall, Tamil; Langer, Ana

2015-06-05

Effective interventions to promote maternal health and address obstetric complications exist, however 800 women die every day during pregnancy and childbirth from largely preventable causes and more than 90% of these deaths occur in low and middle income countries (LMIC). In 2014, the Maternal Health Task Force consulted 26 global maternal health researchers to identify persistent and critical knowledge gaps to be filled to reduce maternal morbidity and mortality and improve maternal health. The vision of maternal health articulated was comprehensive and priorities for knowledge generation encompassed improving the availability, accessibility, acceptability, and quality of institutional labor and delivery services and other effective interventions, such as contraception and safe abortion services. Respondents emphasized the need for health systems research to identify models that can deliver what is known to be effective to prevent and treat the main causes of maternal death at scale in different contexts and to sustain coverage and quality over time. Researchers also emphasized the development of tools to measure quality of care and promote ongoing quality improvement at the facility, district, and national level. Knowledge generation to improve distribution and retention of healthcare workers, facilitate task shifting, develop and evaluate training models to improve "hands-on" skills and promote evidence-based practice, and increase managerial capacity at different levels of the health system were also prioritized. Interviewees noted that attitudes, behavior, and power relationships between health professionals and within institutions must be transformed to achieve coverage of high-quality maternal health services in LMIC. The increasing burden of non-communicable diseases, urbanization, and the persistence of social and economic inequality were identified as emerging challenges that require knowledge generation to improve health system responses and evaluate progress. Respondents emphasized evaluating effectiveness, feasibility, and equity impacts of health system interventions. A prominent role for implementation science, evidence for policy advocacy, and interdisciplinary collaboration were identified as critical areas for knowledge generation to improve maternal health in the post-2015 era.

Improving Quality and Safety of Care Using “Technovigilance”: An Ethnographic Case Study of Secondary Use of Data from an Electronic Prescribing and Decision Support System

PubMed Central

Dixon-Woods, Mary; Redwood, Sabi; Leslie, Myles; Minion, Joel; Martin, Graham P; Coleman, Jamie J

2013-01-01

Context “Meaningful use” of electronic health records to improve quality of care has remained understudied. We evaluated an approach to improving patients’ safety and quality of care involving the secondary use of data from a hospital electronic prescribing and decision support system (ePDSS). Methods We conducted a case study of a large English acute care hospital with a well-established ePDSS. Our study was based on ethnographic observations of clinical settings (162 hours) and meetings (28 hours), informal conversations with clinical staff, semistructured interviews with ten senior executives, and the collection of relevant documents. Our data analysis was based on the constant comparative method. Findings This hospital's approach to quality and safety could be characterized as “technovigilance.” It involved treating the ePDSS as a warehouse of data on clinical activity and performance. The hospital converted the secondary data into intelligence about the performance of individuals, teams, and clinical services and used this as the basis of action for improvement. Through a combination of rapid audit, feedback to clinical teams, detailed and critical review of apparent omissions in executive-led meetings, a focus on personal professional responsibility for patients’ safety and quality care, and the correction of organizational or systems defects, technovigilance was—based on the hospital's own evidence—highly effective in improving specific indicators. Measures such as the rate of omitted doses of medication showed marked improvement. As do most interventions, however, technovigilance also had unintended consequences. These included the risk of focusing attention on aspects of patient safety made visible by the system at the expense of other, less measurable but nonetheless important, concerns. Conclusions The secondary use of electronic data can be effective for improving specific indicators of care if accompanied by a range of interventions to ensure proper interpretation and appropriate action. But care is needed to avoid unintended consequences. PMID:24028694

Motivating medical information system performance by system quality, service quality, and job satisfaction for evidence-based practice.

PubMed

Chang, Ching-Sheng; Chen, Su-Yueh; Lan, Yi-Ting

2012-11-21

No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems.

Merit-Based Incentive Payment System: Meaningful Changes in the Final Rule Brings Cautious Optimism.

PubMed

Manchikanti, Laxmaiah; Helm Ii, Standiford; Calodney, Aaron K; Hirsch, Joshua A

2017-01-01

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) eliminated the flawed Sustainable Growth Rate (SGR) act formula - a longstanding crucial issue of concern for health care providers and Medicare beneficiaries. MACRA also included a quality improvement program entitled, "The Merit-Based Incentive Payment System, or MIPS." The proposed rule of MIPS sought to streamline existing federal quality efforts and therefore linked 4 distinct programs into one. Three existing programs, meaningful use (MU), Physician Quality Reporting System (PQRS), value-based payment (VBP) system were merged with the addition of Clinical Improvement Activity category. The proposed rule also changed the name of MU to Advancing Care Information, or ACI. ACI contributes to 25% of composite score of the four programs, PQRS contributes 50% of the composite score, while VBP system, which deals with resource use or cost, contributes to 10% of the composite score. The newest category, Improvement Activities or IA, contributes 15% to the composite score. The proposed rule also created what it called a design incentive that drives movement to delivery system reform principles with the inclusion of Advanced Alternative Payment Models (APMs).Following the release of the proposed rule, the medical community, as well as Congress, provided substantial input to Centers for Medicare and Medicaid Services (CMS),expressing their concern. American Society of Interventional Pain Physicians (ASIPP) focused on 3 important aspects: delay the implementation, provide a 3-month performance period, and provide ability to submit meaningful quality measures in a timely and economic manner. The final rule accepted many of the comments from various organizations, including several of those specifically emphasized by ASIPP, with acceptance of 3-month reporting period, as well as the ability to submit non-MIPS measures to improve real quality and make the system meaningful. CMS also provided a mechanism for physicians to avoid penalties for non-reporting with reporting of just a single patient. In summary, CMS has provided substantial flexibility with mechanisms to avoid penalties, reporting for 90 continuous days, increasing the low volume threshold, changing the reporting burden and data thresholds and, finally, coordination between performance categories. The final rule has made MIPS more meaningful with bonuses for exceptional performance, the ability to report for 90 days, and to report on 50% of the patients in 2017 and 60% of the patients in 2018. The final rule also reduced the quality measures to 6, including only one outcome or high priority measure with elimination of cross cutting measure requirement. In addition, the final rule reduced the burden of ACI, improved the coordination of performance, reduced improvement activities burden from 60 points to 40 points, and finally improved coordination between performance categories. Multiple concerns remain regarding the reduction in scoring for quality improvement in future years, increase in proportion of MIPS scoring for resource use utilizing flawed, claims based methodology and the continuation of the disproportionate importance of ACI, an expensive program that can be onerous for providers which in many ways has not lived up to its promise. Key words: Medicare Access and CHIP Reauthorization Act of 2015, merit-based incentive payment system, quality performance measures, resource use, improvement activities, advancing care information performance category.

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.

Sublingual Nitroglycerin Administration in Coronary Computed Tomography Angiography: a Systematic Review.

PubMed

Takx, Richard A P; Suchá, Dominika; Park, Jakob; Leiner, Tim; Hoffmann, Udo

2015-12-01

To systematically investigate the literature for the influence of sublingual nitroglycerin administration on coronary diameter, the number of evaluable segments, image quality, heart rate and blood pressure, and diagnostic accuracy of coronary computed tomography (CT) angiography. A systematic search was performed in PubMed, EMBASE and Web of Science. The studies were evaluated for the effect of sublingual nitroglycerin on coronary artery diameter, evaluable segments, objective and subjective image quality, systemic physiological effects and diagnostic accuracy. Due to the heterogeneous reporting of outcome measures, a narrative synthesis was applied. Of the 217 studies identified, nine met the inclusion criteria: seven reported on the effect of nitroglycerin on coronary artery diameter, six on evaluable segments, four on image quality, five on systemic physiological effects and two on diagnostic accuracy. Sublingual nitroglycerin administration resulted in an improved evaluation of more coronary segments, in particular, in smaller coronary branches, better image quality and improved diagnostic accuracy. Side effects were mild and were alleviated without medical intervention. Sublingual nitroglycerin improves the coronary diameter, the number of assessable segments, image quality and diagnostic accuracy of coronary CT angiography without major side effects or systemic physiological changes. • Sublingual nitroglycerin administration results in significant coronary artery dilatation. • Nitroglycerin increases the number of evaluable coronary branches. • Image quality is improved the most in smaller coronary branches. • Nitroglycerin increases the diagnostic accuracy of coronary CT angiography. • Most side effects are mild and do not require medical intervention.

Achieving Continuous Improvement: Theories that Support a System Change.

ERIC Educational Resources Information Center

Armel, Donald

Focusing on improvement is different than focusing on quality, quantity, customer satisfaction, and productivity. This paper discusses Open System Theory, and suggests ways to change large systems. Changing a system (meaning the way all the parts are connected) requires a considerable amount of data gathering and analysis. Choosing the proper…

In pursuit of quality by viable quality assurance system: the controllers' perceptions.

PubMed

Aziz, Anwar

2011-01-01

Patients, families and communities expect safe, competent and compassionate nursing care that has always been a core value of nursing. To meet these expectations, a valid and reliable quality assurance (QA) system is crucial to ensure that nurse-graduates are competent, confident and fit to practice. The QA approach is seen to be fundamental for quality improvement, it would be appropriate to consider its influence in the nursing education in Pakistan as the current situation is evident of non-existence of such a system to assure its quality. The data is drawn from a qualitative case study conducted in 2004. Among a purposive sample of 71 nurses inclusive of a group of Controllers were interviewed on one-to-one basis. Interviews were audio taped to reduce the risk of any misinterpretation and to facilitate the exact description of data as it was said. The non-directive, semi-structured and open-ended questionnaire was used to collect data. Thematic analysis of verbatim transcripts of the interviews was done. The study findings reveal a unanimous desire of the nurses to gauge quality of nurse education through efficient and effective quality assurance system. A crucial need is felt to develop a viable quality assurance system to ensure approved level of quality in nursing education to deliver the right care to the right patient at the right time, every time. The continuous quality assurance and improvement (CQAI) framework based on Deming Quality Cycle (Plan, Do, Check and Act) could facilitate appropriate designing and development of mechanism.

A review of randomized controlled trials of medical record powered clinical decision support system to improve quality of diabetes care.

PubMed

Ali, Syed Mustafa; Giordano, Richard; Lakhani, Saima; Walker, Dawn Marie

2016-03-01

A gap between current diabetes care practice and recommended diabetes care standards has consistently been reported in the literature. Many IT-based interventions have been developed to improve adherence to the quality of care standards for chronic illness like diabetes. The widespread implementation of electronic medical/health records has catalyzed clinical decision support systems (CDSS) which may improve the quality of diabetes care. Therefore, the objective of the review is to evaluate the effectiveness of CDSS in improving quality of type II diabetes care. Moreover, the review aims to highlight the key indicators of quality improvement to assist policy makers in development of future diabetes care policies through the integration of information technology and system. Setting inclusion criteria, a systematic literature search was conducted using Medline, Web of Science and Science Direct. Critical Appraisal Skills Programme (CASP) tools were used to evaluate the quality of studies. Eight randomized controlled trials (RCTs) were selected for the review. In the selected studies, seventeen clinical markers of diabetes care were discussed. Three quality of care indicators were given more importance in monitoring the progress of diabetes care, which is consistent with National Institute for Health and Care Excellence (NICE) guidelines. The presence of these indicators in the studies helped to determine which studies were selected for review. Clinical- and process-related improvements are compared between intervention group using CDSS and control group with usual care. Glycated hemoglobin (HbA1c), low density lipid cholesterol (LDL-C) and blood pressure (BP) were the quality of care indicators studied at the levels of process of care and clinical outcome. The review has found both inconsistent and variable results for quality of diabetes care measures. A significant improvement has been found in the process of care for all three measures of quality of diabetes care. However, weak to modest positive results are observed for the clinical measures of the diabetes care indicators. In addition to this, technology adoption of CDSS is found to be consistently low. The review suggests the need to conduct further empirical research using the critical diabetes care indicators (HbA1c, LDL-C and BP) to ascertain if CDSS improves the quality of diabetes care. Research designs should be improved, especially with regard to baseline characteristics, sample size and study period. With respect to implementation of CDSS, rather than a sudden change of clinical work practice, there should instead be an incremental, gradual adoption of technology that minimizes the disruption in clinical workflow. Copyright © 2016. Published by Elsevier Ireland Ltd.

Pediatric Rapid Response Team: Vital Sign Based System vs. Pediatric Early Warning Score System

DTIC Science & Technology

2017-09-16

quality improvement initiative using the evidence-based PEWS criteria to improve recognition of deteriorating pediatric patients, allocation of PRRT resources, and pediatric staff satisfaction regarding the PRRT process.

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

PubMed

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

2016-09-01

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

Quality Early Education and Child Care From Birth to Kindergarten.

PubMed

Donoghue, Elaine A

2017-08-01

High-quality early education and child care for young children improves physical and cognitive outcomes for the children and can result in enhanced school readiness. Preschool education can be viewed as an investment (especially for at-risk children), and studies show a positive return on that investment. Barriers to high-quality early childhood education include inadequate funding and staff education as well as variable regulation and enforcement. Steps that have been taken to improve the quality of early education and child care include creating multidisciplinary, evidence-based child care practice standards; establishing state quality rating and improvement systems; improving federal and state regulations; providing child care health consultation; as well as initiating other innovative partnerships. Pediatricians have a role in promoting quality early education and child care for all children not only in the medical home but also at the community, state, and national levels. Copyright © 2017 by the American Academy of Pediatrics.

Participation of National Medical Associations in quality improvement activities - International comparison and the Israeli case

PubMed Central

2014-01-01

Background Many countries have devoted considerable efforts in an attempt to improve the performance of their health care systems. National Medical Associations (NMAs), along with other stakeholders, play a part in the promotion of such activities. The purpose of this paper is to explore the nature and level of participation of NMAs in activities of quality improvement in medicine, with a specific emphasis on Israel. Methods The authors conducted a survey among NMAs around the world inquiring as to their involvement in three central aspects of quality improvement: clinical guidelines, quality measurement and continuing medical education (CME). In addition, they conducted a review of the literature in order to gather more information and complete the data collected in the survey. The findings were processed and analyzed comparatively. Results Most of the NMAs surveyed participate in quality improvement activities at least to some extent. NMAs' main involvement is in the regulation of CME and they are involved to a much lesser extent in the preparation of clinical guidelines and in quality measurement. In Israel, the Israeli Medical Association (IMA) has a dominant role in both the preparation of clinical guidelines and the regulation of CME credits. Discussion It is possible that the expertise maintained by the profession, coupled with the organizational power of the NMA as a union, is viewed as beneficial for regulating educational activities in medicine such as CME. Conversely, the issuing of clinical guidelines is usually regarded as a typical scientific activity, and therefore often rests in the hands of professional medical societies. Quality measurement is regarded as a distinctive administrative tool and is usually found in the province of governments. Based on the typology that we introduced in our previous paper, we discovered that the extent of NMAs’ involvement in quality improvement coincides with the mode of governance of the health care system. Conclusions The nature and level of participation of NMAs in activities of quality improvement varies widely. Collaboration of NMAs in this field with other stakeholders is not uncommon, and may contribute to the further development of quality improvement in medicine. PMID:24808940

An intelligent healthcare management system: a new approach in work-order prioritization for medical equipment maintenance requests.

PubMed

Hamdi, Naser; Oweis, Rami; Abu Zraiq, Hamzeh; Abu Sammour, Denis

2012-04-01

The effective maintenance management of medical technology influences the quality of care delivered and the profitability of healthcare facilities. Medical equipment maintenance in Jordan lacks an objective prioritization system; consequently, the system is not sensitive to the impact of equipment downtime on patient morbidity and mortality. The current work presents a novel software system (EQUIMEDCOMP) that is designed to achieve valuable improvements in the maintenance management of medical technology. This work-order prioritization model sorts medical maintenance requests by calculating a priority index for each request. Model performance was assessed by utilizing maintenance requests from several Jordanian hospitals. The system proved highly efficient in minimizing equipment downtime based on healthcare delivery capacity, and, consequently, patient outcome. Additionally, a preventive maintenance optimization module and an equipment quality control system are incorporated. The system is, therefore, expected to improve the reliability of medical equipment and significantly improve safety and cost-efficiency.

Developing an Effective Assessment Process To Support Institutional Effectiveness Efforts.

ERIC Educational Resources Information Center

Albert, Angela R.; Pet-Armacost, Julia

This paper describes a process and an organizational structure in which Institutional Effectiveness (IE) can thrive. When such a system is implemented, continuous quality improvement can be sustained for the long term. Key concepts and philosophies found in the literature regarding continuous quality improvement and assessment in higher education…

Challenges and Opportunities for Evaluating Environmental Education Programs

ERIC Educational Resources Information Center

Carleton-Hug, Annelise; Hug, J. William

2010-01-01

Environmental education organizations can do more to either institute evaluation or improve the quality of their evaluation. In an effort to help evaluators bridge the gap between the potential for high quality evaluation systems to improve environmental education, and the low level of evaluation in actual practice, we reviewed recent…

A strategic approach to quality improvement and patient safety education and resident integration in a general surgery residency.

PubMed

O'Heron, Colette T; Jarman, Benjamin T

2014-01-01

To outline a structured approach for general surgery resident integration into institutional quality improvement and patient safety education and development. A strategic plan to address Accreditation Council for Graduate Medical Education (ACGME) Clinical Learning Environment Review assessments for resident integration into Quality Improvement and Patient Safety initiatives is described. Gundersen Lutheran Medical Foundation is an independent academic medical center graduating three categorical residents per year within an integrated multi-specialty health system serving 19 counties over 3 states. The quality improvement and patient safety education program includes a formal lecture series, online didactic sessions, mandatory quality improvement or patient safety projects, institutional committee membership, an opportunity to serve as a designated American College of Surgeons National Surgical Quality Improvement Project and Quality in Training representative, mandatory morbidity and mortality conference attendance and clinical electives in rural surgery and international settings. Structured education regarding and participation in quality improvement and patient safety programs are able to be accomplished during general surgery residency. The long-term outcomes and benefits of these strategies are unknown at this time and will be difficult to measure with objective data. © 2013 Published by Association of Program Directors in Surgery on behalf of Association of Program Directors in Surgery.

Continuous quality improvement at work: the first team--Part II.

PubMed

Bolt, B J; Lehany-Trese, A M; Williams, T P

1995-01-01

This second part of a two-part article follows Cape Canaveral Hospital's first continuous quality improvement team through the processes of goal setting, system analysis, data gathering, and problem resolution in the area of patients' assignment to observation status. The team's primary goal was data-driven improvement. As detailed here, the team's solution to improve the use of observation status is both time-efficient and offers opportunities for financial gain.

Significant improvement of the quality of bystander first aid using an expert system with a mobile multimedia device.

PubMed

Ertl, Lorenz; Christ, Frank

2007-08-01

Better quality bystander first-aid could improve outcome rates for emergency victims significantly. In this case-control study, we hypothesised that expert knowledge presented step-by-step to untrained helpers using a personal digital assistant (PDA), would improve the quality of bystanders basic life support. We confronted 101 lay-helpers with two standard emergency situations. (1) An unconscious trauma victim with severe bleeding. (2) Cardiopulmonary resuscitation (CPR). Performance was assessed using an Objective Structured Clinical Examination (OSCE). One group was supported by a PDA providing visual and audio instructions, whereas the control group acted only with their current knowledge. The expert system was programmed in HTML-code and displayed on the PDA's Internet browser. The maximum score obtainable was 24 points corresponding to optimal treatment. The control group without the PDA reached 14.8+/-3.5 (mean value+/-standard deviation), whereas the PDA supported group scored significantly higher (21.9+/-2.7, p<0.01). The difference in performance was measurable in all criteria tested and particularly notable in the items: placing in recovery position, airway management and quality of CPR. The PDA based expert system increased the performance of untrained helpers supplying emergency care significantly. Since Internet compatible mobile devices have become widely available, a significant quality improvement in bystander first-aid seems possible.

Lead/acid batteries in systems to improve power quality

NASA Astrophysics Data System (ADS)

Taylor, P.; Butler, P.; Nerbun, W.

Increasing dependence on computer technology is driving needs for extremely high-quality power to prevent loss of information, material, and workers' time that represent billions of dollars annually. This cost has motivated commercial and Federal research and development of energy storage systems that detect and respond to power-quality failures in milliseconds. Electrochemical batteries are among the storage media under investigation for these systems. Battery energy storage systems that employ either flooded lead/acid or valve-regulated lead/acid battery technologies are becoming commercially available to capture a share of this emerging market. Cooperative research and development between the US Department of Energy and private industry have led to installations of lead/acid-based battery energy storage systems to improve power quality at utility and industrial sites and commercial development of fully integrated, modular battery energy storage system products for power quality. One such system by AC Battery Corporation, called the PQ2000, is installed at a test site at Pacific Gas and Electric Company (San Ramon, CA, USA) and at a customer site at Oglethorpe Power Corporation (Tucker, GA, USA). The PQ2000 employs off-the-shelf power electronics in an integrated methodology to control the factors that affect the performance and service life of production-model, low-maintenance, flooded lead/acid batteries. This system, and other members of this first generation of lead/acid-based energy storage systems, will need to compete vigorously for a share of an expanding, yet very aggressive, power quality market.

TBDQ: A Pragmatic Task-Based Method to Data Quality Assessment and Improvement

PubMed Central

Vaziri, Reza; Mohsenzadeh, Mehran; Habibi, Jafar

2016-01-01

Organizations are increasingly accepting data quality (DQ) as a major key to their success. In order to assess and improve DQ, methods have been devised. Many of these methods attempt to raise DQ by directly manipulating low quality data. Such methods operate reactively and are suitable for organizations with highly developed integrated systems. However, there is a lack of a proactive DQ method for businesses with weak IT infrastructure where data quality is largely affected by tasks that are performed by human agents. This study aims to develop and evaluate a new method for structured data, which is simple and practical so that it can easily be applied to real world situations. The new method detects the potentially risky tasks within a process, and adds new improving tasks to counter them. To achieve continuous improvement, an award system is also developed to help with the better selection of the proposed improving tasks. The task-based DQ method (TBDQ) is most appropriate for small and medium organizations, and simplicity in implementation is one of its most prominent features. TBDQ is case studied in an international trade company. The case study shows that TBDQ is effective in selecting optimal activities for DQ improvement in terms of cost and improvement. PMID:27192547

Methods for slow axis beam quality improvement of high power broad area diode lasers

NASA Astrophysics Data System (ADS)

An, Haiyan; Xiong, Yihan; Jiang, Ching-Long J.; Schmidt, Berthold; Treusch, Georg

2014-03-01

For high brightness direct diode laser systems, it is of fundamental importance to improve the slow axis beam quality of the incorporated laser diodes regardless what beam combining technology is applied. To further advance our products in terms of increased brightness at a high power level, we must optimize the slow axis beam quality despite the far field blooming at high current levels. The later is caused predominantly by the built-in index step in combination with the thermal lens effect. Most of the methods for beam quality improvements reported in publications sacrifice the device efficiency and reliable output power. In order to improve the beam quality as well as maintain the efficiency and reliable output power, we investigated methods of influencing local heat generation to reduce the thermal gradient across the slow axis direction, optimizing the built-in index step and discriminating high order modes. Based on our findings, we have combined different methods in our new device design. Subsequently, the beam parameter product (BPP) of a 10% fill factor bar has improved by approximately 30% at 7 W/emitter without efficiency penalty. This technology has enabled fiber coupled high brightness multi-kilowatt direct diode laser systems. In this paper, we will elaborate on the methods used as well as the results achieved.

Development of the Veterans Healthcare Administration (VHA) Ophthalmic Surgical Outcome Database (OSOD) project and the role of ophthalmic nurse reviewers.

PubMed

Lara-Smalling, Agueda; Cakiner-Egilmez, Tulay; Miller, Dawn; Redshirt, Ella; Williams, Dale

2011-01-01

Currently, ophthalmic surgical cases are not included in the Veterans Administration Surgical Quality Improvement Project data collection. Furthermore, there is no comprehensive protocol in the health system for prospectively measuring outcomes for eye surgery in terms of safety and quality. There are 400,000 operative cases in the system per year. Of those, 48,000 (12%) are ophthalmic surgical cases, with 85% (41,000) of those being cataract cases. The Ophthalmic Surgical Outcome Database Pilot Project was developed to incorporate ophthalmology into VASQIP, thus evaluating risk factors and improving cataract surgical outcomes. Nurse reviewers facilitate the monitoring and measuring of these outcomes. Since its inception in 1778, the Veterans Administration (VA) Health System has provided comprehensive healthcare to millions of deserving veterans throughout the U.S. and its territories. Historically, the quality of healthcare provided by the VA has been the main focus of discussion because it did not meet a standard of care comparable to that of the private sector. Information regarding quality of healthcare services and outcomes data had been unavailable until 1986, when Congress mandated the VA to compare its surgical outcomes to those of the private sector (PL-99-166). 1 Risk adjustment of VA surgical outcomes began in 1987 with the Continuous Improvement in Cardiac Surgery Program (CICSP) in which cardiac surgical outcomes were reported and evaluated. 2 Between 1991 and 1993, the National VA Surgical Risk Study (NVASRS) initiated a validated risk-adjustment model for predicting surgical outcomes and comparative assessment of the quality of surgical care in 44 VA medical centers. 3 The success of NVASRS encouraged the VA to establish an ongoing program for monitoring and improving the quality of surgical care, thus developing the National Surgical Quality Improvement Program (NSQIP) in 1994. 4 According to a prospective study conducted between 1991-1997 in 123 VA medical centers by Khuri et al., the 30-day mortality and morbidity rates for major surgeries had decreased by 9% and 30%, respectively. 5 Recently renamed the VA Surgical Quality Improvement Program (VASQIP) in 2010, the quality of surgical outcomes has continued to improve among all documented surgical specialties. Ophthalmic surgery is presumed to have a very low mortality rate and therefore has not been included in the VASQIP database.

Improved image quality in pinhole SPECT by accurate modeling of the point spread function in low magnification systems

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

Pino, Francisco; Roé, Nuria; Aguiar, Pablo, E-mail: pablo.aguiar.fernandez@sergas.es

2015-02-15

Purpose: Single photon emission computed tomography (SPECT) has become an important noninvasive imaging technique in small-animal research. Due to the high resolution required in small-animal SPECT systems, the spatially variant system response needs to be included in the reconstruction algorithm. Accurate modeling of the system response should result in a major improvement in the quality of reconstructed images. The aim of this study was to quantitatively assess the impact that an accurate modeling of spatially variant collimator/detector response has on image-quality parameters, using a low magnification SPECT system equipped with a pinhole collimator and a small gamma camera. Methods: Threemore » methods were used to model the point spread function (PSF). For the first, only the geometrical pinhole aperture was included in the PSF. For the second, the septal penetration through the pinhole collimator was added. In the third method, the measured intrinsic detector response was incorporated. Tomographic spatial resolution was evaluated and contrast, recovery coefficients, contrast-to-noise ratio, and noise were quantified using a custom-built NEMA NU 4–2008 image-quality phantom. Results: A high correlation was found between the experimental data corresponding to intrinsic detector response and the fitted values obtained by means of an asymmetric Gaussian distribution. For all PSF models, resolution improved as the distance from the point source to the center of the field of view increased and when the acquisition radius diminished. An improvement of resolution was observed after a minimum of five iterations when the PSF modeling included more corrections. Contrast, recovery coefficients, and contrast-to-noise ratio were better for the same level of noise in the image when more accurate models were included. Ring-type artifacts were observed when the number of iterations exceeded 12. Conclusions: Accurate modeling of the PSF improves resolution, contrast, and recovery coefficients in the reconstructed images. To avoid the appearance of ring-type artifacts, the number of iterations should be limited. In low magnification systems, the intrinsic detector PSF plays a major role in improvement of the image-quality parameters.« less

The quality case for information technology in healthcare

PubMed Central

Bates, David W

2002-01-01

Background As described in the Institute of Medicine's Crossing the Quality Chasm report, the quality of health care in the U.S. today leaves much to be desired. Discussion One major opportunity for improving quality relates to increasing the use of information technology, or IT. Health care organizations currently invest less in IT than in any other information-intensive industry, and not surprisingly current systems are relatively primitive, compared with industries such as banking or aviation. Nonetheless, a number of organizations have demonstrated that quality can be substantially improved in a variety of ways if IT use is increased in ways that improve care. Specifically, computerization of processes that are error-prone and computerized decision support may substantially improve both efficiency and quality, as well as dramatically facilitate quality measurement. This report discusses the current levels of IT and quality in health care, how quality improvement and management are currently done, the evidence that more IT might be helpful, a vision of the future, and the barriers to getting there. Summary This report suggests that there are five key policy domains that need to be addressed: standards, incentives, security and confidentiality, professional involvement, and research, with financial incentives representing the single most important lever. PMID:12396233

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.

A roadmap for improving healthcare service quality.

PubMed

Kennedy, Denise M; Caselli, Richard J; Berry, Leonard L

2011-01-01

A data-driven, comprehensive model for improving service and creating long-term value was developed and implemented at Mayo Clinic Arizona (MCA). Healthcare organizations can use this model to prepare for value-based purchasing, a payment system in which quality and patient experience measures will influence reimbursement. Surviving and thriving in such a system will require a comprehensive approach to sustaining excellent service performance from physicians and allied health staff (e.g., nurses, technicians, nonclinical staff). The seven prongs in MCA's service quality improvement model are (1) multiple data sources to drive improvement, (2) accountability for service quality, (3) service consultation and improvement tools, (4) service values and behaviors, (5) education and training, (6) ongoing monitoring and control, and (7) recognition and reward. The model was fully implemented and tested in five departments in which patient perception of provider-specific service attributes and/or overall quality of care were below the 90th percentile for patient satisfaction in the vendor's database. Extent of the implementation was at the discretion of department leadership. Perception data rating various service attributes were collected from randomly selected patients and monitored over a 24-month period. The largest increases in patient perception of excellence over the pilot period were realized when all seven prongs of the model were implemented as a comprehensive improvement approach. The results of this pilot may help other healthcare organizations prepare for value-based purchasing.

Foundations for Teaching Excellence: Connecting Early Childhood Quality Rating, Professional Development, and Competency Systems in States

ERIC Educational Resources Information Center

Howes, Carollee, Ed.; Pianta, Robert C., Ed.

2011-01-01

Improving teacher quality in early education is a major part of ensuring young children's school readiness and closing the achievement gap. This is the book decision-makers and administrators need to begin developing coordinated, effective teacher quality systems--ones that not only get teachers ready for the classroom, but also promote continuous…

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

PubMed

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

2013-01-01

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

Provider and systems factors in diabetes quality of care.

PubMed

Ghaznavi, Kimia; Malik, Shaista

2012-02-01

A gap exists in knowledge and the observed frequency with which patients with diabetes actually receive treatment for optimal cardiovascular risk reduction. Many interventions to improve quality of care have been targeted at the health systems level and provider organizations. Changes in several domains of care and investment in quality by organizational leaders are needed to make long-lasting improvements. In the studies reviewed, the most effective strategies often have multiple components, whereas the use of one single strategy, such as reminders only or an educational intervention, is less effective. More studies are needed to examine the effect of several care management strategies simultaneously, such as use of clinical information systems, provider financial incentives, and organizational model on processes of care and outcomes.

Discharge documentation of patients discharged to subacute facilities: a three-year quality improvement process across an integrated health care system.

PubMed

Gandara, Esteban; Ungar, Jonathan; Lee, Jason; Chan-Macrae, Myrna; O'Malley, Terrence; Schnipper, Jeffrey L

2010-06-01

Effective communication among physicians during hospital discharge is critical to patient care. Partners Healthcare (Boston) has been engaged in a multi-year process to measure and improve the quality of documentation of all patients discharged from its five acute care hospitals to subacute facilities. Partners first engaged stakeholders to develop a consensus set of 12 required data elements for all discharges to subacute facilities. A measurement process was established and later refined. Quality improvement interventions were then initiated to address measured deficiencies and included education of physicians and nurses, improvements in information technology, creation of or improvements in discharge documentation templates, training of hospitalists to serve as role models, feedback to physicians and their service chiefs regarding reviewed cases, and case manager review of documentation before discharge. To measure improvement in quality as a result of these efforts, rates of simultaneous inclusion of all 12 applicable data elements ("defect-free rate") were analyzed over time. Some 3,101 discharge documentation packets of patients discharged to subacute facilities from January 1, 2006, through September 2008 were retrospectively studied. During the 11 monitored quarters, the defect-free rate increased from 65% to 96% (p < .001 for trend). The largest improvements were seen in documentation of preadmission medication lists, allergies, follow-up, and warfarin information. Institution of rigorous measurement, feedback, and multidisciplinary, multimodal quality improvement processes improved the inclusion of data elements in discharge documentation required for safe hospital discharge across a large integrated health care system.

Analysis of Best Management Practices for Storm Water Compliance at Air Force Airfields

DTIC Science & Technology

1993-09-01

before selecting an infiltration system. These factors include the local vegetation, soil type and condition, groundwater condition, and storm water quality . The...reduce the peak flow rate of storm water discharges and remove sediments in order to improve storm water quality . Detention facilities should be...discharge rate of runoff and/or provide significant detention time to improve storm water quality through natural physical, chemical, and biological

[Quality in rehabilitation].

PubMed

Jäckel, W H

2010-12-01

Particularly in the context of introduction of quality assurance programmes 15 years ago, "quality" became a central issue for rehabilitation, and its importance is bound to grow in the years to come. After giving a general definition of quality, this article deals more closely with 3 aspects of quality: quality development, quality assurance, and data on quality. Quality development in rehabilitation centres demands an atmosphere that supports change, encourages creativity, courage, transparency and involvement, and reduces fear. The creation of such an atmosphere is, in particular, the responsibility of a centre's management. Routine interviews regarding patient as well as employee satisfaction, and the use of strategic planning and management systems have proven successful instruments in the practice of quality development. Compared with other sectors of the health system, quality assurance in rehabilitation is marked by its comprehensive approach, intense patient orientation, scientific underpinning, and nationwide implementation. Regarding the benefits of these programmes for the health system at large, however, no clear scientific proof is available yet. Data gained from quality assurance programmes on the whole show a high amount of patient satisfaction, good quality of structures and processes as well as an improvement of the patients' health status. Between centres, however, there are marked differences of quality in a number of cases, and long-term effectiveness could be improved in some indications. Finally, suggestions are offered concerning further development of quality in rehabilitation as well as of the quality assurance programmes. © Georg Thieme Verlag KG Stuttgart · New York.

Integrating empowerment evaluation and quality improvement to achieve healthcare improvement outcomes

PubMed Central

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

2015-01-01

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

Work System Assessment to Facilitate the Dissemination of a Quality Improvement Program for Optimizing Blood Culture Use: A Case Study Using a Human Factors Engineering Approach.

PubMed

Xie, Anping; Woods-Hill, Charlotte Z; King, Anne F; Enos-Graves, Heather; Ascenzi, Judy; Gurses, Ayse P; Klaus, Sybil A; Fackler, James C; Milstone, Aaron M

2017-11-20

Work system assessments can facilitate successful implementation of quality improvement programs. Using a human factors engineering approach, we conducted a work system assessment to facilitate the dissemination of a quality improvement program for optimizing blood culture use in pediatric intensive care units at 2 hospitals. Semistructured face-to-face interviews were conducted with clinicians from Johns Hopkins All Children's Hospital and University of Virginia Medical Center. Interview data were analyzed using qualitative content analysis. Blood culture-ordering practices are influenced by various work system factors, including people, tasks, tools and technologies, the physical environment, organizational conditions, and the external environment. A clinical decision-support tool could facilitate implementation by (1) standardizing blood culture-ordering practices, (2) ensuring that prescribing clinicians review the patient's condition before ordering a blood culture, (3) facilitating critical thinking, and (4) empowering nurses to communicate with physicians and advocate for adherence to blood culture-ordering guidelines. The success of interventions for optimizing blood culture use relies heavily on the local context. A work system analysis using a human factors engineering approach can identify key areas to be addressed for the successful dissemination of quality improvement interventions. © The Author 2017. Published by Oxford University Press on behalf of The Journal of the Pediatric Infectious Diseases Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Health Care Spending and Quality in Year 1 of the Alternative Quality Contract

PubMed Central

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E.; He, Yulei; Ellis, Randall P.; Mechanic, Robert E.; Day, Matthew P.; Chernew, Michael E.

2012-01-01

Background In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Methods Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006–2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Results Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group — $15.51 (1.9%) less per quarter (P = 0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P = 0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. Conclusions The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers’ ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.) PMID:21751900

Health care spending and quality in year 1 of the alternative quality contract.

PubMed

Song, Zirui; Safran, Dana Gelb; Landon, Bruce E; He, Yulei; Ellis, Randall P; Mechanic, Robert E; Day, Matthew P; Chernew, Michael E

2011-09-08

In 2009, Blue Cross Blue Shield of Massachusetts (BCBS) implemented a global payment system called the Alternative Quality Contract (AQC). Provider groups in the AQC system assume accountability for spending, similar to accountable care organizations that bear financial risk. Moreover, groups are eligible to receive bonuses for quality. Seven provider organizations began 5-year contracts as part of the AQC system in 2009. We analyzed 2006-2009 claims for 380,142 enrollees whose primary care physicians (PCPs) were in the AQC system (intervention group) and for 1,351,446 enrollees whose PCPs were not in the system (control group). We used a propensity-weighted difference-in-differences approach, adjusting for age, sex, health status, and secular trends to isolate the treatment effect of the AQC in comparisons of spending and quality between the intervention group and the control group. Average spending increased for enrollees in both the intervention and control groups in 2009, but the increase was smaller for enrollees in the intervention group--$15.51 (1.9%) less per quarter (P=0.007). Savings derived largely from shifts in outpatient care toward facilities with lower fees; from lower expenditures for procedures, imaging, and testing; and from a reduction in spending for enrollees with the highest expected spending. The AQC system was associated with an improvement in performance on measures of the quality of the management of chronic conditions in adults (P<0.001) and of pediatric care (P=0.001), but not of adult preventive care. All AQC groups met 2009 budget targets and earned surpluses. Total BCBS payments to AQC groups, including bonuses for quality, are likely to have exceeded the estimated savings in year 1. The AQC system was associated with a modest slowing of spending growth and improved quality of care in 2009. Savings were achieved through changes in referral patterns rather than through changes in utilization. The long-term effect of the AQC system on spending growth depends on future budget targets and providers' ability to further improve efficiencies in practice. (Funded by the Commonwealth Fund and others.).

Quality and productivity improvement program (PPKP) from alumni perspective

NASA Astrophysics Data System (ADS)

Ruza, Nadiah; Mustafa, Zainol

2013-04-01

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

Translations on Environmental Quality, Number 142

DTIC Science & Technology

1977-07-28

Theo Wurm; SUEDEUTSCHE ZEITUNG, 27 May 77) 42 Improved Air Pollution Measurement Systems Discussed . (FRANKFURTER ALLGEMEINE, 28 May 77) 45...lowest cost to the economy and the pollu- tion authority has also gai- ned revenue to use to fur- ther improve water quality . Dr Uriarte saw no... improvement , and restoration of the environment and the rational utilization of water resources; 2. To control and coordinate the implementation of

Research on construction quality and improvement of assembly construction

NASA Astrophysics Data System (ADS)

Cheng, Fei

2017-11-01

Based on the acceleration of the urbanization process and the improvement of the quality of life of our residents, the demand for building construction has been increasing. In this context, the construction industry in order to promote the construction efficiency, quality improvement, to meet the needs of the development of the times to strengthen the new technology, the use of new technologies. At present, China’s engineering construction units in the process of carrying out the project to strengthen the use of assembly-type construction technology, which thus achieved for the traditional construction work low-level, high time-consuming issues, and promote the steady improvement of production efficiency. Based on this, this paper focuses on the analysis of the connotation of the assembly structure and analyzes the quality problems in the construction process of the construction projects and puts forward the improvement measures to promote the improvement of the building quality and the construction of the building Construction speed. Based on this, this paper analyzes the structural system and design of prefabricated building.

Using management information systems to enhance health care quality assurance.

PubMed

Rosser, L H; Kleiner, B H

1995-01-01

Examines how computers and quality assurance are being used to improve the quality of health care delivery. Traditional quality assurance methods have been limited in their ability to effectively manage the high volume of data generated by the health care process. Computers on the other hand are able to handle large volumes of data as well as monitor patient care activities in both the acute care and ambulatory care settings. Discusses the use of computers to collect and analyse patient data so that changes and problems can be identified. In addition, computer models for reminding physicians to order appropriate preventive health measures for their patients are presented. Concludes that the use of computers to augment quality improvement is essential if the quality of patient care and health promotion are to be improved.

"Power quality system," a new system of quality management for globalization: towards innovation and competitive advantages.

PubMed

Abdul-Rahman, H; Berawi, M A

Knowledge Management (KM) addresses the critical issues of organizational adoption, survival and competence in the face of an increasingly changing environment. KM embodies organizational processes that seek a synergistic combination of the data and information processing capabilities of information and communication technologies (ICT), and the creative and innovative capacity of human beings to improve ICT In that role, knowledge management will improve quality management and avoid or minimize losses and weakness that usually come from poor performance as well as increase the competitive level of the company and its ability to survive in the global marketplace. To achieve quality, all parties including the clients, company consultants, contractors, entrepreneurs, suppliers, and the governing bodies (i.e., all involved stake-holders) need to collaborate and commit to achieving quality. The design based organizations in major business and construction companies have to be quality driven to support healthy growth in today's competitive market. In the march towards vision 2020 and globalization (i.e., the one world community) of many companies, their design based organizations need to have superior quality management and knowledge management to anticipate changes. The implementation of a quality system such as the ISO 9000 Standards, Total Quality Management, or Quality Function Deployment (QFD) focuses the company's resources towards achieving faster and better results in the global market with less cost. To anticipate the needs of the marketplace and clients as the world and technology change, a new system, which we call Power Quality System (PQS), has been designed. PQS is a combination of information and communication technologies (ICT) and the creative and innovative capacity of human beings to meet the challenges of the new world business and to develop high quality products.

Combined quality function deployment and logical framework analysis to improve quality of emergency care in Malta.

PubMed

Buttigieg, Sandra Catherine; Dey, Prasanta Kumar; Cassar, Mary Rose

2016-01-01

The purpose of this paper is to develop an integrated patient-focused analytical framework to improve quality of care in accident and emergency (A & E) unit of a Maltese hospital. The study adopts a case study approach. First, a thorough literature review has been undertaken to study the various methods of healthcare quality management. Second, a healthcare quality management framework is developed using combined quality function deployment (QFD) and logical framework approach (LFA). Third, the proposed framework is applied to a Maltese hospital to demonstrate its effectiveness. The proposed framework has six steps, commencing with identifying patients' requirements and concluding with implementing improvement projects. All the steps have been undertaken with the involvement of the concerned stakeholders in the A & E unit of the hospital. The major and related problems being faced by the hospital under study were overcrowding at A & E and shortage of beds, respectively. The combined framework ensures better A & E services and patient flow. QFD identifies and analyses the issues and challenges of A & E and LFA helps develop project plans for healthcare quality improvement. The important outcomes of implementing the proposed quality improvement programme are fewer hospital admissions, faster patient flow, expert triage and shorter waiting times at the A & E unit. Increased emergency consultant cover and faster first significant medical encounter were required to start addressing the problems effectively. Overall, the combined QFD and LFA method is effective to address quality of care in A & E unit. PRACTICAL/IMPLICATIONS: The proposed framework can be easily integrated within any healthcare unit, as well as within entire healthcare systems, due to its flexible and user-friendly approach. It could be part of Six Sigma and other quality initiatives. Although QFD has been extensively deployed in healthcare setup to improve quality of care, very little has been researched on combining QFD and LFA in order to identify issues, prioritise them, derive improvement measures and implement improvement projects. Additionally, there is no research on QFD application in A & E. This paper bridges these gaps. Moreover, very little has been written on the Maltese health care system. Therefore, this study contributes demonstration of quality of emergency care in Malta.

YoungStar in Wisconsin: Analysis of Data as of July 2014. Executive Summary: Key Findings and Analysis

ERIC Educational Resources Information Center

Wisconsin Council on Children and Families, 2014

2014-01-01

YoungStar is a five-star quality rating system for child care providers based on education, learning environment, business methods, and practices around child health and well-being. Through this rating system, the state is addressing several key issues in Wisconsin's child care system. The rating system will: (1) Improve the overall quality of…

Strengthening laboratory systems in resource-limited settings.

PubMed

Olmsted, Stuart S; Moore, Melinda; Meili, Robin C; Duber, Herbert C; Wasserman, Jeffrey; Sama, Preethi; Mundell, Ben; Hilborne, Lee H

2010-09-01

Considerable resources have been invested in recent years to improve laboratory systems in resource-limited settings. We reviewed published reports, interviewed major donor organizations, and conducted case studies of laboratory systems in 3 countries to assess how countries and donors have worked together to improve laboratory services. While infrastructure and the provision of services have seen improvement, important opportunities remain for further advancement. Implementation of national laboratory plans is inconsistent, human resources are limited, and quality laboratory services rarely extend to lower tier laboratories (eg, health clinics, district hospitals). Coordination within, between, and among governments and donor organizations is also frequently problematic. Laboratory standardization and quality control are improving but remain challenging, making accreditation a difficult goal. Host country governments and their external funding partners should coordinate their efforts effectively around a host country's own national laboratory plan to advance sustainable capacity development throughout a country's laboratory system.

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

PubMed

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

2013-10-01

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

Quality Assurance in American and British Higher Education: A Comparison.

ERIC Educational Resources Information Center

Stanley, Elizabeth C.; Patrick, William J.

1998-01-01

Compares quality improvement and accountability processes in the United States and United Kingdom. For the United Kingdom, looks at quality audits, institutional assessment, standards-based quality assurance, and research assessment; in the United States, looks at regional and specialized accreditation, performance indicator systems, academic…

Commentary: measuring quality of care in osteoporosis.

PubMed

Silverman, Stuart L; Curtis, Jeffrey

2013-12-01

We know improving the quality of care in osteoporosis is an important goal. We have made some strides toward measuring quality of osteoporosis care, focusing on process measures regarding care that is provided. Unfortunately, improving care as measured by these process measures does not always yield improved outcomes. We need to hold health care providers and health care systems responsible not only for health care production but for production of health and well-being. However, there is a multiplicity of factors that will need to be considered to make this next step.

Constructed Wetlands

EPA Pesticide Factsheets

these systems can improve water quality, engineers and scientists construct systems that replicate the functions of natural wetlands. Constructed wetlands are treatment systems that use natural processes

Lessons from school: what nurse leaders can learn from education.

PubMed

Davies, Nigel

2015-07-01

The drive to improve quality in the education sector is similar to that in health care, and lessons from the schools system are relevant to nursing leadership. This article discusses these shared traits, and details how school improvement was achieved in London and how a model of learning-centred leadership helped to transform pupil attainment in schools that had been performing poorly. Parallels are drawn between the education inspection system undertaken by Ofsted and the hospital inspections undertaken by the Care Quality Commission, and between the practice discipline-based managerial roles of nurse directors and head teachers. The article suggests that a learning-centred approach to improving the quality of patient care is needed, with a focus on the education and continuing professional development of staff.

Evaluation of food drying with air dehumidification system: a short review

NASA Astrophysics Data System (ADS)

Djaeni, M.; Utari, F. D.; Sasongko, S. B.; Kumoro, A. C.

2018-01-01

Energy efficient drying for food and agriculture products resulting high quality products has been an important issue. Currently, about 50% of total energy for postharvest treatment was used for drying. This paper presents the evaluation of new approach namely air dehumidification system with zeolite for food drying. Zeolite is a material having affinity to water in which reduced the moisture in air. With low moisture content and relative humidity, the air can improve driving force for drying even at low temperature. Thus, the energy efficiency can be potentially enhanced and the product quality can be well retained. For proving the hypothesis, the paddy and onion have been dried using dehumidified air. As performance indicators, the drying time, product quality, and heat efficiency were evaluated. Results indicated that the drying with zeolite improved the performances significantly. At operating temperature ranging 50 - 60°C, the efficiency of drying system can reach 75% with reasonable product quality.

Management strategies to effect change in intensive care units: lessons from the world of business. Part I. Targeting quality improvement initiatives.

PubMed

Gershengorn, Hayley B; Kocher, Robert; Factor, Phillip

2014-02-01

The business community has developed strategies to ensure the quality of the goods or services they produce and to improve the management of multidisciplinary work teams. With modification, many of these techniques can be imported into intensive care units (ICUs) to improve clinical operations and patient safety. In Part I of a three-part ATS Seminar series, we argue for adopting business management strategies in ICUs and set forth strategies for targeting selected quality improvement initiatives. These tools are relevant to health care today as focus is placed on limiting low-value care and measuring, reporting, and improving quality. In the ICU, the complexity of illness and the need to standardize processes make these tools even more appealing. Herein, we highlight four techniques to help prioritize initiatives. First, the "80/20 rule" mandates focus on the few (20%) interventions likely to drive the majority (80%) of improvement. Second, benchmarking--a process of comparison with peer units or institutions--is essential to identifying areas of strength and weakness. Third, root cause analyses, in which structured retrospective reviews of negative events are performed, can be used to identify and fix systems errors. Finally, failure mode and effects analysis--a process aimed at prospectively identifying potential sources of error--allows for systems fixes to be instituted in advance to prevent negative outcomes. These techniques originated in fields other than health care, yet adoption has and can help ICU managers prioritize issues for quality improvement.

Managing Vocabulary Mapping Services

PubMed Central

Che, Chengjian; Monson, Kent; Poon, Kasey B.; Shakib, Shaun C.; Lau, Lee Min

2005-01-01

The efficient management and maintenance of large-scale and high-quality vocabulary mapping is an operational challenge. The 3M Health Information Systems (HIS) Healthcare Data Dictionary (HDD) group developed an information management system to provide controlled mapping services, resulting in improved efficiency and quality maintenance. PMID:16779203

Driving hospital transformation with SLMTA in a regional hospital in Cameroon

PubMed Central

Asong, Terence; Ngale, Elive; Mangwa, Beatrice; Ndasi, Juliana; Mouladje, Maurice; Lekunze, Remmie; Mbome, Victor; Njukeng, Patrick; Shang, Judith

2014-01-01

Background Inspired by the transformation of the Regional Hospital Buea laboratory through implementation of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme, hospital management adapted the SLMTA toolkit to drive hospital-wide quality improvement. Objective This paper describes changes in the hospital following the quality improvement activities in hygiene and sanitation, the outpatient waiting area and the surgical and maternity wards. Methods In March 2011, hospital management established a quality improvement task force and created a hospital-wide quality improvement roadmap, following the SLMTA model. The roadmap comprised improvement projects, accountability plans, patient feedback forms and log books to track quality indicators including patient wait time, satisfaction level, infection rates, birth outcomes and hospital revenue. Results There was steady improvement in service delivery during the 11 months after the introduction of the quality improvement initiatives: patient wait time at the reception was reduced from three hours to less than 30 minutes and patient satisfaction increased from 15% to 60%. Treatment protocols were developed and documented for various units, infrastructure and workflow processes were improved and there was increased staff awareness of the importance of providing quality services. Maternal infection rates dropped from 3% to 0.5% and stillbirths from 5% to < 1%. The number of patients increased as a result of improved services, leading to a 25% increase in hospital revenue. Conclusion The SLMTA programme was adapted successfully to meet the needs of the entire hospital. Such a programme has the potential to impact positively on hospital quality systems; consideration should be made for development of a formal SLMTA-like programme for hospital quality improvement. PMID:29043192

Power quality improvement by using STATCOM control scheme in wind energy generation interface to grid

NASA Astrophysics Data System (ADS)

Kirmani, Sheeraz; Kumar, Brijesh

2018-01-01

“Electric Power Quality (EPQ) is a term that refers to maintaining the near sinusoidal waveform of power distribution bus voltages and currents at rated magnitude and frequency”. Today customers are more aware of the seriousness that the power quality possesses, this prompt the utilities to assure good quality of power to their customer. The power quality is basically customer centric. Increased focus of utilities toward maintaining reliable power supply by employing power quality improvement tools has reduced the power outages and black out considerably. Good power quality is the characteristic of reliable power supply. Low power factor, harmonic pollution, load imbalance, fast voltage variations are some common parameters which are used to define the power quality. If the power quality issues are not checked i.e. the parameters that define power quality doesn't fall within the predefined standards than it will lead into high electricity bill, high running cost in industries, malfunctioning of equipments, challenges in connecting renewable. Capacitor banks, FACTS devices, harmonic filters, SVC’s (static voltage compensators), STATCOM (Static-Compensator) are the solutions to achieve the power quality. The performance of Wind turbine generators is affected by poor quality power, at the same time these wind power generating plant affects the power quality negatively. This paper presents the STATCOM-BESS (battery energy storage system) system and studies its impact on the power quality in a system which consists of wind turbine generator, non linear load, hysteresis controller for controlling the operation of STATCOM and grid. The model is simulated in the MATLAB/Simulink. This scheme mitigates the power quality issues, improves voltage profile and also reduces harmonic distortion of the waveforms. BESS level out the imbalances caused in real power due to intermittent nature of wind power available due to varying wind speeds.

A quality improvement project to improve the Medicare and Medicaid Services (CMS) sepsis bundle compliance rate in a large healthcare system.

PubMed

Raschke, Robert A; Groves, Robert H; Khurana, Hargobind S; Nikhanj, Nidhi; Utter, Ethel; Hartling, Didi; Stoffer, Brenda; Nunn, Kristina; Tryon, Shona; Bruner, Michelle; Calleja, Maria; Curry, Steven C

2017-01-01

Sepsis is a leading cause of mortality and morbidity in hospitalised patients. The Centers for Medicare and Medicaid Services (CMS) mandated that US hospitals report sepsis bundle compliance rate as a quality process measure in October 2015. The specific aim of our study was to improve the CMS sepsis bundle compliance rate from 30% to 40% across 20 acute care hospitals in our healthcare system within 1 year. The study included all adult inpatients with sepsis sampled according to CMS specifications from October 2015 to September 2016. The CMS sepsis bundle compliance rate was tracked monthly using statistical process control charting. A baseline rate of 28.5% with 99% control limits was established. We implemented multiple interventions including computerised decision support systems (CDSSs) to increase compliance with the most commonly missing bundle elements. Compliance reached 42% (99% statistical process control limits 18.4%-38.6%) as CDSS was implemented system-wide, but this improvement was not sustained after CMS changed specifications of the outcome measure. Difficulties encountered elucidate shortcomings of our study methodology and of the CMS sepsis bundle compliance rate as a quality process measure.

Orienting health care information systems toward quality: how Group Health Cooperative of Puget Sound did it.

PubMed

Goverman, I L

1994-11-01

Group Health Cooperative of Puget Sound (GHC), a large staff-model health maintenance organization based in Seattle, is redesigning its information systems to provide the systems and information needed to support its quality agenda. Long-range planning for GHC's information resources was done in three phases. In assessment, interviews, surveys, and a benchmarking effort identified strengths and weaknesses of the existing information systems. We concluded that we needed to improve clinical care and patient management systems and enhance health plan applications. In direction setting, we developed six objectives (for example, approach information systems in a way that is consistent with quality improvement principles). Detailed planning was used to define projects, timing, and resource allocations. Some of the most important efforts in the resulting five-year plan include the development of (1) a computerized patient record; (2) a provider-based clinical workstation for access to patient information, order entry, results reporting, guidelines, and reminders; (3) a comprehensive set of patient management and service quality systems; (4) reengineered structures, policies, and processes within the health plan, supported by a complete set of integrated information systems; (5) a standardized, high-capacity communications network to provide linkages both within GHC and among its business partners; and (6) a revised oversight structure for information services, which forms partnerships with users. A quality focus ensured that each project not only produced its own benefits but also supported the larger organizational goals associated with "total" quality.

[Medical and economic reflections on Restore and Itrel neurostimulation systems for neuropathic pain treatment].

PubMed

Simonneau, A; d'Houtaud, S; Djabarouti, M; Giot, J-P; Magnam, J; Bataille, B; Lapierre, F; Rigoard, P

2009-03-01

In 2007, four patients where implanted with the Restore neurostimulation system for intractable chronic leg pain at the Poitiers Hospital. The potential for improving the patients' quality of life and medical-economic concerns motivated this choice for these highly selected patients. In this paper, we propose brief clinical case reports and discuss the reasons for choosing this new rechargeable system, even though it was initially more expensive than the standard neurostimulation system (Itrel 3). All patients receiving implants declared that they were very satisfied with the quality of stimulation provided by Restore and noted a significant improvement in their quality of life. If this solution becomes advantageous from an economic point of view, clinical data should lend support to the utility of this technological innovation for patients who have hitherto been in treatment failure.

Improved decryption quality and security of a joint transform correlator-based encryption system

NASA Astrophysics Data System (ADS)

Vilardy, Juan M.; Millán, María S.; Pérez-Cabré, Elisabet

2013-02-01

Some image encryption systems based on modified double random phase encoding and joint transform correlator architecture produce low quality decrypted images and are vulnerable to a variety of attacks. In this work, we analyse the algorithm of some reported methods that optically implement the double random phase encryption in a joint transform correlator. We show that it is possible to significantly improve the quality of the decrypted image by introducing a simple nonlinear operation in the encrypted function that contains the joint power spectrum. This nonlinearity also makes the system more resistant to chosen-plaintext attacks. We additionally explore the system resistance against this type of attack when a variety of probability density functions are used to generate the two random phase masks of the encryption-decryption process. Numerical results are presented and discussed.

Adaptive slab laser beam quality improvement using a weighted least-squares reconstruction algorithm.

PubMed

Chen, Shanqiu; Dong, LiZhi; Chen, XiaoJun; Tan, Yi; Liu, Wenjin; Wang, Shuai; Yang, Ping; Xu, Bing; Ye, YuTang

2016-04-10

Adaptive optics is an important technology for improving beam quality in solid-state slab lasers. However, there are uncorrectable aberrations in partial areas of the beam. In the criterion of the conventional least-squares reconstruction method, it makes the zones with small aberrations nonsensitive and hinders this zone from being further corrected. In this paper, a weighted least-squares reconstruction method is proposed to improve the relative sensitivity of zones with small aberrations and to further improve beam quality. Relatively small weights are applied to the zones with large residual aberrations. Comparisons of results show that peak intensity in the far field improved from 1242 analog digital units (ADU) to 2248 ADU, and beam quality β improved from 2.5 to 2.0. This indicates the weighted least-squares method has better performance than the least-squares reconstruction method when there are large zonal uncorrectable aberrations in the slab laser system.

Multiscale Methods for Accurate, Efficient, and Scale-Aware Models of the Earth System

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

Goldhaber, Steve; Holland, Marika

The major goal of this project was to contribute improvements to the infrastructure of an Earth System Model in order to support research in the Multiscale Methods for Accurate, Efficient, and Scale-Aware models of the Earth System project. In support of this, the NCAR team accomplished two main tasks: improving input/output performance of the model and improving atmospheric model simulation quality. Improvement of the performance and scalability of data input and diagnostic output within the model required a new infrastructure which can efficiently handle the unstructured grids common in multiscale simulations. This allows for a more computationally efficient model, enablingmore » more years of Earth System simulation. The quality of the model simulations was improved by reducing grid-point noise in the spectral element version of the Community Atmosphere Model (CAM-SE). This was achieved by running the physics of the model using grid-cell data on a finite-volume grid.« less

Quality improvement--boon or boondoggle?

PubMed

Paterson, M A; Wendel, J

1994-01-01

Is quality improvement (QI) reducing healthcare costs while improving patient care? Researchers find that QI has improved employee satisfaction and morale, but it was designed to do more. One solution is to use problem-solving techniques to help teams identify the level at which they want to address a problem, whether that be the subinstitutional, institutional, or system level. If QI is to fulfill its promise, skilled managers must create effective teams capable of defining and solving complex problems.

Service Discovery Oriented Management System Construction Method

NASA Astrophysics Data System (ADS)

Li, Huawei; Ren, Ying

2017-10-01

In order to solve the problem that there is no uniform method for design service quality management system in large-scale complex service environment, this paper proposes a distributed service-oriented discovery management system construction method. Three measurement functions are proposed to compute nearest neighbor user similarity at different levels. At present in view of the low efficiency of service quality management systems, three solutions are proposed to improve the efficiency of the system. Finally, the key technologies of distributed service quality management system based on service discovery are summarized through the factor addition and subtraction of quantitative experiment.

"Making a difference" - Medical students' opportunities for transformational change in health care and learning through quality improvement projects.

PubMed

Bergh, Anne-Marie; Bac, Martin; Hugo, Jannie; Sandars, John

2016-07-11

Quality improvement is increasingly becoming an essential aspect of the medical curriculum, with the intention of improving the health care system to provide better health care. The aim of this study was to explore undergraduate medical students' experiences of their involvement in quality improvement projects during a district health rotation. Student group reports from rotations in learning centres of the University of Pretoria in Mpumalanga Province, South Africa were analysed for the period 2012 to 2015. Interviews were conducted with health care providers at four learning centres in 2013. Three main themes were identified: (1) 'Situated learning', describing students' exposure to the discrepancies between ideal and reality in a real-life situation and how they learned to deal with complex situations, individually and as student group; (2) 'Facing dilemmas', describing how students were challenged about the non-ideal reality; (3) 'Making a difference', describing the impact of the students' projects, with greater understanding of themselves and others through working in teams but also making a change in the health care system. Quality improvement projects can provide an opportunity for both the transformation of health care and for transformative learning, with individual and 'collective' self-authorship.

Analysis of the longitudinal handling qualities and pilot-induced-oscillation tendencies of the High-Angle-of-Attack Research Vehicle (HARV)

NASA Technical Reports Server (NTRS)

Hess, Ronald A.

1994-01-01

The NASA High-Angle-of Attack Research Vehicle (HARV), a modified F-18 aircraft, experienced handling qualities problems in recent flight tests at NASA Dryden Research Center. Foremost in these problems was the tendency of the pilot-aircraft system to exhibit a potentially dangerous phenomenon known as a pilot-induced oscillation (PIO). When they occur, PIO's can severely restrict performance, sharply dimish mission capabilities, and can even result in aircraft loss. A pilot/vehicle analysis was undertaken with the goal of reducing these PIO tendencies and improving the overall vehicle handling qualities with as few changes as possible to the existing feedback/feedforward flight control laws. Utilizing a pair of analytical pilot models developed by the author, a pilot/vehicle analysis of the existing longitudinal flight control system was undertaken. The analysis included prediction of overall handling qualities levels and PIO susceptability. The analysis indicated that improvement in the flight control system was warranted and led to the formulation of a simple control stick command shaping filter. Analysis of the pilot/vehicle system with the shaping filter indicated significant improvements in handling qualities and PIO tendencies could be achieved. A non-real time simulation of the modified control system was undertaken with a realistic, nonlinear model of the current HARV. Special emphasis was placed upon those details of the command filter implementation which could effect safety of flight. The modified system is currently awaiting evaluation in the real-time, pilot-in-the-loop, Dual-Maneuvering-Simulator (DMS) facility at Langley.

The importance of infrastructure development to high-quality literacy instruction.

PubMed

Cohen, David K; Bhatt, Monica P

2012-01-01

Although the education community has identified numerous effective interventions for improving the literacy of U.S. schoolchildren, little headway has been made in raising literacy capabilities. David K. Cohen and Monica P. Bhatt, of the University of Michigan, contend that a major obstacle is the organizational structure of the U.S. education system. Three features in particular--the lack of educational infrastructure, a decentralized governance system, and the organization of teaching as an occupation--stymie efforts to improve literacy instruction. The authors emphasize that the education system in the United States has always been a patchwork of local school systems that share no common curricula, student examinations, teacher education, or means of observing and improving instruction. Although localities have broad powers over education, few have built the capability to judge or support quality in educational programs. The quality criteria that have developed chiefly concern teachers, not teaching. The decentralization and weak governance of U.S. schooling also deprives teachers of opportunities to build the occupational knowledge and skill that can inform standards for the quality of work, in this case instruction. And, unlike practitioners in other professions teachers have little opportunity to try to strengthen teaching quality by setting standards for entry to the occupation. Cohen and Bhatt review six types of organizational reforms undertaken over the past several decades to improve literacy and other academic outcomes for U.S. students. After briefly describing accountability, comprehensive school reforms, knowledge diffusion, improvement of human capital, and market-based reforms, the authors turn to the Common Core State Standards, an effort initiated by state governors and school leaders to raise student achievement. The authors conclude that the fundamental question about the Common Core, as with the other reforms they discuss, is whether educators and policy makers can mobilize the capability to help states and localities invent, adapt, and implement reliable ways to improve instruction.

Seeing the forests and the trees—innovative approaches to exploring heterogeneity in systematic reviews of complex interventions to enhance health system decision-making: a protocol

PubMed Central

2014-01-01

Background To improve quality of care and patient outcomes, health system decision-makers need to identify and implement effective interventions. An increasing number of systematic reviews document the effects of quality improvement programs to assist decision-makers in developing new initiatives. However, limitations in the reporting of primary studies and current meta-analysis methods (including approaches for exploring heterogeneity) reduce the utility of existing syntheses for health system decision-makers. This study will explore the role of innovative meta-analysis approaches and the added value of enriched and updated data for increasing the utility of systematic reviews of complex interventions. Methods/Design We will use the dataset from our recent systematic review of 142 randomized trials of diabetes quality improvement programs to evaluate novel approaches for exploring heterogeneity. These will include exploratory methods, such as multivariate meta-regression analyses and all-subsets combinatorial meta-analysis. We will then update our systematic review to include new trials and enrich the dataset by surveying authors of all included trials. In doing so, we will explore the impact of variables not, reported in previous publications, such as details of study context, on the effectiveness of the intervention. We will use innovative analytical methods on the enriched and updated dataset to identify key success factors in the implementation of quality improvement interventions for diabetes. Decision-makers will be involved throughout to help identify and prioritize variables to be explored and to aid in the interpretation and dissemination of results. Discussion This study will inform future systematic reviews of complex interventions and describe the value of enriching and updating data for exploring heterogeneity in meta-analysis. It will also result in an updated comprehensive systematic review of diabetes quality improvement interventions that will be useful to health system decision-makers in developing interventions to improve outcomes for people with diabetes. Systematic review registration PROSPERO registration no. CRD42013005165 PMID:25115289

Quality and safety in pediatric anesthesia: how can guidelines, checklists, and initiatives improve the outcome?

PubMed

Hagerman, Nancy S; Varughese, Anna M; Kurth, C Dean

2014-06-01

Cognitive aids are tangible or intangible instruments that guide users in decision-making and in the completion of a complex series of tasks. Common examples include mnemonics, checklists, and algorithms. Cognitive aids constitute very effective approaches to achieve well tolerated, high quality healthcare because they promote highly reliable processes that reduce the likelihood of failure. This review describes recent advances in quality improvement for pediatric anesthesiology with emphasis on application of cognitive aids to impact patient safety and outcomes. Quality improvement encourages the examination of systems to create stable processes and ultimately high-value care. Quality improvement initiatives in pediatric anesthesiology have been shown to improve outcomes and the delivery of efficient and effective care at many institutions. The use of checklists, in particular, improves adherence to evidence-based care in crisis situations, decreases catheter-associated bloodstream infections, reduces blood product utilization, and improves communication during the patient handoff process. Use of this simple tool has been associated with decreased morbidity, fewer medical errors, improved provider satisfaction, and decreased mortality in nonanesthesia disciplines as well. Successful quality improvement initiatives utilize cognitive aids such as checklists and have been shown to optimize pediatric patient experience and anesthesia outcomes and reduce perioperative complications.

Understanding quality improvement is more important now than ever before.

PubMed

Watkins, R W

2014-01-01

With provider payments being adjusted for performance and emphasis being placed on value-based care, large health care systems are already developing the resources necessary to pursue quality improvement (QI) in their practices. This article explains why smaller and/or rural practices also need to learn about and implement QI.

The Ontological Architectures in the Application of a Knowledge Management System for Curricular Assessment

ERIC Educational Resources Information Center

Olson, Brandon D.

2012-01-01

Institutions of higher education are facing increasing pressure to improve the effectiveness and quality of academic programs (Association of Governing Boards, Top public policy issues 2011-2012, 2011). These institutions apply curricular assessment processes as a means to evaluate and improve academic effectiveness and quality. Knowledge…

Improvement of a Harvester Based, Multispectral, Seed Cotton Fiber Quality Sensor

USDA-ARS?s Scientific Manuscript database

A multispectral sensor for in-situ seed cotton fiber quality measurement was developed and tested at Texas A&M University. Results of initial testing of the sensor using machine harvested seed cotton have shown promise. Improvements have been made to the system and the measurement method to meet t...

A qualitative study of contextual factors' impact on measures to reduce surgery cancellations.

PubMed

Hovlid, Einar; Bukve, Oddbjørn

2014-05-13

Contextual factors influence quality improvement outcomes. Understanding this influence is important when adapting and implementing interventions and translating improvements into new settings. To date, there is limited knowledge about how contextual factors influence quality improvement processes. In this study, we explore how contextual factors affected measures to reduce surgery cancellations, which are a persistent problem in healthcare. We discuss the usefulness of the theoretical framework provided by the model for understanding success in quality (MUSIQ) for this kind of research. We performed a qualitative case study at Førde Hospital, Norway, where we had previously demonstrated a reduction in surgery cancellations. We interviewed 20 clinicians and performed content analysis to explore how contextual factors affected measures to reduce cancellations of planned surgeries. We identified three common themes concerning how contextual factors influenced the change process: 1) identifying a need to change, 2) facilitating system-wide improvement, and 3) leader involvement and support. Input from patients helped identify a need to change and contributed to the consensus that change was necessary. Reducing cancellations required improving the clinical system. This improvement process was based on a strategy that emphasized the involvement of frontline clinicians in detecting and improving system problems. Clinicians shared information about their work by participating in improvement teams to develop a more complete understanding of the clinical system and its interdependencies. This new understanding allowed clinicians to detect system problems and design adequate interventions. Middle managers' participation in the improvement teams and in regular work processes was important for successfully implementing and adapting interventions. Contextual factors interacted with one another and with the interventions to facilitate changes in the clinical system, reducing surgery cancellations. The MUSIQ framework is useful for exploring how contextual factors influence the improvement process and how they influence one another. Discussing data in relation to a theoretical framework can promote greater uniformity in reporting findings, facilitating knowledge-building across studies.

Reusability of coded data in the primary care electronic medical record: A dynamic cohort study concerning cancer diagnoses.

PubMed

Sollie, Annet; Sijmons, Rolf H; Helsper, Charles; Numans, Mattijs E

2017-03-01

To assess quality and reusability of coded cancer diagnoses in routine primary care data. To identify factors that influence data quality and areas for improvement. A dynamic cohort study in a Dutch network database containing 250,000 anonymized electronic medical records (EMRs) from 52 general practices was performed. Coded data from 2000 to 2011 for the three most common cancer types (breast, colon and prostate cancer) was compared to the Netherlands Cancer Registry. Data quality is expressed in Standard Incidence Ratios (SIRs): the ratio between the number of coded cases observed in the primary care network database and the expected number of cases based on the Netherlands Cancer Registry. Ratios were multiplied by 100% for readability. The overall SIR was 91.5% (95%CI 88.5-94.5) and showed improvement over the years. SIRs differ between cancer types: from 71.5% for colon cancer in males to 103.9% for breast cancer. There are differences in data quality (SIRs 76.2% - 99.7%) depending on the EMR system used, with SIRs up to 232.9% for breast cancer. Frequently observed errors in routine healthcare data can be classified as: lack of integrity checks, inaccurate use and/or lack of codes, and lack of EMR system functionality. Re-users of coded routine primary care Electronic Medical Record data should be aware that 30% of cancer cases can be missed. Up to 130% of cancer cases found in the EMR data can be false-positive. The type of EMR system and the type of cancer influence the quality of coded diagnosis registry. While data quality can be improved (e.g. through improving system design and by training EMR system users), re-use should only be taken care of by appropriately trained experts. Copyright © 2016. Published by Elsevier B.V.

Motivating medical information system performance by system quality, service quality, and job satisfaction for evidence-based practice

PubMed Central

2012-01-01

Background No previous studies have addressed the integrated relationships among system quality, service quality, job satisfaction, and system performance; this study attempts to bridge such a gap with evidence-based practice study. Methods The convenience sampling method was applied to the information system users of three hospitals in southern Taiwan. A total of 500 copies of questionnaires were distributed, and 283 returned copies were valid, suggesting a valid response rate of 56.6%. SPSS 17.0 and AMOS 17.0 (structural equation modeling) statistical software packages were used for data analysis and processing. Results The findings are as follows: System quality has a positive influence on service quality (γ11= 0.55), job satisfaction (γ21= 0.32), and system performance (γ31= 0.47). Service quality (β31= 0.38) and job satisfaction (β32= 0.46) will positively influence system performance. Conclusions It is thus recommended that the information office of hospitals and developers take enhancement of service quality and user satisfaction into consideration in addition to placing b on system quality and information quality when designing, developing, or purchasing an information system, in order to improve benefits and gain more achievements generated by hospital information systems. PMID:23171394

Evaluation of the Impact of Quality Management Systems on School Climate

ERIC Educational Resources Information Center

Egido Gálvez, Inmaculada; Fernández Cruz, Francisco José; Fernández Díaz, Mª José

2016-01-01

Purpose: Implementation of quality management systems in educational institutions has gradually increased over the last few decades, even though there are still questions about the actual usefulness of these systems for improving school processes and outcomes. The purpose of this paper is to take an in-depth look at the impact, understood as…

Modelling sewer sediment deposition, erosion, and transport processes to predict acute influent and reduce combined sewer overflows and CO(2) emissions.

PubMed

Mouri, Goro; Oki, Taikan

2010-01-01

Understanding of solids deposition, erosion, and transport processes in sewer systems has improved considerably in the past decade. This has provided guidance for controlling sewer solids and associated acute pollutants to protect the environment and improve the operation of wastewater systems. Although measures to decrease combined sewer overflow (CSO) events have reduced the amount of discharged pollution, overflows continue to occur during rainy weather in combined sewer systems. The solution lies in the amount of water allotted to various processes in an effluent treatment system, in impact evaluation of water quality and prediction technology, and in stressing the importance of developing a control technology. Extremely contaminated inflow has been a serious research subject, especially in connection with the influence of rainy weather on nitrogen and organic matter removal efficiency in wastewater treatment plants (WWTP). An intensive investigation of an extremely polluted inflow load to WWTP during rainy weather was conducted in the city of Matsuyama, the region used for the present research on total suspended solid (TSS) concentration. Since the inflow during rainy weather can be as much as 400 times that in dry weather, almost all sewers are unsettled and overflowing when a rain event is more than moderate. Another concern is the energy consumed by wastewater treatment; this problem has become important from the viewpoint of reducing CO(2) emissions and overall costs. Therefore, while establishing a prediction technology for the inflow water quality characteristics of a sewage disposal plant is an important priority, the development of a management/control method for an effluent treatment system that minimises energy consumption and CO(2) emissions due to water disposal is also a pressing research topic with regards to the quality of treated water. The procedure to improve water quality must make use of not only water quality and biotic criteria, but also modelling systems to enable the user to link the effect of changes in urban sewage systems with specific quality, energy consumption, CO(2) emission, and ecological improvements of the receiving water.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes.

PubMed

Boeras, Debrah I; Peeling, Rosanna W; Onyebujoh, Philip; Yahaya, Ali A; Gumede-Moeletsi, Hieronyma N; Ndihokubwayo, Jean B

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance.

The WHO AFRO external quality assessment programme (EQAP): Linking laboratory networks through EQA programmes

PubMed Central

Yahaya, Ali A.; Gumede-Moeletsi, Hieronyma N.

2016-01-01

External Quality Assessment (EQA) surveys performed by the World Health Organization Regional Office for Africa (WHO AFRO) revealed the need for the strengthening of public health microbiology laboratories, particularly for testing of epidemic-prone diseases in the African Region. These surveys revealed common issues such as supply chain management, skilled personnel, logistical support and overall lack of quality standards. For sustainable improvements to health systems as well as global health security, deficiencies identified need to be actively corrected through robust quality assurance programmes and implementation of laboratory quality management systems. Given all the pathogens of public health importance, an external quality assessment programme with a focus on vaccine-preventable diseases and emerging and re-emerging dangerous pathogens is important, and should not be stand-alone, but integrated within laboratory networks as seen in polio, measles, yellow fever and rubella. In 2015, WHO AFRO collaborated with the US Centers for Disease Control and Prevention, the London School of Hygiene & Tropical Medicine and partners in a series of consultations with countries and national and regional EQA providers for the development of quality assurance models to support HIV point-of-care testing and monitoring. These consultations revealed similar challenges as seen in the WHO AFRO surveys. WHO AFRO brought forth its experience in implementing quality standards for health programmes, and also opened discussions on how lessons learned through such established programmes can be utilised to supporting and strengthening the introduction of early infant diagnosis of HIV and viral load point-of-care testing. An optimised external quality assessment programme will impact the ability of countries to meet core capacities, providing improved quality management systems, improving the confidence of diagnostic network services in Africa, and including capacities to detect events of international public health importance. PMID:28879135

Structured data quality reports to improve EHR data quality.

PubMed

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

2015-12-01

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

[Sustainable process improvement with application of 'lean philosophy'].

PubMed

Rouppe van der Voort, Marc B V; van Merode, G G Frits; Veraart, Henricus G N

2013-01-01

Process improvement is increasingly being implemented, particularly with the aid of 'lean philosophy'. This management philosophy aims to improve quality by reducing 'wastage'. Local improvements can produce negative effects elsewhere due to interdependence of processes. An 'integrated system approach' is required to prevent this. Some hospitals claim that this has been successful. Research into process improvement with the application of lean philosophy has reported many positive effects, defined as improved safety, quality and efficiency. Due to methodological shortcomings and lack of rigorous evaluations it is, however, not yet possible to determine the impact of this approach. It is, however, obvious that the investigated applications are fragmentary, with a dominant focus on the instrumental aspect of the philosophy and a lack of integration in a total system, and with insufficient attention to human aspects. Process improvement is required to achieve better and more goal-oriented healthcare. To achieve this, hospitals must develop integrated system approaches that combine methods for process design with continuous improvement of processes and with personnel management. It is crucial that doctors take the initiative to guide and improve processes in an integral manner.

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.

Total Quality Management in Libraries. ERIC Digest.

ERIC Educational Resources Information Center

Masters, Denise G.

Total Quality Management (TQM) is "a system of continuous improvement employing participative management and centered on the needs of customers." Key components of TQM are employee involvement and training, problem-solving teams, statistical methods, long-term goals and thinking, and recognition that the system, not people, produces…

Power and Assessment: A Genealogical Analysis of the CLASS

ERIC Educational Resources Information Center

Gaches, Sonya; Hill, Diana

2017-01-01

The CLASS (classroom assessment scoring system) has become integrally linked with quality rating and improvement systems (QRIS) throughout the United States and other international locations. This relationship reinforces the neoliberal consumer-based perspectives of quality and devalues localized perspectives. This article challenges the notion of…

Nursing Quality Assurance: The Wisconsin System

ERIC Educational Resources Information Center

Hover, Julie; Zimmer, Marie J.

1978-01-01

Evaluation model guidelines for hospital departments of nursing to use in their nursing quality assurance programs are presented as developed in Wisconsin. Four essential components of the Wisconsin outcome evaluation system are criteria, assessment, standards, and improvement of care. Sample tests and charts are included in the article. (MF)

Anesthesia Recordkeeping: Accuracy of Recall with Computerized and Manual Entry Recordkeeping

ERIC Educational Resources Information Center

Davis, Thomas Corey

2011-01-01

Introduction: Anesthesia information management systems are rapidly gaining widespread acceptance. Aggressively promoted as an improvement to manual-entry recordkeeping systems in the areas of accuracy, quality improvement, billing and vigilance, these systems record all patient vital signs and parameters, providing a legible hard copy and…

Honing the accuracy of extreme-ultraviolet optical system testing: at-wavelength and visible-light measurements of the ETS Set-2 projection optic

NASA Astrophysics Data System (ADS)

Goldberg, Kenneth A.; Naulleau, Patrick P.; Bokor, Jeffrey; Chapman, Henry N.

2002-07-01

As the quality of optical systems for extreme ultraviolet lithography improves, high-accuracy wavefront metrology for alignment and qualification becomes ever more important. To enable the development of diffraction-limited EUV projection optics, visible-light and EUV interferometries must work in close collaboration. We present a detailed comparison of EUV and visible-light wavefront measurements performed across the field of view of a lithographic-quality EUV projection optical system designed for use in the Engineering Test Stand developed by the Virtual National Laboratory and the EUV Limited Liability Company. The comparisons reveal that the present level of RMS agreement lies in the 0.3-0.4-nm range. Astigmatism is the most significant aberration component for the alignment of this optical system; it is also the dominant term in the discrepancy, and the aberration with the highest measurement uncertainty. With EUV optical systems requiring total wavefront quality in the (lambda) EUV/50 range, and even higher surface-figure quality for the individual mirror elements, improved accuracy through future comparisons, and additional studies, are required.

The association between improved quality diabetes indicators, health outcomes and costs: towards constructing a "business case" for quality of diabetes care--a time series study.

PubMed

Wilf-Miron, Rachel; Bolotin, Arkadi; Gordon, Nesia; Porath, Avi; Peled, Ronit

2014-12-01

In primary health care systems where member's turnover is relatively low, the question, whether investment in quality of care improvement can make a business case, or is cost effective, has not been fully answered.The objectives of this study were: (1) to investigate the relationship between improvement in selected measures of diabetes (type 2) care and patients' health outcomes; and (2) to estimate the association between improvement in performance and direct medical costs. A time series study with three quality indicators - Hemoglobin A1c (HbA1c) testing, HbA1C and LDL- cholesterol (LDL-C) control - which were analyzed in patients with diabetes, insured by a large health fund. Health outcomes measures used: hospitalization days, Emergency Department (ED) visits and mortality. Poisson, GEE and Cox regression models were employed. Covariates: age, gender and socio-economic rank. 96,553 adult (age >18) patients with diabetes were analyzed. The performance of the study indicators, significantly and steadily improved during the study period (2003-2009). Poor HbA1C (>9%) and inappropriate LDL-C control (>100 mg/dl) were significantly associated with number of hospitalization days. ED visits did not achieve statistical significance. Improvement in HbA1C control was associated with an annual average of 2% reduction in hospitalization days, leading to substantial reduction in tertiary costs. The Hazard ratio for mortality, associated with poor HbA1C and LDL-C, control was 1.78 and 1.17, respectively. Our study demonstrates the effect of continuous improvement in quality care indicators, on health outcomes and resource utilization, among patients with diabetes. These findings support the business case for quality, especially in healthcare systems with relatively low enrollee turnover, where providers, in the long term, could "harvest" their investments in improving quality.

Injection locked oscillator system for pulsed metal vapor lasers

DOEpatents

Warner, Bruce E.; Ault, Earl R.

1988-01-01

An injection locked oscillator system for pulsed metal vapor lasers is disclosed. The invention includes the combination of a seeding oscillator with an injection locked oscillator (ILO) for improving the quality, particularly the intensity, of an output laser beam pulse. The present invention includes means for matching the first seeder laser pulses from the seeding oscillator to second laser pulses of a metal vapor laser to improve the quality, and particularly the intensity, of the output laser beam pulse.

Server-based enterprise collaboration software improves safety and quality in high-volume PET/CT practice.

PubMed

McDonald, James E; Kessler, Marcus M; Hightower, Jeremy L; Henry, Susan D; Deloney, Linda A

2013-12-01

With increasing volumes of complex imaging cases and rising economic pressure on physician staffing, timely reporting will become progressively challenging. Current and planned iterations of PACS and electronic medical record systems do not offer workflow management tools to coordinate delivery of imaging interpretations with the needs of the patient and ordering physician. The adoption of a server-based enterprise collaboration software system by our Division of Nuclear Medicine has significantly improved our efficiency and quality of service.

Phase I Recommendations by the Air Quality Management Work Group to the Clean Air Act Advisory Committee

EPA Pesticide Factsheets

Recommendations to the Clean Air Act Advisory Committee by Air Quality Management Work Group addressing the recommendations made by the National Research Council to improve the U.S. air quality management system.

Improving quality of care in general practices by self-audit, benchmarking and quality circles.

PubMed

Mahlknecht, Angelika; Abuzahra, Muna E; Piccoliori, Giuliano; Enthaler, Nina; Engl, Adolf; Sönnichsen, Andreas

2016-10-01

Guideline adherence of general practitioners (GP) regarding treatment of chronic conditions shows room for improvement. Thus, concepts have to be designed to promote quality of care. The aim of the interventional study "Improvement of Quality by Benchmarking" was to assess whether quality can be improved by self-auditing, benchmarking and quality circles in Salzburg (Austria) and South Tyrol (Italy). In this publication we present the Austrian results. Quality indicators were developed in a consensus process for eight chronic diseases based on pre-existing quality management systems. A quality score consisting of 35 indicators was calculated (0-5 points per indicator depending on fulfilment, maximum 175 points). Data were extracted from the electronic health records of participating practices in 2012, 2013 and 2014. A statistical pre-post analysis was performed using Wilcoxon signed-rank tests. A total of 20 GPs participated in the project. The mean quality score increased from 62.0 at baseline to 84.0 at the second follow-up (p = 0.003). Regarding the individual quality indicators, strong improvements were achieved between baseline and first follow-up, especially in process indicators concerning documentation. Between the first and second follow-up, quality remained in most cases at the same level. The validity of results is limited because of structural and technical problems. Due to the uncontrolled pre-post design we cannot exclude external influences on the results. Nevertheless, the intervention was able to improve measured quality of care. Barriers were detected that should be considered in a possible implementation of quality control programs.

Primary Care Practice Transformation Is Hard Work

PubMed Central

Crabtree, Benjamin F.; Nutting, Paul A.; Miller, William L.; McDaniel, Reuben R.; Stange, Kurt C.; Jaén, Carlos Roberto; Stewart, Elizabeth

2010-01-01

Background Serious shortcomings remain in clinical care in the United States despite widespread use of improvement strategies for enhancing clinical performance based on knowledge transfer approaches. Recent calls to transform primary care practice to a patient-centered medical home present even greater challenges and require more effective approaches. Methods Our research team conducted a series of National Institutes of Health funded descriptive and intervention projects to understand organizational change in primary care practice settings, emphasizing a complexity science perspective. The result was a developmental research effort that enabled the identification of critical lessons relevant to enabling practice change. Results A summary of findings from a 15-year program of research highlights the limitations of viewing primary care practices in the mechanistic terms that underlie current or traditional approaches to quality improvement. A theoretical perspective that views primary care practices as dynamic complex adaptive systems with “agents” who have the capacity to learn, and the freedom to act in unpredictable ways provides a better framework for grounding quality improvement strategies. This framework strongly emphasizes that quality improvement interventions should not only use a complexity systems perspective, but also there is a need for continual reflection, careful tailoring of interventions, and ongoing attention to the quality of interactions among agents in the practice. Conclusions It is unlikely that current strategies for quality improvement will be successful in transforming current primary care practice to a patient-centered medical home without a stronger guiding theoretical foundation. Our work suggests that a theoretical framework guided by complexity science can help in the development of quality improvement strategies that will more effectively facilitate practice change. PMID:20856145

Creating a sustainable culture of quality through the SLMTA programme in a district hospital laboratory in Kenya.

PubMed

Maruti, Phidelis M; Mulianga, Ekesa A; Wambani, Lorna N; Wafula, Melda N; Mambo, Fidelis A; Mutisya, Shadrack M; Wakaria, Eric N; Mbati, Erick M; Amayo, Angela A; Majani, Jonathan M; Nyary, Bryan; Songwe, Kilian A

2014-01-01

Bungoma District Hospital Laboratory (BDHL), which supports a 200-bed referral facility, began its Strengthening Laboratory Management Toward Accreditation (SLMTA) journey in 2011 together with eight other laboratories in the second round of SLMTA rollout in Kenya. To describe how the SLMTA programme and enhanced quality interventions changed the culture and management style at BDHL and instilled a quality system designed to sustain progress for years to come. SLMTA implementation followed the standard three-workshop series, mentorship site visits and audits. In order to build sustainability of progress, BDHL integrated quality improvement processes into its daily operations. The lab undertook a process of changing its internal culture to align all hospital stakeholders - including upper management, clinicians, laboratory staff and maintenance staff - to the mission of sustainable quality practices at BDHL. After 16 months in the SLMTA programme, BDHL improved from zero stars (38%) to four stars (89%). Over a period of two to three years, external quality assessment results improved from 47% to 87%; staff punctuality increased from 49% to 82%; clinician complaints decreased from 83% to 16; rejection rates decreased from 12% to 3%; and annual equipment repairs decreased from 40 to 15. Twelve months later the laboratory scored three stars (81%) in an external surveillance audit conducted by Kenya Accreditation Service (KENAS). Management buy-in, staff participation, use of progress-monitoring tools and feedback systems, as well as incorporation of improvement processes into routine daily activities, were vital in developing and sustaining a culture of quality improvement.

Understanding organisational development, sustainability, and diffusion of innovations within hospitals participating in a multilevel quality collaborative.

PubMed

Dückers, Michel La; Wagner, Cordula; Vos, Leti; Groenewegen, Peter P

2011-03-09

Between 2004 and 2008, 24 Dutch hospitals participated in a two-year multilevel quality collaborative (MQC) comprised of (a) a leadership programme for hospital executives, (b) six quality-improvement collaboratives (QICs) for healthcare professionals and other staff, and (c) an internal programme organisation to help senior management monitor and coordinate team progress. The MQC aimed to stimulate the development of quality-management systems and the spread of methods to improve patient safety and logistics. The objective of this study is to describe how the first group of eight MQC hospitals sustained and disseminated improvements made and the quality methods used. The approach followed by the hospitals was described using interview and questionnaire data gathered from eight programme coordinators. MQC hospitals followed a systematic strategy of diffusion and sustainability. Hospital quality-management systems are further developed according to a model linking plan-do-study-act cycles at the unit and hospital level. The model involves quality norms based on realised successes, performance agreements with unit heads, organisational support, monitoring, and quarterly accountability reports. It is concluded from this study that the MQC contributed to organisational development and dissemination within participating hospitals. Organisational learning effects were demonstrated. System changes affect the context factors in the theory of organisational readiness: organisational culture, policies and procedures, past experience, organisational resources, and organisational structure. Programme coordinator responses indicate that these factors are utilised to manage spread and sustainability. Further research is needed to assess long-term effects.

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…

Longleaf Pine Root System Development and Seedling Quality in Response to Copper Root Pruning and Cavity Size

Treesearch

Mary Anne Sword Sayer; Shi-Jean Susana Sung; James D. Haywood

2011-01-01

Cultural practices that modify root system structure in the plug of container-grown seedlings have the potential to improve root system function after planting. Our objective was to assess how copper root pruning affects the quality and root system development of longleaf pine seedlings grown in three cavity sizes in a greenhouse. Copper root pruning increased seedling...

Systems approach to managing educational quality in the engineering classroom

NASA Astrophysics Data System (ADS)

Grygoryev, Kostyantyn

Today's competitive environment in post-secondary education requires universities to demonstrate the quality of their programs in order to attract financing, and student and academic talent. Despite significant efforts devoted to improving the quality of higher education, systematic, continuous performance measurement and management still have not reached the level where educational outputs and outcomes are actually produced---the classroom. An engineering classroom is a complex environment in which educational inputs are transformed by educational processes into educational outputs and outcomes. By treating a classroom as a system, one can apply tools such as Structural Equation Modeling, Statistical Process Control, and System Dynamics in order to discover cause-and-effect relationships among the classroom variables, control the classroom processes, and evaluate the effect of changes to the course organization, content, and delivery, on educational processes and outcomes. Quality improvement is best achieved through the continuous, systematic application of efforts and resources. Improving classroom processes and outcomes is an iterative process that starts with identifying opportunities for improvement, designing the action plan, implementing the changes, and evaluating their effects. Once the desired objectives are achieved, the quality improvement cycle may start again. The goal of this research was to improve the educational processes and outcomes in an undergraduate engineering management course taught at the University of Alberta. The author was involved with the course, first, as a teaching assistant, and, then, as a primary instructor. The data collected from the course over four years were used to create, first, a static and, then, a dynamic model of a classroom system. By using model output and qualitative feedback from students, changes to the course organization and content were introduced. These changes led to a lower perceived course workload and increased the students' satisfaction with the instructor, but the students' overall satisfaction with the course did not change significantly, and their attitude toward the course subject actually became more negative. This research brought performance measurement to the level of a classroom, created a dynamic model of the classroom system based on the cause-and-effect relationships discovered by using statistical analysis, and used a systematic, continuous improvement approach to modify the course in order to improve selected educational processes and outcomes.

Core components of a comprehensive quality assurance program in anatomic pathology.

PubMed

Nakhleh, Raouf E

2009-11-01

In this article the core components of a comprehensive quality assurance and improvement plan are outlined. Quality anatomic pathology work comes with focus on accurate, timely, and complete reports. A commitment to continuous quality improvement and a systems approach with a persistent effort helps to achieve this end. Departments should have a quality assurance and improvement plan that includes a risk assessment of real and potential problems facing the laboratory. The plan should also list the individuals responsible for carrying out the program with adequate resources, a defined timetable, and annual assessment for progress and future directions. Quality assurance monitors should address regulatory requirements and be organized by laboratory division (surgical pathology, cytology, etc) as well as 5 segments (preanalytic, analytic, postanalytic phases of the test cycle, turn-around-time, and customer satisfaction). Quality assurance data can also be used to evaluate individual pathologists using multiple parameters with peer group comparison.

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…

Casemix systems and their applications.

PubMed

Reid, Beth

2013-01-01

Casemix systems are used in many countries around the world. The reasons for the popularity of casemix systems will be clear once their design features and applications are explained. The specific design issues for acute and other health care settings are discussed, along with their application to paying for care, utilisation review, quality assurance and clinical governance. The quality of the data is important to the integrity of these systems, and the chapter closes with a discussion of the causes of errors in the data and how the quality can be improved.

Artificial intelligence guides system's best practices, cutting costs and improving services.

PubMed

1999-06-01

One for the history books. Clinical care improvement initiatives guided by a sophisticated artificial intelligence program have helped a major Virginia integrated health system make dramatic improvements in the cost and quality of its health care services. Find out how the technological innovation has earned Sentara Health System a place in the permanent collection of the Smithsonian's National Museum of American History.

Obstetric Safety and Quality.

PubMed

Pettker, Christian M; Grobman, William A

2015-07-01

Obstetric safety and quality is an emerging and important topic not only as a result of the pressures of patient and regulatory expectations, but also because of the genuine interest of caregivers to reduce harm, improve outcomes, and optimize care. Although each seeks to improve care by using scientific approaches beyond human physiology and pathophysiology, patient safety methodologies seek to avoid preventable adverse events, whereas health care quality projects aim to achieve the best possible outcomes. It is well-documented that an increasingly complex medical system controlled by human workers is a circumstance subject to recurrent failure. A safety culture encourages a proactive approach to mitigate failure before, during, and after it occurs. This article highlights the key concepts in health care safety and quality and reviews the background of the quality improvement sciences with particular emphasis on obstetric outcomes and quality measures.

Class Model Development Using Business Rules

NASA Astrophysics Data System (ADS)

Skersys, Tomas; Gudas, Saulius

New developments in the area of computer-aided system engineering (CASE) greatly improve processes of the information systems development life cycle (ISDLC). Much effort is put into the quality improvement issues, but IS development projects still suffer from the poor quality of models during the system analysis and design cycles. At some degree, quality of models that are developed using CASE tools can be assured using various. automated. model comparison, syntax. checking procedures. It. is also reasonable to check these models against the business domain knowledge, but the domain knowledge stored in the repository of CASE tool (enterprise model) is insufficient (Gudas et al. 2004). Involvement of business domain experts into these processes is complicated because non- IT people often find it difficult to understand models that were developed by IT professionals using some specific modeling language.

Integrating sentinel watershed-systems into the monitoring and assessment of Minnesota's (USA) waters quality.

PubMed

Magner, J A; Brooks, K N

2008-03-01

Section 303(d) of the Clean Water Act requires States and Tribes to list waters not meeting water quality standards. A total maximum daily load must be prepared for waters identified as impaired with respect to water quality standards. Historically, the management of pollution in Minnesota has been focused on point-source regulation. Regulatory effort in Minnesota has improved water quality over the last three decades. Non-point source pollution has become the largest driver of conventional 303(d) listings in the 21st century. Conventional pollutants, i.e., organic, sediment and nutrient imbalances can be identified with poor land use management practices. However, the cause and effect relationship can be elusive because of natural watershed-system influences that vary with scale. Elucidation is complex because the current water quality standards in Minnesota were designed to work best with water quality permits to control point sources of pollution. This paper presents a sentinel watershed-systems approach (SWSA) to the monitoring and assessment of Minnesota waterbodies. SWSA integrates physical, chemical, and biological data over space and time using advanced technologies at selected small watersheds across Minnesota to potentially improve understanding of natural and anthropogenic watershed processes and the management of point and non-point sources of pollution. Long-term, state-of-the-art monitoring and assessment is needed to advance and improve water quality standards. Advanced water quality or ecologically-based standards that integrate physical, chemical, and biological numeric criteria offer the potential to better understand, manage, protect, and restore Minnesota's waterbodies.

Models and Methods of Aggregating Linguistic Information in Multi-criteria Hierarchical Quality Assessment Systems

NASA Astrophysics Data System (ADS)

Azarnova, T. V.; Titova, I. A.; Barkalov, S. A.

2018-03-01

The article presents an algorithm for obtaining an integral assessment of the quality of an organization from the perspective of customers, based on the method of aggregating linguistic information on a multilevel hierarchical system of quality assessment. The algorithm is of a constructive nature, it provides not only the possibility of obtaining an integral evaluation, but also the development of a quality improvement strategy based on the method of linguistic decomposition, which forms the minimum set of areas of work with clients whose quality change will allow obtaining the required level of integrated quality assessment.

American Society for Enhanced Recovery (ASER) and Perioperative Quality Initiative (POQI) joint consensus statement on measurement to maintain and improve quality of enhanced recovery pathways for elective colorectal surgery.

PubMed

Moonesinghe, S Ramani; Grocott, Michael P W; Bennett-Guerrero, Elliott; Bergamaschi, Roberto; Gottumukkala, Vijaya; Hopkins, Thomas J; McCluskey, Stuart; Gan, Tong J; Mythen, Michael Monty G; Shaw, Andrew D; Miller, Timothy E

2017-01-01

This article sets out a framework for measurement of quality of care relevant to enhanced recovery pathways (ERPs) in elective colorectal surgery. The proposed framework is based on established measurement systems and/or theories, and provides an overview of the different approaches for improving clinical monitoring, and enhancing quality improvement or research in varied settings with different levels of available resources. Using a structure-process-outcome framework, we make recommendations for three hierarchical tiers of data collection. Core, Quality Improvement, and Best Practice datasets are proposed. The suggested datasets incorporate patient data to describe case-mix, process measures to describe delivery of enhanced recovery and clinical outcomes. The fundamental importance of routine collection of data for the initiation, maintenance, and enhancement of enhanced recovery pathways is emphasized.

Research on assessment and improvement method of remote sensing image reconstruction

NASA Astrophysics Data System (ADS)

Sun, Li; Hua, Nian; Yu, Yanbo; Zhao, Zhanping

2018-01-01

Remote sensing image quality assessment and improvement is an important part of image processing. Generally, the use of compressive sampling theory in remote sensing imaging system can compress images while sampling which can improve efficiency. A method of two-dimensional principal component analysis (2DPCA) is proposed to reconstruct the remote sensing image to improve the quality of the compressed image in this paper, which contain the useful information of image and can restrain the noise. Then, remote sensing image quality influence factors are analyzed, and the evaluation parameters for quantitative evaluation are introduced. On this basis, the quality of the reconstructed images is evaluated and the different factors influence on the reconstruction is analyzed, providing meaningful referential data for enhancing the quality of remote sensing images. The experiment results show that evaluation results fit human visual feature, and the method proposed have good application value in the field of remote sensing image processing.

Publicly disclosed information about the quality of health care: response of the US public

PubMed Central

Schneider, E; Lieberman, T

2001-01-01

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care. Key Words: public disclosure; quality of health care; quality improvement PMID:11389318

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

PubMed

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

2012-01-01

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

Quality care during labour and birth: a multi-country analysis of health system bottlenecks and potential solutions

PubMed Central

2015-01-01

Background Good outcomes during pregnancy and childbirth are related to availability, utilisation and effective implementation of essential interventions for labour and childbirth. The majority of the estimated 289,000 maternal deaths, 2.8 million neonatal deaths and 2.6 million stillbirths every year could be prevented by improving access to and scaling up quality care during labour and birth. Methods The bottleneck analysis tool was applied in 12 countries in Africa and Asia as part of the Every Newborn Action Plan process. Country workshops engaged technical experts to complete the survey tool, which is designed to synthesise and grade health system "bottlenecks", factors that hinder the scale up, of maternal-newborn intervention packages. We used quantitative and qualitative methods to analyse the bottleneck data, combined with literature review, to present priority bottlenecks and actions relevant to different health system building blocks for skilled birth attendance and basic and comprehensive emergency obstetric care. Results Across 12 countries the most critical bottlenecks identified by workshop participants for skilled birth attendance were health financing (10 out of 12 countries) and health workforce (9 out of 12 countries). Health service delivery bottlenecks were found to be the most critical for both basic and comprehensive emergency obstetric care (9 out of 12 countries); health financing was identified as having critical bottlenecks for comprehensive emergency obstetric care (9 out of 12 countries). Solutions to address health financing bottlenecks included strengthening national financing mechanisms and removing financial barriers to care seeking. For addressing health workforce bottlenecks, improved human resource planning is needed, including task shifting and improving training quality. For health service delivery, proposed solutions included improving quality of care and establishing public private partnerships. Conclusions Progress towards the 2030 targets for ending preventable maternal and newborn deaths is dependent on improving quality of care during birth and the immediate postnatal period. Strengthening national health systems to improve maternal and newborn health, as a cornerstone of universal health coverage, will only be possible by addressing specific health system bottlenecks during labour and birth, including those within health workforce, health financing and health service delivery. PMID:26390886

Virginia Improves Teaching and Learning (VITAL): A Comprehensive Statewide Data System for Teacher Quality

ERIC Educational Resources Information Center

McLaughlin, Virginia L.; Ward, Thomas J.; Massa, Tod R.

2008-01-01

This article describes the development of Virginia Improves Teaching and Learning (VITAL) as a statewide data warehouse focused on teacher education. The VITAL system is a longitudinal data system that tracks individuals from their entry into teacher preparation programs to employment in public schools. The system goes far beyond typical…

From grass to grace: How SLMTA revolutionised the Bamenda Regional Hospital Laboratory in Cameroon

PubMed Central

Batumani, Nakeli N.; Maruta, Talkmore; Awasom, Charles N.

2014-01-01

Background Public health laboratories form the foundation on which today’s clinical laboratory practice in Cameroon is built. The advent of the Strengthening Laboratory Management Toward Accreditation (SLMTA) programme in 2009 empowered the Bamenda Regional Hospital Laboratory (BRHL) to improve its working culture, practices and management. Objectives To evaluate the results of SLMTA implementation at BRHL and discuss lessons learned. Method In 2010, the SLMTA programme was rolled out in Cameroon to improve laboratory quality management systems in five laboratories, including BRHL. Three workshops were conducted (the first centralised, the remaining two on-site at each laboratory) and improvement projects were implemented after each workshop with the assistance of mentors. Audits were used in order to evaluate performance and to identify areas for further improvement. Results BRHL had the lowest score (18%) amongst the cohort at the baseline audit and the highest (81%) at the official Stepwise Laboratory Quality Improvement Process Towards Accreditation (SLIPTA) audit conducted in August 2013 by the African Society for Laboratory Medicine. Improvements were observed in each of the 12 Quality System Essentials; improvement was especially noteworthy in the areas of facilities and safety, and purchasing and inventory. Staff investment and pride in the quality of laboratory services increased. Conclusion BRHL’s remarkable improvement was achieved with a combination of SLMTA training activities, intensive on-site mentorship and the collective focus of all laboratory staff. The experience at Bamenda Hospital illustrates what can be achieved when a laboratory successfully harnesses the energy of its staff and implements changes to improve the quality of services in a transformation taking them from grass to grace. PMID:29043186

Impact of Quality Management Systems on Teaching-Learning Processes

ERIC Educational Resources Information Center

Cruz, Francisco José Fernández; Gálvez, Inmaculada Egido; Santaolalla, Rafael Carballo

2016-01-01

Purpose: Quality management systems are being used more frequently in educational institutions, although their application has generated a certain amount of disagreement among education experts, who have at times questioned their suitability and usefulness for improving schools. The purpose of this paper is to contribute to this discussion by…

Predicting Observer Training Satisfaction and Certification

ERIC Educational Resources Information Center

Bell, Courtney A.; Jones, Nathan D.; Lewis, Jennifer M.; Liu, Shuangshuang

2013-01-01

The last decade produced numerous studies that show that students learn more from high-quality teachers than they do from lower quality teachers. If instruction is to improve through the use of more rigorous teacher evaluation systems, the implementation of these systems must provide consistent and interpretable information about which aspects of…