Sample records for quality management practices
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Total quality management in orthodontic practice.
Atta, A E
1999-12-01
Quality is the buzz word for the new Millennium. Patients demand it, and we must serve it. Yet one must identify it. Quality is not imaging or public relations; it is a business process. This short article presents quality as a balance of three critical notions: core clinical competence, perceived values that our patients seek and want, and the cost of quality. Customer satisfaction is a variable that must be identified for each practice. In my practice, patients perceive quality as communication and time, be it treatment or waiting time. Time is a value and cost that must be managed effectively. Total quality management is a business function; it involves diagnosis, design, implementation, and measurement of the process, the people, and the service. Kazien is a function that reduces value services, eliminates waste, and manages time and cost in the process. Total quality management is a total commitment for continuous improvement.
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Reverse quality management: developing evidence-based best practices in health emergency management.
Lynch, Tim; Cox, Paul
2006-01-01
The British Columbia Ministry of Health's Framework for Core Functions in Public Health was the catalyst that inspired this review of best practices in health emergency management. The fieldwork was conducted in the fall of 2005 between hurricane Katrina and the South Asia earthquake. These tragedies, shown on 24/7 television news channels, provided an eyewitness account of disaster management, or lack of it, in our global village world. It is not enough to just have best practices in place. There has to be a governance structure that can be held accountable. This review of best practices lists actions in support of an emergency preparedness culture at the management, executive, and corporate/governance levels of the organization. The methodology adopted a future quality management approach of the emergency management process to identify the corresponding performance indictors that correlated with practices or sets of practices. Identifying best practice performance indictors needed to conduct a future quality management audit is described as reverse quality management. Best practices cannot be assessed as stand-alone criteria; they are influenced by organizational culture. The defining of best practices was influenced by doubt about defining a practice it is hoped will never be performed, medical staff involvement, leadership, and an appreciation of the resources required and how they need to be managed. Best practice benchmarks are seen as being related more to "measures" of performance defined locally and agreed on by 2 or more parties rather than to achieving industrial standards. Relating practices to performance indicators and then to benchmarks resulted in the development of a Health Emergency Management Best Practices Matrix that lists specific practice in the different phases of emergency management.
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Quality management in home care: models for today's practice.
Verhey, M P
1996-01-01
In less than a decade, home care providers have been a part of two major transitions in health care delivery. First, because of the advent of managed care and a shift from inpatient to community-based services, home care service delivery systems have experienced tremendous growth. Second, the principles and practices of total quality management and continuous quality improvement have permeated the organization, administration, and practice of home health care. Based on the work of Deming, Juran, and Crosby, the basic tenets of the new quality management philosophy involve a focus on the following five key areas: (1) systems and processes rather than individual performance; (2) involvement, collaboration, and empowerment; (3) internal and external "customers"; (4) data and measurement; and (5) standards, guidelines, and outcomes of care. Home care providers are among those in the forefront who are developing and implementing programs that integrate these foci into the delivery of quality home care services. This article provides a summary of current home care programs that address these five key areas of quality management philosophy and provide models for innovative quality management practice in home care. For further information about each program, readers are referred to the original reports in the home care and quality management journal literature, as cited herein.
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ERIC Educational Resources Information Center
AbdulAzeez, Abbas Tunde
2016-01-01
This research investigated total quality management practices and quality teacher education in public tertiary institutions in Lagos State. The study was therefore designed to analyse management practices in Lagos state tertiary institutions through total quality management structural framework. The selected public tertiary institutions in Lagos…
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Evaluating the effectiveness of implementing quality management practices in the medical industry.
Yeh, T-M; Lai, H-P
2015-01-01
To discuss the effectiveness of 30 quality management practices (QMP) including Strategic Management, Balanced ScoreCard, Knowledge Management, and Total Quality Management in the medical industry. A V-shaped performance evaluation matrix is applied to identify the top ten practices that are important but not easy to use or implement. Quality Function Deployment (QFD) is then utilized to find key factors to improve the implementation of the top ten tools. The questionnaires were sent to the nursing staff and administrators in a hospital through e-mail and posts. A total of 250 copies were distributed and 217 copies were valid. The importance, easiness, and achievement (i.e., implementation level) of 30 quality management practices were used. Key factors for QMP implementation were sequenced in order of importance as top management involvement, inter-department communication and coordination, teamwork, hospital-wide participation, education and training, consultant professionalism, continuous internal auditing, computerized process, and incentive compensation. Top management can implement the V-shaped performance matrix to determine whether quality management practices need improvement and if so, utilize QFD to find the key factors for improvement.
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Effectiveness of a quality management program in dental care practices.
Goetz, Katja; Campbell, Stephen M; Broge, Björn; Brodowski, Marc; Wensing, Michel; Szecsenyi, Joachim
2014-04-28
Structured quality management is an important aspect for improving patient dental care outcomes, but reliable evidence to validate effects is lacking. We aimed to examine the effectiveness of a quality management program in primary dental care settings in Germany. This was an exploratory study with a before-after-design. 45 dental care practices that had completed the European Practice Assessment (EPA) accreditation scheme twice (intervention group) were selected for the study. The mean interval between the before and after assessment was 36 months. The comparison group comprised of 56 dental practices that had undergone their first assessment simultaneously with follow-up assessment in the intervention group. Aggregated scores for five EPA domains: 'infrastructure', 'information', 'finance', 'quality and safety' and 'people' were calculated. In the intervention group, small non-significant improvements were found in the EPA domains. At follow-up, the intervention group had higher scores on EPA domains as compared with the comparison group (range of differences was 4.2 to 10.8 across domains). These differences were all significant in regression analyses, which controlled for relevant dental practice characteristics. Dental care practices that implemented a quality management program had better organizational quality in contrast to a comparison group. This may reflect both improvements in the intervention group and a selection effect of dental practices volunteering for the first round of EPA practice assessment.
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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
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Adapting total quality management for general practice: evaluation of a programme.
Lawrence, M; Packwood, T
1996-01-01
OBJECTIVE: Assessment of the benefits and limitations of a quality improvement programme based on total quality management principles in general practice over a period of one year (October 1993-4). DESIGN: Questionnaires to practice team members before any intervention and after one year. Three progress reports completed by facilitators at four month intervals. Semistructured interviews with a sample of staff from each practice towards the end of the year. SETTING: 18 self selected practices from across the former Oxford Region. Three members of each practice received an initial residential course and three one day seminars during the year. Each practice was supported by a facilitator from their Medical Audit Advisory Group. MEASURES: Extent of understanding and implementation of quality improvement methodology. Number, completeness, and evaluation of quality improvement projects. Practice team members' attitudes to and involvement in team working and quality improvement. RESULTS: 16 of the 18 practices succeeded in implementing the quality improvement methods. 48 initiatives were considered and staff involvement was broad. Practice members showed increased involvement in, and appreciation of, strategic planning and team working, and satisfaction from improved patients services. 11 of the practices intend to continue with the methodology. The commonest barrier expressed was time. CONCLUSION: Quality improvement programmes based on total quality management principles produce beneficial changes in service delivery and team working in most general practices. It is incompatible with traditional doctor centred practice. The methodology needs to be adapted for primary care to avoid quality improvement being seen as separate from routine activity, and to save time. PMID:10161529
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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.
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An Overview of Total Quality Management (TQM) practice in Construction Sector
NASA Astrophysics Data System (ADS)
Likita, A. J.; Zainun, N. Y.; Rahman, I. Abdul; Awal, A. S. M. Abdul; Alias, A. R.; Rahman, M. Q. Abdul; Ghazali, F. E. Mohamed
2018-04-01
In construction sector TQM can be termed as a philosophy which guides construction professionals on the proper execution of construction projects in terms of quality. The aim of this paper is to discuss on quality management practice in construction sector. This paper evaluated five previous researches and the findings were discussed to find a conclusion of TQM practise in construction sector. The study found that TQM had been successfully practice in construction sector at Saudi Arabia, India, US and South Africa. Application of Artificial Neural Network (ANN) help to improve the implementation of TQM in construction sector. In conclusion, quality management practices will give better control of processes in construction sector.
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Effectiveness of a quality-improvement program in improving management of primary care practices.
Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja
2011-12-13
The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. In a before-after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group's second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the Europeaen Practice Assessment.
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MONTANO, Diego
2016-01-01
The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach. PMID:26860787
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Montano, Diego
2016-08-05
The present study proposes a set of quality requirements to management practices by taking into account the empirical evidence on their potential effects on health, the systemic nature of social organisations, and the current conceptualisations of management functions within the framework of comprehensive quality management systems. Systematic reviews and meta-analyses focusing on the associations between leadership and/or supervision and health in occupational settings are evaluated, and the core elements of an ISO 9001 standardisation approach are presented. Six major occupational health requirements to high-quality management practices are identified pertaining to communication processes, organisational justice, role clarity, decision making, social influence processes and management support. It is concluded that the quality of management practices may be improved by developing a quality management system of management practices that ensures not only conformity to product but also to occupational safety and health requirements. Further research may evaluate the practicability of the proposed approach.
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Developing a framework of, and quality indicators for, general practice management in Europe.
Engels, Yvonne; Campbell, Stephen; Dautzenberg, Maaike; van den Hombergh, Pieter; Brinkmann, Henrik; Szécsényi, Joachim; Falcoff, Hector; Seuntjens, Luc; Kuenzi, Beat; Grol, Richard
2005-04-01
To develop a framework for general practice management made up of quality indicators shared by six European countries. Two-round postal Delphi questionnaire in the setting of general practice in Belgium, France, Germany, The Netherlands, Switzerland and the United Kingdom. Six national expert panels, each consisting of 10 members, primarily primary care practitioners and experts in the field of quality in primary care participated in the study. The main outcome measures were: (a) a European framework with indicators for the organization of primary care; and (b) ratings of the face validity of the usefulness of the indicators by expert panels in six countries. Agreement was reached about a definition of practice management across five domains (infrastructure, staff, information, finance, and quality and safety), and a common set of indicators for the organization of general practice. The panellist response rate was 95%. Sixty-two indicators (37%) were rated face valid by all six panels. Examples include out of hours service, accessibility, the content of doctors' bags and staff involvement in quality improvement. No indicators were rated invalid by all six panels. It proved to be possible to develop a European set of indicators for assessing the quality of practice management, despite the differences in health care systems and cultures in the six different countries. These indicators will now be used in a quality assessment procedure of practice management in nine European countries. While organizational indicators are part of the new GMS contract in the UK, this research shows that many practice management issues within primary care are also of relevance in other European countries.
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Effectiveness of a quality-improvement program in improving management of primary care practices
Szecsenyi, Joachim; Campbell, Stephen; Broge, Bjoern; Laux, Gunter; Willms, Sara; Wensing, Michel; Goetz, Katja
2011-01-01
Background: The European Practice Assessment program provides feedback and outreach visits to primary care practices to facilitate quality improvement in five domains (infrastructure, people, information, finance, and quality and safety). We examined the effectiveness of this program in improving management in primary care practices in Germany, with a focus on the domain of quality and safety. Methods: In a before–after study, 102 primary care practices completed a practice assessment using the European Practice Assessment instrument at baseline and three years later (intervention group). A comparative group of 102 practices was included that completed their first assessment using this instrument at the time of the intervention group’s second assessment. Mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100. Results: We found significant improvements in all domains between the first and second assessments in the intervention group. In the domain of quality and safety, improvements in scores (mean scores were based on the proportion of indicators for which a positive response was achieved by all of the practices, on a scale of 0 to 100) were observed in the following dimensions: complaint management (from a mean score of 51.2 at first assessment to 80.7 at second assessment); analysis of critical incidents (from 79.1 to 89.6); and quality development, quality policy (from 40.7 to 55.6). Overall scores at the time of the second assessment were significantly higher in the intervention group than in the comparative group. Interpretation: Primary care practices that completed the European Practice Assessment instrument twice over a three-year period showed improvements in practice management. Our findings show the value of the quality-improvement cycle in the context of practice assessment and the use of established organizational standards for practice management with the
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Development of Quality Management Systems for Clinical Practice Guidelines in Korea.
Jo, Heui-Sug; Kim, Dong Ik; Chang, Sung-Goo; Shin, Ein-Soon; Oh, Moo-Kyung
2015-11-01
This study introduces the Clinical practice guidelines (CPGs) appraisal system by the Korean Academy of Medical Sciences (KAMS). Quality management policies for CPGs vary among different countries, which have their own cultures and health care systems. However, supporting developers in guideline development and appraisals using standardized tools are common practices. KAMS, an organization representing the various medical societies of Korea, has been striving to establish a quality management system for CPGs, and has established a CPGs quality management system that reflects the characteristics of the Korean healthcare environment and the needs of its users. KAMS created a foundation for the development of CPGs, set up an independent appraisal organization, enacted regulations related to the appraisals, and trained appraisers. These efforts could enhance the ability of each individual medical society to develop CPGs, to increase the quality of the CPGs, and to ultimately improve the quality of the information available to decision-makers.
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Total Quality Management Practices in Turkish Primary Schools
ERIC Educational Resources Information Center
Toremen, Fatih; Karakus, Mehmet; Yasan, Tezcan
2009-01-01
Purpose: The purpose of this paper is to determine the extent of total quality management (TQM) practices in primary schools based on teachers' perceptions, and how their perceptions are related to different variables. Design/methodology/approach: In this study, a survey based descriptive scanning model was used. This study was carried out in…
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Pilz, Stefan; Hülsmann, Sylvia; Michallik, Stefan; Rimbach-Schurig, Monika; Schollmeier, Margarita; Sommerhoff, Benedikt; Weßling, Adelheid
2013-01-01
Aiming at the development of perspectives and recommendations for modern quality management in health services the GQMG conducted a study on the role and self-conception of quality managers in hospitals. It seems obvious that the effectiveness of quality management clearly depends on the executive board's skilful installation of quality management, their support of quality managers and, particularly in larger-sized institutions on the coordination of staff units and cross-sectional functions.(As supplied by author). Copyright © 2013. Published by Elsevier GmbH.
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Quality of Disease Management and Risk of Mortality in English Primary Care Practices.
Dusheiko, Mark; Gravelle, Hugh; Martin, Stephen; Smith, Peter C
2015-10-01
To investigate whether better management of chronic conditions by family practices reduces mortality risk. Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5-2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions. © Health Research and Educational Trust.
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Integrating water quality responses to best management practices in Portugal.
Fonseca, André; Boaventura, Rui A R; Vilar, Vítor J P
2018-01-01
Nutrient nonpoint pollution has a significant impact on water resources worldwide. The main challenge of this work was to assess the application of best management practices in agricultural land to comply with water quality legislation for surface waters. The Hydrological Simulation Program-FORTRAN was used to evaluate water quality of Ave River in Portugal. Best management practices (infiltration basin) (BMP) were applied to agricultural land (for 3, 6, 9, 12, and 15% area) with removal efficiencies of 50% for fecal coliforms and 30% for nitrogen, phosphorus, and biochemical oxygen demand. The inflow of water quality constituents was reduced for all scenarios, with fecal coliforms achieving the highest reduction between 5.8 and 28.9% and nutrients and biochemical oxygen demand between 2 and 13%. Biochemical oxygen demand and orthophosphates concentrations achieved a good water quality status according to the European Legislation for scenarios of BMP applied to 3 and 12% agricultural area, respectively. Fecal coliform levels in Ave River basin require further treatment to fall below the established value in the abovementioned legislation. This study shows that agricultural watersheds such as Ave basins demand special attention in regard to nonpoint pollution sources effects on water quality and nutrient loads.
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Kettler, Nele; Chenot, Regine; Jordan, A Rainer
2015-01-01
Statutory health insurance dentists working in private practice have a duty to maintain and improve the quality of dental care. An individual practice's approach to quality management (QM) can be made to reflect the practice's philosophy on quality and standards and can be adapted to the specific requirements of the practice setting they are meant to serve. This study set out to collect data on the subjective perceptions of quality that exist among German dentists, and to canvass their views on the process and benefits of implementing QM systems. In doing so, this study aimed to identify the incentives and obstacles that currently exist in relation to the implementation and further development of practice-based QM systems. As part of a nationally representative cross-sectional study, a random sample of 2,084 dentists was asked to complete a questionnaire on perceptions of quality and QM. The response rate was 40.3 % (n=838). The study's primary end point was defined as the surveyed dentists' interpretative description of quality. The study's secondary end point was defined as the dentists' subjective evaluations of the benefits of QM in the day-to-day management of their own practices. Responses to open-ended questions were analysed using content analysis, while quantitative questions were analysed using descriptive univariate analysis. When analysing respondents' subjective perceptions of quality (primary end point), the following dimensions were revealed as highly significant: patient (mentioned by 31.4 % of the responders), quality of treatment (29.5 %) and staff (14.8 %). As far as the benefits of QM in the day-to-day management of the respondent's own practices (secondary end point) were concerned, these appeared to be linked to the ease of implementation of the organizational tools offered by QM systems: managing emergencies, team meetings and procedural check lists were ranked as "can be implemented to a reasonable degree" and "can be fully implemented
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Quality of Disease Management and Risk of Mortality in English Primary Care Practices
Dusheiko, Mark; Gravelle, Hugh; Martin, Stephen; Smith, Peter C
2015-01-01
Objective To investigate whether better management of chronic conditions by family practices reduces mortality risk. Data Two random samples of 5 million patients registered with over 8,000 English family practices followed up for 4 years (2004/5–2007/8). Measures of the quality of disease management for 10 conditions were constructed for each family practice for each year. The outcome measure was an indicator taking the value 1 if the patient died during a specified year, 0 otherwise. Study Design Cross-section and multilevel panel data multiple logistic regressions were estimated. Covariates included age, gender, morbidity, hospitalizations, attributed socio-economic characteristics, and local health care supply measures. Principal Findings Although a composite measure of the quality of disease management for all 10 conditions was significantly associated with lower mortality, only the quality of stroke care was significant when all 10 quality measures were entered in the regression. Conclusions The panel data results suggest that a 1 percent improvement in the quality of stroke care could reduce the annual number of deaths in England by 782 [95 percent CI: 423, 1140]. A longer study period may be necessary to detect any mortality impact of better management of other conditions. PMID:25597263
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1991-09-26
Quality Management (TQM) through both quantitative and qualitative analyses. Interviews were conducted with top executives from ten exemplar organizations within the Department of Defense (DOD). Survey questionnaires on perceptions of quality practices were administered to a sample of 102 representing members of the executive steering committees at the same organizations. Research identifies lessons learned by top executives during TQM implementation, discusses measures of organization-wide quality management , specifies evaluation mechanisms to
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NASA Astrophysics Data System (ADS)
Jamaluddin, Z.; Razali, A. M.; Mustafa, Z.
2015-02-01
The purpose of this paper is to examine the relationship between the quality management practices (QMPs) and organisational performance for the manufacturing industry in Malaysia. In this study, a QMPs and organisational performance framework is developed according to a comprehensive literature review which cover aspects of hard and soft quality factors in manufacturing process environment. A total of 11 hypotheses have been put forward to test the relationship amongst the six constructs, which are management commitment, training, process management, quality tools, continuous improvement and organisational performance. The model is analysed using Structural Equation Modeling (SEM) with AMOS software version 18.0 using Maximum Likelihood (ML) estimation. A total of 480 questionnaires were distributed, and 210 questionnaires were valid for analysis. The results of the modeling analysis using ML estimation indicate that the fits statistics of QMPs and organisational performance model for manufacturing industry is admissible. From the results, it found that the management commitment have significant impact on the training and process management. Similarly, the training had significant effect to the quality tools, process management and continuous improvement. Furthermore, the quality tools have significant influence on the process management and continuous improvement. Likewise, the process management also has a significant impact to the continuous improvement. In addition the continuous improvement has significant influence the organisational performance. However, the results of the study also found that there is no significant relationship between management commitment and quality tools, and between the management commitment and continuous improvement. The results of the study can be used by managers to prioritize the implementation of QMPs. For instances, those practices that are found to have positive impact on organisational performance can be recommended to
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NASA Astrophysics Data System (ADS)
van Oel, P. R.; Alfredo, K. A.; Russo, T. A.
2015-12-01
Sustainable water management typically emphasizes water resource quantity, with focus directed at availability and use practices. When attention is placed on sustainable water quality management, the holistic, cross-sector perspective inherent to sustainability is often lost. Proper water quality management is a critical component of sustainable development practices. However, sustainable development definitions and metrics related to water quality resilience and management are often not well defined; water quality is often buried in large indicator sets used for analysis, and the policy regulating management practices create sector specific burdens for ensuring adequate water quality. In this research, we investigated the methods by which water quality is evaluated through internationally applied indicators and incorporated into the larger idea of "sustainability." We also dissect policy's role in the distribution of responsibility with regard to water quality management in the United States through evaluation of three broad sectors: urban, agriculture, and environmental water quality. Our research concludes that despite a growing intention to use a single system approach for urban, agricultural, and environmental water quality management, one does not yet exist and is even hindered by our current policies and regulations. As policy continues to lead in determining water quality and defining contamination limits, new regulation must reconcile the disparity in requirements for the contaminators and those performing end-of-pipe treatment. Just as the sustainable development indicators we researched tried to integrate environmental, economic, and social aspects without skewing focus to one of these three categories, policy cannot continue to regulate a single sector of society without considering impacts to the entire watershed and/or region. Unequal distribution of the water pollution burden creates disjointed economic growth, infrastructure development, and policy
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Total Quality Management in Secondary Schools in Kenya: Extent of Practice
ERIC Educational Resources Information Center
Ngware, Moses Waithanji; Wamukuru, David Kuria; Odebero, Stephen Onyango
2006-01-01
Purpose: To investigate the extent to which secondary schools practiced aspects of total quality management (TQM). Design/methodology/approach: A cross-sectional research design was used in this study. A sample of 300 teachers in a residential session during a school holiday provided their perceptions on the practice of TQM in their schools. Data…
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Jones, Roger; Hunt, Claire; Stevens, Richard; Dalrymple, Jamie; Driscoll, Richard; Sleet, Sarah; Smith, Jonathan Blanchard
2009-01-01
Background Although gastrointestinal disorders are common in general practice, clinical guidelines are not always implemented, and few patient-generated quality criteria are available to guide management. Aim To develop quality criteria for the management of four common gastrointestinal disorders: coeliac disease, gastro-oesophageal reflux disease (GORD), inflammatory bowel disease, and irritable bowel syndrome. Design of study Qualitative study including thematic analysis of transcripts from patient focus groups and content analysis of published clinical practice guidelines. Emergent themes were synthesised by a consensus panel, into quality criteria for each condition. Setting Community-based practice in England, UK. Methods Fourteen focus groups were conducted (four for coeliac disease, irritable bowel syndrome, and inflammatory bowel disease, and two for GORD) involving a total of 93 patients (64 females, 29 males; mean age 55.4 years). Quality criteria were based on patients' views and expectations, synthesised with an analysis of clinical practice guidelines. Results A chronic disease management model was developed for each condition. Key themes included improving the timeliness and accuracy of diagnosis, appropriate use of investigations, better provision of information for patients, including access to patient organisations, better communication with, and access to, secondary care providers, and structured follow-up and regular review, particularly for coeliac disease and inflammatory bowel disease. Conclusion This study provides a model for the development of quality markers for chronic disease management in gastroenterology, which is likely to be applicable to other chronic conditions. PMID:19520018
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Responsible Student Affairs Practice: Merging Student Development and Quality Management.
ERIC Educational Resources Information Center
Whitner, Phillip A.; And Others
The merging of Total Quality Management (TQM) and Involvement Theory into a managerial philosophy can assist student affairs professionals with an approach for conducting work that improves student affairs practice. When merged or integrated, accountability can easily be obtained because the base philosophies of qualitative research, TQM, and…
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Routine road maintenance water quality and habitat guide : best management practices
DOT National Transportation Integrated Search
2009-01-01
Since June 9, 1999 the Oregon Department of Transportation (ODOT) has implemented the Routine Road Maintenance: Water Quality and Habitat Guide Best Management Practices (the Guide), and is considered the cornerstone of the ODOT'd Office of Maintenan...
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Defining quality indicators for best-practice management of inflammatory bowel disease in Canada
Nguyen, Geoffrey C; Devlin, Shane M; Afif, Waqqas; Bressler, Brian; Gruchy, Steven E; Kaplan, Gilaad G; Oliveira, Liliana; Plamondon, Sophie; Seow, Cynthia H; Williams, Chadwick; Wong, Karen; Yan, Brian M; Jones, Jennifer
2014-01-01
BACKGROUND: There is a paucity of published data regarding the quality of care of inflammatory bowel disease (IBD) in Canada. Clinical quality indicators are quantitative end points used to guide, monitor and improve the quality of patient care. In Canada, where universal health care can vary significantly among provinces, quality indicators can be used to identify potential gaps in the delivery of IBD care and standardize the approach to interprovincial management. METHODS: The Emerging Practice in IBD Collaborative (EPIC) group generated a shortlist of IBD quality indicators based on a comprehensive literature review. An iterative voting process was used to select quality indicators to take forward. In a face-to-face meeting with the EPIC group, available evidence to support each quality indicator was presented by the EPIC member aligned to it, followed by group discussion to agree on the wording of the statements. The selected quality indicators were then ratified in a final vote by all EPIC members. RESULTS: Eleven quality indicators for the management of IBD within the single-payer health care system of Canada were developed. These focus on accurate diagnosis, appropriate and timely management, disease monitoring, and prevention or treatment of complications of IBD or its therapy. CONCLUSIONS: These quality indicators are measurable, reflective of the evidence base and expert opinion, and define a standard of care that is at least a minimum that should be expected for IBD management in Canada. The next steps for the EPIC group involve conducting research to assess current practice across Canada as it pertains to these quality indicators and to measure the impact of each of these indicators on patient outcomes. PMID:24839622
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Assessing the quality of cost management
DOE Office of Scientific and Technical Information (OSTI.GOV)
Fayne, V.; McAllister, A.; Weiner, S.B.
1995-12-31
Managing environmental programs can be effective only when good cost and cost-related management practices are developed and implemented. The Department of Energy`s Office of Environmental Management (EM), recognizing this key role of cost management, initiated several cost and cost-related management activities including the Cost Quality Management (CQM) Program. The CQM Program includes an assessment activity, Cost Quality Management Assessments (CQMAs), and a technical assistance effort to improve program/project cost effectiveness. CQMAs provide a tool for establishing a baseline of cost-management practices and for measuring improvement in those practices. The result of the CQMA program is an organization that has anmore » increasing cost-consciousness, improved cost-management skills and abilities, and a commitment to respond to the public`s concerns for both a safe environment and prudent budget outlays. The CQMA program is part of the foundation of quality management practices in DOE. The CQMA process has contributed to better cost and cost-related management practices by providing measurements and feedback; defining the components of a quality cost-management system; and helping sites develop/improve specific cost-management techniques and methods.« less
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Nurses' Perceptions and Practices Related to Alarm Management: A Quality Improvement Initiative.
Cameron, Hannah L; Little, Barbara
2018-05-01
The purpose of this quality improvement project was to develop, implement, and assess the effects of an alarm management policy and educational program on nurses' perceptions and practices of alarm management in an acute care hospital. Nurses from an acute care hospital in the southeastern United States attended a mandatory alarm management education program. The hospital implemented the evidence-based alarm management education to achieve the NPSG.06.01.01: Alarm Management. Pre- and posttests were administered to evaluate the education and the changes in nurses' perceptions and practices of clinical alarms. A total of 417 nurses received the educational intervention. All participants completed the pretest, and 215 (51%) completed the voluntary posttest. Significant improvements were made in alarm perceptions and practices. Nurses suggested unit-specific alarm education, improved staffing, and updated equipment. Findings support the benefits of continued education in alarm management for nurses. Bedside nurses are a critical member of a multidisciplinary alarm management team because they are at the forefront of patient safety and most at risk for experiencing alarm fatigue. J Contin Educ Nurs. 2018;49(5):207-215. Copyright 2018, SLACK Incorporated.
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SCIENCE OF INTEGRATED WATERSHED MANAGEMENT: LINKING POLLUTANT CONTROL PRACTICES WITH WATER QUALITY
SCIENCE OF INTEGRATED WATERSHED MANAGEMENT: LINKING POLLUTANT CONTROL PRACTICES WITH WATER QUALITY M. Morrison (NRMRL), C. Nietch (NRMRL), 1. Schubauer-Berigan (NRMRL), M. Hantush (NRMRL), D. Lai (NRMRL), B. Daniel (NERL), M. Griffith (NCEA) Science Questions LTG 3. MYP Sc...
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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)
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Godény, Sándor
2012-01-22
In Hungary, financing of healthcare has decreased relative to the GDP, while the health status of the population is still ranks among the worst in the European Union. Since healthcare financing is not expected to increase, the number of practicing doctors per capita is continuously decreasing. In the coming years, it is an important question that in this situation what methods can be used to prevent further deterioration of the health status of the Hungarian population, and within this is the role of the quality approach, and different methods of quality management. In the present and the forthcoming two articles those standpoints will be summarized which support the need for the integration of quality assurance in the everyday medical practice. In the first part the importance of quality thinking, quality management, quality assurance, necessity of quality measurement and improvement, furthermore, advantages of the quality systems will be discussed.
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Total quality management practices in Malaysia healthcare industry
NASA Astrophysics Data System (ADS)
Ahmad, Md Fauzi; Nee, Phoi Soo; Nor, Nik Hisyamudin Muhd; Wei, Chan Shiau; Hassan, Mohd Fahrul; Hamid, Nor Aziati Abdul
2017-10-01
The aim of total quality management (TQM) is to achieve customer satisfaction. Healthcare industry is very important in Malaysia for providing good healthcare services to public. However, failure to improve quality and efficiency is a big challenge in a healthcare industry in order to increase quality healthcare services. The objectives of this research are to identify the extent level of TQM implementation; and to determine the impact of TQM implementation on business sustainable in healthcare industry. Quantitative approach has been chosen as the methodology of this study. The survey respondents targeted in this research are staffs in Malaysia private clinic. 70 respondents have participated in this research. Data were analysed by Statistical Package Social Science (SPSS). Analysis result showed that there was a positive significant relationship between TQM practices and business sustainable (r=0.774, P<0.05). All TQM factors have significant relationship with business sustainable factors. The findings of this research will help healthcare industry to understand a better and deeper valuable information on the impact of TQM implementation towards business sustainable in Malaysia healthcare industry.
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Colonna, Paolo; Pasini, Evasio; Pitocchi, Oreste; Bovenzi, Francesco; Sorino, Margherita; de Luca, Italo
2003-04-01
It is a difficult task to define practical guidelines and a pragmatic achievement for the new document of the Italian Ministry of Health for structures of the national health system obtaining a quality system according to the ISO 9000 standard. The present article illustrates the different steps to accomplish the quality management in our cardiology department, recently internationally certified, and it gives several practical examples of the path followed in the different sections of the department to obtain the best management of all the Operative Units, identifying customer requests and measuring customer satisfaction.
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[Practical implementation of a quality management system in a radiological department].
Huber, S; Zech, C J
2011-10-01
This article describes the architecture of a project aiming to implement a DIN EN ISO 9001 quality management system in a radiological department. It is intended to be a practical guide to demonstrate each step of the project leading to certification of the system. In a planning phase resources for the implementation of the project have to be identified and a quality management (QM) group as core team has to be formed. In the first project phase all available documents have to be checked and compiled in the QM manual. Moreover all relevant processes of the department have to be described in so-called process descriptions. In a second step responsibilities for the project are identified. Customer and employee surveys have to be carried out and a nonconformity management system has to be implemented. In this phase internal audits are also needed to check the new QM system, which is finally tested in the external certification audit with reference to its conformity with the standards.
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Mohammed, Siti Asma; Yusof, Maryati Mohd
2013-04-01
Poor information quality (IQ) must be understood as a business problem rather than systems problem. In health care organization, what is required is an effective quality management that continuously manages and reviews the factors influencing IQ in health information systems (HIS) so as to achieve the desired outcomes. Hence, in order to understand the issues of information quality management (IQM) practices in health care organizations, a more holistic evaluation study should be undertaken to investigate the IQM practices in health care organizations. It is the aim of this paper to identify the significant evaluation criteria that influence the production of good IQ in HIS. Six selected frameworks and best practices both from health informatics and information systems literature have been reviewed to identify the evaluation criteria from the perspective of human, organizational and technological factors. From the review, it was found that human and organization factors are of greater significance in influencing HIS IQ. Our review depicts that there is still shortage in finding a comprehensive IQM evaluation framework. Thus, the criteria from the frameworks reviewed can be used in combination for more comprehensive evaluation criteria. Integrated IQM evaluation criteria for HIS are then proposed in this study. Poor IQ is the result of complex interdependency within sociotechnical factors in health care organization and lack of formal and structured IQM practices. Thus, a feedback mechanism such as evaluation is needed to understand the issues in depth in the future. © 2012 Blackwell Publishing Ltd.
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NASA Astrophysics Data System (ADS)
Liu, Y.; Engel, B.; Collingsworth, P.; Pijanowski, B. C.
2017-12-01
Nutrient loading from the Maumee River watershed is a significant reason for the harmful algal blooms (HABs) problem in Lake Erie. Strategies to reduce nutrient loading from agricultural areas in the Maumee River watershed need to be explored. Best management practices (BMPs) are popular approaches for improving hydrology and water quality. Various scenarios of BMP implementation were simulated in the AXL watershed (an agricultural watershed in Maumee River watershed) using Soil and Water Assessment Tool (SWAT) and a new BMP cost tool to explore the cost-effectiveness of the practices. BMPs of interest included vegetative filter strips, grassed waterways, blind inlets, grade stabilization structures, wetlands, no-till, nutrient management, residue management, and cover crops. The following environmental concerns were considered: streamflow, Total Phosphorous (TP), Dissolved Reactive Phosphorus (DRP), Total Kjeldahl Nitrogen (TKN), and Nitrate+Nitrite (NOx). To obtain maximum hydrological and water quality benefits with minimum cost, an optimization tool was developed to optimally select and place BMPs by connecting SWAT, the BMP cost tool, and optimization algorithms. The optimization tool was then applied in AXL watershed to explore optimization focusing on critical areas (top 25% of areas with highest runoff volume/pollutant loads per area) vs. all areas of the watershed, optimization using weather data for spring (March to July, due to the goal of reducing spring phosphorus in watershed management plan) vs. full year, and optimization results of implementing BMPs to achieve the watershed management plan goal (reducing 2008 TP levels by 40%). The optimization tool and BMP optimization results can be used by watershed groups and communities to solve hydrology and water quality problems.
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Holton, Christine H; Proudfoot, Judith G; Jayasinghe, Upali W; Grimm, Jane; Bubner, Tanya K; Winstanley, Julie; Harris, Mark F; Beilby, Justin J
2010-11-01
Our aim was to develop a tool to identify specific features of the business and financial management of practices that facilitate better quality care for chronic illness in primary care. Domains of management were identified, resulting in the development of a structured interview tool that was administered in 97 primary care practices in Australia. Interview items were screened and subjected to factor analysis, subscales identified and the overall model fit determined. The instrument's validity was assessed against another measure of quality of care. Analysis provided a four-factor solution containing 21 items, which explained 42.5% of the variance in the total scores. The factors related to administrative processes, human resources, marketing analysis and business development. All scores increased significantly with practice size. The business development subscale and total score were higher for rural practices. There was a significant correlation between the business development subscale and quality of care. The indicators of business and financial management in the final tool appear to be useful predictors of the quality of care. The instrument may help inform policy regarding the structure of general practice and implementation of a systems approach to chronic illness care. It can provide information to practices about areas for further development.
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The reliability-quality relationship for quality systems and quality risk management.
Claycamp, H Gregg; Rahaman, Faiad; Urban, Jason M
2012-01-01
Engineering reliability typically refers to the probability that a system, or any of its components, will perform a required function for a stated period of time and under specified operating conditions. As such, reliability is inextricably linked with time-dependent quality concepts, such as maintaining a state of control and predicting the chances of losses from failures for quality risk management. Two popular current good manufacturing practice (cGMP) and quality risk management tools, failure mode and effects analysis (FMEA) and root cause analysis (RCA) are examples of engineering reliability evaluations that link reliability with quality and risk. Current concepts in pharmaceutical quality and quality management systems call for more predictive systems for maintaining quality; yet, the current pharmaceutical manufacturing literature and guidelines are curiously silent on engineering quality. This commentary discusses the meaning of engineering reliability while linking the concept to quality systems and quality risk management. The essay also discusses the difference between engineering reliability and statistical (assay) reliability. The assurance of quality in a pharmaceutical product is no longer measured only "after the fact" of manufacturing. Rather, concepts of quality systems and quality risk management call for designing quality assurance into all stages of the pharmaceutical product life cycle. Interestingly, most assays for quality are essentially static and inform product quality over the life cycle only by being repeated over time. Engineering process reliability is the fundamental concept that is meant to anticipate quality failures over the life cycle of the product. Reliability is a well-developed theory and practice for other types of manufactured products and manufacturing processes. Thus, it is well known to be an appropriate index of manufactured product quality. This essay discusses the meaning of reliability and its linkages with quality
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Frølich, Anne
2012-02-01
The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are limited, it is necessary to identify efficient methods to improve the quality of care. Comparing health care systems is a well-known method for identifying new knowledge regarding, for instance, organisational methods and principles. Kaiser Permanente (KP), an integrated health care delivery system in the U.S., is recognized as providing high-quality chronic care; to some extent, this is due to KP's implementation of the chronic care model (CCM). This model recommends a range of evidence-based management practices that support the implementation of evidence-based medicine. However, it is not clear which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved. The aim of this dissertation is to describe the effect of determinants, such as organisational structures and management practices including two selected incentives, on the quality of care in chronic diseases. The dissertation is based on four studies with the following purposes: 1) macro- or healthcare system-level identification of organisational structures and principles that affect the quality of health care services, based on a comparison of KP and the Danish health care system; 2) meso- or organisation-level identification of management practices with positive effects on screening rates for hemoglobin A1c and lipid profile in diabetes; 3) evaluation of the effect of the CCM on quality of health care services and continuity of care in a Danish setting; 4) micro- or practice-level evaluation of the
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NASA Astrophysics Data System (ADS)
Alaoui, Abdallah; Schwilch, Gudrun; Barão, Lúcia; Basch, Gottlieb; Sukkel, Wijnand; Lemesle, Julie; Ferreira, Carla; Garcia-Orenes, Fuensanta; Morugan, Alicia; Mataix, Jorge; Kosmas, Costas; Glavan, Matjaž; Tóth, Brigitta; Petrutza Gate, Olga; Lipiec, Jerzy; Reintam, Endla; Xu, Minggang; Di, Jiaying; Fan, Hongzhu; Geissen, Violette
2017-04-01
Agricultural soils are under a wide variety of pressures, including from increasing global demand for food associated with population growth, changing diets, land degradation, and associated productivity reductions potentially exacerbated by climate change. To manage the use of agricultural soils well, decision-makers need science-based, easily applicable, and cost-effective tools for assessing soil quality and soil functions. Since a practical assessment of soil quality requires the integrated consideration of key soil properties and their variations in space and time, providing such tools remains a challenging task. This study aims to assess the impact of innovative agricultural management practices on soil quality in 14 study sites across Europe (10) and China (4), covering the major pedo-climatic zones. The study is part of the European H2020 project iSQAPER, which involves 25 partners across Europe and China and is coordinated by Wageningen University, The Netherlands. iSQAPER is aimed at interactive soil quality assessment in Europe and China for agricultural productivity and environmental resilience. The study began with a thorough literature analysis to inform the selection of indicators for the assessment of soil structure and soil functions. A manual was then developed in order to standardize and facilitate the task of inventorying soil quality and management practices at the case study sites. The manual provides clear and precise instructions on how to assess the 11 selected soil quality indicators based on a visual soil assessment methodology. A newly developed infiltrometer was used to easily assess the soil infiltration capacity in the field and investigate hydrodynamic flow processes. Based on consistent calibration, the infiltrometer enables reliable prediction of key soil hydraulic properties. The main aim of this inventory is to link agricultural management practices to the soil quality status at the case study sites, and to identify innovative
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AGRICULTURAL BEST MANAGEMENT PRACTICE EFFECTIVENESS DATABASE
Resource Purpose:The Agricultural Best Management Practice Effectiveness Database contains the results of research projects which have collected water quality data for the purpose of determining the effectiveness of agricultural management practices in reducing pollutants ...
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Practice management companies improve practices' financial position.
Dupell, T
1997-11-01
To maintain control over healthcare delivery and financial decisions, as well as increase access to capital markets, some group practices are forming their own physician practice management companies. These companies should be organized to balance the expectations of physicians with the values of capital markets. This organization should include retained earnings, financial reporting in accordance with generally accepted accounting principles (GAAP), predictable earnings and cash flow, physician ownership and leadership, and incentives for high-quality management. Three large, primary care and multispecialty clinics that merged to form a new physician practice management company increased their access to capital markets and improved their overall financial position, which will help them achieve long-term survival.
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Benchmarking management practices in Australian public healthcare.
Agarwal, Renu; Green, Roy; Agarwal, Neeru; Randhawa, Krithika
2016-01-01
The purpose of this paper is to investigate the quality of management practices of public hospitals in the Australian healthcare system, specifically those in the state-managed health systems of Queensland and New South Wales (NSW). Further, the authors assess the management practices of Queensland and NSW public hospitals jointly and globally benchmark against those in the health systems of seven other countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. In this study, the authors adapt the unique and globally deployed Bloom et al. (2009) survey instrument that uses a "double blind, double scored" methodology and an interview-based scoring grid to measure and internationally benchmark the management practices in Queensland and NSW public hospitals based on 21 management dimensions across four broad areas of management - operations, performance monitoring, targets and people management. The findings reveal the areas of strength and potential areas of improvement in the Queensland and NSW Health hospital management practices when compared with public hospitals in seven countries, namely, USA, UK, Sweden, France, Germany, Italy and Canada. Together, Queensland and NSW Health hospitals perform best in operations management followed by performance monitoring. While target management presents scope for improvement, people management is the sphere where these Australian hospitals lag the most. This paper is of interest to both hospital administrators and health care policy-makers aiming to lift management quality at the hospital level as well as at the institutional level, as a vehicle to consistently deliver sustainable high-quality health services. This study provides the first internationally comparable robust measure of management capability in Australian public hospitals, where hospitals are run independently by the state-run healthcare systems. Additionally, this research study contributes to the empirical evidence base on the quality of
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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.
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Air quality impacts from prescribed forest fires under different management practices.
Tian, Di; Wang, Yuhang; Bergin, Michelle; Hu, Yongtao; Liu, Yongqiang; Russell, Armistead G
2008-04-15
Large amounts of air pollutants are emitted during prescribed forest fires. Such emissions and corresponding air quality impacts can be modulated by different forest management practices. The impacts of changing burning seasons and frequencies and of controlling emissions during smoldering on regional air quality in Georgia are quantified using source-oriented air quality modeling, with modified emissions from prescribed fires reflecting effects of each practice. Equivalent fires in the spring and winter are found to have a greater impact on PM2.5 than those in summer, though ozone impacts are larger from spring and summer fires. If prescribed fires are less frequent more biofuel is burnt in each fire, leading to larger emissions and air quality impacts per fire. For example, emissions from a fire with a 5-year fire return interval (FRI) are 72% larger than those from a fire of the same acreage with a 2-year FRI. However, corresponding long-term regional impacts are reduced with the longer FRI since the annual burned area is reduced. Total emissions for fires in Georgia with a 5-year FRI are 32% less than those with a 2-year FRI. Smoldering emissions can lead to approximately 1.0 or 1.9 microg/m3 of PM2.5 in the Atlanta PM2.5 nonattainment area during March 2002.
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USDA-ARS?s Scientific Manuscript database
Little is known about management practices that can simultaneously improve soil and environmental quality and sustain crop yields. The effect of a combination of tillage, crop rotation, and N fertilization on soil C and N, global warming potential (GWP), greenhouse gas intensity (GHGI), and malt bar...
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USDA-ARS?s Scientific Manuscript database
Best management practices (BMPs) have been widely used to address hydrology and water quality issues in both agricultural and urban areas. Increasing numbers of BMPs have been studied in research projects and implemented in watershed management projects, but a gap remains in quantifying their effect...
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Sraïri, M T; Benhouda, H; Kuper, M; Le Gal, P Y
2009-02-01
In many developing countries, milk production varies greatly according to farm size, cattle breed, and milking practices. However, production systems often are dominated by smallholder farms. Therefore, relatively small volumes of milk are delivered daily from numerous farms to intermediate cooperatives which supply industrial units. This paper argues that in such two-stage dairy chains, milk quality could be improved by focusing on farming practices rather than on the testing of individual deliveries. Indeed, it is difficult to analyze their quality due to technical, economic, and logistic limitations. The objective of this study is to link on-farm practices with milk chemical quality parameters (fat and protein) and hygienic quality criteria (Aerobic Plate Count, APC and Coliforms). Cattle management practices were monitored monthly over one year on 23 farms located on an irrigation scheme in Morocco. 276 milk samples were analyzed. The monthly variability of milk quality parameters was then characterized. Results show that average cow milk chemical parameters vary within a normal range. They remain primarily linked to the genetic type of cows, the lactation stage, and the conversion of feed concentrates' net energy into milk. Overall milk hygienic quality was poor (APC and Coliforms counts were 100 fold international norms), due essentially to a lack of hygiene and inadequate milking conditions (hands, udder, and teat washing, type of bucket used, dirtiness of cows...). It is suggested that a close monitoring of herd management practices may allow the indirect control of milk quality parameters, thereby avoiding costly analyses of numerous smallholder milk deliveries.
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School Indoor Air Quality Best Management Practices Manual.
ERIC Educational Resources Information Center
Hall, Richard; Ellis, Richard; Hardin, Tim
This manual, written in response to requirements of the Washington State legislature, focuses on practices which can be undertaken during the siting, design, construction, or renovation of a school, recommends practices to help ensure good indoor air quality during building occupancy, and suggests protocols and useful reference documents for…
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Fields, Dail; Roman, Paul M; Blum, Terry C
2012-06-01
To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007-2008. Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. © Health Research and Educational Trust.
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Neale, Anne Victoria; Bowman, Marjorie A; Seehusen, Dean A
Ringing in the new year 2017! This may finally be the year of real practice improvement after many false starts. Research into practice transformation has informed both local work and national policy. Human factors and payment structures are key. And payment structures depend on how quality is measured. Large gaps between practicing physician recommendations for the most important quality measures and those currently imposed externally are exposed in this issue. Also see information on in-practice social work consultations and their outcomes and recommendations from innovators in integrated care, and for chronic opioid therapy management based on visits to many family medicine offices. Visit entropy is negative for hospital readmissions. Another article reaffirms the importance of family physicians in rural obstetrics, including Cesarean deliveries. Two articles address changing Latino health care access. New Mexico's innovative health extension agent implementation now includes research in ways that benefit all. And a glass half-full: the growth in the diversity of family medicine faculty is above average, but is not occurring as quickly as in the general population. © Copyright 2017 by the American Board of Family Medicine.
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USDA-ARS?s Scientific Manuscript database
To better understand, implement and integrate best management practices (BMPs) in agricultural watersheds, critical information on their effectiveness is required. A representative agricultural watershed, Beasley Lake, was used to compare runoff water quality draining through an integrated system of...
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Fields, Dail; Roman, Paul M; Blum, Terry C
2012-01-01
Objective To examine the relationships among general management systems, patient-focused quality management/continuous process improvement (TQM/CPI) processes, resource availability, and multiple dimensions of substance use disorder (SUD) treatment. Data Sources/Study Setting Data are from a nationally representative sample of 221 SUD treatment centers through the National Treatment Center Study (NTCS). Study Design The design was a cross-sectional field study using latent variable structural equation models. The key variables are management practices, TQM/continuous quality improvement (CQI) practices, resource availability, and treatment center performance. Data Collection Interviews and questionnaires provided data from treatment center administrative directors and clinical directors in 2007–2008. Principal Findings Patient-focused TQM/CQI practices fully mediated the relationship between internal management practices and performance. The effects of TQM/CQI on performance are significantly larger for treatment centers with higher levels of staff per patient. Conclusions Internal management practices may create a setting that supports implementation of specific patient-focused practices and protocols inherent to TQM/CQI processes. However, the positive effects of internal management practices on treatment center performance occur through use of specific patient-focused TQM/CPI practices and have more impact when greater amounts of supporting resources are present. PMID:22098342
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School policies and practices that improve indoor air quality.
Everett Jones, Sherry; Smith, Alisa M; Wheeler, Lani S; McManus, Tim
2010-06-01
To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of school health programs and policies at the state, district, and school levels. Using chi-square analyses, the rates of policies and practices that promote indoor air quality were compared between schools with and schools without a formal indoor air quality program. The findings of this study show that 51.4% of schools had a formal indoor air quality management program, and that those schools were significantly more likely than were schools without a program to have policies and use strategies to promote superior indoor air quality. These findings suggest that schools with a formal indoor air quality program are more likely support policies and engage in practices that promote superior indoor air quality.
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de Man, H; Leenen, E J T M; van Knapen, F; de Roda Husman, A M
2014-09-01
Splash parks have been associated with infectious disease outbreaks as a result of exposure to poor water quality. To be able to protect public health, risk factors were identified that determine poor water quality. Samples were taken at seven splash parks where operators were willing to participate in the study. Higher concentrations of Escherichia coli were measured in water of splash parks filled with rainwater or surface water as compared with sites filled with tap water, independent of routine inspection intervals and employed disinfection. Management practices to prevent fecal contamination and guarantee maintaining good water quality at splash parks should include selection of source water of acceptable quality.
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A residency clinic chronic condition management quality improvement project.
Halverson, Larry W; Sontheimer, Dan; Duvall, Sharon
2007-02-01
Quality improvement in chronic disease management is a major agenda for improving health and reducing health care costs. A six-component chronic disease management model can help guide this effort. Several characteristics of the "new model" of family medicine described by the Future of Family Medicine (FFM) Project Leadership Committee are promulgated to foster practice changes that improve quality. Our objective was to implement and assess a quality improvement project guided by the components of a chronic disease management model and FFM new model characteristics. Diabetes was selected as a model chronic disease focus. Multiple practice changes were implemented. A mature electronic medical record facilitated data collection and measurement of quality improvement progress. Data from the diabetes registry demonstrates that our efforts have been effective. Significant improvement occurred in five out of six quality indicators. Multidisciplinary teamwork in a model residency practice guided by chronic disease management principles and the FFM new model characteristics can produce significant management improvements in one important chronic disease.
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[Quality assurance and quality management in intensive care].
Notz, K; Dubb, R; Kaltwasser, A; Hermes, C; Pfeffer, S
2015-11-01
Treatment success in hospitals, particularly in intensive care units, is directly tied to quality of structure, process, and outcomes. Technological and medical advancements lead to ever more complex treatment situations with highly specialized tasks in intensive care nursing. Quality criteria that can be used to describe and correctly measure those highly complex multiprofessional situations have only been recently developed and put into practice.In this article, it will be shown how quality in multiprofessional teams can be definded and assessed in daily clinical practice. Core aspects are the choice of a nursing theory, quality assurance measures, and quality management. One possible option of quality assurance is the use of standard operating procedures (SOPs). Quality can ultimately only be achieved if professional groups think beyond their boundaries, minimize errors, and establish and live out instructions and SOPs.
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Ahmed, Ruhi; Baseman, Harold; Ferreira, Jorge; Genova, Thomas; Harclerode, William; Hartman, Jeffery; Kim, Samuel; Londeree, Nanette; Long, Michael; Miele, William; Ramjit, Timothy; Raschiatore, Marlene; Tomonto, Charles
2008-01-01
In July 2006 the Parenteral Drug Association's Risk Management Task Force for Aseptic Processes, conducted an electronic survey of PDA members to determine current industry practices regarding implementation of Quality Risk Management in their organizations. This electronic survey was open and publicly available via the PDA website and targeted professionals in our industry who are involved in initiating, implementing, or reviewing risk management programs or decisions in their organizations. One hundred twenty-nine members participated and their demographics are presented in the sidebar "Correspondents Profile". Among the major findings are: *The "Aseptic Processing/Filling" operation is the functional area identified as having the greatest need for risk assessment and quality risk management. *The most widely used methodology in industry to identify risk is Failure Mode and Effects Analysis (FMEA). This tool was most widely applied in assessing change control and for adverse event, complaint, or failure investigations. *Despite the fact that personnel training was identified as the strategy most used for controlling/minimizing risk, the largest contributors to sterility failure in operations are still "Personnel". *Most companies still rely on "Manufacturing Controls" to mitigate risk and deemed the utilization of Process Analytical Technology (PAT) least important in this aspect. *A majority of correspondents verified that they did not periodically assess their risk management programs. *A majority of the correspondents desired to see case studies or examples of risk analysis implementation (as applicable to aseptic processing) in future PDA technical reports on risk management.
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Raes, Patricia; Angstwurm, Matthias; Berberat, Pascal; Kadmon, Martina; Rotgans, Jerome; Streitlein-Böhme, Irmgard; Burckhardt, Gerhard; Fischer, Martin R
2014-01-01
Amended in 2013, the current version of the German Medical Licensure Regulation contains structural specifications that are also required of non-university institutions involved in Practical Year clinical training. The criteria are worded in relatively general terms. Furthermore, not all of the structural specifications can be readily applied to every subject area. In order to ensure commensurability in Practical Year instruction in Germany, not least in light of recently introduced Practical Year mobility, it is necessary to define consistent quality criteria for Practical Year training. The authors therefore propose a catalogue of criteria for the quality management process in Practical Year instruction facilities. In January 2014, the board of directors of the German Society for Medical Education decided to establish a committee comprised of representatives from various German medical faculties. In a process similar to the Delphi methodology, the group developed criteria for structure, process and outcome quality in Practical Year training in Germany. The criteria developed for structure, process and outcome quality apply to Practical Year training in academic teaching hospitals and university medical centres. Furthermore, modalities for review are proposed. The present catalogue of criteria is intended to contribute to the formation of a basis for the most consistent quality standards possible for Practical Year instruction in Germany.
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Civil Forensic Psychiatry - part 3: practical aspects of managing a medico-legal practice.
Samuels, Anthony H
2018-06-01
This is the third in a series of papers on Civil Forensic Psychiatry and provides practical advice for forensic psychiatrists, general psychiatrists and trainees who are expanding or contemplating a medico-legal aspect to their practice. Attention to the practice setting, office layout, recording of information, management of documentation, screening of briefs and proper timetabling can improve safety, quality, reliability and workload manageability.
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NASA Astrophysics Data System (ADS)
Ahmad, Mohd Akhir; Asaad, Mohd Norhasni; Saad, Rohaizah; Iteng, Rosman; Rahim, Mohd Kamarul Irwan Abdul
2016-08-01
Global competition in the automotive industry has encouraged companies to implement quality management practices in all managerial aspects to ensure customer satisfaction in products and reduce costs. Therefore, guaranteeing only product quality is insufficient without considering product sustainability, which involves economic, environment, and social elements. Companies that meet both objectives gain advantages in the modern business environment. This study addresses the issues regarding product quality and sustainability in small and medium-sized enterprises in the Malaysian automotive industry. A research was carried out in 91 SMEs automotive suppliers in throughout Malaysia. The analyzed using SPSS ver.23 has been proposed in correlation study. Specifically, this study investigates the relationship between quality management practices and organizational performance as well as the mediating effect of sustainable product development on this relationship.
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Barton, Christopher; Proudfoot, Judith; Amoroso, Cheryl; Ramsay, Emmae; Holton, Christine; Bubner, Tanya; Harris, Mark; Beilby, Justin
2009-06-01
We investigated the quality of primary care asthma management in a sample of Australian general practices. 247 general practitioners (GPs) from 97 practices completed a structured interview about management of asthma, diabetes and hypertension/heart disease. A further structured interview with the senior practice principal and practice manager was used to collect information about practice capacity for chronic disease management. Just under half of GPs (47%) had access to an asthma register and the majority (76%) had access to spirometry in their practice. In terms of routine management of asthma, 12% of GPs reported using spirometry routinely, 13% routinely reviewed written asthma action plans, 27% routinely provided education about trigger factors, 30% routinely reviewed inhaler technique, 24% routinely assessed asthma severity, and 29% routinely assessed physical activity. Practice characteristics such as practice size (p=1.0) and locality (rural/metropolitan) (p=0.7) did not predict quality of asthma management nor did indicators of practice capacity including Business maturity, IT/IM maturity, Multidisciplinary teamwork, and Clinical linkages. Gaps remain in the provision of evidence-based care for patients with asthma in general practice. Markers of practice capacity measured here were not associated with guideline-based respiratory care within practices.
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The quality assurance-risk management interface.
Little, N
1992-08-01
Involvement with both risk management and quality assurance programs has led many authors to the conclusion that the fundamental differences between these activities are, in fact, very small. "At the point of overlap, it is almost impossible to distinguish the purposes and methods of both functions from one another." "Good risk management includes real improvement in patient care through organized quality assurance activities." The interface between a proactive risk management program and a quality assurance program is dynamic and can serve the legitimate interests of both. There is little to be gained by thinking of them as separate entities and much to be gained by sharing the lessons of both. If one thinks of risk management in terms of "risk" to quality patient care, and that "assuring quality" is the most productive type of risk management, then there is no practical reason to separate one from the other.
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Engineering Quality Software: 10 Recommendations for Improved Software Quality Management
2010-04-27
lack of user involvement • Inadequate Software Process Management & Control By Contractors • No “Team” of Vendors and users; little SME participation...1990 Quality Perspectives • Process Quality ( CMMI ) • Product Quality (ISO/IEC 2500x) – Internal Quality Attributes – External Quality Attributes... CMMI /ISO 9000 Assessments – Capture organizational knowledge • Identify best practices, lessons learned Know where you are, and where you need to be
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USDA-ARS?s Scientific Manuscript database
Pasture-based best management practices (BMPs), including stream bank fencing, stream crossings, and bank stabilization, improved water quality ten years after installation by reducing sediment, but did not affect nitrogen concentration. Abundance and diversity of aquatic macroinvertebrates increas...
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Vamos, Eszter P; Pape, Utz J; Bottle, Alex; Hamilton, Fiona Louise; Curcin, Vasa; Ng, Anthea; Molokhia, Mariam; Car, Josip; Majeed, Azeem; Millett, Christopher
2011-09-06
Not enough is known about the association between practice size and clinical outcomes in primary care. We examined this association between 1997 and 2005, in addition to the impact of the Quality and Outcomes Framework, a pay-for-performance incentive scheme introduced in the United Kingdom in 2004, on diabetes management. We conducted a retrospective open-cohort study using data from the General Practice Research Database. We enrolled 422 general practices providing care for 154,945 patients with diabetes. Our primary outcome measures were the achievement of national treatment targets for blood pressure, glycated hemoglobin (HbA(1c)) levels and total cholesterol. We saw improvements in the recording of process of care measures, prescribing and achieving intermediate outcomes in all practice sizes during the study period. We saw improvement in reaching national targets after the introduction of the Quality and Outcomes Framework. These improvements significantly exceeded the underlying trends in all practice sizes for achieving targets for cholesterol level and blood pressure, but not for HbA(1c) level. In 1997 and 2005, there were no significant differences between the smallest and largest practices in achieving targets for blood pressure (1997 odds ratio [OR] 0.98, 95% confidence interval [CI] 0.82 to 1.16; 2005 OR 0.92, 95% CI 0.80 to 1.06 in 2005), cholesterol level (1997 OR 0.94, 95% CI 0.76 to 1.16; 2005 OR 1.1, 95% CI 0.97 to 1.40) and glycated hemoglobin level (1997 OR 0.79, 95% CI 0.55 to 1.14; 2005 OR 1.05, 95% CI 0.93 to 1.19). We found no evidence that size of practice is associated with the quality of diabetes management in primary care. Pay-for-performance programs appear to benefit both large and small practices to a similar extent.
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Alcalde, M J; Suárez, M D; Rodero, E; Álvarez, R; Sáez, M I; Martínez, T F
2017-09-01
Studies aimed to assess up to what extent farming and transport previous to slaughtering might affect physiology and meat quality in young goat kids are needed, with the ultimate purpose of promoting practices that minimize stress in these animals. In this regard the effects of on-farm management and transport duration on some physiological responses and meat quality parameters in goat kids were assessed. Two farms representing 'high' and 'low' welfare-friendly management practices were selected. In total, 32 suckling kids were withdrawn from each farm, transported by road for 2 or 6 h, and then slaughtered. Blood samples were collected both on-farm and in the slaughterhouse, and biochemistry, cell counts and haematocrit were determined. After slaughtering, carcass quality parameters were measured. Longissimus dorsi muscle was dissected and pH, colour parameters, water holding capacity and shear force were measured throughout 8-day ageing period. Results indicate that, regardless its duration, transport caused significant effects on some blood parameters suggesting stress in live animals, like glucose, cortisol or creatine kinase. Despite the marked stress status in animals, this condition was not decisively reflected on L. dorsi quality parameters, but some effects were observed regarding fat cover in carcasses and colour parameters. The results suggest that postmortem changes throughout ageing were more decisive in terms of meat quality than stressful management either on-farm or during transport.
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ERIC Educational Resources Information Center
General Accounting Office, Washington, DC. National Security and International Affairs Div.
The General Accounting Office (GAO) examined the impact of formal total quality management (TQM) practices on the performance of 20 selected U.S. companies that were among the highest-scoring applicants in 1988 and 1989 for the Malcolm Baldridge National Quality Award. Several key indicators used by companies to measure performance were analyzed.…
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NASA total quality management 1989 accomplishments report
NASA Technical Reports Server (NTRS)
1990-01-01
Described here are the accomplishments of NASA as a result of the use of Total Quality Management (TQM). The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories of TQM discussed here are top management leadership and support, strategic planning, focus on the customer, employee training and recognition, employee empowerment and teamwork, measurement and analysis, and quality assurance.
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Non-point source (NPS) pollution is one of the leading causes of water quality impairment within the United States. Conservation, restoration and altered management (CRAM) practices may effectively reduce NPS pollutants discharge into receiving water bodies and enhance local and ...
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Quality management, a directive approach to patient safety.
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.
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Total Quality Management (TQM): Group Dynamics Workshop
1990-05-15
interactions with other OSD decision-making bodies. " Remove barriers /facilitate implementation. " Direct action on unresolved process problems referred...TQM leadership. - Total Quality Management FUNCTIONS: * Translate goals to tangible internal initiatives. " Remove barriers . " Establish and...Quality Management FUNCTIONS: • Identify and remove barriers . " Develop practical process improvements. " Install solutions and measurement systems for
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Analysis of air quality management with emphasis on transportation sources
NASA Technical Reports Server (NTRS)
English, T. D.; Divita, E.; Lees, L.
1980-01-01
The current environment and practices of air quality management were examined for three regions: Denver, Phoenix, and the South Coast Air Basin of California. These regions were chosen because the majority of their air pollution emissions are related to mobile sources. The impact of auto exhaust on the air quality management process is characterized and assessed. An examination of the uncertainties in air pollutant measurements, emission inventories, meteorological parameters, atmospheric chemistry, and air quality simulation models is performed. The implications of these uncertainties to current air quality management practices is discussed. A set of corrective actions are recommended to reduce these uncertainties.
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The Potential Importance of Conservation, Restoration and Altered Management Practices for Water Quality in the Wabash River Watershed Guoxiang Yang1, Elly P.H. Best2, Staci Goodwin3 1 ORISE Postdoc Research Associate at U.S. Environmental Protection Agency, National Risk...
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Total quality management in blood transfusion.
Smit-Sibinga, C T
2000-01-01
Quality management is an ongoing development resulting in consistency products and services and ever increasing customer satisfaction. The ultimum is Total Quality Management. Quality systems and quality management in transfusion medicine have gained considerable attention since the outbreak of the AIDS epidemic. Where product orientation has long been applied through quality control, Good Manufacturing Practice (GMP) principles were introduced, shifting the developments in the direction of process orientation. Globally, and particularly in the more industrialised world people and system orientation has come along with the introduction of the ISO9001 concept. Harmonisation and a degree of uniformity are needed to implement a universally applicable Quality System and related Quality Management. Where the American Association of Blood Banks (AABB) is the professional organisation with the most extensive experience in quality systems in blood transfusion, the European Union and the Council of Europe now are in the process to design a quality system and management applicable to a larger variety of countries, based on a hybrid of current GMP and ISO9001 principles. The International Federation of Red Cross and Red Crescent Societies has developed a more universally to implement Quality Manual, with a pilot project in Honduras. It is recommendable to harmonise the various designs and bring the approaches under one common denominator.
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Quality-Oriented Management of Educational Innovation at Madrasah Ibtidaiyah
ERIC Educational Resources Information Center
Sofanudin, Aji; Rokhman, Fathur; Wasino; Rusdarti
2016-01-01
This study aims to explore the quality-oriented management of educational innovation at Madrasah Ibtidaiyah. Quality-Oriented Management of Educational Innovation is the process of managing new resources (ideas, practices, objects, methods) in the field of education to achieve educational goals or solve the problem of education. New ideas,…
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Quality Improvement in Gastroenterology Clinical Practice
KHERAJ, RAKHI; TEWANI, SUMEET K.; KETWAROO, GYANPRAKASH; LEFFLER, DANIEL A.
2017-01-01
An emphasis on quality improvement (QI) is vital to the cost-effective provision of evidence-based health care. QI projects in gastroenterology have typically focused on endoscopy to minimize or eliminate procedure-related complications or errors. However, a significant component of gastroenterology care is based on the management of chronic disease. Patients with chronic diseases are seen in many different outpatient practices in the community and academia. In an attempt to ensure that every patient receives high-quality care, major gastrointestinal societies have published guidelines on the management of common gastrointestinal complaints. However, adherence to these guidelines varies. We discuss common outpatient gastrointestinal illnesses with established guidelines for management that could benefit from active QI projects; these would ensure a consistently high standard of care for every patient. PMID:22902758
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[ISO 9001:2015 Certification in Quality Management].
Enders, Christian; Lang, Gabriele E; Lang, Gerhard K; Werner, Jens Ulrich
2017-07-01
Quality management improves the structures, processes and results of organizations of all kinds. Many practices and clinics have their existing quality management system certified according to ISO 9001, (e.g., to check their own quality management system or to obtain a testimonial against third parties). The latest version ISO 9001:2015 contains some changes, both structurally and in terms of content. These changes can be met with reasonable efforts. An ISO 9001:2015 certification represents a value for your organization, but these advantages are often not directly measurable. Georg Thieme Verlag KG Stuttgart · New York.
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Lorv, Bailey; Horodyski, Robin; Welton, Cynthia; Vail, John; Simonetto, Luca; Jokanovic, Danilo; Sharma, Richa; Mahoney, Angela Rea; Savoy-Bird, Shay; Bains, Shalu
2017-01-01
There is increasing awareness of the importance of medical device reprocessing (MDR) for the provision of safe patient care. Although industry service standards are available to guide MDR practices, there remains a lack of published key performance indicators (KPIs) and targets that are necessary to evaluate MDR quality for feedback and improvement. This article outlines the development of an initial framework that builds on established guidelines and includes service standards, KPIs and targets for evaluating MDR operations. This framework can support healthcare facilities in strengthening existing practices and enables a platform for collaboration towards better MDR performance management.
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The role of management in an in vitro fertilization practice.
Masler, Steve; Strickland, Robert R
2013-05-01
An in vitro fertilization (IVF) practice is an enterprise. Like any enterprise, it has management that plays a major role, forming the structure, framework, and components that make the practice viable. Management of an IVF practice consists of two key teams: the fertility team and the management team. Management activities of the teams fall into eight core areas: business operations, financial, human resources, information technology, organizational governance, risk management, patient care systems, and quality management. Shady Grove Fertility Centers and Huntington Reproductive Center are two examples of professionally managed large fertility practices, one managed mostly centrally and the other largely managed in a decentralized way. Management is what takes a physician's IVF practice and converts it to a professional enterprise. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.
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Total Quality Management: Empirical, Conceptual, and Practical Issues.
ERIC Educational Resources Information Center
Hackman, J. Richard; Wageman, Ruth
1995-01-01
Total quality management (TQM) has become a U.S. social movement. This commentary analyzes the writings of W. Edwards Deming, Joseph Juran, and Kaoru Ishikawa to assess TQM's coherence, distinctiveness, and likely perseverance. Rhetoric is winning over substance, unrelated interventions are being herded under the TQM banner, and research is not…
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Kimura, Joe; DaSilva, Karen; Marshall, Richard
2008-02-01
The increasing prevalence of chronic illnesses in the United States requires a fundamental redesign of the primary care delivery system's structure and processes in order to meet the changing needs and expectations of patients. Population management, systems-based practice, and planned chronic illness care are 3 potential processes that can be integrated into primary care and are compatible with the Chronic Care Model. In 2003, Harvard Vanguard Medical Associates, a multispecialty ambulatory physician group practice based in Boston, Massachusetts, began implementing all 3 processes across its primary care practices. From 2004 to 2006, the overall diabetes composite quality measures improved from 51% to 58% for screening (HgA1c x 2, low-density lipoprotein, blood pressure in 12 months) and from 13% to 17% for intermediate outcomes (HgA1c
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[Quality management in private practice. A nationwide survey in Germany].
Obermann, K; Müller, P
2007-08-01
Quality management (QM) will soon become mandatory for private practice physicians in Germany. We aimed to assess the knowledge about and state of implementation of QM in German private practices. In cooperation with the Stiftung Gesundheit (Foundation for Health), Hamburg, a stratified sample of 15,383 physicians was requested via e-mail in 2006 to participate in the online survey. The survey covered sources of information and experiences with QM, cost of implementing QM, and general attitudes towards QM in private health care. A total of 787 doctors (5.1% response rate) rendered useful data sets; 16% of doctors had not yet familiarized themselves with QM. The DIN-ISO QM System is by far the best-known system, with 86% of doctors having heard about it. All other systems are known by only 30% or less of the physicians. Only about 20% of private practices have already implemented QM or are about to have it implemented. The cost of QM depends heavily on the system used with DIN-ISO (5600 euros) and EFQM (2800 euros) being the more expensive, while EPA (1800 euros) and QEP (850 euros) are much less costly. All QM systems require roughly the same amount of time from staff to be implemented and maintained. Two thirds of all doctors have not yet decided which QM system to use and contacts during seminars and recommendations from colleagues are most important when selecting a system. The level of satisfaction with QM service providers is generally high. In general, the study revealed a very heterogeneous picture. As with other new technologies or organizational changes there is a group of enthusiastic "early adopters," but we also found a substantial number of physicians (about 25%) who are highly skeptical about implementing QM. They posed a challenge for health policy and service providers alike and careful market segmentation will be needed to cater for the different needs of the different groups of doctors. Moreover, the still rather technical approach towards QM
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NASA Astrophysics Data System (ADS)
Rodriguez, Hector German; Popp, Jennie; Maringanti, Chetan; Chaubey, Indrajeet
2011-01-01
An increased loss of agricultural nutrients is a growing concern for water quality in Arkansas. Several studies have shown that best management practices (BMPs) are effective in controlling water pollution. However, those affected with water quality issues need water management plans that take into consideration BMPs selection, placement, and affordability. This study used a nondominated sorting genetic algorithm (NSGA-II). This multiobjective algorithm selects and locates BMPs that minimize nutrients pollution cost-effectively by providing trade-off curves (optimal fronts) between pollutant reduction and total net cost increase. The usefulness of this optimization framework was evaluated in the Lincoln Lake watershed. The final NSGA-II optimization model generated a number of near-optimal solutions by selecting from 35 BMPs (combinations of pasture management, buffer zones, and poultry litter application practices). Selection and placement of BMPs were analyzed under various cost solutions. The NSGA-II provides multiple solutions that could fit the water management plan for the watershed. For instance, by implementing all the BMP combinations recommended in the lowest-cost solution, total phosphorous (TP) could be reduced by at least 76% while increasing cost by less than 2% in the entire watershed. This value represents an increase in cost of 5.49 ha-1 when compared to the baseline. Implementing all the BMP combinations proposed with the medium- and the highest-cost solutions could decrease TP drastically but will increase cost by 24,282 (7%) and $82,306 (25%), respectively.
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[QUIPS: quality improvement in postoperative pain management].
Meissner, Winfried
2011-01-01
Despite the availability of high-quality guidelines and advanced pain management techniques acute postoperative pain management is still far from being satisfactory. The QUIPS (Quality Improvement in Postoperative Pain Management) project aims to improve treatment quality by means of standardised data acquisition, analysis of quality and process indicators, and feedback and benchmarking. During a pilot phase funded by the German Ministry of Health (BMG), a total of 12,389 data sets were collected from six participating hospitals. Outcome improved in four of the six hospitals. Process indicators, such as routine pain documentation, were only poorly correlated with outcomes. To date, more than 130 German hospitals use QUIPS as a routine quality management tool. An EC-funded parallel project disseminates the concept internationally. QUIPS demonstrates that patient-reported outcomes in postoperative pain management can be benchmarked in routine clinical practice. Quality improvement initiatives should use outcome instead of structural and process parameters. The concept is transferable to other fields of medicine. Copyright © 2011. Published by Elsevier GmbH.
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Mississippi's New Forestry Best Management Practices Video
Andrew James Londo; John Benkert Auel
2004-01-01
Mississippi's latest version of forestry best management practices (BMPs) for water quality was released in 2000. In conjunction with this release, funds were obtained through a Section 319H grant from the Mississippi Department of Environmental Quality to create a new BMPs video. Additional assistance was obtained from Georgia Pacific, PlumCreek, Weyerhaeuser,...
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IMPLEMENTING ACCOUNTABILITY WITHIN A MULTI-POLLUTANT AIR QUALITY MANAGEMENT FRAMEWORK
In 2004, the National Research Council (NRC) published a major assessment of air quality management practices: Air Quality Management in the United States. The assessment resulted from a Congressional directive that the U.S. Environmental Protection Agency commission the Nationa...
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An Effective Time and Management Strategy in Quality Circles.
ERIC Educational Resources Information Center
Halverson, Don E.
Contending that participation in quality circles enhances effective time management by school administrators and teachers, this guide provides both a theoretical briefing and practical recommendations for better time management. A pre- posttest prefaces a review of basic concepts of quality circles with reference to the work of Abraham Maslow,…
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Total Quality Management: Public Sector Applications for Training Programs.
ERIC Educational Resources Information Center
Davis, David S.
Total quality management (TQM) is based on the fundamental philosophy that it is always more effective to do something right the first time than it is to correct deficiencies. It seeks to improve quality and increase customer satisfaction by restructuring traditional management and organizational practices. Common characteristics of TQM include…
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Public health laboratory quality management in a developing country.
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.
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Althausen, Peter L; Mead, Lisa
2014-07-01
The practicing orthopaedic traumatologist must have a sound knowledge of business fundamentals to be successful in the changing healthcare environment. Practice management encompasses multiple topics including governance, the financial aspects of billing and coding, physician extender management, ancillary service development, information technology, transcription utilization, and marketing. Some of these are universal, but several of these areas may be most applicable to the private practice of medicine. Attention to each component is vital to develop an understanding of the intricacies of practice management.
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Leadership and management for quality.
Gillam, Steve; Siriwardena, A Niroshan
2013-01-01
This is the third in a series of articles about the science of quality improvement. Leadership and management are required for change and are therefore important for all quality improvement initiatives. We describe the differences between and features of each, and how they support change in individuals, groups and organisations according to the culture and characteristics of the latter. Finally, we see that leadership competencies are conceptualised in the NHS Leadership Framework and how this can be applied to quality improvement in general practice and healthcare more generally.
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Development of the private practice management standards for psychology.
Mathews, Rebecca; Stokes, David; Littlefield, Lyn; Collins, Leah
2011-01-01
This paper describes the process of developing a set of private practice management standards to support Australian psychologists and promote high quality services to the public. A review of the literature was conducted to identify management standards relevant to psychology, which were further developed in consultation with a panel of experts in psychology or in the development of standards. Forty-three psychologists in independent private practice took part in either a survey (n=22) to provide feedback on the relevance of, and their compliance with, the identified standards, or a 6-month pilot study (n=21) in which a web-based self-assessment instrument evaluating the final set of standards and performance indicators was implemented in their practice to investigate self-reported change in management procedures. The pilot study demonstrated good outcomes for practitioners when evaluation of compliance to the standards was operationalized in a self-assessment format. Study results are based on a small sample size. Nevertheless, relevance and utility of the standards was found providing an initial version of management standards that have relevance to the practice of psychology in Australia, along with a system for evaluating psychological service provision to ensure best practice in service delivery. © 2010 National Association for Healthcare Quality.
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Employee Perceptions of Quality Management: Effects of Employee Orientation Training
ERIC Educational Resources Information Center
Akdere, Mesut; Schmidt, Steven W.
2008-01-01
This empirical study examines employee perceptions of quality management at three different time periods. New employees at a large United States manufacturing organization were surveyed regarding their perceptions of their organization's quality management practices before they attended a new employee orientation training, immediately after the…
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Quality Management Framework for Total Diet Study centres in Europe.
Pité, Marina; Pinchen, Hannah; Castanheira, Isabel; Oliveira, Luisa; Roe, Mark; Ruprich, Jiri; Rehurkova, Irena; Sirot, Veronique; Papadopoulos, Alexandra; Gunnlaugsdóttir, Helga; Reykdal, Ólafur; Lindtner, Oliver; Ritvanen, Tiina; Finglas, Paul
2018-02-01
A Quality Management Framework to improve quality and harmonization of Total Diet Study practices in Europe was developed within the TDS-Exposure Project. Seventeen processes were identified and hazards, Critical Control Points and associated preventive and corrective measures described. The Total Diet Study process was summarized in a flowchart divided into planning and practical (sample collection, preparation and analysis; risk assessment analysis and publication) phases. Standard Operating Procedures were developed and implemented in pilot studies in five organizations. The flowchart was used to develop a quality framework for Total Diet Studies that could be included in formal quality management systems. Pilot studies operated by four project partners were visited by project assessors who reviewed implementation of the proposed framework and identified areas that could be improved. The quality framework developed can be the starting point for any Total Diet Study centre and can be used within existing formal quality management approaches. Copyright © 2017 Elsevier Ltd. All rights reserved.
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Managing Both Quality and Access at Higher Educational Institutions in Tobago
ERIC Educational Resources Information Center
Julien Sealey, Beverley
2011-01-01
This paper will focus on the island of Tobago and indicate what practical solutions are best suited for administrators to manage quality and access at higher educational institutions on the island. The key areas to managing quality identified are the inclusiveness of a quality plan, administrators desire to see quality as an institutional culture…
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Sturtevant, Judith E.; Heaphy, Robert; Hodges, Ann Louise
2006-09-01
The purpose of the Sandia National Laboratories Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. The plan defines the ASC program software quality practices and provides mappings of these practices to Sandia Corporate Requirements CPR 1.3.2 and 1.3.6 and to a Department of Energy document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines. This document also identifies ASC management and software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals.
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School Policies and Practices that Improve Indoor Air Quality
ERIC Educational Resources Information Center
Jones, Sherry Everett; Smith, Alisa M.; Wheeler, Lani S.; McManus, Tim
2010-01-01
Background: To determine whether schools with a formal indoor air quality management program were more likely than schools without a formal program to have policies and practices that promote superior indoor air quality. Methods: This study analyzed school-level data from the 2006 School Health Policies and Programs Study, a national study of…
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A Quality Improvement Collaborative Program for Neonatal Pain Management in Japan
Yokoo, Kyoko; Funaba, Yuuki; Fukushima, Sayo; Fukuhara, Rie; Uchida, Mieko; Aiba, Satoru; Doi, Miki; Nishimura, Akira; Hayakawa, Masahiro; Nishimura, Yutaka; Oohira, Mitsuko
2017-01-01
Background: Neonatal pain management guidelines have been released; however, there is insufficient systematic institutional support for the adoption of evidence-based pain management in Japan. Purpose: To evaluate the impact of a collaborative quality improvement program on the implementation of pain management improvements in Japanese neonatal intensive care units (NICUs). Methods: Seven Japanese level III NICUs participated in a neonatal pain management quality improvement program based on an Institute for Healthcare Improvement collaborative model. The NICUs developed evidence-based practice points for pain management and implemented these over a 12-month period. Changes were introduced through a series of Plan-Do-Study-Act cycles, and throughout the process, pain management quality indicators were tracked as performance measures. Jonckheere's trend test and the Cochran-Armitage test for trend were used to examine the changes in quality indicator implementations over time (baseline, 3 months, 6 months, and 12 months). Findings: Baseline pain management data from the 7 sites revealed substantial opportunities for improvement of pain management, and testing changes in the NICU setting resulted in measurable improvements in pain management. During the intervention phase, all participating sites introduced new pain assessment tools, and all sites developed electronic medical record forms to capture pain score, interventions, and infant responses to interventions. Implications for Practice: The use of collaborative quality improvement techniques played a key role in improving pain management in the NICUs. Implications for Research: Collaborative improvement programs provide an attractive strategy for solving evidence-practice gaps in the NICU setting. PMID:28114148
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Turgeon, Jennifer L.; Minana, Molly A.; Hackney, Patricia
2009-01-01
The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in the US Department of Energy/National Nuclear Security Agency (DOE/NNSA) Quality Criteria, Revision 10 (QC-1) as 'conformance to customer requirements and expectations'. This quality plan defines the SNL ASC Program software quality engineering (SQE) practices and provides a mapping of these practices to the SNL Corporate Process Requirement (CPR) 001.3.6; 'Corporate Software Engineering Excellence'. This plan also identifies ASC management's and themore » software project teams responsibilities in implementing the software quality practices and in assessing progress towards achieving their software quality goals. This SNL ASC Software Quality Plan establishes the signatories commitments to improving software products by applying cost-effective SQE practices. This plan enumerates the SQE practices that comprise the development of SNL ASC's software products and explains the project teams opportunities for tailoring and implementing the practices.« less
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Associations between management practices and colostrum quality on New Zealand dairy farms.
Denholm, K S; Hunnam, J C; Cuttance, E L; McDougall, S
2017-09-01
To describe colostrum quality in spring-calving dairy herds in New Zealand, in terms of Brix, pH and total and coliform bacterial counts and to investigate associations between farm management practices and these measures of colostrum quality. In June 2015, commercial dairy farms (n=105), located in North and South Islands of New Zealand, were visited shortly after the first cows had calved, and when approximately 50% and 80% of the herd had calved (early, middle and late visits). One litre of pooled colostrum that was being fed to newborn calves was collected at each visit and used to determine Brix, pH, total bacterial and coliform counts. A survey of calf management practices was conducted with the herd manager or calf rearer after the final visit. Of 298 pooled colostrum samples tested 29/298 (9.7%) had Brix >22%. Brix was higher on farms where calves were picked up twice daily compared with once daily (18.2 (95% CI=16.5-19.9)% vs. 15.9% (95% CI=15.2-16.6)%; p=0.012), and was lower where first milking colostrum was combined with colostrum obtained at later milkings (15.0 (95% CI=13.9-16.1)%) compared with where it was not (16.9 (95% CI=16.3-17.6)%; p=0.002). Vaccination of all cows against calf diarrhoeal pathogens was associated with increased Brix compared with no vaccination (18.1 (95% CI=16.6-19.6)% vs. 16.3 (95% CI=15.6-17.0)%; p=0.033). Mean pH of samples tested decreased from 5.97 (95% CI=5.84-6.09) to 5.58 (95% CI=5.45-5.71) for early and late-season visits, respectively (p<0.001). Of 268 samples tested, 23 (8.6%) had bacterial counts below the recommended threshold of 1.00×10 5 cfu/mL. Mean bacterial counts increased from 2.75 (95% CI=1.80-3.70)×10 8 to 4.99 (95% CI=3.95-6.03)×10 8 cfu/mL for early and late-season visits, respectively (p<0.001). Of 259 samples tested, 23 (8.9%) had coliform counts below the recommended threshold of 1.00×10 4 cfu/mL. On a large majority of dairy farms included in this study the pooled colostrum fed to newborn calves
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Drinking water quality management: a holistic approach.
Rizak, S; Cunliffe, D; Sinclair, M; Vulcano, R; Howard, J; Hrudey, S; Callan, P
2003-01-01
A growing list of water contaminants has led to some water suppliers relying primarily on compliance monitoring as a mechanism for managing drinking water quality. While such monitoring is a necessary part of drinking water quality management, experiences with waterborne disease threats and outbreaks have shown that compliance monitoring for numerical limits is not, in itself, sufficient to guarantee the safety and quality of drinking water supplies. To address these issues, the Australian National Health and Medical Research Council (NHMRC) has developed a Framework for Management of Drinking Water Quality (the Framework) for incorporation in the Australian Drinking Water Guidelines, the primary reference on drinking water quality in Australia. The Framework was developed specifically for drinking water supplies and provides a comprehensive and preventive risk management approach from catchment to consumer. It includes holistic guidance on a range of issues considered good practice for system management. The Framework addresses four key areas: Commitment to Drinking Water Quality Management, System Analysis and System Management, Supporting Requirements, and Review. The Framework represents a significantly enhanced approach to the management and regulation of drinking water quality and offers a flexible and proactive means of optimising drinking water quality and protecting public health. Rather than the primary reliance on compliance monitoring, the Framework emphasises prevention, the importance of risk assessment, maintaining the integrity of water supply systems and application of multiple barriers to assure protection of public health. Development of the Framework was undertaken in collaboration with the water industry, regulators and other stakeholder, and will promote a common and unified approach to drinking water quality management throughout Australia. The Framework has attracted international interest.
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Nursing practice environment, quality of care, and morale of hospital nurses in Japan.
Anzai, Eriko; Douglas, Clint; Bonner, Ann
2014-06-01
The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. © 2013 Wiley Publishing Asia Pty Ltd.
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Management Practices Used in Agricultural Drainage Ditches to Reduce Gulf of Mexico Hypoxia.
Faust, Derek R; Kröger, Robert; Moore, Matthew T; Rush, Scott A
2018-01-01
Agricultural non-point sources of nutrients and sediments have caused eutrophication and other water quality issues in aquatic and marine ecosystems, such as the annual occurrence of hypoxia in the Gulf of Mexico. Management practices have been implemented adjacent to and in agricultural drainage ditches to promote their wetland characteristics and functions, including reduction of nitrogen, phosphorus, and sediment losses downstream. This review: (1) summarized studies examining changes in nutrient and total suspended solid concentrations and loads associated with management practices in drainage ditches (i.e., riser and slotted pipes, two-stage ditches, vegetated ditches, low-grade weirs, and organic carbon amendments) with emphasis on the Lower Mississippi Alluvial Valley, (2) quantified management system effects on nutrient and total suspended solid concentrations and loads and, (3) identified information gaps regarding water quality associated with these management practices and research needs in this area. In general, management practices used in drainage ditches at times reduced losses of total suspended solids, N, and P. However, management practices were often ineffective during storm events that were uncommon and intense in duration and volume, although these types of events could increase in frequency and intensity with climate change. Studies on combined effects of management practices on drainage ditch water quality, along with research towards improved nutrient and sediment reduction efficiency during intense storm events are urgently needed.
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Leong, Tiong Kung; Zakuan, Norhayati; Mat Saman, Muhamad Zameri; Ariff, Mohd Shoki Md; Tan, Choy Soon
2014-01-01
This paper proposed seven existing and new performance indicators to measure the effectiveness of quality management system (QMS) maintenance and practices in construction industry. This research is carried out with a questionnaire based on QMS variables which are extracted from literature review and project performance indicators which are established from project management's theory. Data collected was analyzed using correlation and regression analysis. The findings indicate that client satisfaction and time variance have positive and significant relationship with QMS while other project performance indicators do not show significant results. Further studies can use the same project performance indicators to study the effectiveness of QMS in different sampling area to improve the generalizability of the findings.
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Leong, Tiong Kung; Ariff, Mohd. Shoki Md.
2014-01-01
This paper proposed seven existing and new performance indicators to measure the effectiveness of quality management system (QMS) maintenance and practices in construction industry. This research is carried out with a questionnaire based on QMS variables which are extracted from literature review and project performance indicators which are established from project management's theory. Data collected was analyzed using correlation and regression analysis. The findings indicate that client satisfaction and time variance have positive and significant relationship with QMS while other project performance indicators do not show significant results. Further studies can use the same project performance indicators to study the effectiveness of QMS in different sampling area to improve the generalizability of the findings. PMID:24701182
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Practical approaches for health care: Indoor air quality management
DOE Office of Scientific and Technical Information (OSTI.GOV)
Turk, A.R.; Poulakos, E.M.
1996-05-01
The management of indoor air quality (IAQ) is of interest to building occupants, managers, owners, and regulators alike. Whether by poor design, improper attention, inadequate maintenance or the intent to save energy, many buildings today have significantly degraded IAQ levels. Acceptable IAQ is defined by the American Society of Heating, Refrigerating, and Air Conditioning Engineers (ASHRAE) in Standard 62-1989 {open_quotes}Ventilation for Acceptable Indoor Air Quality{close_quotes} as {open_quotes}air in which there are no known contaminants at harmful concentrations as determined by cognizant authorities and with which a substantial majority (80 percent or more) of the people exposed do not express dissatisfaction.{close_quotes}more » ASHRAE`s definition not only addresses the chemical compounds that may be present in the air, but it also recognizes a need to address both physiological and psychosocial comfort. The second step is to conduct a performance review of the HVAC systems based on equipment design specifications and guidelines for acceptable IAQ. And the third step is to identify potential chemical, physical and biological sources that are known to contribute to adverse air quality. Upon completion of these three steps, you will able to identify the more significant contributors to IAQ problems and establish applications for prevention and mitigation.« less
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Lean practices for quality results: a case illustration.
Hwang, Pauline; Hwang, David; Hong, Paul
2014-01-01
Increasingly, healthcare providers are implementing lean practices to achieve quality results. Implementing lean healthcare practices is unique compared to manufacturing and other service industries. The purpose of this paper is to present a model that identifies and defines the lean implementation key success factors in healthcare organisations. The model is based on an extant literature review and a case illustration that explores actual lean implementation in a major USA hospital located in a Midwestern city (approximately 300,000 people). An exploratory/descriptive study using observation and follow-up interviews was conducted to identify lean practices in the hospital. Lean practice key drivers include growing elderly populations, rising medical expenses, decreasing insurance coverage and decreasing management support. Effectively implementing lean practices to increase bottom-line results and improve organisational integrity requires sharing goals and processes among healthcare managers and professionals. An illustration explains the model and the study provides a sound foundation for empirical work. Practical implications are included. Lean practices minimise waste and unnecessary hospital stays while simultaneously enhancing customer values and deploying resources in supply systems. Leadership requires clear project targets based on sound front-end planning because initial implementation steps involve uncertainty and ambiguity (i.e. fuzzy front-end planning). Since top management support is crucial for implementing lean practices successfully, a heavyweight manager, who communicates well both with top managers and project team members, is an important success factor when implementing lean practices. Increasingly, green orientation and sustainability initiatives are phrases that replaced lean practices. Effective results; e.g. waste reduction, employee satisfaction and customer values are applicable to bigger competitive challenges arising both in specific
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NASA Astrophysics Data System (ADS)
Beattie, C. I.; Longhurst, J. W. S.; Woodfield, N. K.
The air quality management (AQM) framework in the UK is designed to be an effects-based solution to air pollutants currently affecting human health. The AQM process has been legislated through The Environment Act 1995, which required the National Air Quality Strategy (NAQS) to be published. AQM practice and capability within local authorities has flourished since the publication of the NAQS in March 1997. This paper outlines the policy framework within which the UK operates, both at a domestic and European level, and reviews the air quality management process relating to current UK policy and EU policy. Data from questionnaire surveys are used to indicate the involvement of various sectors of local government in the air quality management process. These data indicate an increasing use of monitoring, and use of air dispersion modelling by English local authorities. Data relating to the management of air quality, for example, the existence and work of air quality groups, dissemination of information to the public and policy measures in place on a local scale to improve air quality, have also been reported. The UK NAQS has been reviewed in 1999 to reflect developments in European legislation, technological and scientific advances, improved air pollution modelling techniques and an increasingly better understanding of the socio-economic issues involved. The AQM process, as implemented by UK local authorities, provides an effective model for other European member states with regards to the implementation of the Air Quality Framework Directive. The future direction of air quality policy in the UK is also discussed.
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Alexander, Jeffrey A; Maeng, Daniel; Casalino, Lawrence P; Rittenhouse, Diane
2013-04-01
To examine the effect of public reporting (PR) and financial incentives tied to quality performance on the use of care management practices (CMPs) among small- and medium-sized physician groups. Survey data from The National Study of Small and Medium-sized Physician Practices were used. Primary data collection was also conducted to assess community-level PR activities. The final sample included 643 practices engaged in quality reporting; about half of these practices were subject to PR. We used a treatment effects model. The instrumental variables were the community-level variables that capture the level of PR activity in each community in which the practices operate. (1) PR is associated with increased use of CMPs, but the estimate is not statistically significant; (2) financial incentives are associated with greater use of CMPs; (3) practices' awareness/sensitivity to quality reports is positively related to their use of CMPs; and (4) combined PR and financial incentives jointly affect CMP use to a greater degree than either of these factors alone. Small- to medium-sized practices appear to respond to PR and financial incentives by greater use of CMPs. Future research needs to investigate the appropriate mix and type of incentive arrangements and quality reporting. © Health Research and Educational Trust.
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NASA Astrophysics Data System (ADS)
Rao, N. S.; Easton, Z. M.; Lee, D. R.; Steenhuis, T. S.
2007-12-01
Nutrient runoff from agricultural fields threatens water quality and can impair habitats in many watersheds. Agencies consider these potential risks as they determine acceptable levels of nutrient loading. For example, in the New York City (NYC) watershed, the Environmental Protection Agency's Total Maximum Daily Load (TMDL) for phosphorus (P) has been set at 15μg P L-1 to protect against eutrophication and bacterial outbreaks. In the NYC watersheds agricultural Best Management Practices (BMPs) are the primary means to control nonpoint source P loading. BMPs include riparian buffers, filter strips, manure storage facilities, crop rotation, stripcropping, tree planting and nutrient management plans (NMPs). Water quality research on BMPs to date has included studies on site-specificity of different BMPs, short and long term BMP efficacy, and placement of BMPs with respect to critical source areas. A necessary complement to studies addressing water quality aspects of different BMPs are studies examining the cost-benefit aspects of BMPs. In general, there are installment, maintenance and opportunity costs associated with each BMP, and there are benefits, including cost share agreements between farmers and farm agencies, and increased efficiency of farm production and maintenance. Combining water quality studies and related cost-benefit analyses would help planners and watershed managers determine how best improve water quality. Our research examines the costs-benefit structure associated with BMP scenarios on a one-farm headwater watershed in the Catskill Mountains of NY. The different scenarios include "with and without" BMPs, combinations of BMPs, and different BMP placements across agricultural fields. The costs associated with each BMP scenarios are determined using information from farm agencies and watershed planning agencies. With these data we perform a cost-benefit analysis for the different BMP scenarios and couple the water quality modeling using the
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Liu, Yaoze; Engel, Bernard A; Flanagan, Dennis C; Gitau, Margaret W; McMillan, Sara K; Chaubey, Indrajeet
2017-12-01
Best management practices (BMPs) have been widely used to address hydrology and water quality issues in both agricultural and urban areas. Increasing numbers of BMPs have been studied in research projects and implemented in watershed management projects, but a gap remains in quantifying their effectiveness through time. In this paper, we review the current knowledge about BMP efficiencies, which indicates that most empirical studies have focused on short-term efficiencies, while few have explored long-term efficiencies. Most simulation efforts that consider BMPs assume constant performance irrespective of ages of the practices, generally based on anticipated maintenance activities or the expected performance over the life of the BMP(s). However, efficiencies of BMPs likely change over time irrespective of maintenance due to factors such as degradation of structures and accumulation of pollutants. Generally, the impacts of BMPs implemented in water quality protection programs at watershed levels have not been as rapid or large as expected, possibly due to overly high expectations for practice long-term efficiency, with BMPs even being sources of pollutants under some conditions and during some time periods. The review of available datasets reveals that current data are limited regarding both short-term and long-term BMP efficiency. Based on this review, this paper provides suggestions regarding needs and opportunities. Existing practice efficiency data need to be compiled. New data on BMP efficiencies that consider important factors, such as maintenance activities, also need to be collected. Then, the existing and new data need to be analyzed. Further research is needed to create a framework, as well as modeling approaches built on the framework, to simulate changes in BMP efficiencies with time. The research community needs to work together in addressing these needs and opportunities, which will assist decision makers in formulating better decisions regarding BMP
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Pearce, Christopher; Shearer, Marianne; Gardner, Karina; Kelly, Jill; Xu, Tony Baixian
2012-01-01
This paper describes how the Melbourne East General Practice Network supports general practice to enable quality of care, it describes the challenges and enablers of change, and the evidence of practice capacity building and improved quality of care. Primary care is well known as a place where quality, relatively inexpensive medical care occurs. General practice is made up of multiple small sites with fragmented systems and a funding system that challenges a whole-of-practice approach to clinical care. General Practice Networks support GPs to synthesise complexity and crystallise solutions that enhance general practice beyond current capacity. Through a culture of change management, GP Networks create the link between the practice and the big picture of the whole health system and reduce the isolation of general practice. They distribute information (evidence-based learning and resources) and provide individualised support, responding to practice need and capacity.
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[Clinical trial data management and quality metrics system].
Chen, Zhao-hua; Huang, Qin; Deng, Ya-zhong; Zhang, Yue; Xu, Yu; Yu, Hao; Liu, Zong-fan
2015-11-01
Data quality management system is essential to ensure accurate, complete, consistent, and reliable data collection in clinical research. This paper is devoted to various choices of data quality metrics. They are categorized by study status, e.g. study start up, conduct, and close-out. In each category, metrics for different purposes are listed according to ALCOA+ principles such us completeness, accuracy, timeliness, traceability, etc. Some general quality metrics frequently used are also introduced. This paper contains detail information as much as possible to each metric by providing definition, purpose, evaluation, referenced benchmark, and recommended targets in favor of real practice. It is important that sponsors and data management service providers establish a robust integrated clinical trial data quality management system to ensure sustainable high quality of clinical trial deliverables. It will also support enterprise level of data evaluation and bench marking the quality of data across projects, sponsors, data management service providers by using objective metrics from the real clinical trials. We hope this will be a significant input to accelerate the improvement of clinical trial data quality in the industry.
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Symptom Management & Quality of Life Concept Design | Division of Cancer Prevention
This video covers a variety of practical considerations for developing a symptom management concept for clinical research. Co-sponsored by the National Cancer Institute Symptom Management and Health Related Quality of Life Steering Committee & the International Society for Quality of Life Research. |
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Comprehensive nursing case management. An advanced practice model.
Taylor, P
1999-01-01
Under managed care and capitated reimbursement systems, case management is a core strategy for providing high-quality, cost-effective care by decreasing fragmentation, enhancing quality, ensuring efficient use of resources, and containing costs. Although case management is used in various areas of the healthcare arena, it suffers from a lack of consensus regarding its definition, essential components, and appropriate application. The purpose of this paper is to examine the components and limitations of existing case management models, outline the competencies of an effective case manager, and present a model of advanced practice nursing case management that focuses on a continuum of care that integrates medical and psychosocial resources to promote optimal clinical fiscal outcomes and enables patients to work as partners with the healthcare team in facilitating and maintaining their physical and emotional well-being.
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Leadership and management in quality radiology
2007-01-01
The practice of medical imaging and interventional radiology are undergoing rapid change in recent years due to technological advances, workload escalation, workforce shortage, globalisation, corporatisation, commercialisation and commoditisation of healthcare. These professional and economical changes are challenging the established norm but may bring new opportunities. There is an increasing awareness of and interest in the quality of care and patient safety in medical imaging and interventional radiology. Among the professional organisations, a range of quality systems are available to address individual, facility and system needs. To manage the limited resources successfully, radiologists and professional organisations must be leaders and champion for the cause of quality care and patient safety. Close collaboration with other stakeholders towards the development and management of proactive, long-term, system-based strategies and infrastructures will underpin a sustainable future in quality radiology. The International Radiology Quality Network can play a useful facilitating role in this worthwhile but challenging endeavour. PMID:21614284
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Perez, Jose A; Faust, Cheryl; Kenyon, Angie
2009-09-01
Education in systems-based practice is a required component of all postgraduate medical education programs in the United States. Competency in this area requires that trainees have an understanding of the health care system sufficient to provide optimal care to patients. Most trainees in residency programs have little understanding of the complexities and challenges of present-day practice in the current system of care and consider themselves unprepared to undertake this activity following completion of training. Training in practice management in residency programs has not been emphasized as an important component of systems-based practice. Historically, practice management training in residency programs has been done using a fully didactic model, and residents have expressed a desire to learn this skill by becoming more directly involved in the operations and management of a practice. The patient visit touches many aspects of the health care system, including clinic operations, insurance, quality, and finances. At our institution, we used the residents' continuity clinic practices as a vehicle to provide education in practice management and systems-based practice by creating a curriculum that included the residents' perceived gaps in knowledge regarding going into practice. This is known as the virtual practice. This curriculum is taught using data obtained from residents' practice to illustrate concepts in many areas, including primary practice operations, malpractice insurance, financial benchmarks, and career planning. Resident self-assessed knowledge of these areas increased after participating in the curriculum, and resident testimonials indicate satisfaction with the project. In addition, residents have become engaged and interested in how their effort translates into performance and how they participate in the health care system.
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Assessment of the Quality Management Models in Higher Education
ERIC Educational Resources Information Center
Basar, Gulsun; Altinay, Zehra; Dagli, Gokmen; Altinay, Fahriye
2016-01-01
This study involves the assessment of the quality management models in Higher Education by explaining the importance of quality in higher education and by examining the higher education quality assurance system practices in other countries. The qualitative study was carried out with the members of the Higher Education Planning, Evaluation,…
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2015/2016 Quality Risk Management Benchmarking Survey.
Waldron, Kelly; Ramnarine, Emma; Hartman, Jeffrey
2017-01-01
This paper investigates the concept of quality risk management (QRM) maturity as it applies to the pharmaceutical and biopharmaceutical industries, using the results and analysis from a QRM benchmarking survey conducted in 2015 and 2016. QRM maturity can be defined as the effectiveness and efficiency of a quality risk management program, moving beyond "check-the-box" compliance with guidelines such as ICH Q9 Quality Risk Management , to explore the value QRM brings to business and quality operations. While significant progress has been made towards full adoption of QRM principles and practices across industry, the full benefits of QRM have not yet been fully realized. The results of the QRM Benchmarking Survey indicate that the pharmaceutical and biopharmaceutical industries are approximately halfway along the journey towards full QRM maturity. LAY ABSTRACT: The management of risks associated with medicinal product quality and patient safety are an important focus for the pharmaceutical and biopharmaceutical industries. These risks are identified, analyzed, and controlled through a defined process called quality risk management (QRM), which seeks to protect the patient from potential quality-related risks. This paper summarizes the outcomes of a comprehensive survey of industry practitioners performed in 2015 and 2016 that aimed to benchmark the level of maturity with regard to the application of QRM. The survey results and subsequent analysis revealed that the pharmaceutical and biopharmaceutical industries have made significant progress in the management of quality risks over the last ten years, and they are roughly halfway towards reaching full maturity of QRM. © PDA, Inc. 2017.
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ISSUES OF BEST MANAGEMENT PRACTICE DESIGN TO IMPROVE WATER QUALITY
Today, many municipalities are implementing low-cost best management practices (BMPs). Structural control BMPs involve building a structure of some kind to store stormwater until it can be discharged into a nearby receiving water. Commonly used structural treatment BMPs include...
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W. Edwards Deming and total quality management: an interpretation for nursing practice.
Williams, T; Howe, R
1992-01-01
The purpose of this article is to introduce nurses to W. Edwards Deming and the 14 points of his management philosophy, the basis of total quality management (TQM) (Deming, 1986). Each of Deming's points has been subject to in-depth analysis from business executives for the past 40 years. Quality improvement is at the very center of TQM. To adopt TQM will require a major thought transformation for many nursing leaders, but the benefits that nurses and the profession as a whole can reap from this revolutionary style of management make the effort to change worthwhile. If you are not satisfied with the status quo and are looking for a better way to conduct business, the information in this article will begin to define quality improvement and will help you strive for the highest possible level of service to your ultimate customer--the patient.
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Minana, Molly A.; Sturtevant, Judith E.; Heaphy, Robert
2005-01-01
The purpose of the Sandia National Laboratories (SNL) Advanced Simulation and Computing (ASC) Software Quality Plan is to clearly identify the practices that are the basis for continually improving the quality of ASC software products. Quality is defined in DOE/AL Quality Criteria (QC-1) as conformance to customer requirements and expectations. This quality plan defines the ASC program software quality practices and provides mappings of these practices to the SNL Corporate Process Requirements (CPR 1.3.2 and CPR 1.3.6) and the Department of Energy (DOE) document, ASCI Software Quality Engineering: Goals, Principles, and Guidelines (GP&G). This quality plan identifies ASC management andmore » software project teams' responsibilities for cost-effective software engineering quality practices. The SNL ASC Software Quality Plan establishes the signatories commitment to improving software products by applying cost-effective software engineering quality practices. This document explains the project teams opportunities for tailoring and implementing the practices; enumerates the practices that compose the development of SNL ASC's software products; and includes a sample assessment checklist that was developed based upon the practices in this document.« less
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[Comprehensive quality management in hospitals--experience and recommendations].
Schubert, H J
1999-03-01
Total quality management concepts, increasingly being introduced into hospitals, offer opportunities for integrative leadership concepts because of their multidimensional character viewed from the aspects of results and from the standpoint of organisational design. Customized for leadership and organisation of hospitals in Germany, questions of introduction strategies as well as recommendations for the integration of total quality understanding into the daily practice of management and employees are discussed. The active support of top and middle management and a combination of radical change in selected problem areas and continual incremental improvements on a broad base have been proven as significant factors for the success in the introductory phase. For a lasting integration of the principles of a comprehensive quality management concept in a hospital, it will be necessary to carry out regularly relevant measurements of success. The results become an important part of agreements with management.
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Evidence-Based Best Practices for Outpatient Management of Warfarin.
Rose, Adam J; Vaiana, Mary
2018-06-01
Many best practices have been described for organizing a clinic to manage warfarin. Although these practices may have face validity, they may not be based on empirical analysis. Here, we describe our decade-long effort to apply the Structure-Process-Outcome model of quality measurement as a basis for measuring and improving outpatient warfarin management in the Veterans Health Administration. The purpose of the article is to raise awareness of this body of work with pharmacists who could potentially incorporate the findings of this work into their own practice settings. We conclude with concrete suggestions for immediate implementation in clinical settings.
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Harned, Douglas A.
1995-01-01
The effects of selected agricultural land-management practices on water quality were assessed in a comparative study of four small basins in the Piedmont province of North Carolina. Agricultural practices, such as tillage and applications of fertilizer and pesticides, are major sources of sediment, nutrients, and pesticides in surface water, and of nutrients and pesticides in ground water. The four study basins included two adjacent row-crop fields, a mixed land-use basin, and a forested basin. One of the row-crop fields (7.4 acres) was farmed by using conservation land-management (CLM) practices, which included strip cropping, contour plowing, field borders, and grassed waterways. The other row-crop field (4.8 acres) was farmed by using standard land-management (SLM) practices, which included continuous cropping, straight-row plowing without regard to land topography, and poorly maintained waterways. The mixed land-use basin (665 acres) was monitored to compare water quality in surface water as SLM practices were converted to CLM practices during the project. The forested basin (44 acres) provided background surface-water hydrologic and chemical-quality conditions. Surface-water flow was reduced by 18 percent by CLM practices compared to surface-water flow from the SLM practices basin. The thickness of the unsaturated zone in the row-crop basins ranged from a few feet to 25 feet. Areas with thick unsaturated zones have a greater capacity to intercept and store nutrients and pesticides than do areas with thinner zones. Sediment concentrations and yields for the SLM practices basin were considerably higher than those for the other basins. The median sediment concentration in surface water for the SLM basin was 3.4 times that of the CLM basin, 8.2 times that of the mixed land-use basin, and 38.4 times that of the forested basin. The total sediment yield for the SLM basin was 2.3 times that observed for the CLM basin, 14.1 times that observed for the mixed land
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Patient-Centered Medical Home Undergraduate Internship, Benefits to a Practice Manager: Case Study.
Sasnett, Bonita; Harris, Susie T; White, Shelly
Health services management interns become practice facilitators for primary care clinics interested in pursuing patient-centered recognition for their practice. This experience establishes a collaborative relationship between the university and clinic practices where students apply their academic training to a system of documentation to improve the quality of patient care delivery. The case study presents the process undertaken, benefits, challenges, lessons learned, and recommendations for intern, practice mangers, and educators. The practice manager benefits as interns become Patient-Centered Medical Home facilitators and assist practice managers in the recognition process.
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Innovative Soil Management Practices (SMP) Assessment in Europe and China
NASA Astrophysics Data System (ADS)
Barão, Lúcia
2017-04-01
The growing world population poses a major challenge to global agricultural food and feed production through the pressure to increase agricultural outputs either by increasing the land area dedicated to agriculture or by productivity increases. Whether in developed or developing regions, agricultural intensification based on conventional approaches has resulted in severe environmental impacts and innovative soil management practices are needed to halter ongoing soil degradation and promote sustainable land management capable to produce more from less. The iSQAPER project - Interactive Soil Quality Assessment in Europe and China for Agricultural Productivity and Environmental Resilience - aims to develop a Soil Quality app (SQAPP) linking soil and agricultural management practices to soil quality indicators. This easy friendly tool will provide a direct and convenient way to advise farmers and other suitable actors in this area, regarding the best management practices to be adopted in very specific and local conditions. In this particular study from iSQAPER, we aimed to identify the most promising innovative soil management practices (SMP) currently used and its geographical distribution along different pedo-climatic regions in Europe (Boreal, Atlantic, Mediterranean Temperate, Mediterranean Semi-Arid, Southern Sub-Continental and Northern Sub-Continental) and China (Middle Temperate, Warm temperate and Central Asia Tropical). So far we have identified 155 farms where innovative SMP's are used, distributed along 4 study site regions located in China (Qiyang, Suining, Zhifanggou and Gongzhuling) and 10 study site regions located in Europe (The Netherlands, France, Portugal, Spain, Greece, Slovenia, Hungary, Romania, Poland and Estonia) and covering the major pedo-climatic regions. From this identification we concluded that the most used innovative SMP's in the study site regions in Europe are Manuring & Composting (14%), Min-till (14%), Crop rotation (12
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Quality Assurance Practices in Obstetric Care: A Survey of Hospitals in California.
Lundsberg, Lisbet S; Lee, Henry C; Dueñas, Grace Villarin; Gregory, Kimberly D; Grossetta Nardini, Holly K; Pettker, Christian M; Illuzzi, Jessica L; Xu, Xiao
2018-02-01
To assess hospital practices in obstetric quality management activities and identify institutional characteristics associated with utilization of evidence-supported practices. Data for this study came from a statewide survey of obstetric hospitals in California regarding their organization and delivery of perinatal care. We analyzed responses from 185 hospitals that completed quality assurance sections of the survey to assess their practices in a broad spectrum of quality enhancement activities. The association between institutional characteristics and adoption of evidence-supported practices (ie, those supported by prior literature or recommended by professional organizations as beneficial for improving birth outcome or patient safety) was examined using bivariate analysis and appropriate statistical tests. Most hospitals regularly audited adherence to written protocols regarding critical areas of care; however, 77.7% and 16.8% reported not having written guidelines on diagnosis of labor arrest and management of abnormal fetal heart rate, respectively. Private nonprofit hospitals were more likely to have a written protocol for management of abnormal fetal heart rate (P=.002). One in 10 hospitals (9.7%) did not regularly review cases with significant morbidity or mortality, and only 69.0% regularly tracked indications for cesarean delivery. Moreover, 26.3%, 14.3%, and 8.7% of the hospitals reported never performing interprofessional simulations for eclampsia, shoulder dystocia, or postpartum hemorrhage, respectively. Teaching status was associated with more frequent simulations in these three areas (P≤.04 for all), while larger volume was associated with more frequent simulations for eclampsia (P=.04). Hospitals in California engage in a wide range of practices to assure or improve quality of obstetric care, but substantial variation in practice exists among hospitals. There is opportunity for improvement in adoption of evidence-supported practices.
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Contract Quality Assurance and Pricing Practices for Patriot Missile Procurements
1995-06-26
The audit objectives were to evaluate DoD and Raytheon quality assurance and pricing practices for Patriot missile circuit boards. We also evaluated the management control program as it applied to the audit objectives.
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NASA Astrophysics Data System (ADS)
Garcia, V.; Cooter, E. J.; Hayes, B.; Murphy, M. S.; Bash, J. O.
2014-12-01
Excess nitrogen (N) resulting from current agricultural management practices can leach into sources of drinking water as nitrate, increasing human health risks of 'blue baby syndrome', hypertension, and some cancers and birth defects. Nitrogen also enters the atmosphere from land surfaces forming air pollution increasing human health risks of pulmonary and cardio-vascular disease. Characterizing and attributing nitrogen from agricultural management practices is difficult due to the complex and inter-related chemical and biological reactions associated with the nitrogen cascade. Coupled physical process-based models, however, present new opportunities to investigate relationships among environmental variables on new scales; particularly because they link emission sources with meteorology and the pollutant concentration ultimately found in the environment. In this study, we applied a coupled meteorology (NOAA-WRF), agricultural (USDA-EPIC) and air quality modelling system (EPA-CMAQ) to examine the impact of nitrogen inputs from corn production on ecosystem and human health and wellbeing. The coupled system accounts for the nitrogen flux between the land surface and air, and the soil surface and groundwater, providing a unique opportunity to examine the effect of management practices such as type and timing of fertilization, tilling and irrigation on both groundwater and air quality across the conterminous US. In conducting the study, we first determined expected relationships based on literature searches and then identified model variables as direct or surrogate variables. We performed extensive and methodical multi-variate regression modelling and variable selection to examine associations between agricultural management practices and environmental condition. We then applied the regression model to predict and contrast pollution levels between two corn production scenarios (Figure 1). Finally, we applied published health functions (e.g., spina bifida and cardio
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Management of infection control in dental practice.
Smith, A; Creanor, S; Hurrell, D; Bagg, J; McCowan, M
2009-04-01
This was an observational study in which the management policies and procedures associated with infection control and instrument decontamination were examined in 179 dental surgeries by a team of trained surveyors. Information relating to the management of a wide range of infection control procedures, in particular the decontamination of dental instruments, was collected by interview and by examination of practice documentation. This study found that although the majority of surgeries (70%) claimed to have a management policy on infection control, only 50% of these were documented. For infection control policies, 79% of surgeries had access to the British Dental Association Advice Sheet A12. Infection control policies were claimed to be present in 89% of surgeries, of which 62% were documented. Seventy-seven per cent of staff claimed to have received specific infection control training, but for instrument decontamination this was provided mainly by demonstration (97%) or observed practice (88%). Many dental nurses (74%) and dental practitioners (57%) did not recognise the symbol used to designate a single-use device. Audit of infection control or decontamination activities was undertaken in 11% of surgeries. The majority of surgeries have policies and procedures for the management of infection control in dental practice, but in many instances these are not documented. The training of staff in infection control and its documentation is poorly managed and consideration should be given to development of quality management systems for use in dental practice.
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Implementing a Quality Management System in the Medical Microbiology Laboratory.
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.
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Hudak, R P; Jacoby, I; Meyer, G S; Potter, A L; Hooper, T I; Krakauer, H
1997-01-01
This article describes a training model that focuses on health care management by applying epidemiologic methods to assess and improve the quality of clinical practice. The model's uniqueness is its focus on integrating clinical evidence-based decision making with fundamental principles of resource management to achieve attainable, cost-effective, high-quality health outcomes. The target students are current and prospective clinical and administrative executives who must optimize decision making at the clinical and managerial levels of health care organizations.
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Managing human resources in healthcare: learning from world class practices--Part I.
Zairi, M
1998-01-01
This paper, which is presented in two parts, is intended to demonstrate that practices related to the area of human resources management, adopted by model organisations that have dominated their markets consistently, can lend themselves very well to the healthcare sector, which is primarily a "people-oriented" sector. As change in a modern business context is set to continue in an unrelenting way, most organisations will be presented with the challenge of developing the necessary skills and areas of expertise to enable them to cope with the demands on them, master technological opportunities at their disposal, learn how to exploit modern management concepts and optimise value to all the stakeholders they intend to serve. This paper draws from best practices using the experiences of quality recognised organisations and many admired names through pioneering human resource policies and practices and through clear demonstrations on the benefits of relying on people as the major "asset". Part I of this article addresses the importance of human resources as revealed through models of management for organisational excellence. In particular, the paper refers to the criteria for excellence in relation to people management using the following prestigious and integrative management models: Deming Prize (Japan); European Quality Award Model (Europe); and Malcolm Baldrige National Quality Award (USA). In addition, this paper illustrates several case studies using organisations known for their pioneering approaches to people management and which led them to win very prestigious quality awards and various international accolades. The paper concludes by reinforcing the point that human resource management in a healthcare context has to be viewed as an integrated set of processes and practices which need to be adhered to from an integrated perspective in order to optimise individuals' performance levels and so that the human potential can be exploited fully.
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NASA Astrophysics Data System (ADS)
Herzog, S.; McCray, J. E.; Higgins, C. P.
2015-12-01
The hyporheic zone is a hotspot for biogeochemical processing that can attenuate a variety of nonpoint source contaminants in streamwater. However, hyporheic zones in urban and agricultural streams are often degraded and poorly connected with surface water. In order to increase hyporheic exchange and improve water quality, we introduced engineered streambeds as a stormwater and restoration best management practice. Modifications to streambed hydraulic conductivity and reactivity are termed Biohydrochemical Enhancement structures for Streamwater Treatment (BEST). BEST are subsurface modules that utilize low- and high-permeability sediments to drive efficient hyporheic exchange, and reactive geomedia to increase reaction rates within the hyporheic zone. This work presents the first physical performance data of BEST modules at the pilot scale. BEST modules were installed in a constructed stream facility at the Colorado School of Mines in Golden, CO. This facility features two 15m artificial streams, which included an all sand control condition alongside the BEST test condition. Streams were continuously operated at a discharge of 1 L/s using recycled water. Time-lapse electrical resistivity surveys demonstrated that BEST modules provided substantially greater hyporheic exchange than the control condition. Water quality samples at the hyporheic and reach scales also revealed greater attenuation of nitrogen, coliforms, and select metals and trace organics by BEST modules relative to the control condition. These experimental results were also compared to previous numerical model simulations to evaluate model accuracy. Together, these results show that BEST may be an effective best management practice for improving streamwater quality in urban and agricultural settings.
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Saunders, Hannele
2015-07-01
To describe quantitative and qualitative best evidence as sources for practical interventions usable in daily care delivery in order to integrate best evidence into clinical decision-making at local practice settings. To illustrate the development, implementation and evaluation of a pain management nursing care bundle based on a clinical practice guideline via a real-world clinical exemplar. Successful implementation of evidence-based practice requires consistent integration of best evidence into daily clinical decision-making. Best evidence comprises high-quality knowledge summarised in systematic reviews and translated into guidelines. However, consistent integration of guidelines into care delivery remains challenging, partly due to guidelines not being in a usable form for daily practice or relevant for the local context. A position paper with a clinical exemplar of a nurse-led, evidence-based quality improvement project to design, implement and evaluate a pain management care bundle translated from a national nursing guideline. A pragmatic approach to integrating guidelines into daily practice is presented. Best evidence from a national nursing guideline was translated into a pain management care bundle and integrated into daily practice in 15 medical-surgical (med-surg) units of nine hospitals of a large university hospital system in Finland. Translation of best evidence from guidelines into usable form as care bundles adapted to the local setting may increase implementation and uptake of guidelines and improve quality and consistency of care delivery. A pragmatic approach to translating a nursing guideline into a pain management care bundle to incorporate best evidence into daily practice may help achieve more consistent and equitable integration of guidelines into care delivery, and better quality of pain management and patient outcomes. © 2015 John Wiley & Sons Ltd.
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Essentials of total quality management: a meta-analysis.
Mosadeghrad, Ali Mohammad
2014-01-01
The purpose of this paper is to identify critical successful factors for Total Quality Management (TQM) implementation. A literature review was conducted to explore the critical successful factors for TQM implementation between 1980 and 2010. A successful TQM implementation need sufficient education and training, supportive leadership, consistent support of top management, customer focus, employee involvement, process management and continuous improvement of processes. The review was limited to articles written in English language during the past 30 years. From a practical point of view, the findings of this paper provide managers with a practical understanding of the factors that are likely to facilitate TQM implementation in organisations. Understanding the factors that are likely to promote TQM implementation would enable managers to develop more effective strategies that will enhance the chances of achieving business excellence.
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The EFQM Excellence Model for Deploying Quality Management: A British-Russian Journey
ERIC Educational Resources Information Center
Steed, Carol; Maslow, Dmitry; Mazaletskaya, Anna
2005-01-01
This paper describes how the Excellence Model[R] developed by the European Foundation for Quality Management (EFQM) can be used and applied within higher education, with practical examples accompanying the Model in a Russian University to raise management quality. (Contains 5 figures, 2 tables, and 1 footnote.)
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Practice Facilitators' and Leaders' Perspectives on a Facilitated Quality Improvement Program.
McHugh, Megan; Brown, Tiffany; Liss, David T; Walunas, Theresa L; Persell, Stephen D
2018-04-01
Practice facilitation is a promising approach to helping practices implement quality improvements. Our purpose was to describe practice facilitators' and practice leaders' perspectives on implementation of a practice facilitator-supported quality improvement program and describe where their perspectives aligned and diverged. We conducted interviews with practice leaders and practice facilitators who participated in a program that included 35 improvement strategies aimed at the ABCS of heart health (aspirin use in high-risk individuals, blood pressure control, cholesterol management, and smoking cessation). Rapid qualitative analysis was used to collect, organize, and analyze the data. We interviewed 17 of the 33 eligible practice leaders, and the 10 practice facilitators assigned to those practices. Practice leaders and practice facilitators both reported value in the program's ability to bring needed, high-quality resources to practices. Practice leaders appreciated being able to set the schedule for facilitation and select among the 35 interventions. According to practice facilitators, however, relying on practice leaders to set the pace of the intervention resulted in a lower level of program intensity than intended. Practice leaders preferred targeted assistance, particularly electronic health record documentation guidance and linkages to state smoking cessation programs. Practice facilitators reported that the easiest interventions were those that did not alter care practices. The dual perspectives of practice leaders and practice facilitators provide a more holistic picture of enablers and barriers to program implementation. There may be greater opportunities to assist small practices through simple, targeted practice facilitator-supported efforts rather than larger, comprehensive quality improvement projects. © 2018 Annals of Family Medicine, Inc.
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Total Quality Management Practices and Their Effects on Organizational Performance
ERIC Educational Resources Information Center
Hung, Richard Yu-Yuan; Lien, Bella Ya-Hui
2004-01-01
This paper reports a study designed to examine the key concepts of Total Quality Management (TQM) implementation and their effects on organizational performance. Process Alignment and People Involvement are two key concepts for successful implementation of TQM. The purpose of this paper is to discuss how these two constructs affect organizational…
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Soil quality indicator responses to row crop, grazed pasture, and agroforestry buffer management
USDA-ARS?s Scientific Manuscript database
Incorporation of trees and establishment of grass buffers within agroecosystems are management practices shown to enhance soil quality. Soil enzyme activities and water stable aggregates (WSA) have been identified as sensitive soil quality indicators to evaluate early responses to soil management. ...
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Quality pain management outcomes: the power of place.
Wild, L R; Mitchell, P H
2000-01-01
This study explores how an organization, as the context of care, influences nursing practice and a nursing-sensitive, quality health outcome-pain management. The results provide important insights into organizational patterns associated with favorable pain management-related outcomes as well as the congruence between and among subunits within the organization. Outcomes were most favorable on units where nurses had attitudes supportive of aggressive pain management and higher levels of coordination and discretion.
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The influence of leadership practices and empowerment on Canadian nurse manager outcomes.
Spence Laschinger, Heather K; Wong, Carol A; Grau, Ashley L; Read, Emily A; Pineau Stam, Lisa M
2012-10-01
To examine the influence of senior nurse leadership practices on middle and first-line nurse managers' experiences of empowerment and organizational support and ultimately on their perceptions of patient care quality and turnover intentions. Empowering leadership has played an important role in staff nurse retention but there is limited research to explain the mechanisms by which leadership influences nurse managers' turnover intentions. This study was a secondary analysis of data collected using non-experimental, predictive mailed survey design. Data from 231 middle and 788 first-line Canadian acute care managers was used to test the hypothesized model using path analysis in each group. The results showed an adequate fit of the hypothesized model in both groups but with an added path between leadership practices and support in the middle line group. Transformational leadership practices of senior nurses empower middle- and first-line nurse managers, leading to increased perceptions of organizational support, quality care and decreased intent to leave. Empowered nurse managers at all levels who feel supported by their organizations are more likely to stay in their roles, remain committed to achieving quality patient care and act as influential role models for potential future leaders. © 2011 Blackwell Publishing Ltd.
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Implementing practice management strategies to improve patient care: the EPIC project.
Attwell, David; Rogers-Warnock, Leslie; Nemis-White, Joanna
2012-01-01
Healthcare gaps, the difference between usual care and best care, are evident in Canada, particularly with respect to our aging, ailing population. Primary care practitioners are challenged to identify, prevent and close care gaps in their practice environment given the competing demands of informed, litigious patients with complex medical needs, ever-evolving scientific evidence with new treatment recommendations across many disciplines and an enhanced emphasis on quality and accountability in healthcare. Patient-centred health and disease management partnerships using measurement, feedback and communication of practice patterns and outcomes have been shown to narrow care gaps. Practice management strategies such as the use of patient registries and recall systems have also been used to help practitioners better understand, follow and proactively manage populations of patients in their practice. The Enhancing Practice to Improve Care project was initiated to determine the impact of a patient-centred health and disease management partnership using practice management strategies to improve patient care and outcomes for patients with chronic kidney disease (CKD). Forty-four general practices from four regions of British Columbia participated and, indeed, demonstrated that care and outcomes for patients with CKD could be improved via the implementation of practice management strategies in a patient-centred partnership measurement model of health and disease management.
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NASA total quality management 1989 accomplishments report
NASA Technical Reports Server (NTRS)
Tai, Betty P. (Editor); Stewart, Lynne M. (Editor)
1990-01-01
NASA and contractor employees achieved many notable improvements in 1989. The highlights of those improvements, described in this seventh annual Accomplishments Report, demonstrate that the people who support NASA's activities are getting more involved in quality and continuous improvement efforts. Their gains solidly support NASA's and this Nation's goal to remain a leader in space exploration and in world-wide market competition, and, when communicated to others through avenues such as this report, foster improvement efforts across government and industry. The principles in practice which led to these process refinements are important cultural elements to any organization's productivity and quality efforts. The categories in this report reflect NASA principles set forth in the 1980's and are more commonly known today as Total Quality Management (TQM): top management leadership and support; strategic planning; focus on the customer; employee training and recognition; employee empowerment and teamwork; measurement and analysis; and quality assurance.
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Appreciative Inquiry for quality improvement in primary care practices.
Ruhe, Mary C; Bobiak, Sarah N; Litaker, David; Carter, Caroline A; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen J; Weyer, Sharon M; Werner, James J; Fry, Ronald E; Stange, Kurt C
2011-01-01
To test the effect of an Appreciative Inquiry (AI) quality improvement strategy on clinical quality management and practice development outcomes. Appreciative inquiry enables the discovery of shared motivations, envisioning a transformed future, and learning around the implementation of a change process. Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical-record review assessed change in PSD rates. Ethnographic field notes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. The PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives, and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited 1 or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective.
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Appreciative Inquiry for Quality Improvement in Primary Care Practices
Ruhe, Mary C.; Bobiak, Sarah N.; Litaker, David; Carter, Caroline A.; Wu, Laura; Schroeder, Casey; Zyzanski, Stephen; Weyer, Sharon M.; Werner, James J.; Fry, Ronald E.; Stange, Kurt C.
2014-01-01
Purpose To test the effect of an Appreciative Inquiry (AI) quality improvement strategy, on clinical quality management and practice development outcomes. AI enables discovery of shared motivations, envisioning a transformed future, and learning around implementation of a change process. Methods Thirty diverse primary care practices were randomly assigned to receive an AI-based intervention focused on a practice-chosen topic and on improving preventive service delivery (PSD) rates. Medical record review assessed change in PSD rates. Ethnographic fieldnotes and observational checklist analysis used editing and immersion/crystallization methods to identify factors affecting intervention implementation and practice development outcomes. Results PSD rates did not change. Field note analysis suggested that the intervention elicited core motivations, facilitated development of a shared vision, defined change objectives and fostered respectful interactions. Practices most likely to implement the intervention or develop new practice capacities exhibited one or more of the following: support from key leader(s), a sense of urgency for change, a mission focused on serving patients, health care system and practice flexibility, and a history of constructive practice change. Conclusions An AI approach and enabling practice conditions can lead to intervention implementation and practice development by connecting individual and practice strengths and motivations to the change objective. PMID:21192206
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Managing Change to a Quality Philosophy: A Partnership Perspective.
ERIC Educational Resources Information Center
Snyder, Karolyn J.; Acker-Hocevar, Michele
Within the past 5 years there has been an international movement to adapt the principles and practices of Total Quality Management work environments to school-restructuring agendas. This paper reports on the development of a model called the Educational Quality System, a benchmark assessment tool for identifying the essential elements of quality…
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Applications of Quality Management in Language Education
ERIC Educational Resources Information Center
Heyworth, Frank
2013-01-01
This review examines applications of quality management (QM) in language education. QM approaches have been adapted from methodologies developed in industrial and commercial settings, and these are briefly described. Key aspects of QM in language education are the definition of purpose, descriptions of principles and practice, including various…
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Human resource management in general practice: survey of current practice.
Newton, J; Hunt, J; Stirling, J
1996-01-01
BACKGROUND: The organization and management of general practice is changing as a result of government policies designed to expand primary health care services. One aspect of practice management which has been underresearched concerns staffing: the recruitment, retention, management and motivation of practice managers. AIM: A study set out to find out who is routinely involved in making decisions about staffing matters in general practice, to establish the extent to which the human resource management function is formalized and specialized, and to describe the characteristics of the practice managers. METHOD: A postal questionnaire was sent to a stratified random sample of 750 general practices in England and Wales in February 1994 enquiring about the practice (for example, the fundholding status and number of general practitioner partners), how the practice dealt with a range of staffing matters and about the practice manager (for example, employment background and training in human resource management). Practices were classed as small (single-handed and two or three general practitioner partners), medium (four or five partners) or large (six or more partners). RESULTS: Replies were received from 477 practices (64%). Practice managers had limited authority to make decisions alone in the majority of practices although there was a greater likelihood of them taking independent action as the size of practice increased. Formality in handling staffing matters (as measured by the existence and use of written policies and procedures) also increased with practice size. Larger practices were more likely than smaller practices to have additional tiers in their management structure through the creation of posts with the titles assistant practice manager, fund manager and senior receptionist. Most practice managers had been recruited from within general practice but larger practices were more likely than smaller practices to recruit from outwith general practice. Three quarters
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Koerkle, E.H.; Fishel, D.K.; Brown, M.J.; Kostelnik, K.M.
1996-01-01
Water quality in the headwaters of the Little Conestoga Creek, Lancaster County, Pa., was investigated from April 1986 through September 1989 to determine possible effects of agricultural nutrient management on water quality. Nutrient management, an agricultural Best-Management Practice, was promoted in the 5.8-square-mile watershed by the U.S. Department of Agriculture Rural Clean Water Program. Nonpoint-source- agricultural contamination was evident in surface water and ground water in the watershed; the greatest contamination was in areas underlain by carbonate rock and with intensive row-crop and animal production. Initial implementation of nutrient management covered about 30 percent of applicable land and was concentrated in the Nutrient-Management Subbasin. By 1989, nutrient management covered about 45 percent of the entire Small Watershed, about 85 percent of the Nutrient- Management Subbasin, and less than 10 percent of the Nonnutrient-Management Subbasin. The number of farms implementing nutrient management increased from 14 in 1986 to 25 by 1989. Nutrient applications to cropland in the Nutrient- Management Subbasin decreased by an average of 35 percent after implementation. Comparison of base- flow surface-water quality from before and after implementation suggests that nutrient management was effective in slowing or reversing increases in concentrations of dissolved nitrate plus nitrite in the Nutrient-Management Subbasin. Although not statistically significant, the Mann-Whitney step-trend coefficient for the Nutrient-Management Subbasin was 0.8 milligram per liter, whereas trend coefficients for the Nonnutrient-Management Subbasin and the Small Watershed were 0.4 and 1.4 milligrams per liter, respectively, for the period of study. Analysis of covariance comparison of concurrent concentrations from the two sub- basins showed a significant decrease in concen- trations from the Nutrient-Management Subbasin compared to the Nonnutrient-Management Subbasin
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ERIC Educational Resources Information Center
Akdere, Mesut
2007-01-01
Organisations are continuously challenged to become more strategic, productive and cost-effective. As a result, quality management has become increasingly important to achieve desired organisational performance outcomes. Quality management considers leadership an important component to implement and sustain quality products and services to…
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Surveying Consumer Satisfaction to Assess Managed-Care Quality: Current Practices
Gold, Marsha; Wooldridge, Judith
1995-01-01
Growing interest in using consumer satisfaction information to enhance quality of care and promote informed consumer choice has accompanied recent expansions in managed care. This article synthesizes information about consumer satisfaction surveys conducted by managed-care plans, government and other agencies, community groups, and purchasers of care. We discuss survey content, methods, and use of consumer survey information. Differences in the use of consumer surveys preclude one instrument or methodology from meeting all needs. The effectiveness of plan-based surveys could be enhanced by increased information on alternative survey instruments and methods and new methodological studies, such as ones developing risk-adjustment methods. PMID:10151887
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Quality Management in Education.
ERIC Educational Resources Information Center
Tribus, Myron
When transferring the methods of quality management from industry to academia, there are important differences that must be considered. This paper describes the differences between traditional management and quality management, and shows how Deming's principles of Total Quality Management (TQM) can be applied to education. Some of these principles…
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Emerging Role of Quality Indicators in Physical Therapist Practice and Health Service Delivery
Klemm, Alexandria; Li, Linda C.; Jones, C. Allyson
2016-01-01
Quality-based care is a hallmark of physical therapy. Treatment effectiveness must be evident to patients, managers, employers, and funders. Quality indicators (QIs) are tools that specify the minimum acceptable standard of practice. They are used to measure health care processes, organizational structures, and outcomes that relate to aspects of high-quality care of patients. Physical therapists can use QIs to guide clinical decision making, implement guideline recommendations, and evaluate and report treatment effectiveness to key stakeholders, including third-party payers and patients. Rehabilitation managers and senior decision makers can use QIs to assess care gaps and achievement of benchmarks as well as to guide quality improvement initiatives and strategic planning. This article introduces the value and use of QIs to guide clinical practice and health service delivery specific to physical therapy. A framework to develop, select, report, and implement QIs is outlined, with total joint arthroplasty rehabilitation as an example. Current initiatives of Canadian and American physical therapy associations to develop tools to help clinicians report and access point-of-care data on patient progress, treatment effectiveness, and practice strengths for the purpose of demonstrating the value of physical therapy to patients, decision makers, and payers are discussed. Suggestions on how physical therapists can participate in QI initiatives and integrate a quality-of-care approach in clinical practice are made. PMID:26089040
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A comparison of quality and utilization problems in large and small group practices.
Gleason, S C; Richards, M J; Quinnell, J E
1995-12-01
Physicians practicing in large, multispecialty medical groups share an organizational culture that differs from that of physicians in small or independent practices. Since 1980, there has been a sharp increase in the size of multispecialty group practice organizations, in part because of increased efficiencies of large group practices. The greater number of physicians and support personnel in a large group practice also requires a relatively more sophisticated management structure. The efficiencies, conveniences, and management structure of a large group practice provide an optimal environment to practice medicine. However, a search of the literature found no data linking a large group practice environment to practice outcomes. The purpose of the study reported in this article was to determine if physicians in large practices have fewer quality and utilization problems than physicians in small or independent practices.
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Quality of Project Management Education and Training Programmes
NASA Astrophysics Data System (ADS)
Bodea, Constanta-Nicoleta; Dascalu, Maria; Coman, Melania
The paper refers to the factors which influence the quality of training and education on project management. A survey was made and the main results are presented. 81 % of the responses came from China. The rest were professionals of different EU nationalities. The percentage of Project Managers who answered the questions is rather low - 8%. In the "Others" category, we have software developers, financial managers and professors, who are involved in both training on project management, but also as team members or team managers in projects, thus ensuring a balanced overview of both theory and practical issues.
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Bonkowski, Sara L; De Gagne, Jennie C; Cade, Makia B; Bulla, Sally A
2018-04-01
Nurses lack adequate pain management knowledge, which can result in poorly managed postsurgical pain. This study aimed to develop, implement, and evaluate pain management education and operational guidelines to improve nursing knowledge and pain management. This quality improvement project employed convenience samples of surgical oncology nurses and postoperative patients. The intervention involved an online module, live education, and operational guideline for pain management. Nurses completed pre- and postintervention practice and attitudes surveys. Random chart reviews of intravenous narcotic administrations the day before discharge were completed to evaluate whether narcotic administration changed after intervention. Readmissions and Hospital Consumer Assessment of Healthcare Providers and Systems data were collected to determine whether the intervention influenced patient satisfaction. A statistically significant improvement in nursing practice and intravenous narcotic administrations demonstrated changes to pain management practices employed by the nursing staff. Although not statistically significant, fewer pain-related readmissions occurred postintervention. Findings demonstrate that targeted pain management continuing education, paired with operational guidelines, improves nursing practice and decreases intravenous narcotic administrations prior to discharge. J Contin Educ Nurs. 2018;49(4):178-185. Copyright 2018, SLACK Incorporated.
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Interventions to manage dual practice among health workers.
Kiwanuka, Suzanne N; Rutebemberwa, Elizeus; Nalwadda, Christine; Okui, Olico; Ssengooba, Freddie; Kinengyere, Alison A; Pariyo, George W
2011-07-06
Dual practice, whereby health workers hold two or more jobs, is a common phenomenon globally. In resource constrained low- and middle-income countries dual practice poses an ongoing threat to the efficiency, quality and equity of health services, especially in the public sector. Identifying effective interventions to manage dual practice is important. To assess the effects of regulations implemented to manage dual practice. Databases searched included: The Cochrane Central Register of Controlled Trials (CENTRAL) 2011, Issue 4, part of The Cochrane Library. www.thecochranelibrary.com, including the Cochrane Effective Practice and Organisation of Care (EPOC) Group Specialised Register (searched 26 May 2011); MEDLINE In-Process & Other Non-Indexed Citations May 24, 2011 (searched 26 May 2011); MEDLINE, Ovid (1948 to May week 2 2011) (searched 26 May 2011); EMBASE, Ovid (1980 to 2011 week 20) (searched 26 May 2011); Science Citation Index and Social Sciences Citation Index, ISI Web of Science (1975 to present) (searched 04 December 2009); LILACS (searched January 2010); and AIM (December 2009) (searched 18 December 2009). Randomized controlled trials, non-randomized controlled trials, controlled before-and-after studies and interrupted-time-series studies. Dual practice was defined as holding more than one job. Studies for inclusion were those focusing on interventions to manage dual practice among health professionals employed in the public health sector. Two review authors independently applied the criteria for inclusion and exclusion of studies when scanning the identified titles and abstracts. The same two review authors independently screened full reports of selected citations. At each stage, results were compared and discrepancies settled through discussion. No studies were found which were eligible for inclusion in this review. There is a need to rigorously evaluate the effects of interventions implemented to manage dual practice among health workers. However
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Park, Youn Shik; Engel, Bernie A; Kim, Jonggun; Theller, Larry; Chaubey, Indrajeet; Merwade, Venkatesh; Lim, Kyoung Jae
2015-03-01
Total Maximum Daily Load is a water quality standard to regulate water quality of streams, rivers and lakes. A wide range of approaches are used currently to develop TMDLs for impaired streams and rivers. Flow and load duration curves (FDC and LDC) have been used in many states to evaluate the relationship between flow and pollutant loading along with other models and approaches. A web-based LDC Tool was developed to facilitate development of FDC and LDC as well as to support other hydrologic analyses. In this study, the FDC and LDC tool was enhanced to allow collection of water quality data via the web and to assist in establishing cost-effective Best Management Practice (BMP) implementations. The enhanced web-based tool provides use of water quality data not only from the US Geological Survey but also from the Water Quality Portal for the U.S. via web access. Moreover, the web-based tool identifies required pollutant reductions to meet standard loads and suggests a BMP scenario based on ability of BMPs to reduce pollutant loads, BMP establishment and maintenance costs. In the study, flow and water quality data were collected via web access to develop LDC and to identify the required reduction. The suggested BMP scenario from the web-based tool was evaluated using the EPA Spreadsheet Tool for the Estimation of Pollutant Load model to attain the required pollutant reduction at least cost. Copyright © 2014 Elsevier Ltd. All rights reserved.
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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
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Tuberculosis management practices of private practitioners in Pune municipal corporation, India.
Bharaswadkar, Sandeep; Kanchar, Avinash; Thakur, Narendra; Shah, Shubhangi; Patnaik, Brinda; Click, Eleanor S; Kumar, Ajay M V; Dewan, Puneet Kumar
2014-01-01
Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India's Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP. We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals. Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices. In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts.
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Tuberculosis Management Practices of Private Practitioners in Pune Municipal Corporation, India
Bharaswadkar, Sandeep; Kanchar, Avinash; Thakur, Narendra; Shah, Shubhangi; Patnaik, Brinda; Click, Eleanor S.; Kumar, Ajay M. V.; Dewan, Puneet Kumar
2014-01-01
Background Private Practitioners (PP) are the primary source of health care for patients in India. Limited representative information is available on TB management practices of Indian PP or on the efficacy of India’s Revised National Tuberculosis Control Programme (RNTCP) to improve the quality of TB management through training of PP. Methods We conducted a cross-sectional survey of a systematic random sample of PP in one urban area in Western India (Pune, Maharashtra). We presented sample clinical vignettes and determined the proportions of PPs who reported practices consistent with International Standards of TB Care (ISTC). We examined the association between RNTCP training and adherence to ISTC by calculating odds ratios and 95% confidence intervals. Results Of 3,391 PP practicing allopathic medicine, 249 were interviewed. Of these, 55% had been exposed to RNTCP. For new pulmonary TB patients, 63% (158/249) of provider responses were consistent with ISTC diagnostic practices, and 34% (84/249) of responses were consistent with ISTC treatment practices. However, 48% (120/249) PP also reported use of serological tests for TB diagnosis. In the new TB case vignette, 38% (94/249) PP reported use of at least one second line anti-TB drug in the treatment regimen. RNTCP training was not associated with diagnostic or treatment practices. Conclusion In Pune, India, despite a decade of training activities by the RNTCP, high proportions of providers resorted to TB serology for diagnosis and second-line anti-TB drug use in new TB patients. Efforts to achieve universal access to quality TB management must account for the low quality of care by PP and the lack of demonstrated effect of current training efforts. PMID:24897374
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Design in Practice: Scenarios for Improving Management Education
ERIC Educational Resources Information Center
Schlenker, Lee; Chantelot, Sébastien
2014-01-01
Despite the increasing attention given to design in business, Design Thinking has had little impact on the quality of business school education. Building upon the foundations of long-standing critiques of management education and the potential for student-centric learning, the authors propose that the use of Design in Practice can significantly…
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USDA/Regional Dairy Quality Management Alliance (RDQM) Project-2008 Report
USDA-ARS?s Scientific Manuscript database
The Regional Dairy Quality Management Alliance (RDQMA) research project has been underway for four years. We have so far been able to study best management practices on three dairy farms in the Northeast. ON these farms very precise data are collected with regard to the health status of the animals ...
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Designing quality course management systems that foster intra-professional education.
Bowers, Helen F
2006-12-01
This paper draws on the experiences of the author in designing and implementing quality course management policies and procedures for vocational and higher educational programs, both overseas and in Australia. In particular, the paper focuses on those programs of study that require practicums within the curriculum. Whether these are clinical nursing placements, physiotherapy hands-on practical blocks or teacher training instruction, there are many principles of adult education that can be applied to the design and development of course management systems that foster inter-professional education. It is important that the components of any such system allow for a multi-faceted approach that relates collaborative learning to collaborative practice and supports a team of professionals through the skilled use of group-based learning, interactive assessments and inter-organisational processes and practices. The term 'course management system' is used here to describe all those policies and procedures that form the framework of any higher education department or faculty that has the overall responsibility for developing curriculum, teaching and learning resources that ensure quality educational outcomes for its students. In these days of multi-skilling, the benefits of inter-professional education may be significant. To guarantee that standards are kept high and learning outcomes are achievable, the management of an educational system must cover many areas of professional practice. It needs to be supported by all stakeholders in the organisation so that there is an environment of understanding, good interpersonal communication, supportive inter-group relations and an atmosphere of professionalism that is pervasive. This paper introduces a third definition to the model and suggests that intra-professional education be added to form a tripartite foundation for quality professional learning outcomes.
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Congdon, Graham; Baker, Tracey; Cheesman, Amanda
2013-03-01
This paper describes a process evaluation project designed to enhance the strategic management of practice learning within a large Hospital in the North of England. The aim of the project was to introduce the role of the Learning Environment Manager with dedicated responsibility for practice learning of undergraduate student nurses within the Hospital's 49 practice-settings. Whilst aspects of this role were already evident in several of these settings, the project sought to locate and standardise responsibilities related to the organisation and management of learning and teaching in practice explicitly within the existing staffing structure of each practice-setting. Focus group interviews were used to explore significant aspects of the project with key stakeholder groups comprising Learning Environment Managers, the Hospital Clinical Educator, Hospital Department Managers, Ward Managers, Mentors, University Link Lecturers and undergraduate Student Nurses. Interview data were analysed using thematic content analysis. The findings of the project suggest that the Learning Environment Manager role affords providers of practice learning with a robust approach to establish organisation-wide benchmarks that standardise the strategic management of practice learning in collaboration with partner Universities. The role incorporated many operational activities previously undertaken by the Hospital Clinical Educator, thus enabling the Hospital Clinical Educator to make a more strategic contribution to the on-going quality monitoring and enhancement of practice learning across the Hospital. The Learning Environment Manager role was found to provide mentors with high levels of support which in turn helped to promote consistent, positive and holistic practice learning experiences for undergraduate student nurses across the Hospital. Importantly, the role offers a potent catalyst for nurses in practice to regain responsibility for practice learning and re-establish the value of
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Practice management based on risk assessment.
Sandberg, Hans
2004-01-01
The management of a dental practice is most often focused on what clinicians do (production of items), and not so much on what is achieved in terms of oral health. The main reason for this is probably that it is easier to measure production and more difficult to measure health outcome. This paper presents a model based on individual risk assessment that aims to achieve a financially sound economy and good oral health. The close-to-the-clinic management tool, the HIDEP Model (Health Improvement in a DEntal Practice) was pioneered initially in Sweden at the end of 1980s. The experience over a 15-year period with different elements of the model is presented, including: the basis of examination and risk assessment; motivation; task delegation and leadership issues; health-finance evaluations; and quality development within a dental clinic. DentiGroupXL, a software program designed to support the work based on the model, is also described.
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The Grand Challenge of Basin-Scale Groundwater Quality Management Modelling
NASA Astrophysics Data System (ADS)
Fogg, G. E.
2017-12-01
The last 50+ years of agricultural, urban and industrial land and water use practices have accelerated the degradation of groundwater quality in the upper portions of many major aquifer systems upon which much of the world relies for water supply. In the deepest and most extensive systems (e.g., sedimentary basins) that typically have the largest groundwater production rates and hold fresh groundwaters on decadal to millennial time scales, most of the groundwater is not yet contaminated. Predicting the long-term future groundwater quality in such basins is a grand scientific challenge. Moreover, determining what changes in land and water use practices would avert future, irreversible degradation of these massive freshwater stores is a grand challenge both scientifically and societally. It is naïve to think that the problem can be solved by eliminating or reducing enough of the contaminant sources, for human exploitation of land and water resources will likely always result in some contamination. The key lies in both reducing the contaminant sources and more proactively managing recharge in terms of both quantity and quality, such that the net influx of contaminants is sufficiently moderate and appropriately distributed in space and time to reverse ongoing groundwater quality degradation. Just as sustainable groundwater quantity management is greatly facilitated with groundwater flow management models, sustainable groundwater quality management will require the use of groundwater quality management models. This is a new genre of hydrologic models do not yet exist, partly because of the lack of modeling tools and the supporting research to model non-reactive as well as reactive transport on large space and time scales. It is essential that the contaminant hydrogeology community, which has heretofore focused almost entirely on point-source plume-scale problems, direct it's efforts toward the development of process-based transport modeling tools and analyses capable
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Wiley, James A; Rittenhouse, Diane R; Shortell, Stephen M; Casalino, Lawrence P; Ramsay, Patricia P; Bibi, Salma; Ryan, Andrew M; Copeland, Kennon R; Alexander, Jeffrey A
2015-01-01
The effective management of patients with chronic illnesses is critical to bending the curve of health care spending in the United States and is a crucial test for health care reform. In this article we used data from three national surveys of physician practices between 2006 and 2013 to determine the extent to which practices of all sizes have increased their use of evidence-based care management processes associated with patient-centered medical homes for patients with asthma, congestive heart failure, depression, and diabetes. We found relatively large increases over time in the overall use of these processes for small and medium-size practices as well as for large practices. However, the large practices used fewer than half of the recommended processes, on average. We also identified the individual processes whose use increased the most and show that greater use of care management processes is positively associated with public reporting of patient experience and clinical quality and with pay-for-performance. Project HOPE—The People-to-People Health Foundation, Inc.
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Pereira, Paulo; Westgard, James O; Encarnação, Pedro; Seghatchian, Jerard; de Sousa, Gracinda
2015-04-01
The screening laboratory has a critical role in the post-transfusion safety. The success of its targets and efficiency depends on the management system used. Even though the European Union directive 2002/98/EC requires a quality management system in blood establishments, its requirements for screening laboratories are generic. Complementary approaches are needed to implement a quality management system focused on screening laboratories. This article briefly discusses the current good manufacturing practices and good laboratory practices, as well as the trends in quality management system standards. ISO 9001 is widely accepted in some European Union blood establishments as the quality management standard, however this is not synonymous of its successful application. The ISO "risk-based thinking" is interrelated with the quality risk-management process of the EuBIS "Standards and criteria for the inspection of blood establishments". ISO 15189 should be the next step on the quality assurance of a screening laboratory, since it is focused on medical laboratory. To standardize the quality management systems in blood establishments' screening laboratories, new national and European claims focused on technical requirements following ISO 15189 is needed. Copyright © 2015 Elsevier Ltd. All rights reserved.
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Changing personnel behavior to promote quality care practices in an intensive care unit
Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh
2005-01-01
The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574
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Best Management Practices for Silvicultural Chemicals and the Science Behind Them
Jerry L. Michael
2004-01-01
Silvicultural chemicals include fertilizers and pesticides applied for forest management. All states east of the Rockies have at least some form of silvicultural chemical best management practices (SCBMPs) and it is widely accepted that SCBMPs effect someprotection of water quality. All SCBMPs recommend handling and application precautions and a minimum width...
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The role of quality assurance in future midwifery practice.
Dawson, J
1993-08-01
Recent recommendations have been made which would give midwives a more central role in maternity care and a greater degree of independence than they currently enjoy. This paper argues that midwives' current attitudes to quality assurance are incompatible with this enhanced role. Research conducted in three health districts is described, which explored the perceptions of nurses, midwives and managers towards quality assurance. The findings indicate that quality assurance (in whatever form that concept is operationalized) is a demonstration of accountability. For managers this accountability is primarily for the service as a whole, whilst nurses and midwives view their accountability as being owed to patients/clients. The main methodology which the study identified as being used for monitoring nursing care was the development and auditing of explicit standards. This approach has been actively promoted by the Royal College of Nursing, enabling nurses to regain control of the purely professional aspects of the nursing profession. Midwives in the study districts showed a marked reluctance to adopt such a strategy, taking the view that as independent practitioners consensus standards would be unacceptable. It is argued that this attitude is inconsistent with the basic principle that professionals are accountable for both demonstrating and developing the quality of professional practice. It is further suggested that midwives currently have an opportunity to regain professional control of midwifery practice, which will be lost unless they are prepared to take responsibility for evaluating the standards for which they are accountable.
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Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.
Kakyo, Tracy Alexis; Xiao, Lily Dongxia
2017-06-01
Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.
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Understanding quality patient care and the role of the practicing nurse.
Owens, Laura D; Koch, Robert W
2015-03-01
Nurses play a vital role in improving the safety and quality of patient care. The authors provide the front-line nurse providers with an overview of critical concepts related to quality management of patient care. A historical approach provides the reader with an overview of the trajectory or the quality in health care movement. Furthermore, the article provides the nurse with a basic understanding of national and international organizations that focus on quality patient care. A brief introduction of measures of quality care is presented as well as implications for nursing practice. Copyright © 2015 Elsevier Inc. All rights reserved.
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TQM: A bibliography with abstracts. [total quality management
NASA Technical Reports Server (NTRS)
Gottlich, Gretchen L. (Editor)
1992-01-01
This document is designed to function as a special resource for NASA Langley scientists, engineers, and managers during the introduction and development of total quality management (TQM) practices at the Center. It lists approximately 300 bibliographic citations for articles and reports dealing with various aspects of TQM. Abstracts are also available for the majority of the citations. Citations are organized by broad subject areas, including case studies, customer service, senior management, leadership, communication tools, TQM basics, applications, and implementation. An introduction and indexes provide additional information on arrangement and availability of these materials.
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Dermatology practice management assures practice development and efficiency.
Wagener, D L
2000-09-01
This article provides an overview of the disciplines involved in managing a dermatology practice today. Several key management processes, including strategic planning, financial analysis, advertising and public relations, information systems management, and compliance program development and monitoring are addressed. This article explores several possible tactics that can be used to help guide your practice in the right direction without overtaxing your resources. Also offered are possible solutions for creating an organization that is poised for success, and a management team capable of steering the practice through the sea of change ahead.
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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.
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A Longitudinal Study of Total Quality Management Processes in Business Colleges.
ERIC Educational Resources Information Center
Vazzana, Gary; Elfrink, John; Bachmann, Duane P.
2000-01-01
Surveys of business school deans in 1995 (n=243) and 1998 (n=151) regarding total quality management (TQM) practices revealed increases in mission and strategy development, goal setting, and use of advisory boards and cross-functional teams. Few are using TQM to manage core learning processes. (SK)
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Visual quality assessment of alternative silvicultural practices in upland hardwood management
Tim McDonald; Bryce Stokes
1997-01-01
Visual impacts of forest operations are of increasing concern to forest managers. Tools are available for evaluating, and potentially avoiding, problems in visual quality resulting from poorly designed harvest unit boundaries. One of these visualization tools is applied in comparing various harvest unit shape alternatives in an upland hardwood stand on steeply sloping...
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Quality Risk Management: Putting GMP Controls First.
O'Donnell, Kevin; Greene, Anne; Zwitkovits, Michael; Calnan, Nuala
2012-01-01
This paper presents a practical way in which current approaches to quality risk management (QRM) may be improved, such that they better support qualification, validation programs, and change control proposals at manufacturing sites. The paper is focused on the treatment of good manufacturing practice (GMP) controls during QRM exercises. It specifically addresses why it is important to evaluate and classify such controls in terms of how they affect the severity, probability of occurrence, and detection ratings that may be assigned to potential failure modes or negative events. It also presents a QRM process that is designed to directly link the outputs of risk assessments and risk control activities with qualification and validation protocols in the GMP environment. This paper concerns the need for improvement in the use of risk-based principles and tools when working to ensure that the manufacturing processes used to produce medicines, and their related equipment, are appropriate. Manufacturing processes need to be validated (or proven) to demonstrate that they can produce a medicine of the required quality. The items of equipment used in such processes need to be qualified, in order to prove that they are fit for their intended use. Quality risk management (QRM) tools can be used to support such qualification and validation activities, but their use should be science-based and subject to as little subjectivity and uncertainty as possible. When changes are proposed to manufacturing processes, equipment, or related activities, they also need careful evaluation to ensure that any risks present are managed effectively. This paper presents a practical approach to how QRM may be improved so that it better supports qualification, validation programs, and change control proposals in a more scientific way. This improved approach is based on the treatment of what are called good manufacturing process (GMP) controls during those QRM exercises. A GMP control can be considered
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Salgado, M.M.; Benitez, J.C.; Pernas, R.
2007-07-01
The Center for Radiation Protection and Hygiene (CPHR) is the institution responsible for the management of radioactive wastes generated from nuclear applications in medicine, industry and research in Cuba. Radioactive Waste Management Service is provided at a national level and it includes the collection and transportation of radioactive wastes to the Centralized Waste Management Facilities, where they are characterized, segregated, treated, conditioned and stored. A Quality Management System, according to the ISO 9001 Standard has been implemented for the RWM Service at CPHR. The Management System includes the radiation safety requirements established for RWM in national regulations and in themore » Licence's conditions. The role of the Regulatory Body and the Radiation Protection Officer in the Quality Management System, the authorization of practices, training and personal qualification, record keeping, inspections of the Regulatory Body and internal inspection of the Radiation Protection Officer, among other aspects, are described in this paper. The Quality Management System has shown to be an efficient tool to demonstrate that adequate measures are in place to ensure the safety in radioactive waste management activities and their continual improvement. (authors)« less
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Incorporating soil health management practices into viable potato cropping systems
USDA-ARS?s Scientific Manuscript database
Soil health is critical to agricultural sustainability, environmental quality, and ecosystem function, but is generally degraded through intensive potato production. Soil and crop management practices beneficial to soil health, such as crop rotations, cover crops and green manures, organic amendment...
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Taylor, Sam D; He, Yi; Hiscock, Kevin M
2016-09-15
Agricultural diffuse water pollution remains a notable global pressure on water quality, posing risks to aquatic ecosystems, human health and water resources and as a result legislation has been introduced in many parts of the world to protect water bodies. Due to their efficiency and cost-effectiveness, water quality models have been increasingly applied to catchments as Decision Support Tools (DSTs) to identify mitigation options that can be introduced to reduce agricultural diffuse water pollution and improve water quality. In this study, the Soil and Water Assessment Tool (SWAT) was applied to the River Wensum catchment in eastern England with the aim of quantifying the long-term impacts of potential changes to agricultural management practices on river water quality. Calibration and validation were successfully performed at a daily time-step against observations of discharge, nitrate and total phosphorus obtained from high-frequency water quality monitoring within the Blackwater sub-catchment, covering an area of 19.6 km(2). A variety of mitigation options were identified and modelled, both singly and in combination, and their long-term effects on nitrate and total phosphorus losses were quantified together with the 95% uncertainty range of model predictions. Results showed that introducing a red clover cover crop to the crop rotation scheme applied within the catchment reduced nitrate losses by 19.6%. Buffer strips of 2 m and 6 m width represented the most effective options to reduce total phosphorus losses, achieving reductions of 12.2% and 16.9%, respectively. This is one of the first studies to quantify the impacts of agricultural mitigation options on long-term water quality for nitrate and total phosphorus at a daily resolution, in addition to providing an estimate of the uncertainties of those impacts. The results highlighted the need to consider multiple pollutants, the degree of uncertainty associated with model predictions and the risk of
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Practice management. Gender offenders.
Gosling, Jennifer
2002-09-26
A postal survey of practice managers in London found that women earned 5,000 Pounds a year less than men, on average. Women who had previously worked as receptionists in the practice were particularly poorly paid. Practice management remains a female-dominated profession. Primary care trusts should seek to standardise rates of pay and promote greater equality.
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Hwang, Jee-In; Park, Hyeoun-Ae
2015-07-01
This study investigated individual and work-related factors associated with nurses' perceptions of evidence-based practice (EBP) and quality improvement (QI), and the relationships between evidence-based practice, quality improvement and clinical errors. Understanding the factors affecting evidence-based practice and quality improvement activities and their relationships with clinical errors is important for designing strategies to promote evidence-based practice, quality improvement and patient safety. A cross-sectional survey was conducted with 594 nurses in two Korean teaching hospitals using the evidence-based practice Questionnaire and quality improvement scale developed in this study. Four hundred and forty-three nurses (74.6%) returned the completed survey. Nurses' ages and educational levels were significantly associated with evidence-based practice scores whereas age and job position were associated with quality improvement scores. There were positive, moderate correlations between evidence-based practice and quality improvement scores. Nurses who had not made any clinical errors during the past 12 months had significantly higher quality improvement skills scores than those who had. The findings indicated the necessity of educational support regarding evidence-based practice and quality improvement for younger staff nurses who have no master degrees. Enhancing quality improvement skills may reduce clinical errors. Nurse managers should consider the characteristics of their staff when implementing educational and clinical strategies for evidence-based practice and quality improvement. © 2013 John Wiley & Sons Ltd.
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CONSIDERATIONS IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY
Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which in... -
CONSIDERATION IN THE DESIGN OF TREATMENT BEST MANAGEMENT PRACTICES (BMPS) TO IMPROVE WATER QUALITY
Today, many municipalities are implementing low-cost best management practices (BMPs). The lowest cost BMPs, termed non-structural or source control BMPs, include practices such as limiting pesticide use in agricultural areas. There are a set of higher cost BMPs, which involve ...
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Laboratory quality management system: road to accreditation and beyond.
Wadhwa, V; Rai, S; Thukral, T; Chopra, M
2012-01-01
This review attempts to clarify the concepts of Laboratory Quality Management System (Lab QMS) for a medical testing and diagnostic laboratory in a holistic way and hopes to expand the horizon beyond quality control (QC) and quality assurance. It provides an insight on accreditation bodies and highlights a glimpse of existing laboratory practices but essentially it takes the reader through the journey of accreditation and during the course of reading and understanding this document, prepares the laboratory for the same. Some of the areas which have not been highlighted previously include: requirement for accreditation consultants, laboratory infrastructure and scope, applying for accreditation, document preparation. This section is well supported with practical illustrations and necessary tables and exhaustive details like preparation of a standard operating procedure and a quality manual. Concept of training and privileging of staff has been clarified and a few of the QC exercises have been dealt with in a novel way. Finally, a practical advice for facing an actual third party assessment and caution needed to prevent post-assessment pitfalls has been dealt with.
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Quality measures for nurse practitioner practice evaluation.
Kleinpell, Ruth; Kapu, April N
2017-08-01
Evaluating the impact of nurse practitioner (NP) practice has become a priority area of focus for demonstrating outcomes. A number of quality measures are available to enable practice-specific evaluation of NP roles and initiatives. This article reviews sources of quality measures that can be used to facilitate quantifying the outcomes of NP practice as part of an overall evaluation agenda. National resources and published literature on NP quality measures were reviewed. Various resources and toolkits exist to assist NPs in identifying outcomes of practice using quality measures. The need to demonstrate outcomes of NP practice remains an ongoing priority area regardless of the clinical practice setting. A variety of sources of quality measures exist that can be used to showcase the effect of NP care. The use of quality measures can be effectively integrated into evaluation of NP role and NP-directed initiatives to demonstrate impact, and enhance the conduct of an NP outcomes assessment. The use of organizational, NP-specific, and national-related quality measures can help to showcase how NP care improves the quality, safety, and costs of health care. ©2017 American Association of Nurse Practitioners.
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A Synthesis of a Quality Management Model for Education in Universities
ERIC Educational Resources Information Center
Srikanthan, G.; Dalrymple, John
2004-01-01
The paper attempts to synthesise the features of the model for quality management in education based on the approaches spelt out in four well-articulated methodologies for the practice of quality in higher education. Each methodology contributes to different views of education from the learners' and the institution's perspectives, providing…
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Total Quality Management in a Knowledge Management Perspective.
ERIC Educational Resources Information Center
Johannsen, Carl Gustav
2000-01-01
Presents theoretical considerations on both similarities and differences between information management and knowledge management and presents a conceptual model of basic knowledge management processes. Discusses total quality management and quality control in the context of information management. (Author/LRW)
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Funk, Luke M; Conley, Dante M; Berry, William R; Gawande, Atul A
2013-11-01
Sub-Saharan Africa has a high surgical burden of disease but performs a disproportionately low volume of surgery. Closing this surgical gap will require increased surgical productivity of existing systems. We examined specific hospital management practices in three sub-Saharan African hospitals that are associated with surgical productivity and quality. We conducted 54 face-to-face, structured interviews with administrators, clinicians, and technicians at a teaching hospital, district hospital, and religious mission hospital across two countries in sub-Saharan Africa. Questions focused on recommended general management practices within five domains: goal setting, operations management, talent management, quality monitoring, and financial oversight. Records from each interview were analyzed in a qualitative fashion. Each hospital's management practices were scored according to the degree of implementation of the management practices (1 = none; 3 = some; 5 = systematic). The mission hospital had the highest number of employees per 100 beds (226), surgeons per operating room (3), and annual number of operations per operating room (1,800). None of the three hospitals had achieved systematic implementation of management practices in all 14 measures. The mission hospital had the highest total management score (44/70 points; average = 3.1 for each of the 14 measures). The teaching and district hospitals had statistically significantly lower management scores (average 1.3 and 1.1, respectively; p < .001). It is possible to meaningfully assess hospital management practices in low resource settings. We observed substantial variation in implementation of basic management practices at the three hospitals. Future research should focus on whether enhancing management practices can improve surgical capacity and outcomes.
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2013-01-01
Background Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. Methods An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. Results The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score ‘Preventive Services’ (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). Conclusions There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology. PMID:23510482
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Ludt, Sabine; Campbell, Stephen M; Petek, Davorina; Rochon, Justine; Szecsenyi, Joachim; van Lieshout, Jan; Wensing, Michel; Ose, Dominik
2013-03-09
Prevention of cardiovascular diseases (CVD) is a major health issue worldwide. Primary care plays an important role in cardiovascular risk management (CVRM). Guidelines and quality of care measures to assess CVRM in primary care practices are available. In this study, we assessed the relationship between structural and organisational practice characteristics and the quality of care provided in individuals at high risk for developing CVD in European primary care. An observational study was conducted in 267 general practices from 9 European countries. Previously developed quality indicators were abstracted from medical records of randomly sampled patients to create a composite quality measure. Practice characteristics were collected by a practice questionnaire and face to face interviews. Data were aggregated using factor analysis to four practice scores representing structural and organisational practice features. A hierarchical multilevel analysis was performed to examine the impact of practice characteristics on quality of CVRM. The final sample included 4223 individuals at high risk for developing CVD (28% female) with a mean age of 66.5 years (SD 9.1). Mean indicator achievement was 59.9% with a greater variation between practices than between countries. Predictors at the patient level (age, gender) had no influence on the outcome. At the practice level, the score 'Preventive Services' (13 items) was positively associated with clinical performance (r = 1.92; p = 0.0058). Sensitivity analyses resulted in a 5-item score (PrevServ_5) that was also positively associated with the outcome (r = 4.28; p < 0.0001). There was a positive association between the quality of CVRM in individuals at high risk for developing CVD and the availability of preventive services related to risk assessment and lifestyle management supported by information technology.
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Emma L. Witt; Christopher D. Barton; Jeffrey W. Stringer; Randy Kolka; Mac A. Cherry
2016-01-01
Streamside management zones (SMZs) are a common best management practice (BMP) used to reduce water quality impacts from logging. The objective of this research was to evaluate the impact of varying SMZ configurations on water quality. Treatments (T1, T2, and T3) that varied in SMZ width, canopy retention within the SMZ, and BMP utilization were applied at the...
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NASA Astrophysics Data System (ADS)
Jamaludin, Amril Hadri; Karim, Nurulzatushima Abdul; Noor, Raja Nor Husna Raja Mohd; Othman, Nurulhidayah; Malik, Sulaiman Abdul
2017-08-01
Construction waste management (CWM) is the practice of minimizing and diverting construction waste, demolition debris, and land-clearing debris from disposal and redirecting recyclable resources back into the construction process. Best practice model means best choice from the collection of other practices that was built for purpose of construction waste management. The practice model can help the contractors in minimizing waste before the construction activities will be started. The importance of minimizing wastage will have direct impact on time, cost and quality of a construction project. This paper is focusing on the preliminary study to determine the factors of waste generation in the construction sites and identify the effectiveness of existing construction waste management practice conducted in Malaysia. The paper will also include the preliminary works of planned research location, data collection method, and analysis to be done by using the Analytical Hierarchy Process (AHP) to help in developing suitable waste management best practice model that can be used in the country.
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Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M
2015-05-11
To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. A cross-sectional study. All Dutch care groups (n=97). 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. The association between quality management, overall and in 6 domains ('organisation of care', 'multidisciplinary teamwork', 'patient centredness', 'performance management', 'quality improvement policy' and 'management strategies') on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. The domain 'management strategies' was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. This first exploratory study on quality management showed weak or no associations between quality management of diabetes care groups and their performance. It remains
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USDA-ARS?s Scientific Manuscript database
Best management practices (BMPs) are popular approaches used to improve hydrology and water quality. Uncertainties in BMP effectiveness over time may result in overestimating long-term efficiency in watershed planning strategies. To represent varying long-term BMP effectiveness in hydrologic/water q...
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Long term management practices influenced soil aggregation and carbon dynamics
USDA-ARS?s Scientific Manuscript database
Soil aggregation protects soil organic C (SOC) against rapid decomposition, improves soil quality, and reduces soil erosion potential. The objectives of this study are to evaluate the effects of long-term (21 yrs.) management practices on SOC, water stable aggregate (WSA), and aggregate-associated ...
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Campmans-Kuijpers, Marjo J E; Baan, Caroline A; Lemmens, Lidwien C; Klomp, Maarten L H; Romeijnders, Arnold C M; Rutten, Guy E H M
2015-01-01
Objectives To enhance the quality of diabetes care in the Netherlands, so-called care groups with three to 250 general practitioners emerged to organise and coordinate diabetes care. This introduced a new quality management level in addition to the quality management of separate general practices. We hypothesised that this new level of quality management might be associated with the aggregate performance indicators on the patient level. Therefore, we aimed to explore the association between quality management at the care group level and its aggregate performance indicators. Design A cross-sectional study. Setting All Dutch care groups (n=97). Participants 23 care groups provided aggregate register-based performance indicators of all their practices as well as data on quality management measured with a questionnaire filled out by 1 or 2 of their quality managers. Primary outcomes The association between quality management, overall and in 6 domains (‘organisation of care’, ‘multidisciplinary teamwork’, ‘patient centredness’, ‘performance management’, ‘quality improvement policy’ and ‘management strategies’) on the one hand and 3 process indicators (the percentages of patients with at least 1 measurement of glycated haemoglobin, lipid profile and systolic blood pressure), and 3 intermediate outcome indicators (the percentages of patients with glycated haemoglobin below 53 mmol/mol (7%); low-density lipoprotein cholesterol below 2.5 mmol/L; and systolic blood pressure below 140 mm Hg) by weighted univariable linear regression. Results The domain ‘management strategies’ was significantly associated with the percentage of patients with a glycated haemoglobin <53 mmol/mol (β 0.28 (0.09; 0.46) p=0.01) after correction for multiple testing. The other domains as well as overall quality management were not associated with aggregate process or outcome indicators. Conclusions This first exploratory study on quality management showed weak
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Making a Difference: Leading and Managing for Quality Improvement in Adult and Community Learning.
ERIC Educational Resources Information Center
Ravenhall, Mark; Kenway, Mike
This guide looks at demands on leaders and managers in adult and community learning (ACL) in the roles and issues they face in the context of quality improvement (QI). It suggests practical approaches for improving the quality of provision for adults. The guide's design builds on current practice toward the desired state of excellence in all…
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Bergholz, W
2008-11-01
In many high-tech industries, quality management (QM) has enabled improvements of quality by a factor of 100 or more, in combination with significant cost reductions. Compared to this, the application of QM methods in health care is in its initial stages. It is anticipated that stringent process management, embedded in an effective QM system will lead to significant improvements in health care in general and in the German public health service in particular. Process management is an ideal platform for controlling in the health care sector, and it will significantly improve the leverage of controlling to bring down costs. Best practice sharing in industry has led to quantum leap improvements. Process management will enable best practice sharing also in the public health service, in spite of the highly diverse portfolio of services that the public health service offers in different German regions. Finally, it is emphasised that "technical" QM, e.g., on the basis of the ISO 9001 standard is not sufficient to reach excellence. It is necessary to integrate soft factors, such as patient or employee satisfaction, and leadership quality into the system. The EFQM model for excellence can serve as proven tool to reach this goal.
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Integrated management of depression: improving system quality and creating effective interfaces.
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.
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West, David R; Radcliff, Tiffany A; Brown, Tiffany; Cote, Murray J; Smith, Peter C; Dickinson, W Perry
2012-01-01
Information about the costs and experiences of collecting and reporting quality measure data are vital for practices deciding whether to adopt new quality improvement initiatives or monitor existing initiatives. Six primary care practices from Colorado's Improving Performance in Practice program participated. We conducted structured key informant interviews with Improving Performance in Practice coaches and practice managers, clinicians, and staff and directly observed practices. Practices had 3 to 7 clinicians and 75 to 300 patients with diabetes, half had electronic health records, and half were members of an independent practice association. The estimated per-practice cost of implementation for the data collection and reporting for the diabetes quality improvement program was approximately $15,552 per practice (about $6.23 per diabetic patient per month). The first-year maintenance cost for this effort was approximately $9,553 per practice ($3.83 per diabetic patient per month). The cost of implementing and maintaining a diabetes quality improvement effort that incorporates formal data collection, data management, and reporting is significant and quantifiable. Policymakers must become aware of the financial and cultural impact on primary care practices when considering value-based purchasing initiatives.
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Nurse managers describe their practice environments.
Warshawsky, Nora E; Lake, Sharon W; Brandford, Arica
2013-01-01
Hospital work environments that support the professional practice of nurses are critical to patient safety. Nurse managers are responsible for creating these professional practice environments for staff nurses, yet little is known about the environments needed to support nurse managers. Domains of nurse managers' practice environment have recently been defined. This is a secondary analysis of 2 cross-sectional studies of organizational characteristics that influence nurse manager practice. Content analysis of the free text comments from 127 nurse managers was used to illustrate the 8 domains of nurse managers' practice environments. Nurse managers valued time spent with their staff; therefore, workloads must permit meaningful interaction. Directors demonstrated trust when they empowered nurse managers to make decisions. Administrative leaders should build patient safety cultures on the basis of shared accountability and mutual respect among the health care team. The expectations of nurse managers have greatly expanded in the volume and complexity of direct reports, patient care areas, and job functions. The nurse managers in this analysis reported characteristics of their practice environments that limit their role effectiveness and may negatively impact organizational performance. Further research is needed to understand the effects of nurse managers' practice environments on staff and patient outcomes.
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Manchikanti, Laxmaiah; Hammer, Marvel; Benyamin, Ramsin M; Hirsch, Joshua A
2016-01-01
Basing their rationale on multiple publications from Institute of Medicine (IOM), specifically Crossing the Quality Chasm, policy makers have focused on a broad range of issues, including assessment of the influence of medical practice organization structures on quality performance and development of quality measures. The 2006 Tax Relief and Health Care Act established the Physician Quality Reporting System (PQRS), to enable eligible professionals to report health care quality and health outcome information that cannot be obtained from standard Medicare claims. However, the Patient Protection and Affordable Care Act (ACA) of 2010 required the Centers for Medicare and Medicaid Services (CMS) to incorporate a combination of cost and quality into the payment systems for health care as a precursor to value-based payments. The final change to PQRS pending initiation after 2018, is based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) which has incorporated alternative payment models and merit-based payment systems. Recent publication of quality performance scores by CMS has been less than optimal. When voluntary participation began in July 2007, providers were paid a bonus for reporting quality measures from 2008 through 2014, ranging from 0.5% to 2% of the Medicare Part B allowed charges furnished during the reporting period. Starting in 2015, penalties started for nonparticipation. Eligible professionals and group practices that failed to satisfactorily report data on quality measures during 2014 are subject to a 2% reduction in Medicare fee-for-service amounts for services furnished by the eligible professional or group practice during 2016. The CMS proposed rule for 2016 physician payments contained a number of provisions with proposed updates to the PQRS and Physician Value-Based Payment Modifier among other changes. The proposed rule is the first release since MACRA repealed the sustainable growth rate formula. CMS proposed to continue many
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Using standard treatment protocols to manage costs and quality of hospital services.
Meyer, J W; Feingold, M G
1993-06-01
The current health care environment has made it critically important that hospital costs and quality be managed in an integrated fashion. Promised health care reforms are expected to make cost reduction and quality enhancement only more important. Traditional methods of hospital cost and quality control have largely been replaced by such approaches as practice parameters, outcomes measurement, clinical indicators, clinical paths, benchmarking, patient-centered care, and a focus on patient selection criteria. This Special Report describes an integrated process for strategically managing costs and quality simultaneously, incorporating key elements of many important new quality and cost control tools. By using a multidisciplinary group process to develop standard treatment protocols, hospitals and their medical staffs address the most important services provided within major product lines. Using both clinical and financial data, groups of physicians, nurses, department managers, financial analysts, and administrators redesign key patterns of care within their hospital, incorporating the best practices of their own and other institutions. The outcome of this process is a new, standardized set of clinical guidelines that reduce unnecessary variation in care, eliminate redundant interventions, establish clear lines of communication for all caregivers, and reduce the cost of each stay. The hospital, medical staff, and patients benefit from the improved opportunities for managed care contracting, more efficient hospital systems, consensus-based quality measures, and reductions in the cost of care. STPs offer a workable and worthwhile approach to positioning the hospital of the 1990s for operational efficiency and cost and quality competitiveness.
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ERIC Educational Resources Information Center
Ballinger, Julie Ann
2013-01-01
Mindfulness-based practices are associated with increased attentional qualities, improved self-focus styles, enhanced empathic understanding, and strengthened self-compassion, making these practices a viable addition to counselor training programs. However, current mindfulness training models are primarily designed for relief of psychological…
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Practice management for academic dermatology departments.
Eaglstein, W H
2000-09-01
Practice management in the academic medical center (AMC) is different than in other environments. Practice is only a part of the practitioner's mission within an AMC. Practice revenue will be subject to a tax or overhead by both the school and the department. Contract and practice guidelines cannot be tailored to the needs of the dermatology practice, because contracts and guidelines are negotiated globally for all of the practices within the AMC. Personnel, on which the practice depends, may report to hospitals and clinics rather than to the practice's management. Even control of the practice's manager may be diluted by a dual or "dotted line" reporting relationship between the department manager and the school practice manager. Although more constraints exist within the AMC, there are some strategic and operational choices that affect a practice's success. Among these are: (1) selection of services offered; (2) creation of satellites; (3) stimulation of faculty effort; (4) enhancement of faculty billing knowledge; and (5) creation of a "tie" between staff and the practice.
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Tu, Pei-Weng; Wu, Shiow-Ing
2015-01-01
The implementation of an effective quality management system has always been considered a principal method for a manufacturer to maintain and improve its product and service quality. Globally many regulatory authorities incorporate quality management system as one of the mandatory requirements for the regulatory control of high-risk medical devices. The present study aims to analyze the GMP enforcement experience in Taiwan between 1998 and 2013. It describes the regulatory implementation of medical device GMP requirement and initiatives taken to assist small and medium-sized enterprises in compliance with the regulatory requirement. Based on statistical data collected by the competent authority and industry research institutes, the present paper reports the growth of Taiwan local medical device industry after the enforcement of GMP regulation. Transition in the production, technologies, and number of employees of Taiwan medical device industry between 1998 and 2013 provides the competent authorities around the world with an empirical foundation for further policy development. PMID:26075255
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Li, Tzu-Wei; Tu, Pei-Weng; Liu, Li-Ling; Wu, Shiow-Ing
2015-01-01
The implementation of an effective quality management system has always been considered a principal method for a manufacturer to maintain and improve its product and service quality. Globally many regulatory authorities incorporate quality management system as one of the mandatory requirements for the regulatory control of high-risk medical devices. The present study aims to analyze the GMP enforcement experience in Taiwan between 1998 and 2013. It describes the regulatory implementation of medical device GMP requirement and initiatives taken to assist small and medium-sized enterprises in compliance with the regulatory requirement. Based on statistical data collected by the competent authority and industry research institutes, the present paper reports the growth of Taiwan local medical device industry after the enforcement of GMP regulation. Transition in the production, technologies, and number of employees of Taiwan medical device industry between 1998 and 2013 provides the competent authorities around the world with an empirical foundation for further policy development.
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Diagnosis and management of endometriosis: the role of the advanced practice nurse in primary care.
Mao, Alexandra J; Anastasi, Joyce K
2010-02-01
To discuss the etiology, clinical presentation, diagnosis, and management of endometriosis for the advanced practice nurse (APN) in primary care. Selected research, clinical studies, clinical practice guidelines, and review articles. Commonly encountered by the APN in primary care, endometriosis is a chronic, progressive inflammatory disease characterized by endometrial lesions, cysts, fibrosis, or adhesions in the pelvic cavity, causing chronic pelvic pain and infertility in women of reproductive age. Because of its frequently normal physical examination findings, variable clinical presentations, and nonspecific, overlapping symptoms with other conditions, endometriosis can be difficult to diagnose. As there currently are no accurate noninvasive diagnostic tests specific for endometriosis, it is imperative for the APN to become knowledgeable about the etiology, clinical presentation, diagnosis, and current treatment options of this disease. The APN in primary care plays an essential role in health promotion through disease management and infertility prevention by providing support and much needed information to the patient with endometriosis. APNs can also facilitate quality of care and manage treatments effectively to improve quality of life, reduce pain, and prevent further progression of disease. Practice recommendations include timely diagnosis, pain management, infertility counseling, patient education, and support for quality of life issues.
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ERIC Educational Resources Information Center
Bush, Tony, Ed.; Bell, Les, Ed.
This book examines the main themes in educational management and leadership, including strategy, human resources, teaching and learning, finance, external relations, and quality. The 19 chapters are divided into 7 sections: "The Context of Educational Management,""Leadership and Strategic Management,""Human Resource Management,""Managing Learning…
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ERIC Educational Resources Information Center
Psychogios, Alexandros G.; Priporas, Constantinos-Vasilios
2007-01-01
This study addresses managers' awareness and familiarity with Total Quality Management (TQM). Eighteen (18) semi-structured, in-depth interviews were conducted with managers working in a variety of service organizations in Greece. The major argument of the study is that although the acronym TQM and some of its concepts and practices are known by a…
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Coulam, Robert; Kralewski, John; Dowd, Bryan; Gans, David
2016-01-01
Although there are numerous studies of the factors influencing the adoption of quality assurance (QA) programs by medical group practices, few have focused on the role of group practice administrators. To gain insights into the role these administrators play in QA programs, we analyzed how medical practices adopted and implemented the Medicare Physician Quality Reporting System (PQRS), the largest physician quality reporting system in the United States. We conducted focus group interviews in 2011 with a national convenience sample of 76 medical group practice administrators. Responses were organized and analyzed using the innovation decision framework of Van de Ven and colleagues. Administrators conducted due diligence on PQRS, influenced how the issue was presented to physicians for adoption, and managed implementation thereafter. Administrators' recommendations were heavily influenced by practice characteristics, financial incentives, and practice commitments to early adoption of quality improvement innovations. Virtually, all who attempted it agreed that PQRS was straightforward to implement. However, the complexities of Medicare's PQRS reports impeded use of the data by administrators to support quality management. Group practice administrators are playing a prominent role in activities related to the quality of patient care--they are not limited to the business side of the practice. Especially, as PQRS becomes more nearly universal after 2014, Medicare should take account of the role that administrators play, by more actively engaging administrators in shaping these programs and making it easier for administrators to use the results. More research is needed on the rapidly evolving role of nonphysician administration in medical group practices. Practice administrators have a larger role than commonly understood in how quality reporting initiatives are adopted and used and are in an exceptional position to influence the more appropriate use of these resources if
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Influences of management of Southern forests on water quantity and quality
Ge Sun; Mark Riedel; Rhett Jackson; Randy Kolka; Devendra Amatya; Jim Shepard
2004-01-01
Water is a key output of southern forests and is critical to other processes, functions, and values of forest ecosystems. This chapter synthesizes published literature about the effects of forest management practices on water quantity and water quality across the Southern United States region. We evaluate the influences of forest management at different temporal and...
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Hall, D.W.; Lietman, P.L.; Koerkle, E.J.
1997-01-01
The U.S. Geological Survey and the Pennsylvania Department of Environmental Protection conducted a study from 1984 to 1990 to determine theeffects of the implementation and practice of nutrient management [an agricultural best-management practice (BMP)] on the quality of surface runoff and ground water at a 55-acre crop and livestock farm in carbonate terrain nearEphrata, Pa. Implementation of nutrient management at Field-Site 2 resulted in application decreases of 33 percent for nitrogen and 29 percent for phosphorus. There wereno significant changes in nitrogen or phosphorusloads for a given amount of runoff from the pre-BMP to the post-BMP periods. However, less than 2 percent of the applied nutrients weredischarged with runoff throughout the study period.After the implementation of nutrient management, statistically significant decreases in concentrations of nitrate in ground-water samples occurred at threeof the four wells monitored throughout the pre- and post-BMP periods. The largest decreases in nitrate concentrations occurred at wells where samples hadthe largest nitrate concentrations prior to nutrient management. Changes in nitrogen applications to the contributing areas of five wells were correlated with nitrate concentrations of the well water. The correlations between the timing and amount of applied nitrogen and changes in ground-water quality met the four conditions that are characteristic of a cause-effect relation: an association, consistency, responsiveness, and a mechanism. Changes in ground-water nitrate concentrations lagged behind changes in loading of nitrogen fertilizers (primarily manure) by approximately 4 to 19 months.
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Ford, Bradley A.; Klutts, J. Stacey; Jensen, Chris S.; Briggs, Angela S.; Robinson, Robert A.; Bruch, Leslie A.; Karandikar, Nitin J.
2017-01-01
Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output. PMID:28913416
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Krasowski, Matthew D; Ford, Bradley A; Klutts, J Stacey; Jensen, Chris S; Briggs, Angela S; Robinson, Robert A; Bruch, Leslie A; Karandikar, Nitin J
2017-01-01
Training in patient safety, quality, and management is widely recognized as an important element of graduate medical education. These concepts have been intertwined in pathology graduate medical education for many years, although training programs face challenges in creating explicit learning opportunities in these fields. Tangibly involving pathology residents in management and quality improvement projects has the potential to teach and reinforce key concepts and further fulfill Accreditation Council for Graduate Medical Education goals for pursuing projects related to patient safety and quality improvement. In this report, we present our experience at a pathology residency program (University of Iowa) in engaging pathology residents in projects related to practical issues of laboratory management, process improvement, and informatics. In this program, at least 1 management/quality improvement project, typically performed during a clinical chemistry/management rotation, was required and ideally resulted in a journal publication. The residency program also initiated a monthly management/informatics series for pathology externs, residents, and fellows that covers a wide range of topics. Since 2010, all pathology residents at the University of Iowa have completed at least 1 management/quality improvement project. Many of the projects involved aspects of laboratory test utilization, with some projects focused on other areas such as human resources, informatics, or process improvement. Since 2012, 31 peer-reviewed journal articles involving effort from 26 residents have been published. Multiple projects resulted in changes in ongoing practice, particularly within the hospital electronic health record. Focused management/quality improvement projects involving pathology residents can result in both meaningful quality improvement and scholarly output.
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Liu, Yaoze; Bralts, Vincent F; Engel, Bernard A
2015-04-01
The adverse influence of urban development on hydrology and water quality can be reduced by applying best management practices (BMPs) and low impact development (LID) practices. This study applied green roof, rain barrel/cistern, bioretention system, porous pavement, permeable patio, grass strip, grassed swale, wetland channel, retention pond, detention basin, and wetland basin, on Crooked Creek watershed. The model was calibrated and validated for annual runoff volume. A framework for simulating BMPs and LID practices at watershed scales was created, and the impacts of BMPs and LID practices on water quantity and water quality were evaluated with the Long-Term Hydrologic Impact Assessment-Low Impact Development 2.1 (L-THIA-LID 2.1) model for 16 scenarios. The various levels and combinations of BMPs/LID practices reduced runoff volume by 0 to 26.47%, Total Nitrogen (TN) by 0.30 to 34.20%, Total Phosphorus (TP) by 0.27 to 47.41%, Total Suspended Solids (TSS) by 0.33 to 53.59%, Lead (Pb) by 0.30 to 60.98%, Biochemical Oxygen Demand (BOD) by 0 to 26.70%, and Chemical Oxygen Demand (COD) by 0 to 27.52%. The implementation of grass strips in 25% of the watershed where this practice could be applied was the most cost-efficient scenario, with cost per unit reduction of $1m3/yr for runoff, while cost for reductions of two pollutants of concern was $445 kg/yr for Total Nitrogen (TN) and $4871 kg/yr for Total Phosphorous (TP). The scenario with very high levels of BMP and LID practice adoption (scenario 15) reduced runoff volume and pollutant loads from 26.47% to 60.98%, and provided the greatest reduction in runoff volume and pollutant loads among all scenarios. However, this scenario was not as cost-efficient as most other scenarios. The L-THIA-LID 2.1 model is a valid tool that can be applied to various locations to help identify cost effective BMP/LID practice plans at watershed scales. Copyright © 2014 Elsevier B.V. All rights reserved.
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Practical Approaches to Quality Improvement for Radiologists.
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.
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Organizational attributes of practices successful at a disease management program.
Cloutier, Michelle M; Wakefield, Dorothy B; Tsimikas, John; Hall, Charles B; Tennen, Howard; Brazil, Kevin
2009-02-01
To assess the contribution of organizational factors to implementation of 3 asthma quality measures: enrollment in a disease management program, development of a written treatment plan, and prescription of severity-appropriate anti-inflammatory therapy. A total of 138 pediatric clinicians and 247 office staff in 13 urban clinics and 23 nonurban private practices completed questionnaires about their practice's organizational characteristics (eg, leadership, communication, perceived effectiveness, job satisfaction). 94% of the clinicians and 92% of the office staff completed questionnaires. When adjusted for confounders, greater practice activity and perceived effectiveness in meeting family needs were associated with higher rates of enrollment in the Easy Breathing program, whereas higher scores for 3 organizational characteristics--communication timeliness, decision authority, and job satisfaction--were associated with both higher enrollment and a greater number of written treatment plans. None of the organizational characteristics was associated with greater use of anti-inflammatory therapy. Three organizational characteristics predicted 2 quality asthma measures: use of a disease management program and creation of a written asthma treatment plan. If these organizational characteristics were amenable to change, then our findings could help focus interventions in areas of effective and acceptable organizational change.
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Todd, Christopher A; Sanchez, Ana M; Garcia, Ambrosia; Denny, Thomas N; Sarzotti-Kelsoe, Marcella
2014-07-01
The EQAPOL contract was awarded to Duke University to develop and manage global proficiency testing programs for flow cytometry-, ELISpot-, and Luminex bead-based assays (cytokine analytes), as well as create a genetically diverse panel of HIV-1 viral cultures to be made available to National Institutes of Health (NIH) researchers. As a part of this contract, EQAPOL was required to operate under Good Clinical Laboratory Practices (GCLP) that are traditionally used for laboratories conducting endpoint assays for human clinical trials. EQAPOL adapted these guidelines to the management of proficiency testing programs while simultaneously incorporating aspects of ISO/IEC 17043 which are specifically designed for external proficiency management. Over the first two years of the contract, the EQAPOL Oversight Laboratories received training, developed standard operating procedures and quality management practices, implemented strict quality control procedures for equipment, reagents, and documentation, and received audits from the EQAPOL Central Quality Assurance Unit. GCLP programs, such as EQAPOL, strengthen a laboratory's ability to perform critical assays and provide quality assessments of future potential vaccines. © 2013.
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Useful measures and models for analytical quality management in medical laboratories.
Westgard, James O
2016-02-01
The 2014 Milan Conference "Defining analytical performance goals 15 years after the Stockholm Conference" initiated a new discussion of issues concerning goals for precision, trueness or bias, total analytical error (TAE), and measurement uncertainty (MU). Goal-setting models are critical for analytical quality management, along with error models, quality-assessment models, quality-planning models, as well as comprehensive models for quality management systems. There are also critical underlying issues, such as an emphasis on MU to the possible exclusion of TAE and a corresponding preference for separate precision and bias goals instead of a combined total error goal. This opinion recommends careful consideration of the differences in the concepts of accuracy and traceability and the appropriateness of different measures, particularly TAE as a measure of accuracy and MU as a measure of traceability. TAE is essential to manage quality within a medical laboratory and MU and trueness are essential to achieve comparability of results across laboratories. With this perspective, laboratory scientists can better understand the many measures and models needed for analytical quality management and assess their usefulness for practical applications in medical laboratories.
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Factual Approach in Decision Making - the Prerequisite of Success in Quality Management
NASA Astrophysics Data System (ADS)
Kučerová, Marta; Škůrková Lestyánszka, Katarína
2013-12-01
In quality management system as well as in other managerial systems, effective decisions must be always based on the data and information analysis, i.e. based on facts, in accordance with the factual approach principle in quality management. It is therefore necessary to measure and collect the data and information about processes. The article presents the results of a conducted survey, which was focused on application of factual approach in decision making. It also offers suggestions for improvements of application of the principle in business practice. This article was prepared using the research results of VEGA project No. 1/0229/08 "Perspectives of the quality management development in relation to the requirements of market in the Slovak Republic".
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Audiology practice management in South Africa: What audiologists know and what they should know
Kritzinger, Alta; Soer, Maggi
2015-01-01
Background In future, the South African Department of Health aims to purchase services from accredited private service providers. Successful private audiology practices can assist to address issues of access, equity and quality of health services. It is not sufficient to be an excellent clinician, since audiology practices are businesses that must also be managed effectively. Objective The objective was to determine the existing and required levels of practice management knowledge as perceived by South African audiologists. Method An electronic descriptive survey was used to investigate audiology practice management amongst South African audiologists. A total of 147 respondents completed the survey. Results were analysed by calculating descriptive statistics. The Z-proportional test was used to identify significant differences between existing and required levels of practice management knowledge. Results Significant differences were found between existing and required levels of knowledge regarding all eight practice management tasks, particularly legal and ethical issues and marketing and accounting. There were small differences in the knowledge required for practice management tasks amongst respondents working in public and private settings. Conclusion Irrespective of their work context, respondents showed that they need significant expansion of practice management knowledge in order to be successful, to compete effectively and to make sense of a complex marketplace. PMID:26809158
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An assessment model for quality management
NASA Astrophysics Data System (ADS)
Völcker, Chr.; Cass, A.; Dorling, A.; Zilioli, P.; Secchi, P.
2002-07-01
SYNSPACE together with InterSPICE and Alenia Spazio is developing an assessment method to determine the capability of an organisation in the area of quality management. The method, sponsored by the European Space Agency (ESA), is called S9kS (SPiCE- 9000 for SPACE). S9kS is based on ISO 9001:2000 with additions from the quality standards issued by the European Committee for Space Standardization (ECSS) and ISO 15504 - Process Assessments. The result is a reference model that supports the expansion of the generic process assessment framework provided by ISO 15504 to nonsoftware areas. In order to be compliant with ISO 15504, requirements from ISO 9001 and ECSS-Q-20 and Q-20-09 have been turned into process definitions in terms of Purpose and Outcomes, supported by a list of detailed indicators such as Practices, Work Products and Work Product Characteristics. In coordination with this project, the capability dimension of ISO 15504 has been revised to be consistent with ISO 9001. As contributions from ISO 9001 and the space quality assurance standards are separable, the stripped down version S9k offers organisations in all industries an assessment model based solely on ISO 9001, and is therefore interesting to all organisations, which intend to improve their quality management system based on ISO 9001.
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2013-01-01
Background Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. Methods/design This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. Discussion This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries
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Campmans-Kuijpers, Marjo J E; Lemmens, Lidwien C; Baan, Caroline A; Gorter, Kees J; Groothuis, Jolanda; van Vuure, Klementine H; Rutten, Guy E H M
2013-04-05
Worldwide, the organisation of diabetes care is changing. As a result general practices and diabetes teams in hospitals are becoming part of new organisations in which multidisciplinary care programs are implemented. In the Netherlands, 97 diabetes care groups and 104 outpatient clinics are working with a diabetes care program. Both types of organisations aim to improve the quality of diabetes care. Therefore, it is essential to understand the comprehensive elements needed for optimal quality management at organisational level. This study aims to assess the current level of diabetes quality management in both care groups and outpatient clinics and its improvement after providing feedback on their quality management system and tailored support. This study is a before-after study with a one-year follow-up comparing the levels of quality management before and after an intervention to improve diabetes quality management. To assess the status of quality management, online questionnaires were developed based on current literature. They consist of six domains: organisation of care, multidisciplinary teamwork, patient centeredness, performance management, quality improvement policy and management strategies. Based on the questionnaires, respondents will receive feedback on their score in a radar diagram and an elucidating table. They will also be granted access to an online toolbox with instruments that proved to be effective in quality of care improvement and with practical examples. If requested, personal support in implementing these tools will be available. After one year quality management will be measured again using the same questionnaire. This study will reveal a nationwide picture of quality management in diabetes care groups and outpatient clinics in the Netherlands and evaluate the effect of offering tailored support. The operationalisation of quality management on organisational level may be of interest for other countries as well.
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NASA Astrophysics Data System (ADS)
Spiegel, Heide; Lehtinen, Taru; Schlatter, Norman; Haslmayr, Hans-Peter; Baumgarten, Andreas; ten Berge, Hein
2015-04-01
Successful agricultural management practices are required to maintain or enhance soil quality; at the same time climate change mitigation is becoming increasingly important. Within the EU project CATCH-C we analysed the effects of different agricultural practices not only on crop productivity, but also on soil quality indicators (e.g. soil organic carbon (SOC)) and climate change (CC) mitigation indicators (e.g. CO2, CH4, N2O emissions). European data sets and associated literature, mainly from long-term experiments were evaluated. This evaluation of agricultural management practices was carried out comparing a set of improved ("best") and often applied ("current") management practices. Positive and negative effects occurred when best management practices are adopted. As expected, none of the investigated practices could comply with all objectives simultaneously, i.e. maintaining high yields, mitigating climate change and improving chemical, physical and biological soil quality. The studied soil management practices "non-inversion tillage", "organic fertilisation" (application of farm yard manure, slurry, compost) and "incorporation of crop residues" represent important management practices for farmers to increase SOC, thus improving soil quality. However, CO2 and, especially, N2O emissions may rise as well. The evaluation of CC mitigation is often limited by the lack of data from - preferably - continuous GHG emission measurements. Thus, more long-term field studies are needed to better assess the CO2, CH4 and, especially, N2O emissions following the above mentioned favorably rated MPs. Only if SOC and GHG emissions are measured in the same field experiments, it will be possible to compute overall balances of necessary CO2-C equivalent emissions. CATCH-C is funded within the 7th Framework Programme for Research, Technological Development and Demonstration, Theme 2 - Biotechnologies, Agriculture & Food. (Grant Agreement N° 289782).
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Hilton, S; Rink, E; Fletcher, J; Sibbald, B; Freeling, P; Szczepura, A; Davies, C; Stilwell, J
1994-01-01
BACKGROUND. The evaluation of near patient testing in British general practice has largely been confined to studies examining individual tests or comparing equipment. AIM. This study set out to determine the attitudes of practice staff to near patient testing, and the extent to which staff undertook quality assessment. METHOD. Four types of near patient testing machines were introduced into 12 general practices in two regions of England, south west Thames and west Midlands. General practitioner and practice nurse attitudes to near patient testing were assessed by semi-structured interview before and six months after the introduction of the machines. The extent to which routine quality assurance procedures were carried out within the surgery and as part of local and national schemes was examined. RESULTS. Although 80% of general practitioners anticipated changing patient management with near patient testing, only two fifths reported having done so after six months. Nurses generally were enthusiastic at the outset, although one third were unhappy about incorporating near patient testing into their work schedules. Time pressure was the most important factor restricting uptake of near patient testing. Nurses performed quality control regularly but complete local external quality assurance procedures were established in only half the practices. All the practices participated in a national scheme for cholesterol assays. CONCLUSION. General practitioners in this study did not find near patient testing a very useful addition to their resources. Pressure on nurses' time was the most frequently reported limitation. PMID:7748669
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Klemenc-Ketis, Zalika; Poplas-Susič, Antonija
2017-12-01
To determine the possible associations between higher levels of selected quality indicators and the characteristics of providers. In 2011, an ongoing project on a new model of family medicine practice was launched in Slovenia; the family physicians' working team (a family physician and a practice nurse) was extended by a nurse practitioner working 0.5 full-time equivalents. This was an example of a personalised team approach to managing chronic patients. We included all family medicine practices in the six units of the Community Health Centre Ljubljana which were participating in the project in December 2015 (N = 66). Data were gathered from automatic electronic reports on quality indicators provided monthly by each practice. We also collected demographic data. There were 66 family medicine teams in the sample, with 165 members of their teams (66 family physicians, 33 nurse practitioners and 66 practice nurses). Fifty-six (84.4%) of the family physicians were women, as were 32 (97.0%) of the nurse practitioners, and 86 (95.5%) of the practice nurses. Multivariate analysis showed that a higher level of the quality indicator "Examination of diabetic foot once per year" was independently associated with nurse practitioners having attended additional education on diabetes, duration of participation in the project, age and years worked since graduation of nurse practitioners, working in the Center unit and not working in the Bezigrad unit. Characteristics of team members are important in fostering quality management of chronic patients. Nurse practitioners working in new model family practices need obligatory, continuous professional education in the management of chronic patients. The quality of care of chronic patients depends on the specific characteristics of the members of the team, which should be taken into account when planning quality improvements. © 2017 John Wiley & Sons Ltd.
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40 CFR 503.24 - Management practices.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Management practices. 503.24 Section... FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Surface Disposal § 503.24 Management practices. (a) Sewage... the permitting authority that through management practices public health and the environment are...
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Total Quality Management: Getting Started
1990-08-01
Quality Management (TQM) program using Organizational Development (OD) intervention techniques to gain acceptance of the program. It emphasizes human behavior and the need for collaborative management and consensus in organizational change. Lessons learned stress the importance of choosing a skilled TQM facilitator, training process action teams, and fostering open communication and teamwork to minimize resistance to change. Keywords: Management planning and control, Quality control, Quality , Management , Organization change, Organization development,
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Total quality management in American industry.
Widtfeldt, A K; Widtfeldt, J R
1992-07-01
The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.
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Baldwin, David; Callister, Matthew; Akram, Ahsan; Cane, Paul; Draffan, Jeanette; Franks, Kevin; Gleeson, Fergus; Graham, Richard; Malhotra, Puneet; Pearson, Philip; Subesinghe, Manil; Waller, David; Woolhouse, Ian
2018-01-01
The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. 7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. BTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations.
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British Thoracic Society quality standards for the investigation and management of pulmonary nodules
Baldwin, David; Callister, Matthew; Akram, Ahsan; Cane, Paul; Draffan, Jeanette; Franks, Kevin; Gleeson, Fergus; Graham, Richard; Malhotra, Puneet; Pearson, Philip; Subesinghe, Manil; Waller, David; Woolhouse, Ian
2018-01-01
Introduction The purpose of the quality standards document is to provide healthcare professionals, commissioners, service providers and patients with a guide to standards of care that should be met for the investigation and management of pulmonary nodules in the UK, together with measurable markers of good practice. Methods Development of British Thoracic Society (BTS) Quality Standards follows the BTS process of quality standard production based on the National Institute for Health and Care Excellence process manual for the development of quality standards. Results 7 quality statements have been developed, each describing a key marker of high-quality, cost-effective care for the investigation and management of pulmonary nodules, and each statement is supported by quality measures that aim to improve the structure, process and outcomes of healthcare. Discussion BTS Quality Standards for the investigation and management of pulmonary nodules form a key part of the range of supporting materials that the Society produces to assist in the dissemination and implementation of guideline recommendations. PMID:29682290
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Quality management for the international transport of laboratory animals.
Leary, Steven L
2008-01-01
Increased collaboration between investigators at different institutions has increased the number of laboratory animals being transported. The current system of laws and regulations governing animal shipments is inconsistent and government agencies often have areas of overlapping regulatory management. Furthermore, the lack of industry-wide shipping standards and good practices contributes to confusion among those responsible for shipment. One answer to these quality control issues would be the establishment of independent, industry-regulated 'good practices' for animal transport, similar to those used in laboratories for experimental design. These good practices could be based on the existing International Air Transport Association Live Animals Regulations, with contributions from representatives of the specialties involved. Additionally, quality control under the current system of patchwork regulations could be improved if each institution, both academic and commercial, would designate a single point of contact to follow each shipment from start to finish.
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STORMWATER BEST MANAGEMENT PRACTICES DESIGN GUIDE VOLUME 3 - BASIN BEST MANAGEMENT PRACTICES
This manual provides design guidelines for a group of stormwater management (SWM) best management practices (BMPs) broadly referred to as basin or pond BMPs. Basin BMPs are the mainstay of stormwater management. Water resources engineers have designed small and large ponds for ma...
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Consolidation of medical groups into physician practice management organizations.
Robinson, J C
1998-01-14
Medical groups are growing and merging to improve efficiency and bargaining leverage in the competitive managed care environment. An increasing number are affiliating with physician practice management (PPM) firms that offer capital financing, expertise in utilization management, and global capitation contracts with health insurance entities. These physician organizations provide an alternative to affiliation with a hospital system and to individual physician contracting with health plans. To describe the growth, structure, and strategy of PPM organizations that coordinate medical groups in multiple markets and contract with health maintenance organizations (HMOs). Case studies, including interviews with administrative and clinical leaders, review of company documents, and analysis of documents from investment bankers, the Securities and Exchange Commission, and industry observers. Medical groups and independent practice associations (IPAs) in California and New Jersey affiliated with MedPartners, FPA Medical Management, and UniMed. Growth in number of primary care and specialty care physicians employed by and contracting with affiliated medical groups; growth in patient enrollment from commercial, Medicare, and Medicaid HMOs; growth in capitation and noncapitation revenues; structure and governance of affiliated management service organizations and professional corporations; and contracting strategies with HMOs. Between 1994 and 1996, medical groups and IPAs affiliated with 3 PPMs grew from 3787 to 25763 physicians; 65% of employed physicians provide primary care, while the majority of contracting physicians provide specialty care. Patient enrollment in HMOs grew from 285503 to 3028881. Annual capitation revenues grew from $190 million to $2.1 billion. Medical groups affiliated with PPMs are capitated for most professional, hospital, and ancillary clinical services and are increasingly delegated responsibility by HMOs for utilization management and quality
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Smith, Alan D; Offodile, O Felix
2008-01-01
The limitations, immeasurable, and seemly unquantifiable aspects of the healthcare service industry, make it imperative that quality assurance programs include total quality management (TQM) and automatic identification and data capture (AIDC)-related technologies. Most of standards used in TQM and AIDC require data, to measure improvement and achieve standardization. Major difference between managing a service firm and managing a product-manufacturing firm is the difficulty of achieving consistently high quality. Examination of two different healthcare service providers in the Pittsburgh, Pennsylvania area offers different views as to the implementation and practice of total quality management techniques and AIDC integration. Since the healthcare service industry must take into account its high customization needs, there are positive steps to make the hospital structure itself more patient friendly and quality related; hence improving its heath-marketing strategies to the general public.
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The economics of water reuse and implications for joint water quality-quantity management
NASA Astrophysics Data System (ADS)
Kuwayama, Y.
2015-12-01
Traditionally, economists have treated the management of water quality and water quantity as separate problems. However, there are some water management issues for which economic analysis requires the simultaneous consideration of water quality and quantity policies and outcomes. Water reuse, which has expanded significantly over the last several decades, is one of these issues. Analyzing the cost effectiveness and social welfare outcomes of adopting water reuse requires a joint water quality-quantity optimization framework because, at its most basic level, water reuse requires decision makers to consider (a) its potential for alleviating water scarcity, (b) the quality to which the water should be treated prior to reuse, and (c) the benefits of discharging less wastewater into the environment. In this project, we develop a theoretical model of water reuse management to illustrate how the availability of water reuse technologies and practices can lead to a departure from established rules in the water resource economics literature for the optimal allocation of freshwater and water pollution abatement. We also conduct an econometric analysis of a unique dataset of county-level water reuse from the state of Florida over the seventeen-year period between 1996 and 2012 in order to determine whether water quality or scarcity concerns drive greater adoption of water reuse practices.
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Strategy Guideline: Quality Management in Existing Homes; Cantilever Floor Example
DOE Office of Scientific and Technical Information (OSTI.GOV)
Taggart, J.; Sikora, J.; Wiehagen, J.
2011-12-01
This guideline is designed to highlight the QA process that can be applied to any residential building retrofit activity. The cantilevered floor retrofit detailed in this guideline is included only to provide an actual retrofit example to better illustrate the QA activities being presented. The goal of existing home high performing remodeling quality management systems (HPR-QMS) is to establish practices and processes that can be used throughout any remodeling project. The research presented in this document provides a comparison of a selected retrofit activity as typically done versus that same retrofit activity approached from an integrated high performance remodeling andmore » quality management perspective. It highlights some key quality management tools and approaches that can be adopted incrementally by a high performance remodeler for this or any high performance retrofit. This example is intended as a template and establishes a methodology that can be used to develop a portfolio of high performance remodeling strategies.« less
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Manage indirect practice expense the way you practice medicine: with information.
Zeller, T L; Senagore, A J; Siegel, G
1999-05-01
Surgeons are increasingly faced with the pressures of maintaining the highest quality of patient care, while at the same time maintaining financial viability. The purpose of this project was to provide a framework for analyzing practice costs for colorectal surgeons using an activity-based cost accounting model. A survey of 11 practices that were diverse in terms of geography, managed care penetration, academic vs. private practice style, and case distribution was performed. In activity-based costing the assignment of typical costs such as staff salaries are assigned to the appropriate business process. The business processes employed in this study were service patients in the office, perform in-office procedures, schedule cases in facilities, service patients in the hospital, insurance authorization, maintain medical records, billing, collections, resolve billing disputes, interaction with third parties, maintain professional education, sustain and manage the practice, maintain the facility, teaching and research, and performing drug studies. The final step is to assign the cost associated with all appropriate business processes to the appropriate cost object. The cost objects in this study were defined as a charge office visit, no-charge office visit, charge hospital visit, in-office procedures, in-facility procedures, and performing drug studies. The data were then analyzed to allow a comparison of four similar practices within the study group. The data demonstrated that the cost of seeing a charge office visit ranged from $55 to $105. Similarly, the cost of seeing a no-charge office visit during the global period ranged from $43 to $100. The study analyzed possible explanations for the wide variability in these costs. It is essential that physicians clearly understand the sources of expenses generated by the operation of their practices. A clear comprehension of costs will lead colorectal surgeons to make appropriate decisions regarding such important issues as
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[Factors influencing the quality of clinical practice guidelines in ovarian cancer].
Castillo-Londoño, J S; Medina-Torres, Y A; Sandoval-Salinas, C; Buitrago-Gutierrez, G; Torres-Ibargüen, M Z; Gonzalez-Rangel, A L
To identify the characteristics of the published clinical practice guidelines for the management of epithelial ovarian cancer that suggest a good methodological quality. A literature review was performed on 25 clinical practice guidelines for epithelial ovarian cancer that were identified in different databases (MEDLINE, Guidelines International Network, National Guidelines Clearing house) published between 2007 and 2014. The quality of the guidelines was evaluated using the Appraisal of Guidelines Research and Evaluation II tool. Descriptive and bivariate analyses were performed to assess the association between the quality of the guidelines and of some of their features and their developers. Just under half (48%) of the guidelines were rated as low quality. Scientific societies or independent centres and private funding, or under-reporting the source of funding, were statistically associated with lower quality of clinical practice guidelines (P<.01). The guidelines developed by National Program Guidelines had a median of consistently higher scores in all domains of the Appraisal of Guidelines Research and Evaluation II, with significant differences in the definition of scope and objectives, the participation of stakeholders, the methodological rigour of development, and applicability to the context. Features such as the nature of the developer and funding of the guidelines are predictors of quality that should be taken into account prior to the use of the recommendations of a document. Copyright © 2016 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
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Stormwater quality management in rail transportation--past, present and future.
Vo, Phuong Tram; Ngo, Huu Hao; Guo, Wenshan; Zhou, John L; Listowski, Andrzej; Du, Bin; Wei, Qin; Bui, Xuan Thanh
2015-04-15
Railways currently play an important role in sustainable transportation systems, owing to their substantial carrying capacity, environmental friendliness and land-saving advantages. Although total pollutant emissions from railway systems are far less than that of automobile vehicles, the pollution from railway operations should not be underestimated. To date, both scientific and practical papers dealing with stormwater management for rail tracks have solely focused on its drainage function. Unlike roadway transport, the potential of stormwater pollution from railway operations is currently mishandled. There have been very few studies into the impact of its operations on water quality. Hence, upon the realisation on the significance of nonpoint source pollution, stormwater management priorities should have been re-evaluated. This paper provides an examination of past and current practices of stormwater management in the railway industry, potential sources of stormwater pollution, obstacles faced in stormwater management and concludes with strategies for future management directions. Copyright © 2015 Elsevier B.V. All rights reserved.
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Best Practices for Real Property Management
2016-04-21
organizations and are experienced in creating reliable and actionable solutions to complex management issues guided by proven best business practices...DEFENSE BUSINESS BOARD For the Secretary of Defense Best Practices for Real Property Management DBB...FY16-02 Recommendations on the best practices for management of Department of Defense real property assets Defense Business
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Petek, Davorina; Mlakar, Mitja
2016-09-01
A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices. A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared. The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort. The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.
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A watershed scale assessment of the impacts of suburban turf management on runoff water quality
NASA Astrophysics Data System (ADS)
Bachman, M.; Inamdar, S. P.; Barton, S.; Duke, J.; Tallamy, D.; Bruck, J.
2014-12-01
Steadily increasing rates of urbanization have raised concerns about the negative impacts of urban runoff on receiving surface water quality. These concerns have been further amplified by landscaping paradigms that encourage high-input, intensively-managed and mono-culture turf and lawn landscapes. We conducted a watershed-scale assessment of turf management practices on water quality vis-à-vis less-intensive management practices that preserve and enhance more diverse and native vegetation. The study treatments with existing/established vegetation and landscaping practices included turf, urban, forest, meadow, and a mixed site with a professional golf course. Stream water sampling was performed during baseflow and storm events. Highest nutrient (nitrate and total nitrogen) concentrations in runoff were observed for the mixed watershed draining the golf course. In contrast, nutrient concentrations in baseflow from the turf watershed were lower than expected and were comparable to those measured in the surrounding meadow and forest sites. Runoff losses from the turf site may have been minimal due to the optimal quality of management implemented. Total nitrogen concentrations from the turf site increased sharply during the first storms following fertilization, suggesting that despite optimal management there exists a risk for nutrient runoff following fertilization. Dissolved organic carbon (DOC) concentrations from the turf site were elevated and aromatic in content while the mixed watershed site yielded more labile DOM. Overall, this study suggests that turf lawns, when managed properly, pose minimal environmental risk to surrounding surface waters. Based on the results of this study, providing homeowners with increased information regarding best management practices for lawn maintenance may serve as a cost-efficient method for reducing suburban runoff pollution.
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Zucali, Maddalena; Bava, Luciana; Colombini, Stefania; Brasca, Milena; Decimo, Marilù; Morandi, Stefano; Tamburini, Alberto; Crovetto, G Matteo
2015-04-01
Anaerobic spore-forming bacteria (ASFB) in milk derive from the farm environment, and the use of silages and management practices are the main responsible of milk ASFB contamination. The aim of this study was to evaluate the relationships between feeding, milking routine and cow hygiene and milk and Grana Padano cheese (produced with and without lysozyme) ASFB contamination. The study involved 23 dairy farms. ASFB in corn silage were on average 2.34 ± 0.87 log10 MPN g(-1). For grass, Italian ryegrass and alfalfa, ASFB (log10 MPN g(-1)) were numerically higher for silages (3.22) than hays (2.85). The use of corn silages of high quality (high lactic and acetic acids concentrations) decreased the milk ASFB contamination, whilst the use of herbage silages did not affect it. The presence (>40%) of cows with dirty udders increased the ASFB contamination of milk, while forestripping had a positive effect (-9% ASFB). Ripened Grana Padano had an ASFB count below the analytical limit; Clostridium tyrobutyricum DNA was found only in wheels produced without lysozyme, which also showed late blowing. The factors increasing milk spore contamination were corn silage quality, cow udder hygiene and inadequate milking routine. Late blowing was present only in cheeses without lysozyme. © 2014 Society of Chemical Industry.
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Quality Management and Information Brokerage.
ERIC Educational Resources Information Center
van Halm, Johan
1995-01-01
To compete effectively, information brokers need to adopt management and marketing tools; Total Quality Management can upgrade an organization's performance by using customer feedback of its services. SERVQUAL identifies gaps in service by assessing quality expectations versus quality experiences. (AEF)
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NASA Astrophysics Data System (ADS)
Liu, Yaoze; Engel, Bernard A.; Flanagan, Dennis C.; Gitau, Margaret W.; McMillan, Sara K.; Chaubey, Indrajeet; Singh, Shweta
2018-05-01
Best management practices (BMPs) are popular approaches used to improve hydrology and water quality. Uncertainties in BMP effectiveness over time may result in overestimating long-term efficiency in watershed planning strategies. To represent varying long-term BMP effectiveness in hydrologic/water quality models, a high level and forward-looking modeling framework was developed. The components in the framework consist of establishment period efficiency, starting efficiency, efficiency for each storm event, efficiency between maintenance, and efficiency over the life cycle. Combined, they represent long-term efficiency for a specific type of practice and specific environmental concern (runoff/pollutant). An approach for possible implementation of the framework was discussed. The long-term impacts of grass buffer strips (agricultural BMP) and bioretention systems (urban BMP) in reducing total phosphorus were simulated to demonstrate the framework. Data gaps were captured in estimating the long-term performance of the BMPs. A Bayesian method was used to match the simulated distribution of long-term BMP efficiencies with the observed distribution with the assumption that the observed data represented long-term BMP efficiencies. The simulated distribution matched the observed distribution well with only small total predictive uncertainties. With additional data, the same method can be used to further improve the simulation results. The modeling framework and results of this study, which can be adopted in hydrologic/water quality models to better represent long-term BMP effectiveness, can help improve decision support systems for creating long-term stormwater management strategies for watershed management projects.
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Total Quality Management Implementation Plan for Military Personnel Management
1989-09-01
2050.. )ATE 3. REPORT TYPE AND DATES CO VERED 4. TITLE AND SUBTITLE 5,rrmir18 . FUNDING NUMBERS Total Quality Management Implementation Plan for...SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Military Personnel Management, Continuous Process Improvement 16. PRICE CODE 17. SECURITY...UNCLASSIFIED UNCLASSIFIED UL NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Prescribed by ANSI Std Z39-16 296-102 TOTAL QUALITY MANAGEMENT I
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Factors Influencing Farmers’ Adoption of Best Management Practices: A Review and Synthesis
Best management practices (BMPs) for reducing agricultural non-point source pollution are widely available. However, agriculture remains a major global contributor to degradation of waters because farmers often do not adopt BMPs. To improve water quality, it is necessary to under...
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Practice, clinical management, and financial arrangements of practicing generalists.
Keating, Nancy L; Landon, Bruce E; Ayanian, John Z; Borbas, Catherine; Guadagnoli, Edward
2004-05-01
To describe the practice settings, financial arrangements, and management strategies experienced by generalist physicians and identify factors associated with reporting pressure to limit referrals, pressure to see more patients, and career dissatisfaction. Cross-sectional mail survey. Six hundred nineteen generalist physicians (62% response rate) caring for managed care patients in 3 Minnesota health plans during 1999. Twenty-six percent of physicians reported pressure to limit referrals. In adjusted analyses, female physicians and those who were board certified acted as gatekeepers for most of their patients, received incentives based on performance reports and quality profiles, and received direct income from capitation, and were more likely than others to report this pressure (all P <.05). Sixty-two percent reported pressure to see more patients. In adjusted analyses, this pressure was more frequent among physicians in practices owned by health systems, those using physician extenders, and among physicians paid by salary with performance adjustment or those receiving at least some capitation (all P <.05). One-quarter (24%) of physicians were dissatisfied with their career in medicine. In adjusted analyses, physicians reporting pressure to limit referrals (risk ratio, 1.12; 95% confidence interval, 1.01 to 1.19) and those reporting pressure to see more patients (risk ratio, 1.37; 95% confidence interval, 1.08 to 1.66) were more likely to be dissatisfied than other physicians. Pressures to limit referrals and to see more patients are common, particularly among physicians paid based on productivity or capitation, and they are associated with career dissatisfaction. Whether future changes in practice arrangements or compensation strategies can decrease such physician-reported pressures, and ultimately improve physician satisfaction, will be an important area for future study.
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Moran, L J; Brown, W J; McNaughton, S A; Joham, A E; Teede, H J
2017-03-01
Do weight management practices differ in women with and without PCOS? Women in the general population with self-reported PCOS are more likely to be using healthy weight management practices and alternative non-lifestyle measures for weight management than women without PCOS. Lifestyle management is the first-line treatment in PCOS. However, the specific weight management practices used by women with PCOS and their effect on diet and physical activity are unclear. The study was a population-based observational cross-sectional study involving women in the 1973-1978 cohort (n = 7767 total; n = 556 with PCOS, n = 7211 without PCOS). Women with and without self-reported PCOS were included. Self-reported outcome measures included healthy lifestyle-related or alternative non-lifestyle-related (e.g. laxatives or smoking) weight management practices, dietary intake and physical activity. Women with PCOS were more likely to be following both healthy [reducing meal or snack size (odds ratio (OR) 1.50, 95% CI 1.14, 1.96, P = 0.004) and reducing fat or sugar intake (OR 1.32, 95% CI 1.03, 1.69, P = 0.027) or following a low glycaemic index diet (OR 2.88, 95% CI 2.30, 3.59, P < 0.001)] and alternative [smoking (OR 1.60, 95% CI 1.02, 2.52, P = 0.043) or use of laxative, diet pills, fasting or diuretics (OR 1.45, 95% CI 1.07, 1.97, P = 0.017)] weight management practices than women without PCOS. In PCOS, the use of a range of healthy weight management practices was associated with increases in physical activity (P < 0.001), diet quality (P < 0.001), percentage protein intake (P < 0.001) and decreases in glycaemic index (P < 0.001), and percentages of fat (P = 0.001), saturated fat (P < 0.001) or fibre (P = 0.003). Use of alternative weight management practices was associated with decreases in diet quality. Limitations include the use of self-reported data for PCOS, height, weight, diet, physical activity and weight management behaviours. In PCOS, we should focus on improving
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Comparison of Quality Engineering Practices in Malaysian and Indonesian Automotive Related Companies
NASA Astrophysics Data System (ADS)
Putri, Nilda Tri; Sha'ri Mohd, Yusof; Irianto, Dradjad
2016-02-01
The main motivating factor driving this research is to find differences between the automotive related companies in Malaysia and Indonesia with regard to quality engineering (QE) implementation. A comparative study between Malaysia and Indonesia provides the opportunity to gain perspective and thorough understanding of the similarities and differences on the critical factors for successful QE practices in the context of both these countries. Face to face interviews are used to compare the QE practices in two automotive companies in Malaysia and Indonesia, respectively. The findings of study showed that both countries have clear quality objectives to achieving zero defects in processes and products and total customer satisfaction. Top and middle management in both countries were found to be directly involved in quality improvement on the shop floor to provide On-The-Job training and actively encourage team members to perform quality problem solving through the formation of quality control circles (QCC) particularly in Indonesia automotive industry. In Malaysia automotive industry, the implementation was not fully effective, but they have started to cultivate those values in the daily execution. Based on the case study results and analysis, the researcher has provided suggestions for both countries as an improvement plan for successful QE implementation. These recommendations will allow management to implement appropriate strategies for better QE implementation which hopefully can improve company's performance and ultimately the making the automotive industry in both countries to reach world class quality. It is strongly believed that the findings of this study can help Malaysia and Indonesia automotive industries in their efforts to become more effective and competitive.
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Quality assessment of practice nurse communication with type 2 diabetes patients.
Mulder, Bob C; van Belzen, Milou; Lokhorst, Anne Marike; van Woerkum, Cees M J
2015-02-01
Nurse self-management support for type 2 diabetes patients may benefit from applying theory-based behavior change counseling. The 5As model was used to assess if, and how, nurses applied the five key elements of self-management support in standard care. Seven practice nurses audio-recorded consultations with 66 patients. An existing instrument for assessing counseling quality was used to determine if the 5As were applied. Applied As were compared with quality criteria, to provide an in-depth assessment. In almost every consultation, nurses assessed health behaviors, and arranged a follow-up meeting. However, nurses advised behavior change in less than half of the consultations, while setting goals and assisting patients to overcome barriers were used even less. Comparing applied As with quality criteria revealed several issues that could be improved. Nurses consistently discussed health behaviors with patients, but important elements of self-management support were not applied. Self-management support may benefit from training nurses in performing assessments that form the base for specific advice, setting goals, and addressing barriers to behavior change. Nurses also have to learn how to combine being medical expert and behavioral counselor. Clarifying both roles to patients may facilitate communication and establishing a collaborative relationship. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
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Understanding the role of land use in urban stormwater quality management.
Goonetilleke, Ashantha; Thomas, Evan; Ginn, Simon; Gilbert, Dale
2005-01-01
Urbanisation significantly impacts water environments with increased runoff and the degradation of water quality. The management of quantity impacts are straight forward, but quality impacts are far more complex. Current approaches to safeguard water quality are largely ineffective and guided by entrenched misconceptions with a primary focus on 'end-of-pipe' solutions. The outcomes of a research study presented in the paper, which investigated relationships between water quality and six different land uses offer practical guidance in the planning of future urban developments. In terms of safeguarding water quality, high-density residential development which results in a relatively smaller footprint would be the preferred option. The research study outcomes bring into question a number of fundamental concepts and misconceptions routinely accepted in stormwater quality management. The research findings confirmed the need to move beyond customary structural measures and identified the key role that urban planning can play in safeguarding urban water environments.
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Do quality indicators for general practice teaching practices predict good outcomes for students?
Bartlett, Maggie; Potts, Jessica; McKinley, Bob
2016-07-01
Keele medical students spend 113 days in general practices over our five-year programme. We collect practice data thought to indicate good quality teaching. We explored the relationships between these data and two outcomes for students; Objective Structured Clinical Examination (OSCE) scores and feedback regarding the placements. Though both are surrogate markers of good teaching, they are widely used. We collated practice and outcome data for one academic year. Two separate statistical analyses were carried out: (1) to determine how much of the variation seen in the OSCE scores was due to the effect of the practice and how much to the individual student. (2) to identify practice characteristics with a relationship to student feedback scores. (1) OSCE performance: 268 students in 90 practices: six quality indicators independently influenced the OSCE score, though without linear relationships and not to statistical significance. (2) Student satisfaction: 144 students in 69 practices: student feedback scores are not influenced by practice characteristics. The relationships between the quality indicators we collect for practices and outcomes for students are not clear. It may be that neither the quality indicators nor the outcome measures are reliable enough to inform decisions about practices' suitability for teaching.
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The role of practical wisdom in nurse manager practice: why experience matters.
Cathcart, Eloise Balasco; Greenspan, Miriam
2013-10-01
To illustrate through the interpretation of one representative nurse manager's narrative how the methodology of practice articulation gives language to the ways practical wisdom develops in leadership practice and facilitates learning. Patricia Benner's corpus of research has demonstrated that reflection on clinical narratives comes closer than other pedagogical methods to replicating and enhancing the experiential learning required for the development of practical wisdom. Using Benner's methodology of practice articulation, 91 nurse managers wrote and read to a peer group a narrative of their lived experience in the role. The groups interpreted the narratives to extract the skilled knowledge and ethics embedded in the practice of the nurse manager authors. One narrative was chosen for this paper because it is a particularly clear exemplar of how practical wisdom develops in nurse manager practice. Articulating and reflecting on experiential learning led to an understanding of how practical wisdom developed in one nurse manager's practice. Interpretation of the narrative of one nurse manager illustrated how reflection on a complex ethical dilemma was a source of character development for the individual and the peer group. Describing and interpreting how practical wisdom develops for individual nurse managers can be a source of learning for the narrative author and other role incumbents who need to make sound decisions and take prudent action in ethically challenging situations. © 2013 John Wiley & Sons Ltd.
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Padilha, J M; Sousa, P A F; Pereira, F M S
2018-03-01
To propose nursing clinical practice changes to improve the development of patient self-management. Chronic obstructive pulmonary disease is one of the main causes of chronic morbidity, loss of quality of life and high mortality rates. Control of the disease's progression, the preservation of autonomy in self-care and maintenance of quality of life are extremely challenging for patients to execute in their daily living. However, there is still little evidence to support nursing clinical practice changes to improve the development of self-management. A participatory action research study was performed in a medicine inpatient department and the outpatient unit of a Portuguese hospital. The sample comprised 52 nurses and 99 patients. For data collection, we used interviews, participant observation and content analysis. The main elements of nursing clinical practice that were identified as a focus for improvement measures were the healthcare model, the organization of healthcare and the documentation of a support decision-making process. The specific guidelines, the provision of material to support decision-making and the optimization of information sharing between professionals positively influenced the change process. This change improved the development of self-management skills related to the awareness of the need for 'change', hope, involvement, knowledge and abilities. The implemented changes have improved health-related behaviours and clinical outcomes. To support self-management development skills, an effective nursing clinical practice change is needed. This study has demonstrated the relevance of a portfolio of techniques and tools to help patients adopt healthy behaviours. The involvement and participation of nurses and patients in the conceptualization, implementation and evaluation of policy change are fundamental issues to improve the quality of nursing care and clinical outcomes. © 2017 International Council of Nurses.
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Total Quality Management (TQM) Bibliography
1990-04-01
GTE FIE COPY DTIC c" ECTE 8JUL 25 1990u TOTAL QUALITY MANAGEMENT (TQM) BIBLIOGRAPHY APRIL-1990 Jointly supported by __’__________-_________ Jointly...Arsenal, AL 35898-5241 1I. TITLE (Include Security Classification) TOTAL QUALITY MANAGEMENT (TQM) BIBL IRAPHY APRIL-1990 12. PERSONAL AUTHOR(S) Knott...implementation of the concept of total quality management (TQM). The selected coverage includes books, periodical articles, conference papers and reports. Coded
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[Quality management in intensive care medicine].
Martin, J; Braun, J-P
2014-02-01
Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.
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[Quality management in intensive care medicine].
Martin, J; Braun, J-P
2013-09-01
Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system.
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[Quality management is associated with high quality services in health care].
Nielsen, Tenna Hassert; Riis, Allan; Mainz, Jan; Jensen, Anne-Louise Degn
2013-12-09
In these years, quality management has been the focus in order to meet high quality services for the patients in Danish health care. This article provides information on quality management and quality improvement and it evaluates its effectiveness in achieving better organizational structures, processes and results in Danish health-care organizations. Our findings generally support that quality management is associated with high quality services in health care.
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Alexander, Jeffrey A; Hearld, Larry R; Jiang, H Joanna; Fraser, Irene
2007-01-01
Evidence-based management assumes that available research evidence is consistent with the problems and decision-making conditions faced by those who will utilize this evidence in practice. This article attempts to identify how hospital leaders view key determinants of hospital quality and costs, as well as the fundamental ways these leaders "think" about solutions to quality and cost issues in their organizations. The objective of this analysis is to better inform the research agenda and approaches pursued by health services research so that this research reflects the "realities" of practice in hospitals. We conducted a series of semistructured interviews with a convenience sample of eight hospital and three health system leaders. Questions focused on current and future challenges facing hospitals as they relate to hospital quality, costs, and efficiency, and potential solutions to those challenges. Nine major organizational and managerial factors emerged from the interviews, including staffing, evidence-based practice, information technology, data availability and benchmarking, and leadership. Hospital leaders tend to think about these factors systemically and consider process-related factors as the important drivers of cost and quality. The results suggest a need to expand the methods utilized by health services researchers to make their research more relevant to health care managers. Expanding research methods to reflect the systemic way that managers view the challenges and solutions facing their organizations may enhance the application of research findings into management practice. Finally, better communication is needed between the research and practice communities. Researchers must learn to think more like managers if their research is to be relevant, and managers must learn to more effectively communicate their issues with the research community and frame their problems in researchable terms.
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Perceived safety management practices in the logistics sector.
Auyong, Hui-Nee; Zailani, Suhaiza; Surienty, Lilis
2016-03-09
Malaysia's progress on logistics has been slowed to keep pace with its growth in trade. The Government has been pressing companies to improve the safety of their activities in order to reduce society's loss due to occupational accidents and illnesses. Occupational safety and health is a crucial part of a workplace because every worker has to take care of his/her own safety and health. The main occupational safety and health (OSH) national policy in Malaysia is the enactment of the Occupational Safety and Health Act (OSHA) 1994. Only those companies which have excellent health and safety care have good quality and productive employees. This study investigated safety management practices in the logistics sector. The present study is concerned with the human factors to safety in the logistics industry. The authors examined the perceived safety management practices of workers in the logistics sector. The purpose was to identify the perception of safety management practices of Malaysian logistics personnel. Survey questionnaires were distributed to assess logistics personnel about management commitment. The quantitative method using the availability sampling method was applied. The data gathered from the survey were analysed using SPSS software. The responses to the survey were rated according to the Likert scale type, with '1' indicating strongly disagree and '5' indicating strongly agree. One hundred and three employees of logistics functions completed the survey. The highest mean scores were found for fire apparatus, prioritisation of safety, and safety policy. The results from this study also emphasise the importance of the management's commitment in enhancing workplace safety. Specifically, companies should maintain good relations between the employer and the employee to help reduce workplace injuries.
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Organizational management practices for achieving software process improvement
NASA Technical Reports Server (NTRS)
Kandt, Ronald Kirk
2004-01-01
The crisis in developing software has been known for over thirty years. Problems that existed in developing software in the early days of computing still exist today. These problems include the delivery of low-quality products, actual development costs that exceed expected development costs, and actual development time that exceeds expected development time. Several solutions have been offered to overcome out inability to deliver high-quality software, on-time and within budget. One of these solutions involves software process improvement. However, such efforts often fail because of organizational management issues. This paper discusses business practices that organizations should follow to improve their chances of initiating and sustaining successful software process improvement efforts.
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[Pharmaceutical product quality control and good manufacturing practices].
Hiyama, Yukio
2010-01-01
This report describes the roles of Good Manufacturing Practices (GMP) in pharmaceutical product quality control. There are three keys to pharmaceutical product quality control. They are specifications, thorough product characterization during development, and adherence to GMP as the ICH Q6A guideline on specifications provides the most important principles in its background section. Impacts of the revised Pharmaceutical Affairs Law (rPAL) which became effective in 2005 on product quality control are discussed. Progress of ICH discussion for Pharmaceutical Development (Q8), Quality Risk Management (Q9) and Pharmaceutical Quality System (Q10) are reviewed. In order to reconstruct GMP guidelines and GMP inspection system in the regulatory agencies under the new paradigm by rPAL and the ICH, a series of Health Science studies were conducted. For GMP guidelines, product GMP guideline, technology transfer guideline, laboratory control guideline and change control system guideline were written. For the GMP inspection system, inspection check list, inspection memo and inspection scenario were proposed also by the Health Science study groups. Because pharmaceutical products and their raw materials are manufactured and distributed internationally, collaborations with other national authorities are highly desired. In order to enhance the international collaborations, consistent establishment of GMP inspection quality system throughout Japan will be essential.
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Parker, Louise E; Kirchner, JoAnn E; Bonner, Laura M; Fickel, Jacqueline J; Ritchie, Mona J; Simons, Carol E; Yano, Elizabeth M
2009-02-01
There is a growing consensus that a hybrid of two common approaches to quality improvement (QI), local participatory QI and expert QI, might be the best method for achieving quality care. Achieving such a hybrid requires that content experts establish an ongoing dialogue with both frontline staff members and managers. In this study we examined frontline staff members' and managers' preferences regarding how to conduct such a dialogue, and we provide practical suggestions for implementation. The two groups shared a number of preferences (e.g., verbal face-to-face exchanges, discussions focused on quality of care). There were also some differences. For example, although managers were interested in discussions of business aspects (e.g., costs), frontline staff members were concerned with workload issues. Finally, although informants acknowledged that engaging in a QI dialogue was time consuming, they also believed it was essential if health care organizations are to improve the quality of care they provide.
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Application of Total Quality Management System in Thai Primary Schools
ERIC Educational Resources Information Center
Prueangphitchayathon, Setthiya; Tesaputa, Kowat; Somprach, Kanokorn
2015-01-01
The present study seeks to develop a total quality management (TQM) system that can be applied to primary schools. The approach focuses on customer orientation, total involvement of all constituencies and continuous improvement. TQM principles were studied and synthesized according to case studies of the best practices in 3 primary schools (small,…
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Soil management: The key to soil quality and sustainable agriculture
NASA Astrophysics Data System (ADS)
Basch, Gottlieb; Barão, Lúcia; Soares, Miguel
2017-04-01
Today, after the International Year of Soils in 2015 and the proclamation by the International Union of Soil Sciences of the International Decade of Soils 2015-2020, much attention is paid to soil quality. Often used interchangeably, both terms, soil quality and soil health, refer to dynamic soil properties such as soil organic matter or pH, while soil quality also includes inherent soil properties such as texture or mineral composition. However, it is the dynamic or manageable properties that adequate soil management can influence and thus contribute to a well-functioning soil environment capable to deliver the soil-mediated provisioning, regulating and supporting ecosystem services and soil functions. This contribution intends to highlight the key principles of sustainable soil management and provide evidence that they are compliant with a productive, resource efficient and ecologically friendly agriculture. Paradoxically, and despite benefitting from good soil quality, agriculture itself when based on conventional, especially intensive tillage-based soil management practices contributes decisively to soil degradation and to several of the soil threats as identified by the Soil Thematic Strategy, being soil erosion and soil organic matter decline the most notorious ones. To mitigate soil degradation, the European Union's Common Agricultural Policy has introduced conservation measures, mainly through cross-compliance measures supposed to guarantee minimum soil cover, to limit soil erosion and to maintain the levels of soil organic matter. However, it remains unclear to what extent EU member states apply these 'Good Agricultural and Environmental Condition' (GAEC) measures to their utilized agricultural areas. Effective and cost-efficient soil management systems able to conserve or to restore favourable soil conditions, to minimize soil erosion and to invert soil organic matter and soil biodiversity decline and improve soil structure are those capable to mimic as
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Nurse managers' conceptions of quality management as promoted by peer supervision.
Hyrkäs, Kristiina; Koivula, Meeri; Lehti, Kristiina; Paunonen-Ilmonen, Marita
2003-01-01
The aim of the study was to describe nurse managers' conceptions of quality management in their work as promoted by peer supervision. Quality management is one of the topical issues in a nurse manager's demanding and changing work. As first-line managers, they have a key role in quality management which is seen to create the system and environment for high quality services and quality improvement. Despite the official recommendations and definitions of quality management, several published reports have shown that there is no single solution for quality management. Peer supervision or the support provided by it to nursing managers have rarely been a subject of study. This study was carried out at Tampere University Hospital between 1996 and 1998. The peer supervision intervention was organized once a month, 2 hours at a time and in closed supervisor-led groups of nine nurse managers. Data were collected by themed interviews. Fifteen nurse managers participated in the study. The data were analysed using the phenomenographic method. Two main categories were formed of nurse managers' conceptions. The first described supportive and reflective characteristics of peer supervision. This main category was described by horizontal, hierarchical categories of support from peer group and reflection. The second main category described nurse managers' conceptions of individual development of leadership during peer supervision. This main category was also described by three horizontal categories: personal growth, finding psychological resources and internalization of leadership. The finding of this study show that peer supervision benefited nurse managers in quality management through reflection and support. The reflective and supportive characteristics of peer supervision promoted the nurse managers' individual development, but also that of leadership. It can be concluded that peer supervision promotes quality management in nurse managers' work.
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Quality risk management in pharmaceutical development.
Charoo, Naseem Ahmad; Ali, Areeg Anwer
2013-07-01
The objective of ICH Q8, Q9 and Q10 documents is application of systemic and science based approach to formulation development for building quality into product. There is always some uncertainty in new product development. Good risk management practice is essential for success of new product development in decreasing this uncertainty. In quality by design paradigm, the product performance properties relevant to the patient are predefined in target product profile (TPP). Together with prior knowledge and experience, TPP helps in identification of critical quality attributes (CQA's). Initial risk assessment which identifies risks to these CQA's provides impetus for product development. Product and process are designed to gain knowledge about these risks, devise strategies to eliminate or mitigate these risks and meet objectives set in TPP. By laying more emphasis on high risk events the protection level of patient is increased. The process being scientifically driven improves the transparency and reliability of the manufacturer. The focus on risk to the patient together with flexible development approach saves invaluable resources, increases confidence on quality and reduces compliance risk. The knowledge acquired in analysing risks to CQA's permits construction of meaningful design space. Within the boundaries of the design space, variation in critical material characteristics and process parameters must be managed in order to yield a product having the desired characteristics. Specifications based on product and process understanding are established such that product will meet the specifications if tested. In this way, the product is amenable to real time release, since specifications only confirm quality but they do not serve as a means of effective process control.
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The European initiative for quality management in lung cancer care.
Blum, Torsten G; Rich, Anna; Baldwin, David; Beckett, Paul; De Ruysscher, Dirk; Faivre-Finn, Corinne; Gaga, Mina; Gamarra, Fernando; Grigoriu, Bogdan; Hansen, Niels C G; Hubbard, Richard; Huber, Rudolf Maria; Jakobsen, Erik; Jovanovic, Dragana; Konsoulova, Assia; Kollmeier, Jens; Massard, Gilbert; McPhelim, John; Meert, Anne-Pascale; Milroy, Robert; Paesmans, Marianne; Peake, Mick; Putora, Paul-Martin; Scherpereel, Arnaud; Schönfeld, Nicolas; Sitter, Helmut; Skaug, Knut; Spiro, Stephen; Strand, Trond-Eirik; Taright, Samya; Thomas, Michael; van Schil, Paul E; Vansteenkiste, Johan F; Wiewrodt, Rainer; Sculier, Jean-Paul
2014-05-01
Lung cancer is the commonest cause of cancer-related death worldwide and poses a significant respiratory disease burden. Little is known about the provision of lung cancer care across Europe. The overall aim of the Task Force was to investigate current practice in lung cancer care across Europe. The Task Force undertook four projects: 1) a narrative literature search on quality management of lung cancer; 2) a survey of national and local infrastructure for lung cancer care in Europe; 3) a benchmarking project on the quality of (inter)national lung cancer guidelines in Europe; and 4) a feasibility study of prospective data collection in a pan-European setting. There is little peer-reviewed literature on quality management in lung cancer care. The survey revealed important differences in the infrastructure of lung cancer care in Europe. The European guidelines that were assessed displayed wide variation in content and scope, as well as methodological quality but at the same time there was relevant duplication. The feasibility study demonstrated that it is, in principle, feasible to collect prospective demographic and clinical data on patients with lung cancer. Legal obligations vary among countries. The European Initiative for Quality Management in Lung Cancer Care has provided the first comprehensive snapshot of lung cancer care in Europe.
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Total Quality and Organization Development. Total Quality Series.
ERIC Educational Resources Information Center
Lindsay, William M.; Petrick, Joseph A.
As the global business environment becomes more turbulent, quality management seems more indispensable. This book offers strategies for integrating the theory and practice of Total Quality Management (TQM) with organizational-development (OD) theory at all organizational levels. Chapter 1 answers the question "Why Total Quality Management and…
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Henderson, Amanda; Winch, Sarah
2008-01-01
Leadership strategies are important in facilitating the nursing profession to reach their optimum standards in the practice environment. To compare and contrast the central tenets of contemporary quality initiatives that are commensurate with enabling the environment so that best practice can occur. Democratic leadership, accessible and relevant education and professional development, the incorporation of evidence into practice and the ability of facilities to be responsive to change are core considerations for the successful maintenance of practice standards that are consistent with best nursing practice. While different concerns of management drive the adoption of contemporary approaches, there are many similarities in the how these approaches are translated into action in the clinical setting. Managers should focus on core principles of professional nursing that add value to practice rather than business processes.
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Evolving approaches to management of quality in clinical microbiology.
Bartlett, R C; Mazens-Sullivan, M; Tetreault, J Z; Lobel, S; Nivard, J
1994-01-01
Quality management in clinical microbiology began in the 1960s. Both government and professional societies introduced programs for proficiency testing and laboratory inspection and accreditation. Many laboratory scientists and pathologists were independently active and creative in expanding efforts to monitor and improve practices. The initial emphasis was placed on intralaboratory process. Later, attention was shifted to physician ordering, specimen collection, reporting, and use of information. Quality management in the laboratory depends in large part on the monitoring of indicators that provide some evidence of how laboratory resources are being used and how the information benefits patient care. Continuous quality improvement should be introduced. This consists of a more thorough assessment of doing the right things versus the wrong things in terms of customer demand and satisfaction and studying the cumulative effect of error when responsibility is passed from one person to another. Prevention of error is accomplished more through effective training and continuing education than through surveillance. Also, this system will force more conscious attention to meeting the expectations of the many customers that must be satisfied by laboratory services, including patients, physicians, third-party payers, and managed-care organizations. PMID:8118791
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Strategies for Implementation: The El Camino College Total Quality Management Story.
ERIC Educational Resources Information Center
Schauerman, Sam; Peachy, Burt
1994-01-01
Traces the development of the principles and practices of Total Quality Management (TQM) at El Camino College, in California. Discusses institutional resistance to change and the need for careful implementation analysis and constituent group involvement. Includes a nine-item bibliography of theoretical and descriptive works. (MAB)
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Impact of production practices on physicochemical properties of rice grain quality.
Bryant, Rolfe J; Anders, Merle; McClung, Anna
2012-02-01
Rice growers are interested in new technologies that can reduce input costs while maintaining high field yields and grain quality. The bed-and-furrow (BF) water management system benefits farmers through decreased water usage, labor, and fuel as compared to standard flood management. Fertilizer inputs can be reduced by producing rice in rotation with soybeans, a nitrogen-fixing crop, and with the use of slow-release fertilizers that reduce nitrogen volatilization and run-off. However, the influence of these cultural management practices on rice physicochemical properties is unknown. Our objective was to evaluate the influence of nitrogen fertilizer source, water management system, and crop rotation on rice grain quality. Grain protein concentration was lower in a continuous rice production system than in a rice-soybean rotation. Neither amylose content nor gelatinization temperature was altered by fertilizer source, crop rotation, or water management. BF water management decreased peak and breakdown viscosities relative to a flooded system. Peak and final paste viscosities were decreased by all fertilizer sources, whereas, crop rotation had no influence on the Rapid Visco Analyser profile. Sustainable production systems that decrease water use and utilize crop rotations and slow-release fertilizers have no major impact on rice physicochemical properties. Published 2011 by John Wiley & Sons, Ltd.
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Nurse managed occupational health services: a primary care model in practice.
Childre, F
1997-10-01
1. Managed care focus on delivering health care which values prevention, early intervention, continuity of care, commitment to quality care, and outcomes, as well as client satisfaction. Occupational health nurses routinely integrate these values into their practice. 2. An on-site model of primary health care delivery, incorporating the fundamentals of occupational health nursing, can bring significant savings to the organization in health related costs. 3. Case management may provide the greatest potential for growth in occupational health nursing. It is a method that can be used together with managed care to maximize quality health care services. 4. Viewing health related costs as an investment as opposed to part of a benefit plan, influences employees to make positive choices. It also impacts the delivery of health care services on a systematic, global level, which affects total health care costs.
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Principles and Practices for Quality Assurance and Quality Control
Jones, Berwyn E.
1999-01-01
Quality assurance and quality control are vital parts of highway runoff water-quality monitoring projects. To be effective, project quality assurance must address all aspects of the project, including project management responsibilities and resources, data quality objectives, sampling and analysis plans, data-collection protocols, data quality-control plans, data-assessment procedures and requirements, and project outputs. Quality control ensures that the data quality objectives are achieved as planned. The historical development and current state of the art of quality assurance and quality control concepts described in this report can be applied to evaluation of data from prior projects.
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Region 7 Quality Management Plan
To document adherence to EPA Order 5360.1 A2, EPA requires each organizational unitto develop a quality management plan per the specifications in EPA Requirements for QualityManagement Plans, EPA QA R-2.
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Management of venous leg ulcers in general practice - a practical guideline.
Sinha, Sankar; Sreedharan, Sadhishaan
2014-09-01
Chronic venous leg ulcers are the most common wounds seen in general practice. Their management can be both challenging and time-consuming. To produce a short practical guideline incorporating the TIME concept and A2BC2D approach to help general practitioners and their practice nurses in delivering evidence-based initial care to patients with chronic venous leg ulcers. Most chronic venous leg ulcers can be managed effectively in the general practice setting by following the simple, evidence-based approach described in this article. Figure 1 provides a flow chart to aid in this process. Figure 2 illustrates the principles of management in general practice. Effective management of chronic ulcers involves the assessment of both the ulcer and the patient. The essential requirements of management are to debride the ulcer with appropriate precautions, choose dressings that maintain adequate moisture balance, apply graduated compression bandage after evaluation of the arterial circulation and address the patient's concerns, such as pain and offensive wound discharge.
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Defense Depot Tracy Total Quality Management Plan
1989-07-01
PAGES TQM (Total Quality Management ), Depot Operations, Continuous Process Improvement 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...make up our pcrceptions of Total Quality Management . Our goal is to improve those proven management processes that have brought us success while being...MANIAGEMENT F. QUALITY AUDITS OF PRODUCTS AND OPERATIONS ASSETS MANAGEMENT 00 i .......... / ~899 29 03 1 EFENSE DEPOT TACY TOTAL QUALITY MANAGEMENT PLAN
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Savage, Jeff A; Ribaudo, Marc O
2013-11-15
Pollution in the Chesapeake Bay is a problem and has been a focus of federal and state initiatives to reduce nutrient pollution from agriculture and other sources since 1983. In 2010 EPA established a TMDL for the watershed. Producers may voluntarily respond to intense and focused policy scrutiny by adopting best management practices. A detailed analysis of water quality best management practices by animal feeding operations inside and outside the watershed yield insight into this relationship. Our findings support the hypothesis that farmers will adopt water quality measures if links are made clear and there is an expectation of future regulations. Published by Elsevier Ltd.
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Craig, Lorraine; Krewski, Dan; Samet, Jonathan; Shortreed, John; van Bree, Leendert; Krupnick, Alan J
2008-01-01
This statement is the result of discussions held at the 2005 NERAM IV Colloquium "International Perspectives on Air Quality: Risk Management Principles for Policy Development" and represents the collective views of 35 delegates, including international air quality policy analysts, academics, nongovernmental organizations, industry representatives, and decision makers from Mexico, Canada, the United States, the United Kingdom, Brazil, Hong Kong, and The Netherlands on principles for global air quality management. The objective of the colloquium was to "establish principles for air quality management based on the identification of international best practice in air quality policy development and implementation." This statement represents the main findings of a breakout group discussion session, presentations of an international panel of speakers from Canada, the United States, Mexico, and Hong Kong and views of the delegates expressed in plenary discussions. NERAM undertook a transparent process to try to ensure that the statement would accurately reflect the conference discussions, including documenting the proceedings and inviting delegates' comments on draft versions of the statement.
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Bischoff, Erik W M A; Akkermans, Reinier; Bourbeau, Jean; van Weel, Chris; Vercoulen, Jan H; Schermer, Tjard R J
2012-11-28
To assess the long term effects of two different modes of disease management (comprehensive self management and routine monitoring) on quality of life (primary objective), frequency and patients' management of exacerbations, and self efficacy (secondary objectives) in patients with chronic obstructive pulmonary disease (COPD) in general practice. 24 month, multicentre, investigator blinded, three arm, pragmatic, randomised controlled trial. 15 general practices in the eastern part of the Netherlands. Patients with COPD confirmed by spirometry and treated in general practice. Patients with very severe COPD or treated by a respiratory physician were excluded. A comprehensive self management programme as an adjunct to usual care, consisting of four tailored sessions with ongoing telephone support by a practice nurse; routine monitoring as an adjunct to usual care, consisting of 2-4 structured consultations a year with a practice nurse; or usual care alone (contacts with the general practitioner at the patients' own initiative). The primary outcome was the change in COPD specific quality of life at 24 months as measured with the chronic respiratory questionnaire total score. Secondary outcomes were chronic respiratory questionnaire domain scores, frequency and patients' management of exacerbations measured with the Nijmegen telephonic exacerbation assessment system, and self efficacy measured with the COPD self-efficacy scale. 165 patients were allocated to self management (n=55), routine monitoring (n=55), or usual care alone (n=55). At 24 months, adjusted treatment differences between the three groups in mean chronic respiratory questionnaire total score were not significant. Secondary outcomes did not differ, except for exacerbation management. Compared with usual care, more exacerbations in the self management group were managed with bronchodilators (odds ratio 2.81, 95% confidence interval 1.16 to 6.82) and with prednisolone, antibiotics, or both (3.98, 1.10 to 15
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The Relationship Among Heart Failure Disease Management, Quality of Care, and Hospitalizations.
Chung, Eugene S; Bartone, Cheryl; Daly, Kathleen; Menon, Santosh; McDonald, Mark
2015-01-01
Heart failure (HF) affects 5.1 million adult patients, accounting for over 1 million hospitalizations, 1.8 million office visits, and nearly 680,000 emergency department visits annually. HF hospitalizations have been incorporated into a national measure of hospital and provider quality, with associated financial penalties based on the 30-day readmission rate after an index hospitalization for HF. However, it is not clear whether the number of HF-related hospitalizations or 30-day readmissions is consistently related to quality of care. The relationships between various measures of HF care quality and hospitalization rates were evaluated by performing a cohort study of an HF disease management program in a clinical practice setting. Following the statistical analyses assessing outcomes and survival, the conclusion was that an HF disease management program in clinical practice associated with improved utilization of evidence-based medical and device therapies tends to improve ejection fraction and survival, and reduce sex and race disparities, but not with an associated reduction in hospitalizations or total hospital days.
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Effect of beach management policies on recreational water quality.
Kelly, Elizabeth A; Feng, Zhixuan; Gidley, Maribeth L; Sinigalliano, Christopher D; Kumar, Naresh; Donahue, Allison G; Reniers, Adrianus J H M; Solo-Gabriele, Helena M
2018-04-15
When beach water monitoring programs identify poor water quality, the causes are frequently unknown. We hypothesize that management policies play an important role in the frequency of fecal indicator bacteria (FIB) exceedances (enterococci and fecal coliform) at recreational beaches. To test this hypothesis we implemented an innovative approach utilizing large amounts of monitoring data (n > 150,000 measurements per FIB) to determine associations between the frequency of contaminant exceedances and beach management practices. The large FIB database was augmented with results from a survey designed to assess management policies for 316 beaches throughout the state of Florida. The FIB and survey data were analyzed using t-tests, ANOVA, factor analysis, and linear regression. Results show that beach geomorphology (beach type) was highly associated with exceedance of regulatory standards. Low enterococci exceedances were associated with open coast beaches (n = 211) that have sparse human densities, no homeless populations, low densities of dogs and birds, bird management policies, low densities of seaweed, beach renourishment, charge access fees, employ lifeguards, without nearby marinas, and those that manage storm water. Factor analysis and a linear regression confirmed beach type as the predominant factor with secondary influences from grooming activities (including seaweed densities and beach renourishment) and beach access (including charging fees, employing lifeguards, and without nearby marinas). Our results were observable primarily because of the very large public FIB database available for analyses; similar approaches can be adopted at other beaches. The findings of this research have important policy implications because the selected beach management practices that were associated with low levels of FIB can be implemented in other parts of the US and around the world to improve recreational beach water quality. Copyright © 2018 Elsevier Ltd. All
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Katz, Steven J; Hawley, Sarah T; Morrow, Monica; Griggs, Jennifer J; Jagsi, Reshma; Hamilton, Ann S; Graff, John J; Friese, Christopher R; Hofer, Timothy P
2010-01-01
The Institute of Medicine has called for more coordinated cancer care models that correspond to initiatives led by cancer providers and professional organizations. These initiatives parallel those underway to integrate the management of patients with chronic conditions. We developed 5 breast cancer patient and practice management process measures based on the Chronic Care Model. We then performed a survey to evaluate patterns and correlates of these measures among attending surgeons of a population-based sample of patients diagnosed with breast cancer between June 2005 and February 2007 in Los Angeles and Detroit (N = 312; response rate, 75.9%). Surgeon practice specialization varied markedly with about half of the surgeons devoting 15% or less of their total practice to breast cancer, whereas 16.2% of surgeons devoted 50% or more. There was also large variation in the extent of the use of patient and practice management processes with most surgeons reporting low use. Patient and practice management process measures were positively associated with greater levels of surgeon specialization and the presence of a teaching program. Cancer program status was weakly associated with patient and practice management processes. Low uptake of patient and practice management processes among surgeons who treat breast cancer patients may indicate that surgeons are not convinced that these processes matter, or that there are logistical and cost barriers to implementation. More research is needed to understand how large variations in patient and practice management processes might affect the quality of care for patients with breast cancer.
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ORGANIZATIONAL ATTRIBUTES OF PRACTICES SUCCESSFUL AT A DISEASE MANAGEMENT PROGRAM
Cloutier, Michelle M.; Wakefield, Dorothy B.; Tsimikas, John; Hall, Charles B.; Tennen, Howard; Brazil, Kevin
2009-01-01
Objective To assess the contribution of organizational factors to implementation of three asthma quality measures: enrollment in a disease management program, development of a written treatment plan and prescribing severity-appropriate anti-inflammatory therapy. Study design 138 pediatric clinicians and 247 office staff in 13 urban clinics and 23 non-urban, private practices completed questionnaires about their practice’s organizational characteristics (e.g. leadership, communication, perceived effectiveness, job satisfaction). Results 94% of clinicians and 92% of office staff completed questionnaires. When adjusted for confounders, greater practice activity and perceived effectiveness in meeting family needs was associated with higher rates of Easy Breathing enrollment, whereas higher scores for three organizational characteristics--communication timeliness, decision authority and job satisfaction--were associated both with higher numbers of enrolled children and a greater number of written treatment plans. None of the organizational characteristics were associated with greater use of anti-inflammatory therapy. Conclusions Three organizational characteristics predicted two quality asthma measures - use of a disease management program and creation of a written asthma treatment plan. If these organizational characteristics are amenable to change, our results could help focus interventions in areas of effective and acceptable organizational change. PMID:18835488
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Torrejón, Antonio; Oltra, Lorena; Hernández-Sampelayo, Paloma; Marín, Laura; García-Sánchez, Valle; Casellas, Francesc; Alfaro, Noelia; Lázaro, Pablo; Vera, María Isabel
2013-01-01
nursing management of inflammatory bowel disease (IBD) is highly relevant for patient care and outcomes. However, there is evidence of substantial variability in clinical practices. The objectives of this study were to develop standards of healthcare quality for nursing management of IBD and elaborate the evaluation tool "Nursing Care Quality in IBD Assessment" (NCQ-IBD) based on these standards. a 178-item healthcare quality questionnaire was developed based on a systematic review of IBD nursing management literature. The questionnaire was used to perform two 2-round Delphi studies: Delphi A included 27 IBD healthcare professionals and Delphi B involved 12 patients. The NCQ-IBD was developed from the list of items resulting from both Delphi studies combined with the Scientific Committee´s expert opinion. the final NCQ-IBD consists of 90 items, organized in13 sections measuring the following aspects of nursing management of IBD: infrastructure, services, human resources, type of organization, nursing responsibilities, nurse-provided information to the patient, nurses training, annual audits of nursing activities, and nursing research in IBD. Using the NCQ-IBD to evaluate these components allows the rating of healthcare quality for nursing management of IBD into 4 categories: A (highest quality) through D (lowest quality). the use of the NCQ-IBD tool to evaluate nursing management quality of IBD identifies areas in need of improvement and thus contribute to an enhancement of care quality and reduction in clinical practice variations.
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Dondi, Maurizio; Paez, Diana; Torres, Leonel; Marengo, Mario; Delaloye, Angelika Bischof; Solanki, Kishor; Van Zyl Ellmann, Annare; Lobato, Enrique Estrada; Miller, Rodolfo Nunez; Giammarile, Francesco; Pascual, Thomas
2018-05-01
The International Atomic Energy Agency (IAEA) developed a comprehensive program-Quality Management Audits in Nuclear Medicine (QUANUM). This program covers all aspects of nuclear medicine practices including, but not limited to, clinical practice, management, operations, and services. The QUANUM program, which includes quality standards detailed in relevant checklists, aims at introducing a culture of comprehensive quality audit processes that are patient oriented, systematic, and outcome based. This paper will focus on the impact of the implementation of QUANUM on daily routine practices in audited centers. Thirty-seven centers, which had been externally audited by experts under IAEA auspices at least 1 year earlier, were invited to run an internal audit using the QUANUM checklists. The external audits also served as training in quality management and the use of QUANUM for the local teams, which were responsible of conducting the internal audits. Twenty-five out of the 37 centers provided their internal audit report, which was compared with the previous external audit. The program requires that auditors score each requirement within the QUANUM checklists on a scale of 0-4, where 0-2 means nonconformance and 3-4 means conformance to international regulations and standards on which QUANUM is based. Our analysis covering both general and clinical areas assessed changes on the conformance status on a binary manner and the level of conformance scores. Statistical analysis was performed using nonparametric statistical tests. The evaluation of the general checklists showed a global improvement on both the status and the levels of conformances (P < 0.01). The evaluation of the requirements by checklist also showed a significant improvement in all, with the exception of Hormones and Tumor marker determinations, where changes were not significant. Of the 25 evaluated institutions, 88% (22 of 25) and 92% (23 of 25) improved their status and levels of conformance
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Larochelle, Jean-Louis; Feldman, Debbie Ehrmann; Levesque, Jean-Frederic
2014-11-01
Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement. We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions. In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed. Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization. Copyright © 2014 Longwoods Publishing.
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Larochelle, Jean-Louis; Feldman, Debbie Ehrmann; Levesque, Jean-Frederic
2014-01-01
Objective: Specialist physicians may act either as consultants or co-managers for patients with chronic diseases along with their primary healthcare (PHC) physician. We assessed factors associated with specialist involvement. Methods: We used questionnaire and administrative data to measure co-management and patient and PHC practice characteristics in 702 primary care patients with common chronic diseases. Analysis included multilevel logistic regressions. Results In all, 27% of the participants were co-managed. Persons with more severe chronic diseases and lower health-related quality of life were more likely to be co-managed. Persons who were older, had a lower socioeconomic status, resided in rural regions and who were followed in a PHC practice with an advanced practice nurse were less likely to be co-managed. Discussion: Co-management of patients with chronic diseases by a specialist is associated with higher clinical needs but demonstrates social inequalities. PHC practices more adapted to chronic care may help optimize specialist resources utilization. PMID:25617515
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Growth, Yield and Fruit Quality of Grapevines under Organic and Biodynamic Management
Döring, Johanna; Frisch, Matthias; Tittmann, Susanne; Stoll, Manfred; Kauer, Randolf
2015-01-01
The main objective of this study was to determine growth, yield and fruit quality of grapevines under organic and biodynamic management in relation to integrated viticultural practices. Furthermore, the mechanisms for the observed changes in growth, yield and fruit quality were investigated by determining nutrient status, physiological performance of the plants and disease incidence on bunches in three consecutive growing seasons. A field trial (Vitis vinifera L. cv. Riesling) was set up at Hochschule Geisenheim University, Germany. The integrated treatment was managed according to the code of good practice. Organic and biodynamic plots were managed according to Regulation (EC) No 834/2007 and Regulation (EC) No 889/2008 and according to ECOVIN- and Demeter-Standards, respectively. The growth and yield of the grapevines differed strongly among the different management systems, whereas fruit quality was not affected by the management system. The organic and the biodynamic treatments showed significantly lower growth and yield in comparison to the integrated treatment. The physiological performance was significantly lower in the organic and the biodynamic systems, which may account for differences in growth and cluster weight and might therefore induce lower yields of the respective treatments. Soil management and fertilization strategy could be responsible factors for these changes. Yields of the organic and the biodynamic treatments partially decreased due to higher disease incidence of downy mildew. The organic and the biodynamic plant protection strategies that exclude the use of synthetic fungicides are likely to induce higher disease incidence and might partially account for differences in the nutrient status of vines under organic and biodynamic management. Use of the biodynamic preparations had little influence on vine growth and yield. Due to the investigation of important parameters that induce changes especially in growth and yield of grapevines under
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ERIC Educational Resources Information Center
Tyson, Ben; Unson, Christine; Edgar, Nick
2017-01-01
Three community engagement projects on the South Island of New Zealand are enacting education and communication initiatives to improve the uptake of best management practices on farms regarding nutrient management for improving water quality. Understanding the enablers and barriers to effective community-based catchment management is fundamental…
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Lusco, Vincent C; Martinez, Serge A; Polk, Hiram C
2005-01-01
Surgical residents typically receive limited exposure to business and practice management during their training. As a result, residents are ill-prepared for issues related to starting a practice, coding, collecting, and taking a meaningful role within the medical community in promoting quality and safety and in containing health care costs. With the introduction of the core competencies and the current overhaul of surgical education, we believe there is an opportunity to include business and practice management into resident training. Program directors in general surgery (189 of 242) responded to a 9-question mailed survey inquiring about their opinions regarding training surgical residents in business and practice management. Most program directors agreed or strongly agreed (87%) that residents should be trained in business and practice management. Seventy percent believed that their current trainees were inadequately trained in this area. Over half (63%) believed that this training should begin during postgraduate years 2 to 5. Development of simple curricula aimed at preparing surgical residents for business and practice management could promote the contemporary education of surgeons.
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Robust data enables managers to promote good practice.
Bassett, Sally; Westmore, Kathryn
2012-11-01
This is the third in a series of articles examining the components of good corporate governance. The effective and efficient use of information and sources of information is crucial for good governance. This article explores the ways in which boards and management can obtain and use information to monitor performance and promote good practice, and how boards can be assured about the quality of information on which they rely. The final article in this series will look at the role of accountability in corporate governance.
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Engels, Yvonne; van den Hombergh, Pieter; Mokkink, Henk; van den Hoogen, Henk; van den Bosch, Wil; Grol, Richard
2006-01-01
Aim To study the effects of a team-based model for continuous quality improvement (CQI) on primary care practice management. Design of study Randomised controlled trial. Setting Twenty-six intervention and 23 control primary care practices in the Netherlands. Method Practices interested in taking part in the CQI project were, after assessment of their practice organisation, randomly assigned to the intervention or control groups. During a total of five meetings, a facilitator helped the teams in the intervention group select suitable topics for quality improvement and follow a structured approach to achieve improvement objectives. Checklists completed by an outreach visitor, questionnaires for the GPs, staff and patients were used to assemble data on the number and quality of improvement activities undertaken and on practice management prior to the start of the intervention and 1 year later. Results Pre-test and post-test data were compared for the 26 intervention and 23 control practices. A significant intervention effect was found for the number of improvement objectives actually defined (93 versus 54, P<0.001) and successfully completed (80 versus 69% of the projects, P<0.001). The intervention group also improved on more aspects of practice management, as measured by our practice visit method, than the control group but none of these differences proved statistically significant. Conclusion The intervention exerted a significant effect on the number and quality of improvement projects undertaken and self-defined objectives met. Failure of the effects of the intervention on the other dimensions of practice management to achieve significance may be due to the topics selected for some of the improvement projects being only partly covered by the assessment instrument. PMID:17007709
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Contribution to systematic education of quality management in Slovak health care.
Rusnakova, V; Bacharova, L
2001-01-01
Of the study was to contribute to quality improvement initiatives in Slovak health services through systematic approach to the education and training in quality management (QM). Consequently, the main objectives were to analyse the content of the education in QM abroad, to conduct an audit of perceived training needs in Slovakia, and to propose the design of QM training programme to be applied within CME scheme based on the study results. Triangular method in the design of the study was implemented. Review of relevant information, data from the questionnaire and semi-structured interview in the sample of 67 Slovak trainees from Health Management School and School of Public Health--were adopted in complementary fashion. Highlighted in the survey are positive attitudes to training in quality management documented by the median score higher than 6 in all tested areas, on scale 0-10. No significant differences in profession groups as physicians, nurses, HC managers or among training institutions involved were displayed. However, potential obstacles were identified in deeper study using interviews. The absence of knowledge and skills in management in general and in quality management approaches especially are observed. Typically, the role of strategic planning is undermined. The large scale of quality management approaches is converted to problems of accreditation. Barriers to participative culture, innovation, devolution of accountability, resistance to change and to team based management are authentic findings as well. Drawn from the study were related to: fostering managers--"transformational leaders" for locally driven decision making in health care policy and practice; need of training activities for the continuing education in quality with respect to specific target groups interests and their level of knowledge in management; content of training oriented towards combination of rational utilization of information, critical analytical skills and planning for quality
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Reflective practice: a framework for case manager development.
Brubakken, Karen; Grant, Sara; Johnson, Mary K; Kollauf, Cynthia
2011-01-01
The role of a nurse case manager (NCM) incorporates practice that is built upon knowledge gained in other roles as well as components unique to case management. The concept of reflective practice was used in creating a framework to recognize the developmental stages that occur within community based case management practice. The formation of this framework and its uses are described in this article. The practice setting is a community based case management department in a large midwestern metropolitan health care system with Magnet recognition. Advanced practice nurses provide care for clients with chronic health conditions. Twenty-four narratives were used to identify behaviors of community based case managers and to distinguish stages of practice. The behaviors of advanced practice found within the narratives were labeled and analyzed for similarities. Related behaviors were grouped and descriptor statements were written. These statements grouped into 3 domains of practice: relationship/partnership, coordination/collaboration, and clinical knowledge/decision making. The statements in each domain showed practice variations from competent to expert, and 3 stages were determined. Reliability and validity of the framework involved analysis of additional narratives. The reflective practice process, used for monthly case review presentations, provides opportunity for professional development and group learning focused on improving case manager practice. The framework is also being used in orientation as new case managers acclimate to the role. Reflective writing has unveiled the richness and depth of nurse case manager practice. The depth of knowledge and skills involved in community-based case management is captured within this reflective practice framework. This framework provides a format for describing community based case manager practice development over the course of time and has been used as a tool for orientation and peer review.
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Air Quality Management Process Cycle
Air quality management are activities a regulatory authority undertakes to protect human health and the environment from the harmful effects of air pollution. The process of managing air quality can be illustrated as a cycle of inter-related elements.
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Forestry best management practices relationships with aquatic and riparian fauna: A review
Brooke M. Warrington; W. Michael Aust; Scott M. Barrett; W. Mark Ford; C. Andrew Dolloff; Erik B. Schilling; T. Bently Wigley; M. Chad Bolding
2017-01-01
Forestry best management practices (BMPs) were developed to minimize water pollution from forestry operations by primarily addressing sediment and sediment transport, which is the leading source of pollution from silviculture. Implementation of water quality BMPs may also benefit riparian and aquatic wildlife, although wildlife benefits were not driving forces...
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ERIC Educational Resources Information Center
McMahon, Mary
2004-01-01
This paper represents the second of two papers written as part of the National Standards and Accreditation of Career Practitioners project. The first, a scoping paper titled Shaping a career development culture: Quality standards, quality practice, quality outcomes (McMahon, 2004), provided information for and guided discussion at the National…
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Effect of Drainage and Management Practices on Hydrology of Pine Plantation
R. Wayne Skaggs; Devendra M. Amatya; G. M. Chescheir; C. D. Blanton; J. W. Gilliam
2006-01-01
This paper reviews results of long-term studies, initiated in the late 1980s, to determine the hydrologic and water quality impacts of drainage and related water and forest management practices on a poorly drained site in Carteret County, North Carolina. Three watersheds, each approximately 25 ha, were instrumented to measure and record drainage rate, water table depth...
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[Quality assurance and total quality management in residential home care].
Nübling, R; Schrempp, C; Kress, G; Löschmann, C; Neubart, R; Kuhlmey, A
2004-02-01
Quality, quality assurance, and quality management have been important topics in residential care homes for several years. However, only as a result of reform processes in the German legislation (long-term care insurance, care quality assurance) is a systematic discussion taking place. Furthermore, initiatives and holistic model projects, which deal with the assessment and improvement of service quality, were developed in the field of care for the elderly. The present article gives a critical overview of essential developments. Different comprehensive approaches such as the implementation of quality management systems, nationwide expert-based initiatives, and developments towards professionalizing care are discussed. Empirically based approaches, especially those emphasizing the assessment of outcome quality, are focused on in this work. Overall, the authors conclude that in the past few years comprehensive efforts have been made to improve the quality of care. However, the current situation still requires much work to establish a nationwide launch and implementation of evidence-based quality assurance and quality management.
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USDA-ARS?s Scientific Manuscript database
Reducing phosphorus loss from agricultural land is important for improvement and protection of surface water quality. Agricultural models can be used to determine management impacts on P loss and therefore serve as a guide for recommending best management practices. However, the models must be comp...
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Structured data quality reports to improve EHR data quality.
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.
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Total Quality Management Implementation Plan.
1989-06-01
Quality Management Implementation Plan 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING ORGANIZATION Defense General...E 14. SUBJECT TERMS 15. NUMBER OF PAGES TOM (Total Quality Management ), Continuous Process Improvement,_________ Depot Operations, Supply Support 16
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Roberts, Eric T; Mehrotra, Ateev; McWilliams, J Michael
2017-05-01
Consolidation of physician practices has intensified concerns that providers with greater market power may be able to charge higher prices without having to deliver better care, compared to providers with less market power. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and practices' quality and efficiency of care. Using commercial claims data, we classified practices as being high- or low-price. We used national data from the Consumer Assessment of Healthcare Providers and Systems survey and linked claims for Medicare beneficiaries to compare high- and low-price practices in the same geographic area in terms of care quality, utilization, and spending. Compared with low-price practices, high-price practices were much larger and received 36 percent higher prices. Patients of high-price practices reported significantly higher scores on some measures of care coordination and management but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of preventive services, acute care use, or total Medicare spending. This suggests an overall weak relationship between practice prices and the quality and efficiency of care and calls into question claims that high-price providers deliver substantially higher-value care. Project HOPE—The People-to-People Health Foundation, Inc.
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Spence Laschinger, Heather K; Zhu, Junhong; Read, Emily
2016-07-01
To test a model examining the effects of structural empowerment and support for professional practice on new graduate nurses' perceived professional practice behaviours, perceptions of care quality and subsequent job satisfaction and career turnover intentions. The nursing worklife model describes relationships between supportive nursing work environments and nurse and patient outcomes. The influence of support for professional practice on new nurses' perceptions of professional nursing behaviours within this model has not been tested. Structural equation modelling in Mplus was used to analyse data from a national survey of new nurses across Canada (n = 393). The hypothesised model was supported: χ²(122) = 346.726, P = 0.000; CFI = 0.917; TLI = 0.896; RMSEA = 0.069. Professional practice behaviour was an important mechanism through which empowerment and supportive professional practice environments influenced nurse-assessed quality of care, which was related to job satisfaction and lower intentions to leave nursing. Job satisfaction and career retention of new nurses are related to perceptions of work environment factors that support their professional practice behaviours and high-quality patient care. Nurse managers can support new graduate nurses' professional practice behaviour by providing empowering supportive professional practice environments. © 2016 John Wiley & Sons Ltd.
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Total Quality Management, DLA Finance Center
1989-07-01
ton. DC 20503. DATE 3. REPORT TYPE AND DATES COVERED SJuly 1989 4. TITLE AND SUBTIT’LE 5. FUNDING NUMBERS Total Quality Management , DLA Finance Center 6...1989 ~ D 14. SUBJECT TERMS 15. NUMBER OF PAGES TQM (Total Quality Management ), Continuous Process Improvement. ., I Management 16. PRICE CODE 17...CONCEPTS TQM BASICS Total Quality Management (TQM) is a concept which is based on the work of a variety of people in a variety of fields. It includes
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NASA Astrophysics Data System (ADS)
Bushnell, M.; Waldmann, C.; Hermes, J.; Tamburri, M.
2017-12-01
Many oceanographic observation groups create and maintain QA, QC, and best practices (BP) to ensure efficient and accurate data collection and quantify quality. Several entities - IOOS® QARTOD, AtlantOS, ACT, WMO/IOC JCOMM OCG - have joined forces to document existing practices, identify gaps, and support development of emerging techniques. While each group has a slightly different focus, many underlying QA/QC/BP needs can be quite common. QARTOD focuses upon real-time data QC, and has produced manuals that address QC tests for eleven ocean variables. AtlantOS is a research and innovation project working towards the integration of ocean-observing activities across all disciplines in the Atlantic Basin. ACT brings together research institutions, resource managers, and private companies to foster the development and adoption of effective and reliable sensors for coastal, freshwater, and ocean environments. JCOMM promotes broad international coordination of oceanographic and marine meteorological observations and data management and services. Leveraging existing efforts of these organizations is an efficient way to consolidate available information, develop new practices, and evaluate the use of ISO standards to judge the quality of measurements. ISO standards may offer accepted support for a framework for an ocean data quality management system, similar to the meteorological standards defined by WMO (https://www.wmo.int/pages/prog/arep/gaw/qassurance.html). We will first cooperatively develop a plan to create a QA/QC/BP manual. The resulting plan will describe the need for such a manual, the extent of the manual, the process used to engage the community in creating it, the maintenance of the resultant document, and how these things will be done. It will also investigate standards for metadata. The plan will subsequently be used to develop the QA/QC/BP manual, providing guidance which advances the standards adopted by IOOS, AtlantOS, JCOMM, and others.
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Creating quality practice environments: not easy, but essential.
Winslow, Wendy
2004-01-01
Quality practice environments for registered nurses correlate positively with job satisfaction, productivity, recruitment, retention and client outcomes. However, when registered nurses work in environments that do not enable them to consistently meet their nursing practice standards, patient safety is jeopardized. This article describes the development of Canada's first guidelines for a quality practice environment for registered nurses in all practice environments. It is a tool healthcare leaders can use to improve the practice environment of all health professionals and to promote patient safety.
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Agriculture and stream water quality: A biological evaluation of erosion control practices
NASA Astrophysics Data System (ADS)
Lenat, David R.
1984-07-01
Agricultural runoff affects many streams in North Carolina. However, there is is little information about either its effect on stream biota or any potential mitigation by erosion control practices. In this study, benthic macroinvertebrates were sampled in three different geographic areas of North Carolina, comparing control watersheds with well-managed and poorly managed watersheds. Agricultural streams were characterized by lower taxa richness (especially for intolerant groups) and low stability. These effects were most evident at the poorly managed sites. Sedimentation was the apparent major problem, but some changes at agricultural sites implied water quality problems. The groups most intolerant of agricultural runoff were Ephemeroptera, Plecoptera and Trichoptera. Tolerant species were usually filter-feeders or algal grazers, suggesting a modification of the food web by addition of particulate organic matter and nutrients. This study clearly indicates that agricultural runoff can severely impact stream biota. However, this impact can be greatly mitigated by currently recommended erosion control practices.
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Khan, Stuart J; Deere, Daniel; Leusch, Frederic D L; Humpage, Andrew; Jenkins, Madeleine; Cunliffe, David
2015-11-15
Among the most widely predicted and accepted consequences of global climate change are increases in both the frequency and severity of a variety of extreme weather events. Such weather events include heavy rainfall and floods, cyclones, droughts, heatwaves, extreme cold, and wildfires, each of which can potentially impact drinking water quality by affecting water catchments, storage reservoirs, the performance of water treatment processes or the integrity of distribution systems. Drinking water guidelines, such as the Australian Drinking Water Guidelines and the World Health Organization Guidelines for Drinking-water Quality, provide guidance for the safe management of drinking water. These documents present principles and strategies for managing risks that may be posed to drinking water quality. While these principles and strategies are applicable to all types of water quality risks, very little specific attention has been paid to the management of extreme weather events. We present a review of recent literature on water quality impacts of extreme weather events and consider practical opportunities for improved guidance for water managers. We conclude that there is a case for an enhanced focus on the management of water quality impacts from extreme weather events in future revisions of water quality guidance documents. Copyright © 2015 Elsevier Ltd. All rights reserved.
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van Lieshout, Jan; Grol, Richard; Campbell, Stephen; Falcoff, Hector; Capell, Eva Frigola; Glehr, Mathias; Goldfracht, Margalit; Kumpusalo, Esko; Künzi, Beat; Ludt, Sabine; Petek, Davorina; Vanderstighelen, Veerle; Wensing, Michel
2012-10-05
Primary care has an important role in cardiovascular risk management (CVRM) and a minimum size of scale of primary care practices may be needed for efficient delivery of CVRM . We examined CVRM in patients with coronary heart disease (CHD) in primary care and explored the impact of practice size. In an observational study in 8 countries we sampled CHD patients in primary care practices and collected data from electronic patient records. Practice samples were stratified according to practice size and urbanisation; patients were selected using coded diagnoses when available. CVRM was measured on the basis of internationally validated quality indicators. In the analyses practice size was defined in terms of number of patients registered of visiting the practice. We performed multilevel regression analyses controlling for patient age and sex. We included 181 practices (63% of the number targeted). Two countries included a convenience sample of practices. Data from 2960 CHD patients were available. Some countries used methods supplemental to coded diagnoses or other inclusion methods introducing potential inclusion bias. We found substantial variation on all CVRM indicators across practices and countries. We computed aggregated practice scores as percentage of patients with a positive outcome. Rates of risk factor recording varied from 55% for physical activity as the mean practice score across all practices (sd 32%) to 94% (sd 10%) for blood pressure. Rates for reaching treatment targets for systolic blood pressure, diastolic blood pressure and LDL cholesterol were 46% (sd 21%), 86% (sd 12%) and 48% (sd 22%) respectively. Rates for providing recommended cholesterol lowering and antiplatelet drugs were around 80%, and 70% received influenza vaccination. Practice size was not associated to indicator scores with one exception: in Slovenia larger practices performed better. Variation was more related to differences between practices than between countries. CVRM measured by
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[Identifying indicators of good practice in clinical and healthcare management].
Bermúdez Tamayo, C; Olry de Labry Lima, A; García Mochón, L
To identify good practices in order to develop and implement indicators of health outcomes for clinical and healthcare management, as well as the characteristics for an indicator to be considered adequate. A scoping review was performed, with the following phases: 1) Search and identification of bibliography. 2) Selection of relevant documents. Including those studies that discussed issues related to good practices for the use of health indicators in the management field. Those published in a language other than English or Spanish or before 2006 were excluded. 3) Analysis and extraction of information. 4) Consultation with stakeholders, using a qualitative methodology through Concept Mapping, with the participation of 40 experts (decision-makers, scientific societies, and health professionals). The data collection process included an inductive and structured procedure, with prioritisation of ideas grouped into clusters, according to feasibility and importance criteria (0-10 scale). Good practices identified 2 levels: 1) macro-management: Define a framework for the evaluation of indicators and establish a benchmark of indicators. 2) meso-management: Establish indicators according to evidence and expert consensus, taking into account priority areas and topics, testing before final use, and communicate results adequately. The characteristics of a suitable indicator are: 1) Approach of an important issue, 2) Scientific validity, 3) Possibility of measurement with reliable data, 4) Meaning of useful and applicable measurement, and 5) Wide scope. The best practices for the use of indicators in clinical and healthcare management can make it easier to monitor performance and accountability, as well as to support the decision-making addressed at the development of initiatives for quality improvement. Copyright © 2018 SECA. Publicado por Elsevier España, S.L.U. All rights reserved.
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Troy, A.B.; Strong, A.M.; Bosworth, S.C.; Donovan, T.M.; Buckley, N.J.; Wilson, M.L.
2005-01-01
In the northeastern United States, most populations of grassland songbirds occur on private lands. However, little information exists about the attitudes of farmers toward habitat management for this guild. To address this information gap, we surveyed 131 dairy farmers in Vermont's Champlain Valley to assess current hayfield management practices and farmers' willingness to adopt more "bird-friendly" practices. Our results showed a clear trend toward earlier and more frequent hayfield cuts. Farmers indicated they have little flexibility to alter the timing of their cuts on most of their land. However, many farmers (49%) indicated a willingness to adopt alternative management practices on at least a small portion of their land. Combined with the fact that many farmers characterized parts of their land as "wasteland," or economically unproductive land, this result suggests that some leeway exists for increasing songbird habitat quality on at least portions of dairy farms. Although significant differences existed in the amount of land for which farmers were willing to adopt alternative management based on herd size, acreage, and experience, the directionality of these relationships could not be established except tentatively for herd size, in which case it appeared that farmers with smaller herds were more likely to dedicate a greater percentage of their land to alternative management. The results of this study likely have relevance to dairy farms throughout the northern-tier dairy states. Given the increasing trend for agricultural land to be converted into housing, we recommend that extension and education efforts target farmers with large hayfield acreages, encouraging the maintenance of high-quality habitat for grassland songbirds.
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Hijazi, Heba H.; Harvey, Heather L.; Alyahya, Mohammad S.; Alshraideh, Hussam A.; Al abdi, Rabah M.; Parahoo, Sanjai K.
2018-01-01
Targeting the patient’s needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital’s engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses’ perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a
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Hijazi, Heba H; Harvey, Heather L; Alyahya, Mohammad S; Alshraideh, Hussam A; Al Abdi, Rabah M; Parahoo, Sanjai K
2018-01-01
Targeting the patient's needs and preferences has become an important contributor for improving care delivery, enhancing patient satisfaction, and achieving better clinical outcomes. This study aimed to examine the impact of applying quality management practices on patient centeredness within the context of health care accreditation and to explore the differences in the views of various health care workers regarding the attributes affecting patient-centered care. Our study followed a cross-sectional survey design wherein 4 Jordanian public hospitals were investigated several months after accreditation was obtained. Total 829 clinical/nonclinical hospital staff members consented for study participation. This sample was divided into 3 main occupational categories to represent the administrators, nurses, as well as doctors and other health professionals. Using a structural equation modeling, our results indicated that the predictors of patient-centered care for both administrators and those providing clinical care were participation in the accreditation process, leadership commitment to quality improvement, and measurement of quality improvement outcomes. In particular, perceiving the importance of the hospital's engagement in the accreditation process was shown to be relevant to the administrators (gamma = 0.96), nurses (gamma = 0.80), as well as to doctors and other health professionals (gamma = 0.71). However, the administrator staff (gamma = 0.31) was less likely to perceive the influence of measuring the quality improvement outcomes on the delivery of patient-centered care than nurses (gamma = 0.59) as well as doctors and other health care providers (gamma = 0.55). From the nurses' perspectives only, patient centeredness was found to be driven by building an institutional framework that supports quality assurance in hospital settings (gamma = 0.36). In conclusion, accreditation is a leading factor for delivering patient-centered care and should be on a hospital
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40 CFR 130.6 - Water quality management plans.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 21 2010-07-01 2010-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... and certified and approved updates to those plans. Continuing water quality planning shall be based...
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NASA Astrophysics Data System (ADS)
Yang, G.; Best, E. P.; Goodwin, S.
2013-12-01
Non-point source (NPS) pollution is one of the leading causes of water quality impairment within the United States. Conservation, restoration and altered management (CRAM) practices may effectively reduce NPS pollutants to receiving water bodies and enhance local and regional ecosystem services. Barriers for the implementation of CRAM include uncertainties related to the extent to which nutrients are removed by CRAM at various spatial and temporal scales, longevity, optimal placement of CRAM within the landscape, and implementation / operation / maintenance costs. We conducted a study aimed at the identification of optimal placement of CRAM in watersheds that reduces N loading to an environmentally sustainable level, at an acceptable, known, cost. For this study, we used a recently developed screening-level modeling approach, WQM-TMDL-N, running in the ArcGIS environment, to estimate nitrogen loading under current land use conditions (NLCD 2006). This model was equipped with a new option to explore the performances of placement of various CRAM types and areas to reduce nitrogen loading to a State-accepted Total Maximum Daily Load (TMDL) standard, with related annual average TN concentration, and a multi-objective algorithm optimizing load and cost. CRAM practices explored for implementation in rural area included buffer strips, nutrient management practices, and wetland restoration. We initially applied this modeling approach to the Tippecanoe River (TR) watershed (8-digit HUC), a headwater of the Wabash River (WR) watershed, where CRAM implementation in rural and urban areas is being planned and implemented at various spatial scales. Consequences of future land use are explored using a 2050 land use/land cover map forecasted by the Land Transformation Model. The WR watershed, IN, drains two-thirds of the state's 92 counties and supports predominantly agricultural land use. Because the WR accounts for over 40% of the nutrient loads of the Ohio River and
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Effectiveness of barnyard best management practices in Wisconsin
Stuntebeck, Todd D.; Bannerman, Roger T.
1998-01-01
In 1978, the Wisconsin Legislature committed to protecting water quality by enacting the Nonpoint Source Water Pollution Abatement Program. Through this program, cost-share money is provided within priority watersheds to control sources of nonpoint pollution. Most of the cost-share dollars for rural watersheds have been used to implement barnyard Best Management Practices (BMPs) because barnyards are believed to be a major source of pollutants, most notably phosphorus. Reductions in phosphorus loads of as much as 95 percent have been predicted for the barnyard BMPs recommended for priority watersheds.
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Total Quality Management Implementation Strategy: Directorate of Quality Assurance
1989-05-01
Total Quality Control Harrington, H. James The Improvement Process Imai, Masaaki Kaizen Ishikawa , Kaoru What is Total Quality Control Ishikawa ... Kaoru Statistical Quality Control Juran, J. M. Managerial Breakthrough Juran, J. M. Quality Control Handbook Mizuno, Ed Managing for Quality Improvements
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Quality management and perceptions of teamwork and safety climate in European hospitals.
Kristensen, Solvejg; Hammer, Antje; Bartels, Paul; Suñol, Rosa; Groene, Oliver; Thompson, Caroline A; Arah, Onyebuchi A; Kutaj-Wasikowska, Halina; Michel, Philippe; Wagner, Cordula
2015-12-01
This study aimed to investigate the associations of quality management systems with teamwork and safety climate, and to describe and compare differences in perceptions of teamwork climate and safety climate among clinical leaders and frontline clinicians. We used a multi-method, cross-sectional approach to collect survey data of quality management systems and perceived teamwork and safety climate. Our data analyses included descriptive and multilevel regression methods. Data on implementation of quality management system from seven European countries were evaluated including patient safety culture surveys from 3622 clinical leaders and 4903 frontline clinicians. Perceived teamwork and safety climate. Teamwork climate was reported as positive by 67% of clinical leaders and 43% of frontline clinicians. Safety climate was perceived as positive by 54% of clinical leaders and 32% of frontline clinicians. We found positive associations between implementation of quality management systems and teamwork and safety climate. Our findings, which should be placed in a broader clinical quality improvement context, point to the importance of quality management systems as a supportive structural feature for promoting teamwork and safety climate. To gain a deeper understanding of this association, further qualitative and quantitative studies using longitudinally collected data are recommended. The study also confirms that more clinical leaders than frontline clinicians have a positive perception of teamwork and safety climate. Such differences should be accounted for in daily clinical practice and when tailoring initiatives to improve teamwork and safety climate. © The Author 2015. Published by Oxford University Press in association with the International Society for Quality in Health Care; all rights reserved.
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An overview of Quality Management System implementation in a research laboratory
NASA Astrophysics Data System (ADS)
Molinéro-Demilly, Valérie; Charki, Abdérafi; Jeoffrion, Christine; Lyonnet, Barbara; O'Brien, Steve; Martin, Luc
2018-02-01
The aim of this paper is to show the advantages of implementing a Quality Management System (QMS) in a research laboratory in order to improve the management of risks specific to research programmes and to increase the reliability of results. This paper also presents experience gained from feedback following the implementation of the Quality process in a research laboratory at INRA, the French National Institute for Agronomic Research and details the various challenges encountered and solutions proposed to help achieve smoother adoption of a QMS process. The 7Ms (Management, Measurement, Manpower, Methods, Materials, Machinery, Mother-nature) methodology based on the Ishikawa `Fishbone' diagram is used to show the effectiveness of the actions considered by a QMS, which involve both the organization and the activities of the laboratory. Practical examples illustrate the benefits and improvements observed in the laboratory.
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Management practices used in agricultural drainage ditches to reduce Gulf of Mexico hypoxia
USDA-ARS?s Scientific Manuscript database
Agricultural non-point sources of nutrients and sediments have caused eutrophication and other water quality issues in aquatic and marine ecosystems, such as the annual occurrence of hypoxia in the Gulf of Mexico. Management practices have been implemented adjacent to and in agricultural drainage di...
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Probability concepts in quality risk management.
Claycamp, H Gregg
2012-01-01
Essentially any concept of risk is built on fundamental concepts of chance, likelihood, or probability. Although risk is generally a probability of loss of something of value, given that a risk-generating event will occur or has occurred, it is ironic that the quality risk management literature and guidelines on quality risk management tools are relatively silent on the meaning and uses of "probability." The probability concept is typically applied by risk managers as a combination of frequency-based calculation and a "degree of belief" meaning of probability. Probability as a concept that is crucial for understanding and managing risk is discussed through examples from the most general, scenario-defining and ranking tools that use probability implicitly to more specific probabilistic tools in risk management. A rich history of probability in risk management applied to other fields suggests that high-quality risk management decisions benefit from the implementation of more thoughtful probability concepts in both risk modeling and risk management. Essentially any concept of risk is built on fundamental concepts of chance, likelihood, or probability. Although "risk" generally describes a probability of loss of something of value, given that a risk-generating event will occur or has occurred, it is ironic that the quality risk management literature and guidelines on quality risk management methodologies and respective tools focus on managing severity but are relatively silent on the in-depth meaning and uses of "probability." Pharmaceutical manufacturers are expanding their use of quality risk management to identify and manage risks to the patient that might occur in phases of the pharmaceutical life cycle from drug development to manufacture, marketing to product discontinuation. A probability concept is typically applied by risk managers as a combination of data-based measures of probability and a subjective "degree of belief" meaning of probability. Probability as
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40 CFR 130.6 - Water quality management plans.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 22 2011-07-01 2011-07-01 false Water quality management plans. 130.6... QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM... when they are needed to address water quality problems. (1) Total maximum daily loads. TMDLs in...
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Quality management in Irish health care.
Ennis, K; Harrington, D
1999-01-01
This paper reports on the findings from a quantitative research study of quality management in the Irish health-care sector. The study findings suggest that quality management is what hospitals require to become more cost-effective and efficient. The research also shows that the culture of health-care institutions must change to one where employees experience pride in their work and where all are involved and committed to continuous quality improvement. It is recommended that a shift is required from the traditional management structures to a more participative approach. Furthermore, all managers whether from a clinical or an administration background must understand one another's role in the organisation. Finally, for quality to succeed in the health-care sector, strong committed leadership is required to overcome tensions in quality implementation.
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Improving quality of care in general practices by self-audit, benchmarking and quality circles.
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.
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A process for developing standards to promote quality in general practice.
Khoury, Julie; Krejany, Catherine J; Versteeg, Roald W; Lodewyckx, Michaela A; Pike, Simone R; Civil, Michael S; Jiwa, Moyez
2018-06-02
Since 1991, the Royal Australian College of General Practitioners' (RACGP) Standards for General Practices (the Standards) have provided a framework for quality care, risk management and best practice in the operation of Australian general practices. The Standards are also linked to incentives for general practice remuneration. These Standards were revised in 2017. The objective of this study is to describe the process undertaken to develop the fifth edition Standards published in 2017 to inform future standards development both nationally and internationally. A modified Delphi process was deployed to develop the fifth edition Standards. Development was directed by the RACGP and led by an expert panel of GPs and representatives of stakeholder groups who were assisted and facilitated by a team from RACGP. Each draft was released for stakeholder feedback and tested twice before the final version was submitted for approval by the RACGP board. Four rounds of consultation and two rounds of piloting were carried out over 32 months. The Standards were redrafted after each round. One hundred and fifty-two individuals and 225 stakeholder groups participated in the development of the Standards. Twenty-three new indicators were recommended and grouped into three sections in a new modular structure that was different from the previous edition. The Standards represent the consensus view of national stakeholders on the indicators of quality and safety in Australian general practice and primary care.
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Investigation of priorities in water quality management based on correlations and variations.
Boyacıoğlu, Hülya; Gündogdu, Vildan; Boyacıoğlu, Hayal
2013-04-15
The development of water quality assessment strategies investigating spatial and temporal changes caused by natural and anthropogenic phenomena is an important tool in management practices. This paper used cluster analysis, water quality index method, sensitivity analysis and canonical correlation analysis to investigate priorities in pollution control activities. Data sets representing 22 surface water quality parameters were subject to analysis. Results revealed that organic pollution was serious threat for overall water quality in the region. Besides, oil and grease, lead and mercury were the critical variables violating the standard. In contrast to inorganic variables, organic and physical-inorganic chemical parameters were influenced by variations in physical conditions (discharge, temperature). This study showed that information produced based on the variations and correlations in water quality data sets can be helpful to investigate priorities in water management activities. Moreover statistical techniques and index methods are useful tools in data - information transformation process. Copyright © 2013 Elsevier Ltd. All rights reserved.
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Zafar, Waleed; Mojtabai, Ramin
2011-07-01
Chronic care model (CCM) envisages a multicomponent systematic remodeling of ambulatory care to improve chronic diseases management. Application of CCM in primary care management of depression has traditionally lagged behind the application of this model in management of other common chronic illnesses. In past research, the use of CCM has been operationalized by measuring the use of evidence-based organized care management processes (CMPs). To compare the use of CMPs in treatment of depression with the use of these processes in treatment of diabetes and asthma and to examine practice-level correlates of this use. Using data from the 2008 Health Tracking Physician Survey, a nationally representative sample of physicians in the United States, we compared the use of 5 different CMPs: written guidelines in English and other languages for self-management, availability of staff to educate patients about self-management, availability of nurse care managers for care coordination, and group meetings of patients with staff. We further examined the association of practice-level characteristics with the use of the 5 CMPs for management of depression. CMPs were more commonly used for management of diabetes and asthma than for depression. The use of CMPs for depression was more common in health maintenance organizations [adjusted odds ratios (AOR) ranging from 2.45 to 5.98 for different CMPs], in practices that provided physicians with feedback regarding quality of care to patients (AOR range, 1.42 to 1.69), and in practices with greater use of clinical information technology (AOR range, 1.06 to 1.11). The application of CMPs in management of depression continues to lag behind other common chronic conditions. Feedbacks on quality of care and expanded use of information technology may improve application of CMPs for depression care in general medical settings.
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Roberts, Eric T.; Mehrotra, Ateev; McWilliams, J. Michael
2017-01-01
Provider consolidation has intensified concerns that providers with market power may be able to charge higher prices without having to deliver better care. Providers have argued that higher prices cover the costs of delivering higher-quality care. We examined the relationship between physician practice prices for outpatient services and the quality and efficiency of care provided to their patients. Using commercial claims, we classified practices as high-priced or low-priced. We compared care quality, utilization, and spending between high-priced and low-priced practices in the same areas using data from the Consumer Assessment of Health Care Providers and Systems survey and linked claims for Medicare beneficiaries. Compared with low-priced practices, high-priced practices were much larger and received 36% higher prices. Patients of high-priced practices reported significantly higher scores on some measures of care coordination and management, but did not differ meaningfully in their overall care ratings, other domains of patient experiences (including physician ratings and access to care), receipt of mammography, vaccinations, or diabetes services, acute care use, or total Medicare spending. These findings suggest an overall weak relationship between practices’ prices and the quality and efficiency of care they provide, calling into question claims that high-priced providers deliver substantially higher-value care. PMID:28461352
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Management practices in substance abuse treatment programs.
McConnell, K John; Hoffman, Kim A; Quanbeck, Andrew; McCarty, Dennis
2009-07-01
Efforts to understand how to improve the delivery of substance abuse treatment have led to a recent call for studies on the "business of addiction treatment." This study adapts an innovative survey tool to collect baseline management practice data from 147 addiction treatment programs enrolled in the Network for the Improvement of Addiction Treatment 200 project. Measures of "good" management practice were strongly associated with days to treatment admission. Management practice scores were weakly associated with revenues per employee but were not correlated with operating margins. Better management practices were more prevalent among programs with a higher number of competitors in their catchment area.
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Total Quality Management (TQM). Implementers Workshop
1990-05-15
SHEE’T :s t’ii ,rrl DEPARTMENT OF DEFENSE May 15, 1990 Lfl CN I TOTAL QUALITY MANAGEMENT (TQM) Implementers Workshop © Copyright 1990 Booz.Allen...must be continually performed in order to achieve successful TQM implementation. 1-5 = TOTAL QUALITY MANAGEMENT Implementers Workshop Course Content...information, please refer to the student manual, Total Quality Management (TOM) Awareness Seminar, that was provided for the Awareness Course. You may
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MO-F-211-01: Methods for Completing Practice Quality Improvement (PQI).
Johnson, J; Brown, K; Ibbott, G; Pawlicki, T
2012-06-01
Practice Quality Improvement (PQI) is becoming an expected part of routine practice in healthcare as an approach to provide more efficient, effective and high quality care. Additionally, as part of the ABR's Maintenance of Certification (MOC) pathway, medical physicists are now expected to complete a PQI project. This session will describe the history behind and benefits of the ABR's MOC program, provide details of quality improvement methods and how to successfully complete a PQI project. PQI methods include various commonly used engineering and management tools. The Plan-Do-Study-Act (PDSA) cycle will be presented as one project planning and implementation tool. Other PQI analysis instruments such as flowcharts, Pareto charts, process control charts and fishbone diagrams will also be explained with examples. Cause analysis, solution development and implementation, and post-implementation measurement will be presented. Project identification and definition as well as appropriate measurement tool selection will be offered. Methods to choose key quality metrics (key quality indicators) will also be addressed. Several sample PQI projects and templates available through the AAPM and other organizations will be described. At least three examples of completed PQI projects will be shared. 1. Identify and define a PQI project 2. Identify and select measurement methods/techniques for use with the PQI project 3. Describe example(s) of completed projects. © 2012 American Association of Physicists in Medicine.
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Cooper, Jeffrey D
2004-01-01
This case study-based on this practice's application for the 2003 HIMSS Davies Award for Primary Care-describes the processes, costs and benefits of the implementation of an EHR in a solo practice. The organization, management and value of an EHR implementation is described, as well as a description of the physician's 15 business objectives, which shows how each objective was met and to what degree and gives specific financial data. An EHR that is implemented in a small practice improves quality of patient care, office efficiency and patient safety. A small practice can realize significant ROI from an EHR.
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Toward a System of Total Quality Management: Applying the Deming Approach to the Education Setting.
ERIC Educational Resources Information Center
McLeod, Willis B.; And Others
1992-01-01
Recently, the Petersburg (Virginia) Public Schools have moved away from a highly centralized organizational structure to a Total Quality Management system featuring shared decision making and school-based management practices. The district was guided by Deming's philosophy that all stakeholders should be involved in defining the level of products…
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Management Documentation: Indicators & Good Practice at Cultural Heritage Places
NASA Astrophysics Data System (ADS)
Eppich, R.; Garcia Grinda, J. L.
2015-08-01
Documentation for cultural heritage places usually refers to describing the physical attributes, surrounding context, condition or environment; most of the time with images, graphics, maps or digital 3D models in their various forms with supporting textural information. Just as important as this type of information is the documentation of managerial attributes. How do managers of cultural heritage places collect information related to financial or economic well-being? How are data collected over time measured, and what are significant indicators for improvement? What quality of indicator is good enough? Good management of cultural heritage places is essential for conservation longevity, preservation of values and enjoyment by the public. But how is management documented? The paper will describe the research methodology, selection and description of attributes or indicators related to good management practice. It will describe the criteria for indicator selection and why they are important, how and when they are collected, by whom, and the difficulties in obtaining this information. As importantly it will describe how this type of documentation directly contributes to improving conservation practice. Good practice summaries will be presented that highlight this type of documentation including Pamplona and Ávila, Spain and Valletta, Malta. Conclusions are drawn with preliminary recommendations for improvement of this important aspect of documentation. Documentation of this nature is not typical and presents a unique challenge to collect, measure and communicate easily. However, it is an essential category that is often ignored yet absolutely essential in order to conserve cultural heritage places.
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Quality of chronic kidney disease management in primary care: a retrospective study.
Van Gelder, Vincent A; Scherpbier-De Haan, Nynke D; De Grauw, Wim J C; Vervoort, Gerald M M; Van Weel, Chris; Biermans, Marion C J; Braspenning, Jozé C C; Wetzels, Jack F M
2016-01-01
Early detection and appropriate management of chronic kidney disease (CKD) in primary care are essential to reduce morbidity and mortality. To assess the quality of care (QoC) of CKD in primary healthcare in relation to patient and practice characteristics in order to tailor improvement strategies. Retrospective study using data between 2008 and 2011 from 47 general practices (207 469 patients of whom 162 562 were adults). CKD management of patients under the care of their general practitioner (GP) was qualified using indicators derived from the Dutch interdisciplinary CKD guideline for primary care and nephrology and included (1) monitoring of renal function, albuminuria, blood pressure, and glucose, (2) monitoring of metabolic parameters, and alongside the guideline: (3) recognition of CKD. The outcome indicator was (4) achieving blood pressure targets. Multilevel logistic regression analysis was applied to identify associated patient and practice characteristics. Kidney function or albuminuria data were available for 59 728 adult patients; 9288 patients had CKD, of whom 8794 were under GP care. Monitoring of disease progression was complete in 42% of CKD patients, monitoring of metabolic parameters in 2%, and blood pressure target was reached in 43.1%. GPs documented CKD in 31.4% of CKD patients. High QoC was strongly associated with diabetes, and to a lesser extent with hypertension and male sex. Room for improvement was found in all aspects of CKD management. As QoC was higher in patients who received structured diabetes care, future CKD care may profit from more structured primary care management, e.g. according to the chronic care model. Quality of care for chronic kidney disease patients in primary care can be improved. In comparison with guideline advice, adequate monitoring of disease progression was observed in 42%, of metabolic parameters in 2%, correct recognition of impaired renal function in 31%, and reaching blood pressure targets in 43% of chronic
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[Quality management in cardiovascular echography].
Gullace, Giuseppe
2002-12-01
The quality management of an organization can be defined as the ability to identify, plan and implement programs of measure, analysis, verification and control that allow to monitor management, resources, activities, processes and output/outcome of the same organization, including the satisfaction of the customers. Whatever the model used, it is demonstrated that the management-quality system, either for professional quality or for organization, turns out to be effective even in the health organizations within and to any level of organizational-structural complexity. The present paper concerns the experience of the Italian Society of Cardiovascular Echography (SIEC) on quality certification, both as a scientific society compared to other health organizations and to cardiovascular echo laboratories, and the definition of minimum requirements for the accreditation of the same laboratories. The model most frequently used for quality management is represented by the ISO 9000: Vision 2000, that is a management model with specific reference to the organization and the customer satisfaction. The model applied to the health structure needs a rapid change in mentality that addresses the operators to define, share and achieve objectives to be brought on by means of an active collaboration, group activity and deep sense of belonging necessary to the attainment of expected objectives. When the model is applied by a scientific society, it is necessary to take into account the different structural and functional organization, the constitution and the operators differing on the point of view of origin, experiences, mentality, and roles. The ISO 9000: Vision 2000 model can be applied also to the cardiovascular echo laboratory which may be compared to a simple organization; for its corrected functioning, SIEC has defined minimal requirements for the accreditation, realization and modalities to carry out and manage quality. The quality system represents a new way of operating of an
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Implementation of quality management for clinical bacteriology in low-resource settings.
Barbé, B; Yansouni, C P; Affolabi, D; Jacobs, J
2017-07-01
The declining trend of malaria and the recent prioritization of containment of antimicrobial resistance have created a momentum to implement clinical bacteriology in low-resource settings. Successful implementation relies on guidance by a quality management system (QMS). Over the past decade international initiatives were launched towards implementation of QMS in HIV/AIDS, tuberculosis and malaria. To describe the progress towards accreditation of medical laboratories and to identify the challenges and best practices for implementation of QMS in clinical bacteriology in low-resource settings. Published literature, online reports and websites related to the implementation of laboratory QMS, accreditation of medical laboratories and initiatives for containment of antimicrobial resistance. Apart from the limitations of infrastructure, equipment, consumables and staff, QMS are challenged with the complexity of clinical bacteriology and the healthcare context in low-resource settings (small-scale laboratories, attitudes and perception of staff, absence of laboratory information systems). Likewise, most international initiatives addressing laboratory health strengthening have focused on public health and outbreak management rather than on hospital based patient care. Best practices to implement quality-assured clinical bacteriology in low-resource settings include alignment with national regulations and public health reference laboratories, participating in external quality assurance programmes, support from the hospital's management, starting with attainable projects, conducting error review and daily bench-side supervision, looking for locally adapted solutions, stimulating ownership and extending existing training programmes to clinical bacteriology. The implementation of QMS in clinical bacteriology in hospital settings will ultimately boost a culture of quality to all sectors of healthcare in low-resource settings. Copyright © 2017 The Authors. Published by
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2015-01-01
Background Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. Objective To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Design Multicenter, multilevel cross-sectional study. Setting and Participants Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. Intervention None. Measures Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Results and Limitations Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. Conclusions There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly
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Sunol, Rosa; Wagner, Cordula; Arah, Onyebuchi A; Kristensen, Solvejg; Pfaff, Holger; Klazinga, Niek; Thompson, Caroline A; Wang, Aolin; DerSarkissian, Maral; Bartels, Paul; Michel, Philippe; Groene, Oliver
2015-01-01
Given the amount of time and resources invested in implementing quality programs in hospitals, few studies have investigated their clinical impact and what strategies could be recommended to enhance its effectiveness. To assess variations in clinical practice and explore associations with hospital- and department-level quality management systems. Multicenter, multilevel cross-sectional study. Seventy-three acute care hospitals with 276 departments managing acute myocardial infarction, deliveries, hip fracture, and stroke in seven countries. None. Predictor variables included 3 hospital- and 4 department-level quality measures. Six measures were collected through direct observation by an external surveyor and one was assessed through a questionnaire completed by hospital quality managers. Dependent variables included 24 clinical practice indicators based on case note reviews covering the 4 conditions (acute myocardial infarction, deliveries, hip fracture and stroke). A directed acyclic graph was used to encode relationships between predictors, outcomes, and covariates and to guide the choice of covariates to control for confounding. Data were provided on 9021 clinical records by 276 departments in 73 hospitals. There were substantial variations in compliance with the 24 clinical practice indicators. Weak associations were observed between hospital quality systems and 4 of the 24 indicators, but on analyzing department-level quality systems, strong associations were observed for 8 of the 11 indicators for acute myocardial infarction and stroke. Clinical indicators supported by higher levels of evidence were more frequently associated with quality systems and activities. There are significant gaps between recommended standards of care and clinical practice in a large sample of hospitals. Implementation of department-level quality strategies was significantly associated with good clinical practice. Further research should aim to develop clinically relevant quality
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Practice management: observations, issues, and empirical evidence.
Wong, H M; Braithwaite, J
2001-02-01
The primary objective of this study is to provide objective, empirical, evidence-based practice management information. This is a hitherto under-researched area of considerable interest for both the practitioner and educator. A questionnaire eliciting a mix of structured and free text responses was administered to a random sample of 480 practitioners who are members of the American Academy of Periodontology. Potential respondents not in private practice were excluded and the next listed person substituted. The results provide demographic and descriptive information about some of the main issues and problems facing practice managers, central to which are information technology (IT), financial, people management, and marketing. Human resource and marketing management appear to represent the biggest challenges. Periodontists running practices would prefer more information, development, and support in dealing with IT, finance, marketing, and people management. The empirical evidence reported here suggests that although tailored educational programs on key management issues at both undergraduate and postgraduate levels have become ubiquitous, nevertheless some respondents seek further training opportunities. Evidence-based practice management information will be invaluable to the clinician considering strategic and marketing planning, and also for those responsible for the design and conduct of predoctoral and postdoctoral programs.
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Managers and the new definition of quality.
Chilgren, Allison A
2008-01-01
The manager, particularly the mid-level manager, has a vital role in the success of any healthcare organization, especially in the realm of patient perception of quality. To patients, "quality" means how well a service was delivered, not how technically superior the actual service or clinical component turned out. This definition of quality can also be referred to as patient satisfaction. Managers, with help of an integrative team, can develop quality processes geared toward patient expectations by doing a number of things, including the following: clearly identify outcomes, and empower employees to achieve those goals; form an integrated quality development team to establish quality metrics; build in cultural competence into quality processes; and align the organization's mission to the overall quality program. With a successful quality program, managers can expect a considerable return on investment, satisfied patients and staff, and improved clinical outcomes.
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40 CFR 130.6 - Water quality management plans.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 40 Protection of Environment 23 2012-07-01 2012-07-01 false Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...
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40 CFR 130.6 - Water quality management plans.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 23 2013-07-01 2013-07-01 false Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...
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40 CFR 130.6 - Water quality management plans.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 40 Protection of Environment 22 2014-07-01 2013-07-01 true Water quality management plans. 130.6 Section 130.6 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) WATER PROGRAMS WATER QUALITY PLANNING AND MANAGEMENT § 130.6 Water quality management plans. (a) Water quality management (WQM...
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Internal versus External Quality Management
ERIC Educational Resources Information Center
Hofman, Roelande H.; Dijkstra, Nynke J.; Hofman, W. H. Adriaan
2008-01-01
This article presents the findings of research into quality management in Dutch elementary schools using theories of school accountability and school improvement as fundamentals. The study is based on data gathered from almost 1000 school leaders. It attempts to determine whether different types of quality management exist in primary schools.…
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22 CFR 96.39 - Information disclosure and quality control practices.
Code of Federal Regulations, 2011 CFR
2011-04-01
... 22 Foreign Relations 1 2011-04-01 2011-04-01 false Information disclosure and quality control... for Convention Accreditation and Approval Information Disclosure, Fee Practices, and Quality Control Policies and Practices § 96.39 Information disclosure and quality control practices. (a) The agency or...
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22 CFR 96.39 - Information disclosure and quality control practices.
Code of Federal Regulations, 2010 CFR
2010-04-01
... 22 Foreign Relations 1 2010-04-01 2010-04-01 false Information disclosure and quality control... for Convention Accreditation and Approval Information Disclosure, Fee Practices, and Quality Control Policies and Practices § 96.39 Information disclosure and quality control practices. (a) The agency or...
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22 CFR 96.39 - Information disclosure and quality control practices.
Code of Federal Regulations, 2014 CFR
2014-04-01
... 22 Foreign Relations 1 2014-04-01 2014-04-01 false Information disclosure and quality control... for Convention Accreditation and Approval Information Disclosure, Fee Practices, and Quality Control Policies and Practices § 96.39 Information disclosure and quality control practices. (a) The agency or...
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22 CFR 96.39 - Information disclosure and quality control practices.
Code of Federal Regulations, 2012 CFR
2012-04-01
... 22 Foreign Relations 1 2012-04-01 2012-04-01 false Information disclosure and quality control... for Convention Accreditation and Approval Information Disclosure, Fee Practices, and Quality Control Policies and Practices § 96.39 Information disclosure and quality control practices. (a) The agency or...
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22 CFR 96.39 - Information disclosure and quality control practices.
Code of Federal Regulations, 2013 CFR
2013-04-01
... 22 Foreign Relations 1 2013-04-01 2013-04-01 false Information disclosure and quality control... for Convention Accreditation and Approval Information Disclosure, Fee Practices, and Quality Control Policies and Practices § 96.39 Information disclosure and quality control practices. (a) The agency or...
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40 CFR 503.14 - Management practices.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 31 2013-07-01 2013-07-01 false Management practices. 503.14 Section 503.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Land Application § 503.14 Management practices. (a) Bulk...
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40 CFR 503.45 - Management practices.
Code of Federal Regulations, 2013 CFR
2013-07-01
... 40 Protection of Environment 31 2013-07-01 2013-07-01 false Management practices. 503.45 Section 503.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Incineration § 503.45 Management practices. (a)(1) An...
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40 CFR 503.14 - Management practices.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 40 Protection of Environment 31 2012-07-01 2012-07-01 false Management practices. 503.14 Section 503.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Land Application § 503.14 Management practices. (a) Bulk...
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40 CFR 503.14 - Management practices.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 30 2011-07-01 2011-07-01 false Management practices. 503.14 Section 503.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Land Application § 503.14 Management practices. (a) Bulk...
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40 CFR 503.45 - Management practices.
Code of Federal Regulations, 2012 CFR
2012-07-01
... 40 Protection of Environment 31 2012-07-01 2012-07-01 false Management practices. 503.45 Section 503.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Incineration § 503.45 Management practices. (a)(1) An...
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40 CFR 503.14 - Management practices.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 40 Protection of Environment 30 2014-07-01 2014-07-01 false Management practices. 503.14 Section 503.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Land Application § 503.14 Management practices. (a) Bulk...
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40 CFR 503.45 - Management practices.
Code of Federal Regulations, 2011 CFR
2011-07-01
... 40 Protection of Environment 30 2011-07-01 2011-07-01 false Management practices. 503.45 Section 503.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Incineration § 503.45 Management practices. (a)(1) An...
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40 CFR 503.45 - Management practices.
Code of Federal Regulations, 2014 CFR
2014-07-01
... 40 Protection of Environment 30 2014-07-01 2014-07-01 false Management practices. 503.45 Section 503.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Incineration § 503.45 Management practices. (a)(1) An...
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40 CFR 503.14 - Management practices.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Management practices. 503.14 Section 503.14 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Land Application § 503.14 Management practices. (a) Bulk...
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40 CFR 503.45 - Management practices.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 29 2010-07-01 2010-07-01 false Management practices. 503.45 Section 503.45 Protection of Environment ENVIRONMENTAL PROTECTION AGENCY (CONTINUED) SEWAGE SLUDGE STANDARDS FOR THE USE OR DISPOSAL OF SEWAGE SLUDGE Incineration § 503.45 Management practices. (a)(1) An...
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Bour, Robert K.; Pozniak, Myron; Ranallo, Frank N.
2015-01-01
The purpose of this paper is to describe our experience with the AAPM Medical Physics Practice Guideline 1.a: “CT Protocol Management and Review Practice Guideline”. Specifically, we will share how our institution's quality management system addresses the suggestions within the AAPM practice report. We feel this paper is needed as it was beyond the scope of the AAPM practice guideline to provide specific details on fulfilling individual guidelines. Our hope is that other institutions will be able to emulate some of our practices and that this article would encourage other types of centers (e.g., community hospitals) to share their methodology for approaching CT protocol optimization and quality control. Our institution had a functioning CT protocol optimization process, albeit informal, since we began using CT. Recently, we made our protocol development and validation process compliant with a number of the ISO 9001:2008 clauses and this required us to formalize the roles of the members of our CT protocol optimization team. We rely heavily on PACS‐based IT solutions for acquiring radiologist feedback on the performance of our CT protocols and the performance of our CT scanners in terms of dose (scanner output) and the function of the automatic tube current modulation. Specific details on our quality management system covering both quality control and ongoing optimization have been provided. The roles of each CT protocol team member have been defined, and the critical role that IT solutions provides for the management of files and the monitoring of CT protocols has been reviewed. In addition, the invaluable role management provides by being a champion for the project has been explained; lack of a project champion will mitigate the efforts of a CT protocol optimization team. Meeting the guidelines set forth in the AAPM practice guideline was not inherently difficult, but did, in our case, require the cooperation of radiologists, technologists, physicists, IT
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Watershed and stormwater managers need modeling tools to evaluate alternative plans for water quality management and flow abatement techniques in urban and developing areas. A watershed-scale, decision-support framework that is based on cost optimization is needed to support gov...
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Total Quality Management: A Recipe for Success
1990-04-02
Total Quality Management (TQM) is a high level Department of Defense (DOD) initiative that is being touted as the primary management tool to force...to create a DOD wide organizational climate that will stimulate and perpetuate individual productivity enhancing contributions. Keywords: Quality control; Quality management ; TQM.
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[Cancer pain management: Systematic review and critical appraisal of clinical practice guidelines].
Martínez-Nicolás, I; Ángel-García, D; Saturno, P J; López-Soriano, F
2016-01-01
Although several clinical practice guidelines have been developed in the last decades, cancer pain management is still deficient. The purpose of this work was to carry out a comprehensive and systematic literature review of current clinical practice guidelines on cancer pain management, and critically appraise their methodology and content in order to evaluate their quality and validity to cope with this public health issue. A systematic review was performed in the main databases, using English, French and Spanish as languages, from 2008 to 2013. Reporting and methodological quality was rated with the Appraisal of Guidelines, Research and Evaluation II (AGREE-II) tool, including an inter-rater reliability analysis. Guideline recommendations were extracted and classified into several categories and levels of evidence, aiming to analyse guidelines variability and evidence-based content comprehensiveness. Six guidelines were included. A wide variability was found in both reporting and methodological quality of guidelines, as well as in the content and the level of evidence of their recommendations. The Scottish Intercollegiate Guidelines Network guideline was the best rated using AGREE-II, while the Sociedad Española de Oncología Médica guideline was the worst rated. The Ministry of Health Malaysia guideline was the most comprehensive, and the Scottish Intercollegiate Guidelines Network guideline was the second one. The current guidelines on cancer pain management have limited quality and content. We recommend Ministry of Health Malaysia and Scottish Intercollegiate Guidelines Network guidelines, whilst Sociedad Española de Oncología Médica guideline still needs to improve. Copyright © 2015 SECA. Published by Elsevier Espana. All rights reserved.
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Total Quality Management: Institutional Research Applications.
ERIC Educational Resources Information Center
Heverly, Mary Ann
Total Quality Management (TQM), a technique traditionally reserved for the manufacturing sector, has recently spread to service companies, government agencies, and educational institutions. TQM places responsibility for quality problems with management rather than on the workers. A principal concept of TQM is the management of Process Variation,…
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Need of risk management practice amongst bumiputera contractors in Malaysia construction industries
NASA Astrophysics Data System (ADS)
Syuhada Fadzil, Nur; Noor, Nurazuwa Md; Rahman, Ismail Abdul
2017-11-01
Malaysia construction industry has been growing continuously with double-digit growth for the past two decades. There are many issues surrounded the industry such as delay in delivery, cost overrun, quality and safety. In bumiputera contractor’s context, the literature review found that 32 issues were encountered in the construction project. These issues can be handled properly with the application of risk management. According to previous researchers, application of risk management in Malaysia construction industry is at the low level where it is implemented in traditional ways that are brainstorming and checklist. These were due to lack of knowledge, the high cost of hiring experts and avoiding extra cost. Besides that, this study also intentions to analyse the risk categories in the construction industry as well as identify risk management process to resolve the construction issues. Hence, this paper presents issues engulfed by Bumiputera contractors which can partly be resolved by applying risk management practice in carrying out the construction activity. This may inspire the contractors to apply the risk management practice in ensuring the success of their construction project.
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Low-Cost Air Quality Monitoring Tools: From Research to Practice (A Workshop Summary)
Griswold, William G.; RS, Abhijit; Johnston, Jill E.; Herting, Megan M.; Thorson, Jacob; Collier-Oxandale, Ashley; Hannigan, Michael
2017-01-01
In May 2017, a two-day workshop was held in Los Angeles (California, U.S.A.) to gather practitioners who work with low-cost sensors used to make air quality measurements. The community of practice included individuals from academia, industry, non-profit groups, community-based organizations, and regulatory agencies. The group gathered to share knowledge developed from a variety of pilot projects in hopes of advancing the collective knowledge about how best to use low-cost air quality sensors. Panel discussion topics included: (1) best practices for deployment and calibration of low-cost sensor systems, (2) data standardization efforts and database design, (3) advances in sensor calibration, data management, and data analysis and visualization, and (4) lessons learned from research/community partnerships to encourage purposeful use of sensors and create change/action. Panel discussions summarized knowledge advances and project successes while also highlighting the questions, unresolved issues, and technological limitations that still remain within the low-cost air quality sensor arena. PMID:29143775
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Guerrier, B; Halm, É; Craman, M; Dujols, J-P; Norkowski, J-L; Meynard, K
2017-10-01
In 2015, the quality group of the radiotherapy clinic Groupement de Radiothérapie et d'Oncologie des Pyrénées (GROP, Pau, France) decided to review the deployment of its quality approach in order to optimize it continuously. For this, two improvements were proposed: an involvement of process drivers and a material and financial investment in document management software. The implementation of these organizational and managerial provisions enabled us to better cover the requirements of the ISO 9001 standard, the international reference in quality management. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.
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Lavoie-Tremblay, Mélanie; Fernet, Claude; Lavigne, Geneviève L; Austin, Stéphanie
2016-03-01
To investigate the impact of nurse managers exercising transformational vs. abusive leadership practices with novice nurses. In a nursing shortage context, it is important to understand better the factors that potentially influence the retention of nurses in the early stages of their career. A large body of research has found that transformational leadership practices have a positive influence on employee functioning. However, very little research exists about the detrimental impact of abusive leadership practices, much less in a nursing context. A cross-sectional design where 541 nurses from the province of Quebec (Canada) were questioned in the fall of 2013. A self-administered questionnaire was completed by nurses with less than five years of nursing experience. Results from three linear regression analysis indicated that transformational leadership practices potentially lead to high quality care and weak intention to quit the healthcare facilities. Conversely, abusive leadership practices potentially lead to poorer quality care and to strong intention to quit the healthcare facilities and the nursing profession. Paying close attention to the leadership practices of nurse managers could prove effective in improving patient care and increasing the retention of new nurses, which is helpful in resolving the nursing shortage. Our results specifically suggest not only that we promote supportive leadership practices (transformational leadership) but, most of all, that we spread the word that abusive leadership creates working conditions that could be detrimental to the practice of nursing at career start. © 2015 John Wiley & Sons Ltd.
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Use Management Techniques in Office Practice
ERIC Educational Resources Information Center
Holehan, E. Lee
1977-01-01
Notes that authenticity can be added to student work projects in an office practice class by having the teacher assume the role of the office manager or supervisor and putting office management techniques into practice. Ways in which such techniques may be infused into classes are examined. (TA)
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Williams, Peter Huw; de Lusignan, Simon
2006-01-01
The Royal College of Physicians (RCP) have produced guidelines for stroke management in primary care; this guidance is taken to be the gold standard for the care of people with stroke. UK general practitioners now have a quality-based contract which includes a Quality and Outcomes Framework (QOF). This consists of financially remunerated 'quality points' for specific disease areas, including stroke. Achievement of these quality points is measured by extracting a limited list of computer codes from practice computer systems. To investigate whether a high stroke quality score is associated with adherence to RCP guidelines. Examination of computer and written medical records of all patients with a diagnosis of stroke. Two general practices, one in southwest London, one in Surrey, with a combined practice population of over 20 000. Both practices had a similar age-sex profile and prevalence of stroke. One practice scored 93.5% (29/31) of the available stroke quality points. The other practice achieved 73.4% (22.75/31), and only did better in one stroke quality target. However, the practice scoring fewer quality points had much better adherence to RCP guidance: 96% of patients were assessed in secondary care compared with 79% (P=0.001); 64% of stroke patients were seen the same day, compared with 44%; 56% received rehabilitation compared with 37%. Higher quality points did not reflect better adherence to RCP guidance. This audit highlights a gap between relatively simplistic measures of quality in the QOF, dependent on the recording of a narrow range of computer codes, and the actual standard of care being delivered. Research is needed to see whether this finding is generalisable and how the Quality and Outcomes Framework might be better aligned with delivering best practice.
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Measuring Job Content: Skills, Technology, and Management Practices. Discussion Paper No. 1357-08
ERIC Educational Resources Information Center
Handel, Michael J.
2008-01-01
The conceptualization and measurement of key job characteristics has not changed greatly for most social scientists since the Dictionary of Occupational Titles and Quality of Employment surveys were created, despite their recognized limitations. However, debates over the roles of job skill requirements, technology, and new management practices in…
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Terhaar, Mary F; Sylvia, Martha
2016-01-01
The aim of this investigation was to evaluate, monitor and manage the quality of projects conducted and work produced as evidence of scholarship upon completion of Doctor of Nursing Practice education. The Doctor of Nursing Practice is a relatively new degree which prepares nurses for high impact careers in diverse practice settings around the globe. Considerable variation characterises curricula across schools preparing Doctors of Nursing Practice. Accreditation assures curricula are focused on attainment of the Doctor of Nursing Practice essentials, yet outcomes have not been reported to help educators engage in programme improvement. This work has implications for nursing globally because translating strong evidence into practice is key to improving outcomes in direct care, leadership, management and education. The Doctor of Nursing Practice student learns to accomplish translation through the conduct of projects. Evaluating the rigour and results of these projects is essential to improving the quality, safety and efficacy of translation, improvements in care and overall system performance. A descriptive study was conducted to evaluate the scholarly products of Doctor of Nursing Practice education in one programme across four graduating classes. A total of 80 projects, conducted across the USA and around the globe, are described using a modification of the Uncertainty, Pace, Complexity Model. The per cent of students considered to have produced high quality work in relation to target expectations as well as the per cent that conducted means testing increased over the four study years. Evaluation of scope, complexity and rigour of scholarly work products has driven improvements in the curriculum and informed the work of faculty and advisors. Methods, evaluation and outcomes conformed around a set of expectations for scholarship and rigour have resulted in measurable outcomes, and quality publications have increased over time. © 2015 John Wiley & Sons Ltd.
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Evaluation of a practice-based intervention to improve the management of pediatric asthma.
Ragazzi, Helen; Keller, Adrienne; Ehrensberger, Ryan; Irani, Anne-Marie
2011-02-01
Pediatric asthma remains a significant burden upon patients, families, and the healthcare system. Despite the availability of evidence-based best practice asthma management guidelines for over a decade, published studies suggest that many primary care physicians do not follow them. This article describes the Provider Quality Improvement (PQI) intervention with six diverse community-based practices. A pediatrician and a nurse practitioner conducted the year-long intervention, which was part of a larger CDC-funded project, using problem-based learning within an academic detailing model. Process and outcome assessments included (1) pre- and post-intervention chart reviews to assess eight indicators of quality care, (2) post-intervention staff questionnaires to assess contact with the intervention team and awareness of practice changes, and (3) individual semi-structured interviews with physician and nurse champions in five of the six practices. The chart review indicated that all six practices met predefined performance improvement criteria for at least four of eight indicators of quality care, with two practices meeting improvement criteria for all eight indicators. The response rate for the staff questionnaires was high (72%) and generally consistent across practices, demonstrating high staff awareness of the intervention team, the practice "asthma champions," and changes in practice patterns. In the semi-structured interviews, several respondents attributed the intervention's acceptability and success to the expertise of the PQI team and expressed the belief that sustaining changes would be critically dependent on continued contact with the team. Despite significant limitations, this study demonstrated that interventions that are responsive to individual practice cultures can successfully change practice patterns.
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A computational framework is presented for analyzing the uncertainty in model estimates of water quality benefits of best management practices (BMPs) in two small (<10 km2) watersheds in Indiana. The analysis specifically recognizes the significance of the difference b...
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A Risk-based Assessment And Management Framework For Multipollutant Air Quality
Frey, H. Christopher; Hubbell, Bryan
2010-01-01
The National Research Council recommended both a risk- and performance-based multipollutant approach to air quality management. Specifically, management decisions should be based on minimizing the exposure to, and risk of adverse effects from, multiple sources of air pollution and that the success of these decisions should be measured by how well they achieved this objective. We briefly describe risk analysis and its application within the current approach to air quality management. Recommendations are made as to how current practice could evolve to support a fully risk- and performance-based multipollutant air quality management system. The ability to implement a risk assessment framework in a credible and policy-relevant manner depends on the availability of component models and data which are scientifically sound and developed with an understanding of their application in integrated assessments. The same can be said about accountability assessments used to evaluate the outcomes of decisions made using such frameworks. The existing risk analysis framework, although typically applied to individual pollutants, is conceptually well suited for analyzing multipollutant management actions. Many elements of this framework, such as emissions and air quality modeling, already exist with multipollutant characteristics. However, the framework needs to be supported with information on exposure and concentration response relationships that result from multipollutant health studies. Because the causal chain that links management actions to emission reductions, air quality improvements, exposure reductions and health outcomes is parallel between prospective risk analyses and retrospective accountability assessments, both types of assessment should be placed within a single framework with common metrics and indicators where possible. Improvements in risk reductions can be obtained by adopting a multipollutant risk analysis framework within the current air quality management
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Christine Esposito
2006-01-01
The public's acceptance of forest management practices, including fuels reduction, is heavily based on how forests look. Fuels managers can improve their chances of success by considering aesthetics when making management decisions. This fact sheet reviews a three-part general strategy for managing fuels and visual quality: planning, implementation, and monitoring...
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Total Quality Management Simplified.
ERIC Educational Resources Information Center
Arias, Pam
1995-01-01
Maintains that Total Quality Management (TQM) is one method that helps to monitor and improve the quality of child care. Lists four steps for a child-care center to design and implement its own TQM program. Suggests that quality assurance in child-care settings is an ongoing process, and that TQM programs help in providing consistent, high-quality…
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Portuguese food composition database quality management system.
Oliveira, L M; Castanheira, I P; Dantas, M A; Porto, A A; Calhau, M A
2010-11-01
') comments, complaints and satisfaction, with minor adaptation. Implementation of the FCDB QMS proved to be a way of reducing the subjectivity of the compilation process and fully documenting it, and also facilitates training of new compilers. Furthermore, it has strengthened cooperation and trust among FCDB actors, as all of them were called to be involved in the process. On the basis of our practical results, we can conclude that ISO/IEC 17025 management requirements are an adequate reference for the implementation of INSA's FCDB QMS with the advantages of being well known to all members of staff and also being a common quality language among laboratories producing FCD. Combining quality systems and food composition activities endows the FCDB compilation process with flexibility, consistency and transparency, and facilitates its monitoring and assessment, providing the basis for strengthening confidence among users, data producers and compilers.
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How Quality Improvement Practice Evidence Can Advance the Knowledge Base.
OʼRourke, Hannah M; Fraser, Kimberly D
2016-01-01
Recommendations for the evaluation of quality improvement interventions have been made in order to improve the evidence base of whether, to what extent, and why quality improvement interventions affect chosen outcomes. The purpose of this article is to articulate why these recommendations are appropriate to improve the rigor of quality improvement intervention evaluation as a research endeavor, but inappropriate for the purposes of everyday quality improvement practice. To support our claim, we describe the differences between quality improvement interventions that occur for the purpose of practice as compared to research. We then carefully consider how feasibility, ethics, and the aims of evaluation each impact how quality improvement interventions that occur in practice, as opposed to research, can or should be evaluated. Recommendations that fit the evaluative goals of practice-based quality improvement interventions are needed to support fair appraisal of the distinct evidence they produce. We describe a current debate on the nature of evidence to assist in reenvisioning how quality improvement evidence generated from practice might complement that generated from research, and contribute in a value-added way to the knowledge base.
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Bickel, Kathleen E; McNiff, Kristen; Buss, Mary K; Kamal, Arif; Lupu, Dale; Abernethy, Amy P; Broder, Michael S; Shapiro, Charles L; Acheson, Anupama Kurup; Malin, Jennifer; Evans, Tracey; Krzyzanowska, Monika K
2016-09-01
Integrated into routine oncology care, palliative care can improve symptom burden, quality of life, and patient and caregiver satisfaction. However, not all oncology practices have access to specialist palliative medicine. This project endeavored to define what constitutes high-quality primary palliative care as delivered by medical oncology practices. An expert steering committee outlined 966 palliative care service items, in nine domains, each describing a candidate element of primary palliative care delivery for patients with advanced cancer or high symptom burden. Using modified Delphi methodology, 31 multidisciplinary panelists rated each service item on three constructs: importance, feasibility, and scope within medical oncology practice. Panelists endorsed the highest proportion of palliative care service items in the domains of End-of-Life Care (81%); Communication and Shared Decision Making (79%); and Advance Care Planning (78%). The lowest proportions were in Spiritual and Cultural Assessment and Management (35%) and Psychosocial Assessment and Management (39%). In the largest domain, Symptom Assessment and Management, there was consensus that all symptoms should be assessed and managed at a basic level, with more comprehensive management for common symptoms such as nausea, vomiting, diarrhea, dyspnea, and pain. Within the Appropriate Palliative Care and Hospice Referral domain, there was consensus that oncology practices should be able to describe the difference between palliative care and hospice to patients and refer patients appropriately. This statement describes the elements comprising high-quality primary palliative care for patients with advanced cancer or high symptom burden, as delivered by oncology practices. Oncology providers wishing to enhance palliative care delivery may find this information useful to inform operational changes and quality improvement efforts. Copyright © 2016 by American Society of Clinical Oncology.
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Cortinhas, Cristina Simões; Botaro, Bruno Garcia; de Macedo, Susana Nori; Dos Santos, Marcos Veiga
2018-04-30
This study identified the association of management practices and herd characteristics with milk quality of bulk tanks in southeastern, Brazil. Milk samples were collected weekly during 8 weeks from 63 dairy herds. Bulk tanks were evaluated for total bacteria (TBC), preliminary incubation (PIC), pasteurization (PC), coliform (CC), and somatic cell counts (SCC). Associations found were type of milking system utilized in the farm with TBC, PIC, and SCC; the use of gloves for milking with TBC and PIC; sanitation of milking equipment prior to milking with PC and CC; strip cup testing of cows with PC; teat washing prior to milking with SCC; pre-milking teat disinfection with TBC and CC; post-dipping with TBC and SCC; and the alkaline-acid washing procedure of milking equipment with PIC and PC. The regression analysis explained the variation of bulk tank PC (- 0.47 log cfu/mL) due to the adoption of strip cup test (P = 0.036) and, by 0.366 log cfu/mL due to alkaline and acid washing of milking equipment (P = 0.036). Herringbone milking systems adopted on farms represented a change of - 0.11 log cfu/mL on the log SCC (P = 0.048). Findings may provide a guideline to prioritize efforts aimed at improving milk quality at the farm level in Brazil.
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Lan, X Y; Zhao, S G; Zheng, N; Li, S L; Zhang, Y D; Liu, H M; McKillip, J; Wang, J Q
2017-06-01
Contamination of raw milk with bacterial pathogens is potentially hazardous to human health. The aim of this study was to evaluate the total bacteria count (TBC) and presence of pathogens in raw milk in Northern China along with the associated herd management practices. A total of 160 raw milk samples were collected from 80 dairy herds in Northern China. All raw milk samples were analyzed for TBC and pathogens by culturing. The results showed that the number of raw milk samples with TBC <2 × 10 6 cfu/mL and <1 × 10 5 cfu/mL was 146 (91.25%) and 70 (43.75%), respectively. A total of 84 (52.50%) raw milk samples were Staphylococcus aureus positive, 72 (45.00%) were Escherichia coli positive, 2 (1.25%) were Salmonella positive, 2 (1.25%) were Listeria monocytogenes positive, and 3 (1.88%) were Campylobacter positive. The prevalence of S. aureus was influenced by season, herd size, milking frequency, disinfection frequency, and use of a Dairy Herd Improvement program. The TBC was influenced by season and milk frequency. The correlation between TBC and prevalence of S. aureus or E. coli is significant. The effect size statistical analysis showed that season and herd (but not Dairy Herd Improvement, herd size, milking frequency, disinfection frequency, and area) were the most important factors affecting TBC in raw milk. In conclusion, the presence of bacteria in raw milk was associated with season and herd management practices, and further comprehensive study will be powerful for effectively characterizing various factors affecting milk microbial quality in bulk tanks in China. Copyright © 2017 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.
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Total Quality Management in Education. Second Edition.
ERIC Educational Resources Information Center
Sallis, Edward
Quality is at the top of most agendas, and improving quality is probably the most important task facing any institution. In addition, quality is difficult to define or measure. This book, the second edition of "Total Quality Management in Education," introduces the key concepts of Total Quality Management (TQM) and demonstrates how they…
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Electronic health records in four community physician practices: impact on quality and cost of care.
Welch, W Pete; Bazarko, Dawn; Ritten, Kimberly; Burgess, Yo; Harmon, Robert; Sandy, Lewis G
2007-01-01
To assess the impact of the electronic health record (EHR) on cost (i.e., payments to providers) and process measures of quality of care. Retrospective before-after-study-control. From the database of a large managed care organization (MCO), we obtained the claims of patients from four community physician practices that implemented the EHR and from about 50 comparison practices without the EHR in the same counties. The diverse patient and practice populations were chosen to be a sample more representative of typical private practices than has previously been studied. For four chronic conditions, we used commercially-available software to analyze cost per episode over a year and the rate of adherence to clinical guidelines as a measure of quality. The implementation of the EHR had a modest positive impact on the quality measure of guideline adherence for hypertension and hyperlipidemia, but no significant impact for diabetes and coronary artery disease. No measurable impact on the short-term cost per episode was found. Discussions with the study practices revealed that the timing and comprehensiveness of EHR implementation varied across practices, creating an intervention variable that was heterogeneous. Guideline adherence increased across practices without EHRs and slightly faster in practices with EHRs. Measuring the impact of EHRs on cost per episode was challenging, because of the difficulty of completely capturing the long-term episodic costs of a chronic condition. Few practices associated with the study MCO had implemented EHRs in any form, much less utilizing standardized protocols.
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Crosson, Jesse C; Ohman-Strickland, Pamela A; Hahn, Karissa A; DiCicco-Bloom, Barbara; Shaw, Eric; Orzano, A John; Crabtree, Benjamin F
2007-01-01
Care of patients with diabetes requires management of complex clinical information, which may be improved by the use of an electronic medical record (EMR); however, the actual relationship between EMR usage and diabetes care quality in primary care settings is not well understood. We assessed the relationship between EMR usage and diabetes care quality in a sample of family medicine practices. We conducted cross-sectional analyses of baseline data from 50 practices participating in a practice improvement study. Between April 2003 and December 2004 chart auditors reviewed a random sample of medical records from patients with diabetes in each practice for adherence to guidelines for diabetes processes of care, treatment, and achievement of intermediate outcomes. Practice leaders provided medical record system information. We conducted multivariate analyses of the relationship between EMR usage and diabetes care adjusting for potential practice- and patient-level confounders and practice-level clustering. Diabetes care quality in all practices showed room for improvement; however, after adjustment, patient care in the 37 practices not using an EMR was more likely to meet guidelines for process (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.42-3.57) treatment (OR, 1.67; 95% CI, 1.07-2.60), and intermediate outcomes (OR, 2.68; 95% CI, 1.49-4.82) than in the 13 practices using an EMR. The use of an EMR in primary care practices is insufficient for insuring high-quality diabetes care. Efforts to expand EMR use should focus not only on improving technology but also on developing methods for implementing and integrating this technology into practice reality.
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Ali, Syed Mustafa; Anjum, Naveed; Kamel Boulos, Maged N; Ishaq, Muhammad; Aamir, Javariya; Haider, Ghulam Rasool
2018-01-16
Data quality is core theme of programme's performance assessment and many organizations do not have any data quality improvement strategy, wherein data quality dimensions and data quality assessment framework are important constituents. As there is limited published research about the data quality specifics that are relevant to the context of Pakistan's Tuberculosis control programme, this study aims at identifying the applicable data quality dimensions by using the 'fitness-for-purpose' perspective. Forty-two respondents pooled a total of 473 years of professional experience, out of which 223 years (47%) were in TB control related programmes. Based on the responses against 11 practical cases, adopted from the routine recording and reporting system of Pakistan's TB control programme (real identities of patient were masked), completeness, accuracy, consistency, vagueness, uniqueness and timeliness are the applicable data quality dimensions relevant to the programme's context, i.e. work settings and field of practice. Based on a 'fitness-for-purpose' approach to data quality, this study used a test-based approach to measure management's perspective and identified data quality dimensions pertinent to the programme and country specific requirements. Implementation of a data quality improvement strategy and achieving enhanced data quality would greatly help organizations in promoting data use for informed decision making.
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Collaborating to embrace evidence-informed management practices within Canada's health system.
Strelioff, Wayne; Lavoie-Tremblay, Mélanie; Barton, Melissa
2007-01-01
In late 2005, 11 major national health organizations decided to work together to build healthier workplaces for healthcare providers. To do so, they created a pan-Canadian collaborative of 45 experts and asked them to develop an action strategy to improve healthcare workplaces. One of the first steps taken by members of the collaborative was to adopt the following shared belief statements to guide their thinking: "We believe it is unacceptable to fund, govern, manage, work in or receive care in an unhealthy health workplace," and, "A fundamental way to better healthcare is through healthier healthcare workplaces." This commentary provides an overview of the Quality Worklife-Quality Healthcare Collaborative action strategy. This strategy embraces the thinking set out by the lead papers (by Shamian and El-Jardali and by Clements, Dault and Priest) and brings to life evidence-informed management practices.
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Time management strategies in nursing practice.
Waterworth, Susan
2003-09-01
With the increasing emphasis on efficiency and effectiveness in health care, how a nurse manages her time is an important consideration. Whilst time management is recognized as an important component of work performance and professional nursing practice, the reality of this process in nursing practice has been subject to scant empirical investigation. To explore how nurses organize and manage their time. A qualitative study was carried out, incorporating narratives (22 nurses), focus groups (24 nurses) and semi-structured interviews (22 nurses). In my role as practitioner researcher I undertook observation and had informal conversations, which provided further data. Study sites were five health care organizations in the United Kingdom during 1995-1999. Time management is complex, with nurses using a range of time management strategies and a repertoire of actions. Two of these strategies, namely routinization and prioritizing, are discussed, including their implications for understanding time management by nurses in clinical practice. Ignoring the influence of 'others', the team and the organization perpetuates a rather individualistic and self-critical perspective of time management. This may lead to a failure to address problems in the organizing of work, and the co-ordinating of care involving other health care workers.
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NASA Astrophysics Data System (ADS)
Murali, Swetha; Ponmalar, V.
2017-07-01
To make innovation and continuous improvement as a norm, some traditional practices must become unlearnt. Change for growth and competitiveness are required for sustainability for any profitable business such as the construction industry. The leading companies are willing to implement Total Quality Management (TQM) principles, to realise potential advantages and improve growth and efficiency. Ironically, researches recollected quality as the most significant provider for competitive advantage in industrial leadership. The two objectives of this paper are 1) Identify TQM effectiveness in residential projects and 2) Identify the client satisfaction/dissatisfaction areas using Analytical Hierarchy Process (AHP) and suggest effective mitigate measures. Using statistical survey techniques like set of questionnaire survey, it is observed that total quality management was applied in some leading successful organization to an extent. The main attributes for quality achievement can be defined as teamwork and better communication with single agreed goal between client and contractor. Onsite safety is a paramount attribute in the identifying quality within the residential projects. It was noticed that the process based quality methods such as onsite safe working condition; safe management system and modern engineering process safety controls etc. as interlinked functions. Training and effective communication with all stakeholders on quality management principles is essential for effective quality work. Late Only through effective TQM principles companies can avoid some contract litigations with an increased client satisfaction Index.
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Transcultural Pain Management: Theory, Practice, and Nurse-Client Partnerships.
Rosa, William E
2018-02-01
Nursing is becoming increasingly aware of its impact as a global profession. Part of this evolution is the understanding that the Western evidence-based construct may not be reliably or universally applicable to transcultural settings and clients. In a global world, no 'one size fits all' and no singular approach to pain management is appropriate; there are, quite literally, infinite variations in cross-cultural dynamics. Nurses working in the field of pain management must be able to navigate their responsibilities within the global health context. The role of the pain management nurse in the global world is to provide individualized and culturally relevant pain management for clients, which is mindful of multifactorial contributors to the pain experience, such as the physiologic, affective, cognitive, behavioral, sociocultural, and environmental, and to view adequate pain management as an international human right. Through the skillful integration of theory, practice, and the ability to build respectful and responsible nurse-client partnerships, pain management nurses can deliver contextually relevant care that promotes safety, quality, and healing. Copyright © 2017 American Society for Pain Management Nursing. Published by Elsevier Inc. All rights reserved.
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Strategic Issues in Quality Management: 1. Theoretical Considerations.
ERIC Educational Resources Information Center
Johannsen, Carl Gustav
1996-01-01
Examines the relationship between strategic management and quality management concepts in a library and information services setting. Conceptual frameworks are presented and a new strategic quality management framework, inspired by the Japanese policy deployment approach, is developed that also discusses total quality management. (Author/LRW)
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What can family medicine practices do to facilitate knowledge management?
Orzano, A John; Ohman-Strickland, Pamela A; Patel, Meghal
2008-01-01
Family medicine practices face increasing demands to enhance efficiency and quality of care. Current solutions propose major practice redesign and investment in sophisticated technology. Knowledge management (KM) is a process that increases the capacity of a practice to deliver effective care by finding and sharing information and knowledge among practice members or by developing new knowledge for use by the practice. Our preliminary research in family medicine practices has suggested improved patient outcomes with greater and more effective KM. Research in other organizational settings has suggested that KM can be facilitated by certain organizational characteristics. To identify those organizational characteristics within a family medicine practice that management can effect to enhance KM. We performed a cross-sectional secondary analysis of second-year data from 13 community family medicine practices participating in a practice improvement project. Practice KM, leaderships' promotion of participatory decision making, existence of activities supportive of human resource processes, and effective communication were derived from clinician's, nurses', and staff's responses to a survey eliciting responses on practice organizational characteristics. Hierarchical linear modeling examined relationships between individual practice members' perception of KM and organizational characteristics of the practice, controlling for practice covariates (solo-group, electronic medical record use, and perception of a chaotic practice environment) and staff-level covariates (gender, age, and role). Practices with greater participatory decision making and human resources' processes and effective communication significantly (p < .019, p < .0001, and p < .004) increased odds of reporting satisfactory KM (odds ratio = 2.48, 95% confidence interval = 1.32-4.65; odds ratio = 10.84, 95% confidence interval = 4.04-29.12; and odds ratio = 4.95, 95% confidence interval = 2.02-12.16). The sizes
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Barton, Spencer E; Campbell, Jeffrey W; Piatt, Joseph H
2013-04-01
The authors define and examine the properties of 2 new, practice-based quality measures for the management of hydrocephalus. The Surgical Activity Rate (SAR) is defined as the number of definitive operations for the treatment of hydrocephalus performed in a neurosurgical practice over the course of a year, divided by the number of patients with hydrocephalus seen in follow-up during that year. The Revision Quotient (RQ) is defined as the number of definitive revision operations performed in a neurosurgical practice in the course of a year, divided by the number of definitive initial operations during that year for patients with newly diagnosed hydrocephalus. Using published actuarial shunt survival data, the authors conducted Monte Carlo simulations of a pediatric neurosurgical practice to illustrate the properties and interpretations of the SAR and RQ. They used data from the Kids' Inpatient Database (KID) for 2009 to calculate RQs for hospitals accounting for more than 10 admissions coded for initial CSF shunt insertions. During the initial growth phase of a simulated neurosurgical practice, the SAR approached its steady-state value much earlier than the RQ. Both measures were sensitive to doubling or halving of monthly failure rates. In the 2009 KID, 117 hospitals reported more than 10 initial shunt insertions. The weighted mean (± standard deviation) RQ for these hospitals was 1.79 ± 0.69. Among hospitals performing 50 or more initial shunt insertions, the RQ ranged between 0.71 and 3.65. The SAR and RQ have attractive qualitative features as practice-based quality measures. The RQ, at least, exhibits clinically meaningful interhospital variation as applied to CSF shunt surgery. The SAR and RQ merit prospective field-testing as measures of quality in the management of childhood hydrocephalus.
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Total Quality Management in Logistics: A Case Study from the Trucking Industry
1992-06-01
Quality Management (TQM) movement on the logistics industry as a whole, and, more specifically, its impact within the trucking industry. Its focus then narrows to study the practical aspects of implementing a W. Edwards Deming-based quality program within a particular trucking company, Mason Transporters, Inc. The effectiveness of the company’s implementation effort is assessed using data collected from a survey questionnaire, formal interviews, and personal observations during an on- site visit. Successes and shortcomings of the implementation process are highlighted
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Clinical Practices in Collegiate Concussion Management.
Baugh, Christine M; Kroshus, Emily; Stamm, Julie M; Daneshvar, Daniel H; Pepin, Michael J; Meehan, William P
2016-06-01
In recent years, sports leagues and sports medicine experts have developed guidelines for concussion management. The extent to which current clinical practice is consistent with guideline recommendations is unclear. At the collegiate level, there have been few examinations of concussion management practices and the extent to which meaningful differences across divisions of competition exist. The purposes of this study were to (1) examine current practices in concussion diagnosis and management at National Collegiate Athletic Association (NCAA) member colleges, (2) explore the extent to which current practices reflect current recommendations for concussion diagnosis and management, and (3) determine whether there are differences in management patterns across divisions of competition. Descriptive epidemiology study. An electronic questionnaire was sent to sports medicine clinicians at all NCAA member colleges during September and October 2013. Clinicians were asked about baseline assessments, diagnosis and management practices, return-to-play protocols, the perceived prevalence of underdiagnosis, and basic demographic information. Approximately 30% (n = 866) of contacted clinicians, representing nearly 50% (n = 527) of NCAA member colleges, responded to the questionnaire. Preparticipation baseline examinations were administered at the majority of schools (95%), but most (87.5%) administered baseline assessments only to selected high-risk athletes. Computerized neurocognitive testing and balance assessments were most commonly used as preseason baseline and postinjury assessments. Multimodal examination in line with NCAA and other guidance was used only at a minority of institutions. Athletic trainers most commonly administered and interpreted the preseason baseline examination. Most clinicians reported that their institutions' practices were in line with NCAA guidelines during the first 24 hours of an athlete's concussion diagnosis, with exact percentages varying
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Total Quality Management Implementation Plan: Defense Depot, Ogden
1989-07-01
NUMBERS Total Quality Management Implementation Plan Defense Depot Ogden 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES) 8. PERFORMING...PAGES TQM (Total Quality Management ), Continuous Process Improvement, Depot Operations, Process Action Teams 16. PRICE CODE 17. SECURITY...034 A Message From The Commander On Total Quality Management i fully support the DLA aoproacii to Total Quality Management . As stated by General
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Educational Management: Theory and Practice.
ERIC Educational Resources Information Center
Bush, Tony
This document is a chapter in "The Principles and Practice of Educational Management," which aims to provide a systematic and analytical introduction to the study of educational management. The structure of the book reflects the main substantive areas of educational leadership and management, and most of the major themes are covered in the…
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Do Clinical Practice Guidelines Improve Quality?
Baldassari, Cristina M
2017-07-01
Controversy exists surrounding how to best define and assess quality in the health care setting. Clinical practice guidelines (CPGs) have been developed to improve the quality of medical care by highlighting key clinical recommendations based on recent evidence. However, data linking CPGs to improvements in outcomes in otolaryngology are lacking. Numerous barriers contribute to difficulties in translating CPGs to improvements in quality. Future initiatives are needed to improve CPG adherence and define the impact of CPG recommendations on the quality of otolaryngologic care provided to our patients.
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Managed care and total quality management: a necessary integration.
Phoon, J; Corder, K; Barter, M
1996-01-01
The process of quality improvement/total quality management (QI/TQM) plays a key role in the delivery of health care in a managed care system. The concepts and ideas surrounding QI/TQM and managed care are interrelated, and the success of health care delivery depends on the integration and coexistence of these two philosophies. In looking more closely at these concepts, it becomes clear that the principles of QI/TQM must underlie strategic decisions involved in the implementation of a managed care system. Nurses play a key role in the success of this integration as nurse case managers, nurse practitioners, and nurse administrators. They have a direct impact on the many variables and goals of both QI/TQM and managed care.
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Practice management education during surgical residency.
Jones, Kory; Lebron, Ricardo A; Mangram, Alicia; Dunn, Ernest
2008-12-01
Surgical education has undergone radical changes in the past decade. The introductions of laparoscopic surgery and endovascular techniques have required program directors to alter surgical training. The 6 competencies are now in place. One issue that still needs to be addressed is the business aspect of surgical practice. Often residents complete their training with minimal or no knowledge on coding of charges or basic aspects on how to set up a practice. We present our program, which has been in place over the past 2 years and is designed to teach the residents practice management. The program begins with a series of 10 lectures given monthly beginning in August. Topics include an introduction to types of practices available, negotiating a contract, managed care, and marketing the practice. Both medical and surgical residents attend these conferences. In addition, the surgical residents meet monthly with the business office to discuss billing and coding issues. These are didactic sessions combined with in-house chart reviews of surgical coding. The third phase of the practice management plan has the coding team along with the program director attend the outpatient clinic to review in real time the evaluation and management coding of clinic visits. Resident evaluations were completed for each of the practice management lectures. The responses were recorded on a Likert scale. The scores ranged from 4.1 to 4.8 (average, 4.3). Highest scores were given to lectures concerning negotiating employee agreements, recruiting contracts, malpractice insurance, and risk management. The medical education department has tracked resident coding compliance over the past 2 years. Surgical coding compliance increased from 36% to 88% over a 12-month period. The program director who participated in the educational process increased his accuracy from 50% to 90% over the same time period. When residents finish their surgical training they need to be ready to enter the world of business
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Quality in translation: case management in the international marketplace.
Beichl, Lisa; Craig, Kathy
2009-01-01
This article identifies three categories of case management (CM), in-country, international, and micro, that are poised to serve as the quality proxy for the international medical patient in the rapidly emerging globalized healthcare marketplace. The content concentrates on describing in-country CM and international CM (ICM). Because CM professionals are the providers of patient-centered quality and safety improvements, they are capable of filling the chasm between the travel industry and the regulators who specialize in accrediting hospital systems. In-country and ICM case managers are equipped to perform surveillance and intervention at the level of the international patient's bedside, activate network connections, and use culture-sensitive communication skills to safeguard patients in their individual sojourns abroad. The article discusses useful concepts and sources, including an algorithmic tool under development that is geared to identify and quantify risks for lay and business individuals who seek to engage the global medical market. The article's information is provided for front-line and front-office healthcare practitioners to understand or enter the worldwide medical marketplace. Content is targeted to CM generalists, specialists, and business developers interested in learning about safeguarding the patients who travel internationally to receive medical care. It can also be applied by those within and outside the healthcare practice arena, particularly those interested in the development of quality initiatives. All research and syntheses were executed by the authors. Sources included scholarly treatises, business correspondence, medical tourism literature, corporate Internet profiles, news releases, and healthcare industry investigative and monitoring agencies. International health insurance, economics, and financing expertise stems from one author (L.B.). Clinical competencies stem from the international practice experiences of one author (K.C.). This
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The role of hospital managers in quality and patient safety: a systematic review
Parand, Anam; Dopson, Sue; Renz, Anna; Vincent, Charles
2014-01-01
Objectives To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. Design A systematic review of the literature. Methods A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15 447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles. Results The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals. Conclusions There is some evidence that managers’ time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance. PMID:25192876
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TU-AB-BRD-04: Development of Quality Management Program
DOE Office of Scientific and Technical Information (OSTI.GOV)
Thomadsen, B.
2015-06-15
Current quality assurance and quality management guidelines provided by various professional organizations are prescriptive in nature, focusing principally on performance characteristics of planning and delivery devices. However, published analyses of events in radiation therapy show that most events are often caused by flaws in clinical processes rather than by device failures. This suggests the need for the development of a quality management program that is based on integrated approaches to process and equipment quality assurance. Industrial engineers have developed various risk assessment tools that are used to identify and eliminate potential failures from a system or a process before amore » failure impacts a customer. These tools include, but are not limited to, process mapping, failure modes and effects analysis, fault tree analysis. Task Group 100 of the American Association of Physicists in Medicine has developed these tools and used them to formulate an example risk-based quality management program for intensity-modulated radiotherapy. This is a prospective risk assessment approach that analyzes potential error pathways inherent in a clinical process and then ranks them according to relative risk, typically before implementation, followed by the design of a new process or modification of the existing process. Appropriate controls are then put in place to ensure that failures are less likely to occur and, if they do, they will more likely be detected before they propagate through the process, compromising treatment outcome and causing harm to the patient. Such a prospective approach forms the basis of the work of Task Group 100 that has recently been approved by the AAPM. This session will be devoted to a discussion of these tools and practical examples of how these tools can be used in a given radiotherapy clinic to develop a risk based quality management program. Learning Objectives: Learn how to design a process map for a radiotherapy process Learn
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Oblinger, Carolyn J.
2004-01-01
The Triangle Area Water Supply Monitoring Project was initiated in October 1988 to provide long-term water-quality data for six area water-supply reservoirs and their tributaries. In addition, the project provides data that can be used to determine the effectiveness of large-scale changes in water-resource management practices, document differences in water quality among water-supply types (large multiuse reservoir, small reservoir, run-of-river), and tributary-loading and in-lake data for water-quality modeling of Falls and Jordan Lakes. By September 2001, the project had progressed in four phases and included as many as 34 sites (in 1991). Most sites were sampled and analyzed by the U.S. Geological Survey. Some sites were already a part of the North Carolina Division of Water Quality statewide ambient water-quality monitoring network and were sampled by the Division of Water Quality. The network has provided data on streamflow, physical properties, and concentrations of nutrients, major ions, metals, trace elements, chlorophyll, total organic carbon, suspended sediment, and selected synthetic organic compounds. Project quality-assurance activities include written procedures for sample collection, record management and archive, collection of field quality-control samples (blank samples and replicate samples), and monitoring the quality of field supplies. In addition to project quality-assurance activities, the quality of laboratory analyses was assessed through laboratory quality-assurance practices and an independent laboratory quality-control assessment provided by the U.S. Geological Survey Branch of Quality Systems through the Blind Inorganic Sample Project and the Organic Blind Sample Project.
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Eley, Diann S; Patterson, Elizabeth; Young, Jacqui; Fahey, Paul P; Del Mar, Chris B; Hegney, Desley G; Synnott, Robyn L; Mahomed, Rosemary; Baker, Peter G; Scuffham, Paul A
2013-01-01
The Australian government's commitment to health service reform has placed general practice at the centre of its agenda to manage chronic disease. Concerns about the capacity of GPs to meet the growing chronic disease burden has stimulated the implementation and testing of new models of care that better utilise practice nurses (PN). This paper reports on a mixed-methods study nested within a larger study that trialled the feasibility and acceptability of a new model of nurse-led chronic disease management in three general practices. Patients over 18 years of age with type 2 diabetes, hypertension or stable ischaemic heart disease were randomised into PN-led or usual GP-led care. Primary outcomes were self-reported quality of life and perceptions of the model's feasibility and acceptability from the perspective of patients and GPs. Over the 12-month study quality of life decreased but the trend between groups was not statistically different. Qualitative data indicate that the PN-led model was acceptable and feasible to GPs and patients. It is possible to extend the scope of PN care to lead the routine clinical management of patients' stable chronic diseases. All GPs identified significant advantages to the model and elected to continue with the PN-led care after our study concluded.
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Attributing nitrogen (N) in the environment to emissions from agricultural management practices is difficult because of the complex and inter-related chemical and biological reactions associated with N and its cascading effects across land, air and water. Such analyses are criti...
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Total Quality Management (TQM) as the Procedure for Management of Integrated Academics.
ERIC Educational Resources Information Center
Anderson, Lowell D.
Total Quality Management (TQM) is a way of doing business that involves every employee, both labor and management, in an effort to improve quality and productivity. The quality management concept consists of common principles: (1) customer focus; (2) process focus; (3) failure prevention; (4) mobilization of work force; (5) decision making based…
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Sadana, Divyajot; Pratzer, Ariella; Scher, Lauren J; Saag, Harry S; Adler, Nicole; Volpicelli, Frank M; Auron, Moises; Frank, Steven M
2018-01-01
Although blood transfusion is a lifesaving therapy for some patients, transfusion has been named 1 of the top 5 overused procedures in US hospitals. As unnecessary transfusions only increase risk and cost without providing benefit, improving transfusion practice is an effective way of promoting high-value care. Most high-quality clinical trials supporting a restrictive transfusion strategy have been published in the past 5 to 10 years, so the value of a successful patient blood management program has only recently been recognized. We review the most recent transfusion practice guidelines and the evidence supporting these guidelines. We also discuss several medical societies' Choosing Wisely campaigns to reduce or eliminate overuse of transfusions. A blueprint is presented for developing a patient blood management program, which includes discussion of specific methods for optimizing transfusion practice.
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Best Practices for Management of Biocontaminated Waste ...
Report The purpose of these best practices is to provide federal, state, territorial, and local waste management entities information on techniques and methodologies that have the potential to improve the handling and management of biocontaminated waste streams after a biological agent incident. These best practices are intended to be general in nature serving as a resource to a variety of biological agents in a variety of situations; however, these best practices also present a specific homeland security scenario – a biological attack with Bacillus anthracis (B. anthracis) – to help illustrate specific waste management considerations.
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Tomer, M D; Locke, M A
2011-01-01
The Conservation Effects Assessment Project was established to quantify water quality benefits of conservation practices supported by the U.S. Department of Agriculture (USDA). In 2004, watershed assessment studies were begun in fourteen agricultural watersheds with varying cropping systems, landscapes, climate, and water quality concerns. This paper reviews USDA Agricultural Research Service 'Benchmark' watershed studies and the challenge of identifying water quality benefits in watersheds. Study goals included modeling and field research to assess practices, and evaluation of practice placement in watersheds. Not all goals were met within five years but important lessons were learned. While practices improved water quality, problems persisted in larger watersheds. This dissociation between practice-focused and watershed-scale assessments occurred because: (1) Conservation practices were not targeted at critical sources/pathways of contaminants; (2) Sediment in streams originated more from channel and bank erosion than from soil erosion; (3) Timing lags, historical legacies, and shifting climate combined to mask effects of practice implementation; and (4) Water quality management strategies addressed single contaminants with little regard for trade-offs among contaminants. These lessons could help improve conservation strategies and set water quality goals with realistic timelines. Continued research on agricultural water quality could better integrate modeling and monitoring capabilities, and address ecosystem services.
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Transforming an EPA QA/R-2 quality management plan into an ISO 9002 quality management system.
Kell, R A; Hedin, C M; Kassakhian, G H; Reynolds, E S
2001-01-01
The Environmental Protection Agency's (EPA) Office of Emergency and Remedial Response (OERR) requires environmental data of known quality to support Superfund hazardous waste site projects. The Quality Assurance Technical Support (QATS) Program is operated by Shaw Environmental and Infrastructure, Inc. to provide EPA's Analytical Operations Center (AOC) with performance evaluation samples, reference materials, on-site laboratory auditing capabilities, data audits (including electronic media data audits), methods development, and other support services. The new QATS contract awarded in November 2000 required that the QATS Program become ISO 9000 certified. In a first for an EPA contractor, the QATS staff and management successfully transformed EPA's QA/R-2 type Quality Management Plan into a Quality Management System (QMS) that complies with the requirements of the internationally recognized ISO 9002 standard and achieved certification in the United States, Canada, and throughout Europe. The presentation describes how quality system elements of ISO 9002 were implemented on an already existing quality system. The psychological and organizational challenges of the culture change in QATS' day-to-day operations will be discussed for the benefit of other ISO 9000 aspirants.
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Fiehe, Sandra; Wagner, Georg; Schlanstein, Peter; Rosefort, Christiane; Kopp, Rüdger; Bensberg, Ralf; Knipp, Peter; Schmitz-Rode, Thomas; Steinseifer, Ulrich; Arens, Jutta
2014-04-01
The ultimate objective of university research and development projects is usually to create knowledge, but also to successfully transfer results to industry for subsequent marketing. We hypothesized that the university technology transfer requires efficient measures to improve this important step. Besides good scientific practice, foresighted and industry-specific adapted documentation of research processes in terms of a quality management system might improve the technology transfer. In order to bridge the gap between research institute and cooperating industry, a model project has been accompanied by a project specific amount of quality management. However, such a system had to remain manageable and must not constrain the researchers' creativity. Moreover, topics and research team are strongly interdisciplinary, which entails difficulties regarding communication because of different perspectives and terminology. In parallel to the technical work of the model project, an adaptable quality management system with a quality manual, defined procedures, and forms and documents accompanying the research, development and validation was implemented. After process acquisition and analysis the appropriate amount of management for the model project was identified by a self-developed rating system considering project characteristics like size, innovation, stakeholders, interdisciplinarity, etc. Employees were trained according to their needs. The management was supported and the technical documentation was optimized. Finally, the quality management system has been transferred successfully to further projects.
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Project management practice and its effects on project success in Malaysian construction industry
NASA Astrophysics Data System (ADS)
Haron, N. A.; Devi, P.; Hassim, S.; Alias, A. H.; Tahir, M. M.; Harun, A. N.
2017-12-01
The rapid economic development has increased the demand for construction of infrastructure and facilities globally. Sustainable development and globalization are the new ‘Zeitgeist’ of the 21st century. In order to implement these projects successfully and to meet the functional aim of the projects within their lifetime, an efficient project management practice is needed. The aim of this study is to identify the critical success factors (CSFs) and the extent of use of project management practice which affects project success, especially during the implementation stage. Data were obtained from self-administered questionnaires with 232 respondents. A mixed method of data collection was adopted using semi-structured interview and questionnaire approach. The result of the analysis of data obtained showed that new and emerging criteria such as customer satisfaction, competency of the project team, and performance of subcontractors/suppliers are becoming measures of success in addition to the classic iron triangle’s view of time, cost and quality. An insight on the extent of use of different project management practice in the industry was also achieved from the study.
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NASA Astrophysics Data System (ADS)
Guzman, Jose German
The removal of crop residues left after harvest is being considered as a potential feedstock source for bioethanol production which can contribute to the reduction of fossil fuel use and net greenhouse gas (GHG). The objectives of this study were to: (i) examine how tillage, N fertilization rates, residue removal, and their interactions affect crop productivity, (ii) SOC and soil physical properties, and (iii) GHG emissions, and (iv) calculated a soil C budget to determine how much crop residue can be sustainably be removed in Central and Southwest Iowa. After three years of residue removal under different management practices, the findings of this study suggest that a portion of the corn residue that is left on the soil surface after harvest can be removed, with no negative impacts in the short term continuous corn yield in sites at Central and Southwest Iowa. However, significant decreases in SOC sequestration rates, microbial biomass-C, bulk density, soil penetration resistance, wet aggregate stability, and infiltration rates were observed, but varied with soil type and management practices. Additionally, soil surface CO2 and N2O emissions were responsive to management practices; primarily by altering soil temperature, soil water content, soil mineral N, and crop growth. Results from soil C budget show that in 2010 when corn growth was not water stressed (lack of moisture), approximately 35 and 30% of the residue could be sustainably removed in the Central and Southwest sites, respectively. In 2011, drier soil conditions resulted in approximately 2 and 49% of the residue could be sustainably removed in the Central and Southwest sites, respectively.
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Total Quality Management. A Selected Bibliography
1994-03-01
THE FEDERAL GOVERNMENT, by Frank L . Lewis and others. Washington: May 1991. 34pp. (TS156 157 1991) Periodical Articles Aggarwal, Sumer. "A Quick Guide...to Total Quality Management." BUSINESS HORIZONS, Vol. 36, May-June 1993, pp. 66-68. Axline, Larry L . "TQM: A Look in the Mirror." MANAGEMENT REVIEW...Schuler, Randall S., and Harris, Drew L . MANAGING QUALITY: THE PRIMER FOR MIDDLE MANAGERS. Reading, MA: Addison-Wesley, 1992. 202pp. (HD62.15 S38
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Relating management practices and nutrient export in agricultural watersheds of the United States
Sprague, Lori A.; Gronberg, Jo Ann M.
2012-01-01
Relations between riverine export (load) of total nitrogen (N) and total phosphorus (P) from 133 large agricultural watersheds in the United States and factors affecting nutrient transport were evaluated using empirical regression models. After controlling for anthropogenic inputs and other landscape factors affecting nutrient transport-such as runoff, precipitation, slope, number of reservoirs, irrigated area, and area with subsurface tile drains-the relations between export and the area in the Conservation Reserve Program (CRP) (N) and conservation tillage (P) were positive. Additional interaction terms indicated that the relations between export and the area in conservation tillage (N) and the CRP (P) progressed from being clearly positive when soil erodibility was low or moderate, to being close to zero when soil erodibility was higher, to possibly being slightly negative only at the 90th to 95th percentile of soil erodibility values. Possible explanations for the increase in nutrient export with increased area in management practices include greater transport of soluble nutrients from areas in conservation tillage; lagged response of stream quality to implementation of management practices because of nitrogen transport in groundwater, time for vegetative cover to mature, and/or prior accumulation of P in soils; or limitations in the management practice and stream monitoring data sets. If lags are occurring, current nutrient export from agricultural watersheds may still be reflecting the influence of agricultural land-use practices that were in place before the implementation of these management practices.
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Giannoli, Jean-Marc; Szymanowicz, Anton
2011-01-01
We propose a set of recommendations and practices to optimize the use of quality control of medical biology examinations. The fundamentals are reviewed: definition of a series of analysis, IQC at one or more level, Westgard alert rules and rejection, practical remedial actions to take for the technician, corrective and preventive actions to be implemented by the biologist. We have also formalized three flowcharts to guide the technician in their daily practice to ensure analytical quality of investigations carried out. These decision trees are the result of the experience submitted by an accredited and professional laboratory attentive to the ongoing improvement of IQC. This article can provide useful assistance to biologists for accreditation but also aims to foster collaboration reliable medical biology laboratory at the appropriate management of patients.
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Total quality management and nursing: a shared vision.
Morey, W
1996-09-01
The application of the Total Quality Management (TQM) philosophy within the health care sector would enhance the development of nursing power, leadership and knowledge. TQM challenges conventional management techniques as it requires a participative management style in order to be effective. There are many potential benefits for nurses, when quality assurance monitoring within a hierarchical management structure, is replaced with a focus on continuous quality improvement by every member of staff. These benefits are described within the context of both organisational and personal commitment to Total Quality Management.
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DLA-X Total Quality Management (TQM) Implementation Plan
1989-07-01
PAGES TOM (Total Quality Management ), Continuous Process Improvement.( .) 4L-- Administration 16. PRICE CODE 17. SECURITY CLASSIFICATION 18. SECURITY...NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) Pr.-cr,bed by ANSI Std ,,fl.f 296-102 DLA-X TOTAL QUALITY MANAGEMENT (TQM) IMPLEMENTATION PLAN o...application of proven Total Quality Management techniques. Quality Policy: Responsibility for quality is delegated to every employee ;11 DLA-X. Every
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Ha, Miae; Wu, May
Sound crop and land management strategies can maintain land productivity and improve the environmental sustainability of agricultural crop and feedstock production. This study evaluates the improvement of water sustainability through an integrated landscaping management strategy, where landscaping design, land management operations, crop systems, and agricultural best management practices (BMPs) play equal roles. The strategy was applied to the watershed of the South Fork Iowa River in Iowa, with a focus on implementing riparian buffers and converting low productivity land to provide cellulosic biomass while benefiting soil and water quality. The Soil and Water Assessment Tool (SWAT) was employed to simulatemore » the impact of integrated landscape design on nutrients, suspended sediments, and flow on the watershed and subbasin scales. First, the study evaluated the representation of buffer strip as a vegetative barrier and as a riparian buffer using trapping efficiency and area ratio methods in SWAT. For the riparian buffer, the area ratio method tends to be more conservative, especially in nitrate loadings, while the trapping efficiency method generates more optimistic results. The differences between the two methods increase with buffer width. The two methods may not be comparable for the field-scale vegetative barrier simulation because of limitations in model spatial resolution. Landscape scenarios were developed to quantify water quality under (1) current land use, (2) partial land conversion to switchgrass, and (3) riparian buffer implementation. Results show that when low productivity land (15.2% of total watershed land area) is converted to grow switchgrass, suspended sediment, total nitrogen, total phosphorus, and nitrate loadings are reduced by 69.3%, 55.5%, 46.1%, and 13.4%, respectively, in the watershed surface streams. The reduction was less extensive when riparian buffer strips (30 m or 50 m) were applied to the stream network at 1.4% of total
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Biological and biochemical soil quality indicators for agricultural management
NASA Astrophysics Data System (ADS)
Bongiorno, Giulia
2017-04-01
Soil quality is defined as the capacity of a soil to perform multiple functions. Agricultural soils can, in principle, sustain a wide range of functions. However, negative pressure exerted by natural and anthropogenic soil threats such as soil erosion, soil organic matter losses and soil compaction have the potential to permanently damage soil quality. Soil chemical, physical and biological parameters can be used as indicators of soil quality. The specific objective of this study is to assess the suitability of novel soil parameters as soil quality indicators. We focus on biological/biochemical parameters, due to the unique role of soil biota in soil functions and to their high sensitivity to disturbances. The novel indicators are assessed in ten European long-term field experiments (LTEs) with different agricultural land use (arable and permanent crops), management regimes and pedo-climatic characteristics. The contrasts in agricultural management are represented by conventional/reduced tillage, organic/mineral fertilization and organic matter addition/no organic matter addition. We measured two different pools of labile organic carbon (dissolved organic carbon (DOC), and permanganate oxidizable carbon (POXC)), and determined DOC quality through its fractionation in hydrophobic and hydrophilic compounds. In addition, total nematode abundance has been assessed with qPCR. These parameters will be related to soil functions which have been measured with a minimum data set of indicators for soil quality (including TOC, macronutrients, and soil respiration). As a preliminary analysis, the Sensitivity Index (SI) for a given LTE was calculated for DOC and POXC according to Bolinder et al., 1999 as the ratio of the soil attribute under modified practices (e.g. reduced tillage) compared to the conventional practices (e.g. conventional tillage). The overall effect of the sustainable management on the indicators has been derived by calculating an average SI for those LTEs
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Do competition and managed care improve quality?
Sari, Nazmi
2002-10-01
In recent years, the US health care industry has experienced a rapid growth of managed care, formation of networks, and an integration of hospitals. This paper provides new insights about the quality consequences of this dynamic in US hospital markets. I empirically investigate the impact of managed care and hospital competition on quality using in-hospital complications as quality measures. I use random and fixed effects, and instrumental variable fixed effect models using hospital panel data from up to 16 states in the 1992-1997 period. The paper has two important findings: First, higher managed care penetration increases the quality, when inappropriate utilization, wound infections and adverse/iatrogenic complications are used as quality indicators. For other complication categories, coefficient estimates are statistically insignificant. These findings do not support the straightforward view that increases in managed care penetration are associated with decreases in quality. Second, both higher hospital market share and market concentration are associated with lower quality of care. Hospital mergers have undesirable quality consequences. Appropriate antitrust policies towards mergers should consider not only price and cost but also quality impacts. Copyright 2002 John Wiley & Sons, Ltd.
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Courtney, Darren B; Duda, Stephanie; Szatmari, Peter; Henderson, Joanna; Bennett, Kathryn
2018-05-02
This study aimed to systematically identify and appraise clinical practice guidelines (CPGs) relating to the assessment and management of suicide risk and self-harm in children and adolescents. Our research question is as follows: For young people (under 18 years old) presenting to clinical care with suicide ideation or a history of self-harm, what is the quality of up-to-date CPGs? Using the PRISMA format, we systematically identified CPGs meeting our inclusion and exclusion criteria. Subsequently, two independent raters conducted appraisals of the eligible CPGs using the Appraisal of Guidelines for Research and Evaluation II instrument. CPGs were then classified as "poor quality," "minimum quality," and "high quality" using operationally defined criteria developed a priori. We identified 10 eligible CPGs published or renewed between 2005 and May 2017. Only the long-term management of self-harm CPGs produced by the National Institute for Health and Care Excellence met "high-quality" criteria. Despite multiple options of CPGs published to choose from, only one was identified as "high quality," where bias is adequately minimized. Clinicians are advised to direct resources to implementing the "high-quality" CPG. © 2018 The American Association of Suicidology.
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Diagnosis and management of dementia in family practice.
Wilcock, Jane; Jain, Priya; Griffin, Mark; Thuné-Boyle, Ingela; Lefford, Frances; Rapp, David; Iliffe, Steve
2016-01-01
Improving quality of care for people with dementia is a high priority. Considerable resources have been invested in financial incentives, guideline development, public awareness and educational programmes to promote earlier diagnosis and better management. Evaluating family physicians' concordance with guidelines on diagnosis and management of people with dementia, from first documentation of symptoms to formal diagnosis. Analysis of medical records of 136 people with dementia recruited by 19 family practices in NW London and surrounding counties. Practices invited 763 people with dementia to participate, 167 (22%) agreed. Complete records were available for 136 (18%). The majority of records included reference to recommended blood tests, informant history and caregiver concerns. Presence or absence of symptoms of depression, psychosis, other behavioural and psychological symptoms of dementia, and cognitive function tests were documented in 30%-40% of records. Documentation of discussions about signs and symptoms of dementia, treatment options, care, support, financial, legal and advocacy advice were uncommon. Comparison of these findings from a similar study in 2000-2002 suggests improvements in concordance with blood tests, recording informant history, presence or absence of depression or psychosis symptoms. There was no difference in documenting cognitive function tests. Immediate referral to specialists was more common in the recent study. Five years after UK dementia guidelines and immediately after the launch of the dementia strategy, family physicians appeared concordant with clinical guidelines for dementia diagnosis (other than cognitive function tests), and referred most patients immediately. However, records did not suggest systematic dementia management.
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Improving Operational Readiness through Total Quality Management
1991-06-21
DTIC AD-A236 611 EL CT F NAVAL WAR COLL GE C Newport, R. I. IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT by Herb Westphal Defense...IMPROVING OPERATIONAL READINESS THROUGH TOTAL QUALITY MANAGEMENT (TQM) A Case Study: The Defense Mapping Agency Combat Support Center (DMACSC) initiated a...of the Defense Mapping Agency Combat Support Center’s (DMACSC) Total Quality Management (TQM) improvement methodology. This allows the reader to
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Bosch, Marije; Halfens, Ruud J G; van der Weijden, Trudy; Wensing, Michel; Akkermans, Reinier; Grol, Richard
2011-03-01
Increasingly, policy reform in health care is discussed in terms of changing organizational culture, creating practice teams, and organizational quality management. Yet, the evidence for these suggested determinants of high-quality care is inconsistent. To determine if the type of organizational culture (Competing Values Framework), team climate (Team Climate Inventory), and preventive pressure ulcer quality management at ward level were related to the prevalence of pressure ulcers. Also, we wanted to determine if the type of organizational culture, team climate, or the institutional quality management related to preventive quality management at the ward level. In this cross-sectional observational study multivariate (logistic) regression analyses were performed, adjusting for potential confounders and institution-level clustering. Data from 1274 patients and 460 health care professionals in 37 general hospital wards and 67 nursing home wards in the Netherlands were analyzed. The main outcome measures were nosocomial pressure ulcers in patients at risk for pressure ulcers (Braden score ≤ 18) and preventive quality management at ward level. No associations were found between organizational culture, team climate, or preventive quality management at the ward level and the prevalence of nosocomial pressure ulcers. Institutional quality management was positively correlated with preventive quality management at ward level (adj. β 0.32; p < 0.001). Although the prevalence of nosocomial pressure ulcers varied considerably across wards, it did not relate to organizational culture, team climate, or preventive quality management at the ward level. These results would therefore not subscribe the widely suggested importance of these factors in improving health care. However, different designs and research methods (that go beyond the cross-sectional design) may be more informative in studying relations between such complex factors and outcomes in a more meaningful way
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Chase, Sabrina M.; Miller, William L.; Shaw, Eric; Looney, Anna; Crabtree, Benjamin F.
2011-01-01
Purpose Incorporating quality improvement (QI) into resident education and clinical care is challenging. This report explores key characteristics shaping the relative success or failure of QI efforts in seven primary care practices serving as family medicine residency training sites. Method The authors used data from the 2002–2008 Using Learning Teams for Reflective Adaptation (ULTRA) study to conduct a comparative case analysis. This secondary data analysis focused on seven residency training practices' experiences with RAP (reflective adaptive process), a 12-week intensive QI process. Field notes, meeting notes, and audiotapes of RAP meetings were used to construct case summaries. A matrix comparing key themes across practices was used to rate practices' QI progress during RAP on a scale of 0 to 3. Results Three practices emerged as unsuccessful (scores of 0–1) and four as successful (scores of 2–3). Larger practices with previous QI experience, faculty with extensive exposure to QI literature, and an office manager, residency director, or medical director who advocated for the process made substantial progress during RAP, succeeding at QI. Smaller practices without these characteristics were unable to do so. Successful practices also engaged residents in the QI process and identified serious problems as potential crises; unsuccessful practices did not. Conclusions Larger residency training practices are more likely to have the resources and characteristics that permit them to create a QI-supportive culture leading to QI success. The authors suggest, however, that smaller practices may increase their chances of success by adopting a developmental approach to QI. PMID:22030767
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Pascual, Thomas N B
2016-08-01
This essay will explore the critical issues and challenges surrounding lifelong learning for professionals, initially exploring within the profession and organizational context of nuclear medicine practice. It will critically examine how the peer-review process called Quality Management Audits in Nuclear Medicine Practice (QUANUM) of the International Atomic Energy Agency (IAEA) can be considered a lifelong learning opportunity to instill a culture of quality to improve patient care and elevate the status of the nuclear medicine profession and practice within the demands of social changes, policy, and globalization. This will be explored initially by providing contextual background to the identity of the IAEA as an organization responsible for nuclear medicine professionals, followed by the benefits that QUANUM can offer. Further key debates surrounding lifelong learning, such as compulsification of lifelong learning and impact on professional change, will then be weaved through the discussion using theoretical grounding through a qualitative review of the literature. Keeping in mind that there is very limited literature focusing on the implications of QUANUM as a lifelong learning process for nuclear medicine professionals, this essay uses select narratives and observations of QUANUM as a lifelong learning process from an auditor's perspective and will further provide a comparative perspective of QUANUM on the basis of other lifelong learning opportunities such as continuing professional development activities and observe parallelisms on its benefits and challenges that it will offer to other professionals in other medical speciality fields and in the teaching profession.
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Quality management benchmarking: FDA compliance in pharmaceutical industry.
Jochem, Roland; Landgraf, Katja
2010-01-01
By analyzing and comparing industry and business best practice, processes can be optimized and become more successful mainly because efficiency and competitiveness increase. This paper aims to focus on some examples. Case studies are used to show knowledge exchange in the pharmaceutical industry. Best practice solutions were identified in two companies using a benchmarking method and five-stage model. Despite large administrations, there is much potential regarding business process organization. This project makes it possible for participants to fully understand their business processes. The benchmarking method gives an opportunity to critically analyze value chains (a string of companies or players working together to satisfy market demands for a special product). Knowledge exchange is interesting for companies that like to be global players. Benchmarking supports information exchange and improves competitive ability between different enterprises. Findings suggest that the five-stage model improves efficiency and effectiveness. Furthermore, the model increases the chances for reaching targets. The method gives security to partners that did not have benchmarking experience. The study identifies new quality management procedures. Process management and especially benchmarking is shown to support pharmaceutical industry improvements.
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Reid, Beth A; Ridoutt, Lee; O'Connor, Paul; Murphy, Deirdre
2017-09-01
This is the second of two articles about best practice in the management of coding services. The best practice project was part of a year-long project conducted in the Republic of Ireland to review the quality of the Hospital Inpatient Enquiry data for its use in activity-based funding. The four methods used to address the best practice aspect of the project were described in detail in Part 1. The results included in this article are those relating to the coding manager's background, preparation and style, clinical coder (CC) workforce adequacy, the CC workforce structure and career pathway, and the physical and psychological work environment for the clinical coding service. Examples of best practice were found in the study hospitals but there were also areas for improvement. Coding managers would benefit from greater support in the form of increased opportunities for management training and a better method for calculating CC workforce numbers. A career pathway is needed for CCs to progress from entry to expert CC, mentor, manager and quality controller. Most hospitals could benefit from investment in infrastructure that places CCs in a physical environment that tells them they are an important part of the hospital and their work is valued.
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Landscaping practices, land use patterns and stormwater quantity and quality in urban watersheds
NASA Astrophysics Data System (ADS)
Miles, B.; Band, L. E.
2011-12-01
Increasing quantity and decreasing quality of urban stormwater threatens biodiversity in local streams and reservoirs, jeopardizes water supplies, and ultimately contributes to estuarine eutrophication. To estimate the effects that present and alternative landscaping practices and land use patterns may have on urban stormwater quantity and quality, simulations of existing land use/land cover using the Regional Hydro-Ecologic Simulation System (RHESSys), a process-based surface hydrology and biogeochemistry model, were developed for watersheds in Baltimore, MD (as part of the Baltimore Ecosystem Study (BES) NSF Long-Term Ecological Research (LTER) site) and Durham, NC (as part of the NSF Urban Long-Term Research Area (ULTRA) program). The influence of land use patterns and landscaping practices on nutrient export in urban watersheds has been explored as part of the BES; this work has focused on improving our understanding of how residential landscaping practices (i.e. lawn fertilization rates) vary across land use and socioeconomic gradients. Elsewhere, others have explored the political ecology of residential landscaping practices - seeking to understand the economic, political, and cultural influences on the practice of high-input residential turf-grass management. Going forward, my research will synthesize and extend this prior work. Rather than pre-supposing predominant residential land use patterns and landscaping practices (i.e. lower-density periphery development incorporating high-input turf landscapes) alternate land use and landscaping scenarios (e.g. higher-density/transit-oriented development, rain gardens, vegetable gardens, native plant/xeriscaping) will be developed through interviews/focus groups with stakeholders (citizens, public officials, developers, non-profits). These scenarios will then be applied to the RHESSys models already developed for catchments in Baltimore and Durham. The modeled scenario results will be used to identify alternate land
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Baek, JongDeuk; Seidman, Robert L
2015-01-01
Factors in the practice environment, such as health information technology (IT) infrastructure, availability of other clinical resources, and financial incentives, may influence whether practices are able to successfully implement the patient-centered medical home (PCMH) model and realize its benefits. This study investigates the impacts of those PCMH-related elements on primary care physicians' perception of quality of care. A multiple logistic regression model was estimated using the 2004 to 2005 CTS Physician Survey, a national sample of salaried primary care physicians (n = 1733). The patient-centered practice environment and availability of clinical resources increased physicians' perceived quality of care. Although IT use for clinical information access did enhance physicians' ability to provide high quality of care, a similar positive impact of IT use was not found for e-prescribing or the exchange of clinical patient information. Lack of resources was negatively associated with physician perception of quality of care. Since health IT is an important foundation of PCMH, patient-centered practices are more likely to have health IT in place to support care delivery. However, despite its potential to enhance delivery of primary care, simply making health IT available does not necessarily translate into physicians' perceptions that it enhances the quality of care they provide. It is critical for health-care managers and policy makers to ensure that primary care physicians fully recognize and embrace the use of new technology to improve both the quality of care provided and the patient outcomes.
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A Randomized, Controlled Trial of a Shared Panel Management Program for Small Practices.
Bishop, Tara F; Ryan, Andrew M; Chen, Melinda A; Mendelsohn, Jayme; Gottlieb, Daniel; Shih, Sarah; Desai, Priya; Wolff, Elizabeth A; Casalino, Lawrence P
2016-10-01
To determine whether a shared panel management program was effective at improving quality of care for patients with uncontrolled chronic disease. Data were extracted from electronic health records. Randomized controlled trial of a panel management program initiated by New York City Department of Health and Mental Hygiene. Patients from 20 practices with an uncontrolled chronic disease and a lapse in care were assigned to the intervention (a phone call requesting that the patient schedule a physician appointment) or usual care. Outcomes were visits to physician practices, body mass index measurement, blood pressure measurement and control, use of antithrombotics, and low-density lipoprotein measurement and control. Panel managers were able to successfully speak with 1,676 patients (14.7 percent of the intervention group). There were no significant differences in outcomes between the intervention and usual care groups. Successfully contacted patients were more likely to have an office visit within 1 year of randomization (45.6 percent [95 percent CI: 22.8, 26.9] vs. 38.1 percent [95 percent CI: 36.8, 39.3]) and more likely to be on antithrombotics (24.4 percent [95 percent CI: 17.7, 31.0]) versus those in the usual care group (17.0 percent [95 percent CI: 13.9, 20.0]) but had no other difference in quality. A shared, low-intensity panel management program run by a city health department did not improve quality of care for patients with chronic illnesses and lapses in care. © Health Research and Educational Trust.
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Strategic Information Resources Management: Fundamental Practices.
ERIC Educational Resources Information Center
Caudle, Sharon L.
1996-01-01
Discusses six fundamental information resources management (IRM) practices in successful organizations that can improve government service delivery performance. Highlights include directing changes, integrating IRM decision making into a strategic management process, performance management, maintaining an investment philosophy, using business…
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Putnam, James E.; Hansen, Cristi V.
2014-01-01
As the Nation’s principle earth-science information agency, the U.S. Geological Survey (USGS) is depended on to collect data of the highest quality. This document is a quality-assurance plan for groundwater activities (GWQAP) of the Kansas Water Science Center. The purpose of this GWQAP is to establish a minimum set of guidelines and practices to be used by the Kansas Water Science Center to ensure quality in groundwater activities. Included within these practices are the assignment of responsibilities for implementing quality-assurance activities in the Kansas Water Science Center and establishment of review procedures needed to ensure the technical quality and reliability of the groundwater products. In addition, this GWQAP is intended to complement quality-assurance plans for surface-water and water-quality activities and similar plans for the Kansas Water Science Center and general project activities throughout the USGS. This document provides the framework for collecting, analyzing, and reporting groundwater data that are quality assured and quality controlled. This GWQAP presents policies directing the collection, processing, analysis, storage, review, and publication of groundwater data. In addition, policies related to organizational responsibilities, training, project planning, and safety are presented. These policies and practices pertain to all groundwater activities conducted by the Kansas Water Science Center, including data-collection programs, interpretive and research projects. This report also includes the data management plan that describes the progression of data management from data collection to archiving and publication.
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Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine
2015-07-01
Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.
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NASA Astrophysics Data System (ADS)
Sage, Jérémie; Berthier, Emmanuel; Gromaire, Marie-Christine
2015-07-01
Over the last decade, a growing interest has been shown toward innovative stormwater management practices, breaking away from conventional "end of pipe" approaches (based on conveying water offsite to centralized detention facilities). Innovative strategies, referred to as sustainable urban drainage systems, low impact development (LID) or green infrastructures, advocating for management of runoff as close to its origin as possible, have therefore gained a lot of popularity among practitioners and public authorities. However, while the need for pollution control is generally well accepted, there is no wide agreement about management criteria to be given to developers. This article hence aims to compare these criteria through literature analysis of different state or local stormwater management manuals or guidelines, investigating both their suitability for pollution control and their influence on best management practices selection and design. Four categories of criteria were identified: flow-rate limitations, "water quality volumes" (to be treated), volume reduction (through infiltration or evapotranspiration), and non-hydrologic criteria (such as loads reduction targets or maximum effluent concentrations). This study suggests that hydrologic criteria based on volume reduction (rather than treatment) might generally be preferable for on-site control of diffuse stormwater pollution. Nonetheless, determination of an appropriate management approach for a specific site is generally not straightforward and presents a variety of challenges for site designers seeking to satisfy local requirements in addressing stormwater quantity and quality issues. The adoption of efficient LID solution may therefore strongly depend on the guidance given to practitioners to account for these management criteria.
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Practical management of anticoagulation in patients with atrial fibrillation.
Kovacs, Richard J; Flaker, Greg C; Saxonhouse, Sherry J; Doherty, John U; Birtcher, Kim K; Cuker, Adam; Davidson, Bruce L; Giugliano, Robert P; Granger, Christopher B; Jaffer, Amir K; Mehta, Bella H; Nutescu, Edith; Williams, Kim A
2015-04-07
Anticoagulation for atrial fibrillation has become more complex due to the introduction of new anticoagulant agents, the number and kinds of patients requiring therapy, and the interactions of those patients in the matrix of care. The management of anticoagulation has become a "team sport" involving multiple specialties in multiple sites of care. The American College of Cardiology, through the College's Anticoagulation Initiative, convened a roundtable of experts from multiple specialties to discuss topics important to the management of patients requiring anticoagulation and to make expert recommendations on issues such as the initiation and interruption of anticoagulation, quality of anticoagulation care, management of major and minor bleeding, and treatment of special populations. The attendees continued to work toward consensus on these topics, and present the key findings of this roundtable in a state-of- the-art review focusing on the practical aspects of anticoagulation care for the patient with atrial fibrillation. Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
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Pamela J. Edwards; Frederica Wood; Robin L. Quinlivan
2016-01-01
Literature describing the effectiveness of best management practices (BMPs) applicable to forest roads is reviewed and synthesized. Effectiveness is considered from the perspective of protecting water quality and water resources. Both paved and unpaved forest roads are considered, but BMPs that involve substantial engineering are not considered. Some of the BMPs...
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Best management practices for reducing nutrient loads in a sub-watershed of Chesapeake Bay
USDA-ARS?s Scientific Manuscript database
Water quality improvement in the Chesapeake Bay is a grave concern. An initiative to reduce the nutrient loads to stream has been undertaken to attain a target total maximum daily load (TMDL) at Chesapeake Bay. A general guideline with a set of best management practices (BMPs) has been in place for ...
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Andrew James Londo; John Benkert Auel
2004-01-01
This study examined the knowledge levels of Mississippi nonindustrial private forest (NIPF) landowners relative to best management practices (BMPs) for water quality. Data were collected through surveys of participants in BMP programs held in conjunction with County Forestry Association (CFA) meetings throughout Mississippi during 2001-02. Ten CFAs participated in this...
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ERIC Educational Resources Information Center
Munoz, Marco A.
This paper explores Total Quality Management (TQM) as an organizational theory applied to educational administration of higher education. The first part of the paper describes the principles of TQM, and the second part considers TQM in higher education. The third section is a general conclusion that takes into consideration the leadership…
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An Introduction to Quality Management: Selected Readings.
total quality management (TQM). Through the kind permission of a number of publishers, we have been able to reproduce here some key articles about...TQM. It is not the intent of this technical note to provide a comprehensive study of quality management , but rather to aid in planning for an...implementation of the Deming approach to TQM. Although the Navy aviation community chose the Deming approach to quality management , as reflected in the selected
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Wan, Yongshan; Qian, Yun; Migliaccio, Kati White; Li, Yuncong; Conrad, Cecilia
2014-03-01
Most studies using multivariate techniques for pollution source evaluation are conducted in free-flowing rivers with distinct point and nonpoint sources. This study expanded on previous research to a managed "canal" system discharging into the Indian River Lagoon, Florida, where water and land management is the single most important anthropogenic factor influencing water quality. Hydrometric and land use data of four drainage basins were uniquely integrated into the analysis of 25 yr of monthly water quality data collected at seven stations to determine the impact of water and land management on the spatial variability of water quality. Cluster analysis (CA) classified seven monitoring stations into four groups (CA groups). All water quality parameters identified by discriminant analysis showed distinct spatial patterns among the four CA groups. Two-step principal component analysis/factor analysis (PCA/FA) was conducted with (i) water quality data alone and (ii) water quality data in conjunction with rainfall, flow, and land use data. The results indicated that PCA/FA of water quality data alone was unable to identify factors associated with management activities. The addition of hydrometric and land use data into PCA/FA revealed close associations of nutrients and color with land management and storm-water retention in pasture and citrus lands; total suspended solids, turbidity, and NO + NO with flow and Lake Okeechobee releases; specific conductivity with supplemental irrigation supply; and dissolved O with wetland preservation. The practical implication emphasizes the importance of basin-specific land and water management for ongoing pollutant loading reduction and ecosystem restoration programs. Copyright © by the American Society of Agronomy, Crop Science Society of America, and Soil Science Society of America, Inc.
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Quality Management for Schools.
ERIC Educational Resources Information Center
Mulligan, Dorothy
1992-01-01
W. Edwards Deming introduced management principles that helped Japan become a world economic power. Virginia is attempting to adapt these techniques to education with a grant that provides training and support for school personnel in several school districts. Describes a quality management program at Christa McAuliffe Elementary School that has…
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DOE Office of Scientific and Technical Information (OSTI.GOV)
Not Available
1991-10-01
According to {section} 35.32, Quality Management Program,'' of 10 CFR Part 35, Medical Use of Byproduct Material,'' applicants or licensees, as applicable, are required to establish a quality management (QM) program. This regulatory guide provides guidance to licensees and applicants for developing policies and procedures for the QM program. This guide does not restrict or limit the licensee from using other guidance that may be equally useful in developing a QM program, e.g., information available from the Joint Commission on Accreditation of Healthcare Organizations or the American College of Radiology. Any information collection activities mentioned in this regulatory guide aremore » contained as requirements in 10 CFR Part 35, which provides the regulatory basis for this guide. This information collection requirements in 10 CFR Part 35 have been cleared under OMB Clearance No. 3150-0010.« less
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NASA Astrophysics Data System (ADS)
Hoover, F. A.; Bowling, L. C.; Prokopy, L. S.
2015-12-01
Urban stormwater is an on-going management concern in municipalities of all sizes. In both combined or separated sewer systems, pollutants from stormwater runoff enter the natural waterway system during heavy rain events. Urban flooding during frequent and more intense storms are also a growing concern. Therefore, stormwater best-management practices (BMPs) are being implemented in efforts to reduce and manage stormwater pollution and overflow. The majority of BMP water quality studies focus on the small-scale, individual effects of the BMP, and the change in water quality directly from the runoff of these infrastructures. At the watershed scale, it is difficult to establish statistically whether or not these BMPs are making a difference in water quality, given that watershed scale monitoring is often costly and time consuming, relying on significant sources of funds, which a city may not have. Hence, there is a need to quantify the level of sampling needed to detect the water quality impact of BMPs at the watershed scale. In this study, a power analysis was performed on data from an urban watershed in Lafayette, Indiana, to determine the frequency of sampling required to detect a significant change in water quality measurements. Using the R platform, results indicate that detecting a significant change in watershed level water quality would require hundreds of weekly measurements, even when improvement is present. The second part of this study investigates whether the difficulty in demonstrating water quality change represents a barrier to adoption of stormwater BMPs. Semi-structured interviews of community residents and organizations in Chicago, IL are being used to investigate residents understanding of water quality and best management practices and identify their attitudes and perceptions towards stormwater BMPs. Second round interviews will examine how information on uncertainty in water quality improvements influences their BMP attitudes and perceptions.
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Validation of a Quality Management Metric
2000-09-01
quality management metric (QMM) was used to measure the performance of ten software managers on Department of Defense (DoD) software development programs. Informal verification and validation of the metric compared the QMM score to an overall program success score for the entire program and yielded positive correlation. The results of applying the QMM can be used to characterize the quality of software management and can serve as a template to improve software management performance. Future work includes further refining the QMM, applying the QMM scores to provide feedback
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Internal quality control: best practice.
Kinns, Helen; Pitkin, Sarah; Housley, David; Freedman, Danielle B
2013-12-01
There is a wide variation in laboratory practice with regard to implementation and review of internal quality control (IQC). A poor approach can lead to a spectrum of scenarios from validation of incorrect patient results to over investigation of falsely rejected analytical runs. This article will provide a practical approach for the routine clinical biochemistry laboratory to introduce an efficient quality control system that will optimise error detection and reduce the rate of false rejection. Each stage of the IQC system is considered, from selection of IQC material to selection of IQC rules, and finally the appropriate action to follow when a rejection signal has been obtained. The main objective of IQC is to ensure day-to-day consistency of an analytical process and thus help to determine whether patient results are reliable enough to be released. The required quality and assay performance varies between analytes as does the definition of a clinically significant error. Unfortunately many laboratories currently decide what is clinically significant at the troubleshooting stage. Assay-specific IQC systems will reduce the number of inappropriate sample-run rejections compared with the blanket use of one IQC rule. In practice, only three or four different IQC rules are required for the whole of the routine biochemistry repertoire as assays are assigned into groups based on performance. The tools to categorise performance and assign IQC rules based on that performance are presented. Although significant investment of time and education is required prior to implementation, laboratories have shown that such systems achieve considerable reductions in cost and labour.
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Linking Theory with Practice in Basic Management
ERIC Educational Resources Information Center
Carroll, Archie B.
1974-01-01
Instructors of management in higher education have not been cautious in explaining the relation between practice and theory in their basic courses. The author distinguished between the two in suggesting that management theory is based on observed practices and may or may not have broader application. (AG)
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Huang, Jeannie S; Chun, Stanford; Sandhu, Amanpreet; Terrones, Laura
2013-11-01
To assess the Health and Obesity: Prevention and Education (HOPE) Curriculum Project, a web-based clinician education program that promotes appropriate screening, prevention, and management of weight among youth by pediatric practitioners, based on the 2007 Expert Committee recommendations. The project currently provides Maintenance of Certification (MOC) Part 4 credit through the American Board of Pediatrics. Participants identified themselves to the HOPE MOC Part 4 program. Enrollees were required to complete all continuing medical education modules (10.5 hours). Knowledge acquisition and self-reported confidence levels related to screening, prevention, and management practices of pediatric obesity were measured using preknowledge and postknowledge questionnaires. Participants were also required to perform a quality improvement project and submit practice performance data from repeated medical chart reviews over time. Knowledge acquisition, self-efficacy, and practice performance data were analyzed using repeated-measures analyses. The 51 participants demonstrated significant improvements in knowledge acquisition and self-efficacy scores after viewing individual modules. In addition, participants demonstrated significant improvements in measured clinical compliance with recommended practices over time. Participation in the HOPE MOC Part 4 program appeared to improve knowledge acquisition, self-efficacy, and physician compliance with recommended practice recommendations for the screening, prevention, and management of pediatric obesity. Further data are required to determine whether such practice-based improvements translate into actual reduction in patient weight and/or reduction in health-related costs related to overweight and obesity in youth. Copyright © 2013 Mosby, Inc. All rights reserved.
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Untangling practice redesign from disease management: how do we best care for the chronically ill?
Coleman, Katie; Mattke, Soeren; Perrault, Patrick J; Wagner, Edward H
2009-01-01
In the past 10 years, a wide spectrum of chronic care improvement interventions has been tried and evaluated to improve health outcomes and reduce costs for chronically ill individuals. On one end of the spectrum are disease-management interventions--often organized by commercial vendors--that work with patients but do little to engage medical practice. On the other end are quality-improvement efforts aimed at redesigning the organization and delivery of primary care and better supporting patient self-management. This qualitative review finds that carve-out disease management interventions that target only patients may be less effective than those that also work to redesign care delivery. Imprecise nomenclature and poor study design methodology limit quantitative analysis. More innovation and research are needed to understand how disease-management components can be more meaningfully embedded within practice to improve patient care.
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Total Quality Management in Higher Education.
ERIC Educational Resources Information Center
Sherr, Lawrence A.; Lozier, G. Gredgory
1991-01-01
Total Quality Management, based on theories of W. Edward Deming and others, is a style of management using continuous process improvement characterized by mission and customer focus, a systematic approach to operations, vigorous development of human resources, long-term thinking, and a commitment to ensuring quality. The values espoused by this…
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Total Quality Management: A Selected Bibliography
1992-03-01
Total Quality Management (TQM) in the Department of Defense is a strategy for continuously improving performance at every level, and in all areas of...reflects selected books, documents, periodical articles, and videos on the subject of Total Quality Management (TQM) in the collection of the U.S. Army War College Library.
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Managing Change from a Quality Perspective.
ERIC Educational Resources Information Center
Snyder, Karolyn J.
This paper presents findings of a study that examined the change process in 28 schools, with a focus on how principals went about transforming traditional school-work cultures into quality systems. The principals had participated in Managing Productive Schools (MPS), a comprehensive systems-approach program based on quality management concepts.…
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Financial literacy as an essential element in nursing management practice.
Talley, Linda B; Thorgrimson, Diane H; Robinson, Nellie C
2013-01-01
Grooming nurses at all levels of the organization to master health care executive skills is critical to the organization's success and the individual's growth. Selecting and executing next steps for nursing leadership team development is critical to success. Leaders must make it their responsibility to provide nurses with increased exposure to quality, safety, and financial data, thereby allowing nurses to translate data while achieving and sustaining successful outcomes. The work of the CNO Dashboard to measure, report, trend, and translate clinical and non-clinical outcomes must be integrated throughout all levels of nursing staff so that nursing practice is positioned to continually strive for best practice. The education and evolution of nurses as business managers is critical to building a strong RN workforce.
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Koerkle, Edward H.
2000-01-01
Analyses of water samples collected over a 5-year period (1993-98) in the Mill Creek and Muddy Run Basins during implementation of agricultural best-management practices (BMP’s) indicate statistically significant trends in the concentrations of several nutrient species and in nonfilterable residue (suspended solids). The strongest trends identified were those indicated by a more than 50- percent decrease in the flow-adjusted concentrations of total and dissolved phosphorus and total residue in base flow in the two streams. Analyses of stormflow samples showed a 31-percent decrease in the flow-adjusted concentration of total phosphorus in Mill Creek and a 54-percent decrease in total nonfilterable residue in Muddy Run. A 58-percent increase in the flow-adjusted concentration of total ammonia nitrogen in stormflow was found at Muddy Run.Although the effects of a specific BMP on the indicated trends is uncertain, results of statistical trend tests of the data suggest that stream fencing, possibly in concert with other practices, such as stream crossings for livestock, barnyard runoff control, manure-storage facilities, and rotational grazing, was effective in improving water quality during base flow and probably low to moderate stormflow conditions. Additional improvements in water quality in the Mill Creek and Muddy Run Basins seems likely as the implementation of BMP’s is expected to continue. Thus, the full effect of BMP implementation in the two basins may not be observed for some time.
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ERIC Educational Resources Information Center
Ibach, Kimberly L.
2014-01-01
This body of work presents the summary of findings; explanation of implications; discussion of conclusions; and recommendations about practice, policy and future research regarding principal leadership in school districts recognized as national Baldrige Award winners. This study widened the scope and definition of quality management in education…
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DESC (Defense Electronics Supply Center) Total Quality Management Plan
1989-04-01
Paoerwort Reduction Proodt(0704.01 ge. Washington. DC 20S03 4. TITLE AND SUBTITLE Api598 . FUNDING NUMBERS DESC Total Quality Management Master Plan...OF PAGES TQM (Total Quality Management ), Continuous Process Improvement,_________ cTainingManagement 16. PRICE CODE 17. SECURITY CLASSIFICATION 18... QUALITY MANAGEMENT As you read the DESC Total Quality Management Plan, I ask each of you to make a commitment to continuously strive for improvement
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Total Quality Management Implementation Plan: DLA-N
1989-07-01
e Wastimto , n. Othe 20 Seato3 4. TITLE AND SUBTITLE S. FUNDING NUMBERS DLA-N Total Quality Management 6. AUTHOR(S) 7. PERFORMING ORGANIZATION NAME(S...PAGES TQM (Total Quality Management ), Continuous Process Improvement.(; , Defense National Stockpile 16. PRICE CODEI17. SECURITY CLASSIFICATION 18...IUNCLASSIFIED UL NSN 7540-01-280-5500 Standard Form 298 (Rev. 2-89) pr"!Cbed ty ANSI Std Z39’B6 296-102 DLA - N TOTAL QUALITY MANAGEMENT IMPLEMENTATION PLAN I
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ERIC Educational Resources Information Center
Seymour, Daniel
Based on a survey of Quality Management (QM) practitioners at 21 colleges, this study presents the 10 most difficult implementation hurdles to QM in higher education and a set of hurdle-clearing strategies. The hurdles are: (1) lack of time to implement QM; (2) perception that QM is something for janitorial and housing staffs but not applicable to…
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Duarte, Neville T; Goodson, Jane R; Arnold, Edwin W
2013-01-01
When carefully constructed, performance management systems can help health care organizations direct their efforts toward strategic goals, high performance, and continuous improvement needed to ensure high-quality patient care and cost control. The effective management of performance is an integral component in hospital and health care systems that are recognized for excellence by the Malcolm Baldrige National Quality Award in Health Care. Using the framework in the 2011-2012 Health Care Criteria for Performance Excellence, this article identifies the best practices in performance management demonstrated by 15 Baldrige recipients. The results show that all of the recipients base their performance management systems on strategic goals, outcomes, or competencies that cascade from the organizational to the individual level. At the individual level, each hospital or health system reinforces the strategic direction with performance evaluations of leaders and employees, including the governing board, based on key outcomes and competencies. Leader evaluations consistently include feedback from internal and external stakeholders, creating a culture of information sharing and performance improvement. The hospitals or health care systems also align their reward systems to promote high performance by emphasizing merit and recognition for contributions. Best practices can provide a guide for leaders in other health systems in developing high-performance work systems.
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Integrating modal-based NDE techniques and bridge management systems using quality management
NASA Astrophysics Data System (ADS)
Sikorsky, Charles S.
1997-05-01
The intent of bridge management systems is to help engineers and managers determine when and where to spend bridge funds such that commerce and the motoring public needs are satisfied. A major shortcoming which states are experiencing is the NBIS data available is insufficient to perform certain functions required by new bridge management systems, such as modeling bridge deterioration and predicting costs. This paper will investigate how modal based nondestructive damage evaluation techniques can be integrated into bridge management using quality management principles. First, quality from the manufacturing perspective will be summarized. Next, the implementation of quality management in design and construction will be reinterpreted for bridge management. Based on this, a theory of approach will be formulated to improve the productivity of a highway transportation system.
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Agi, Maher A N; Nishant, Rohit
2017-03-01
In this study, we establish a set of 19 influential factors on the implementation of Green Supply Chain Management (GSCM) practices and analyse the interaction between these factors and their effect on the implementation of GSCM practices using the Interpretive Structural Modelling (ISM) method and the "Matrice d'Impacts Croisés Multiplication Appliquée à un Classement" (MICMAC) analysis on data compiled from interviews with supply chain (SC) executives based in the Gulf countries (Middle East region). The study reveals a strong influence and driving power of the nature of the relationships between SC partners on the implementation of GSCM practices. We especially found that dependence, trust, and durability of the relationship with SC partners have a very high influence. In addition, the size of the company, the top management commitment, the implementation of quality management and the employees training and education exert a critical influence on the implementation of GSCM practices. Contextual elements such as the industry sector and region and their effect on the prominence of specific factors are also highlighted through our study. Finally, implications for research and practice are discussed. Copyright © 2016 Elsevier Ltd. All rights reserved.
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Variations in the service quality of medical practices.
Ly, Dan P; Glied, Sherry A
2013-11-01
To examine regional variation in the service quality of physician practices and to assess the association of this variation with the supply and organization of physicians. Secondary analyses of the Community Tracking Study (CTS) household and physician surveys. A total of 40,339 individuals who had seen a primary care physician because of an illness or injury and 17,345 generalist physicians across 4 survey time periods in 60 CTS sites were included. Service quality measures used were lag between making an appointment and seeing a physician, and wait time at the physician's office. Our supply measure was the physician-to-population ratio. Our organizational measure was the percentage of physicians in group practices. Multivariate regressions were performed to examine the relationship between service quality and the supply and organization of physicians. There was substantial variation in the service quality of physician visits across the country. For example, in 2003, the average wait time to see a doctor was 16 minutes in Milwaukee but more than 41 minutes in Miami; the average appointment lag for a sick visit in 2003 was 1.2 days in west-central Alabama but almost 6 days in Northwestern Washington. Service quality was not associated with the primary care physician-to-population ratio and had varying associations with the organization of practices. Cross-site variation in service quality of care in primary care has been large, persistent, and associated with the organization of practices. Areas with higher primary care physician-to-population ratios had longer, not shorter, appointment lags.
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[Benchmarking in ambulatory care practices--The European Practice Assessment (EPA)].
Szecsenyi, Joachim; Broge, Björn; Willms, Sara; Brodowski, Marc; Götz, Katja
2011-01-01
The European Practice Assessment (EPA) is a comprehensive quality management which consists of 220 indicators covering 5 domains (infrastructure, people, information, finance, and quality and safety). The aim of the project presented was to evaluate EPA as an instrument for benchmarking in ambulatory care practices. A before-and-after design with a comparison group was chosen. One hundred and two practices conducted EPA at baseline (t1) and at the 3-year follow-up (t2). A further 209 practices began EPA at t2 (comparison group). Since both practice groups differed in several variables (age of GP, location and size of practice), a matched-pair design based on propensity scores was applied leading to a subgroup of 102 comparable practices (out of the 209 practices). Data analysis was carried out using Z scores of the EPA domains. The results showed significant improvements in all domains between t1 and t2 as well as between the comparison group and t2. Furthermore, the results demonstrate that the implementation of total quality management and the re-assessment of the EPA procedure can lead to significant improvements in almost all domains. Copyright © 2011. Published by Elsevier GmbH.
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Spreading the "good news" of total quality management: faith, conversion, and commitment.
Fleming, S T; Bopp, K D; Anderson, K G
1993-01-01
In many ways the spread of total quality management (TQM) across this country can be compared to a religious conversion. Both cases are characterized by a philosophical shift with far-reaching changes in responsibilities and incentives for the people involved. This article bridges the disciplines of theology and health services management by elaborating a metaphor in which TQM is compared to various aspects of the Judeo-Christian faiths, such as the role of laws and standards; the importance of miracles, prophets, and evangelists; and the practical applications of living out the faith.
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Modelling raw water quality: development of a drinking water management tool.
Kübeck, Ch; van Berk, W; Bergmann, A
2009-01-01
Ensuring future drinking water supply requires a tough management of groundwater resources. However, recent practices of economic resource control often does not involve aspects of the hydrogeochemical and geohydraulical groundwater system. In respect of analysing the available quantity and quality of future raw water, an effective resource management requires a full understanding of the hydrogeochemical and geohydraulical processes within the aquifer. For example, the knowledge of raw water quality development within the time helps to work out strategies of water treatment as well as planning finance resources. On the other hand, the effectiveness of planed measurements reducing the infiltration of harmful substances such as nitrate can be checked and optimized by using hydrogeochemical modelling. Thus, within the framework of the InnoNet program funded by Federal Ministry of Economics and Technology, a network of research institutes and water suppliers work in close cooperation developing a planning and management tool particularly oriented on water management problems. The tool involves an innovative material flux model that calculates the hydrogeochemical processes under consideration of the dynamics in agricultural land use. The program integrated graphical data evaluation is aligned on the needs of water suppliers.
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EDUCATING MANAGERS ABOUT QUALITY THROUGH CUSTOMER-SUPPLIER UNDERSTANDING
The successful implementation of a Quality System depends largely on the commitment to Quality by managers and their participation in the quality management process. oday, an accepted definition of quality is largely based on the concept of customer and supplier partnerships in a...
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Griffiths, Peter; Maben, Jill; Murrells, Trevor
2011-10-01
An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as being a dominant factor. However the literature has tended to consider staffing and organisational factors separately. We aim to determine whether relationships between the quality of clinical care and nurse staffing in general practice are attenuated or enhanced when organisational factors associated with quality of care are considered. We further aim to determine the relative contribution and interaction between these factors. We used routinely collected data from 8409 English general practices. The data, on organisational factors and the quality of clinical care for a range of long term conditions, is gathered as part of "Quality and Outcomes Framework" pay for performance system. Regression models exploring the relationship of staffing and organisational factors with care quality were fitted using MPLUS statistical modelling software. Higher levels of nurse staffing, clinical recording, education and reflection on the results of patient surveys were significantly associated with improved clinical care for COPD, CHD, Diabetes and Hypothyroidism after controlling for organisational factors. There was some evidence of attenuation of the estimated nurse staffing effect when organisational factors were considered, but this was small. The effect of staffing interacted significantly with the effect of organisational factors. Overall however, the characteristics that emerged as the strongest predictors of quality of clinical care were not staffing levels but the organisational factors of clinical recording, education and training and use of patient
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Howell, D; Oliver, T K; Keller-Olaman, S; Davidson, J R; Garland, S; Samuels, C; Savard, J; Harris, C; Aubin, M; Olson, K; Sussman, J; MacFarlane, J; Taylor, C
2014-04-01
Sleep disturbance is prevalent in cancer with detrimental effects on health outcomes. Sleep problems are seldom identified or addressed in cancer practice. The purpose of this review was to identify the evidence base for the assessment and management of cancer-related sleep disturbance (insomnia and insomnia syndrome) for oncology practice. The search of the health literature included grey literature data sources and empirical databases from June 2004 to June 2012. The evidence was reviewed by a Canadian Sleep Expert Panel, comprised of nurses, psychologists, primary care physicians, oncologists, physicians specialized in sleep disturbances, researchers and guideline methodologists to develop clinical practice recommendations for pan-Canadian use reported in a separate paper. Three clinical practice guidelines and 12 randomized, controlled trials were identified as the main source of evidence. Additional guidelines and systematic reviews were also reviewed for evidence-based recommendations on the assessment and management of insomnia not necessarily in cancer. A need to routinely screen for sleep disturbances was identified and the randomized, controlled trial (RCT) evidence suggests benefits for cognitive behavioural therapy for improving sleep quality in cancer. Sleep disturbance is a prevalent problem in cancer that needs greater recognition in clinical practice and in future research.
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Collaborating to embrace evidence-informed management practices within Canada's health system.
Strelioff, Wayne; Lavoie-Tremblay, Mélanie; Barton, Melissa
2007-01-01
In late 2005, 11 major national health organizations decided to work together to build healthier workplaces for healthcare providers. To do so, they created a pan-Canadian collaborative of 45 experts and asked them to develop an action strategy to improve healthcare workplaces. One of the first steps taken by members of the collaborative was to adopt the following shared belief statements to guide their thinking: "We believe it is unacceptable to fund, govern, manage, work in or receive care in an unhealthy health workplace," and, "A fundamental way to better healthcare is through healthier healthcare workplaces. This commentary provides an overview of the Quality Worklife-Quality Healthcare Collaborative action strategy. This strategy embraces the thinking set out by the lead papers in a recent Special Issue of Healthcare Papers (www.Longwoods.com/special_issues.php) focused on developing healthy workplaces for healthcare workers, and brings to Life evidence-informed management practices.
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Horie, Shigeo
2017-03-01
Drug-induced nephron-toxicity hampers the effective cancer chemotherapy and impairs the quality of life of the patients. Now eGFR has substituted Ccr for the estimation of renal function. The concepts and clinical significance of CKD and AKI have been established. These progress of clinical nephrology can improve the management of cancer chemotherapy. Clinical practice guidelines for the management of kidney disease in cancer survivors supports health-related professional to practice based on the evidence, which will enhance the efficacy of the treatment and QOL of the cancer survivors.
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Federal Register 2010, 2011, 2012, 2013, 2014
2012-12-10
... Quality Implementation Plans; California; South Coast Air Quality Management District; Prevention of... Implementation Plan (SIP) revision for the South Coast Air Quality Management District (SCAQMD or District... in a August 15, 2012 letter from the South Coast Air Quality Management District regarding specific...
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Camille Flinders; Daniel L. McLaughlin; Larry Korhnak; William J. Arthurs; Joan Ikoma; Matthew J. Cohen; Erik B. Schilling
2016-01-01
Watersheds dominated by forest cover typically have high quality water. In managed forests, fertilizers may be periodically applied during the growing period. The Florida Forest Service has developed Best Management Practices (BMPs) for managed forests to minimize the potential impacts of forestry operations, including fertilization, to forest streams and maintain ...
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Forestry best management practices relationships with aquatic and riparian fauna: A review
Warrington, Brooke M.; Aust, W. Michael; Barrett, Scott M.; Ford, W. Mark; Dolloff, C. Andrew; Schilling, Erik B.; Wigley, T. Bently; Bolding, M. Chad
2017-01-01
Forestry best management practices (BMPs) were developed to minimize water pollution from forestry operations by primarily addressing sediment and sediment transport, which is the leading source of pollution from silviculture. Implementation of water quality BMPs may also benefit riparian and aquatic wildlife, although wildlife benefits were not driving forces for BMP development. Therefore, we reviewed literature regarding potential contributions of sediment-reducing BMPs to conservation of riparian and aquatic wildlife, while realizing that BMPs also minimize thermal, nutrient, and chemical pollution. We reached five important conclusions: (1) a significant body of research confirms that forestry BMPs contribute to the protection of water quality and riparian forest structure; (2) data-specific relationships between forestry BMPs and reviewed species are limited; (3) forestry BMPs for forest road construction and maintenance, skid trails, stream crossings, and streamside management zones (SMZs) are important particularly for protection of water quality and aquatic species; (4) stream crossings should be carefully selected and installed to minimize sediment inputs and stream channel alterations; and (5) SMZs promote retention of older-age riparian habitat with benefits extending from water bodies to surrounding uplands. Overall, BMPs developed for protection of water quality should benefit a variety of riparian and aquatic species that are sensitive to changes in water quality or forest structure.
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40 CFR 35.2102 - Water quality management planning.
Code of Federal Regulations, 2010 CFR
2010-07-01
... 40 Protection of Environment 1 2010-07-01 2010-07-01 false Water quality management planning. 35... Administrator shall first determine that the project is: (a) Included in any water quality management plan being implemented for the area under section 208 of the Act or will be included in any water quality management plan...
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Verification of a quality management theory: using a delphi study.
Mosadeghrad, Ali Mohammad
2013-11-01
A model of quality management called Strategic Collaborative Quality Management (SCQM) model was developed based on the quality management literature review, the findings of a survey on quality management assessment in healthcare organisations, semi-structured interviews with healthcare stakeholders, and a Delphi study on healthcare quality management experts. The purpose of this study was to verify the SCQM model. The proposed model was further developed using feedback from thirty quality management experts using a Delphi method. Further, a guidebook for its implementation was prepared including a road map and performance measurement. The research led to the development of a context-specific model of quality management for healthcare organisations and a series of guidelines for its implementation. A proper model of quality management should be developed and implemented properly in healthcare organisations to achieve business excellence.
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USDA-ARS?s Scientific Manuscript database
To ensure current land use strategies and management practices are economically, environmentally, and socially sustainable, tools and techniques for assessing and quantifying changes in soil quality/health (SQ) need to be developed through rigorous research and potential use by consultants, and othe...
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Chronic Disease Management in Family Practice: Clinical Note.
1998-03-01
disease management in the family practice selling. This paper discusses chronic disease management in the family practice selling....Chronic disease management is the process of evaluating and treating a medical condition or disease state which can not be readily cured so as to...minimize it’s negative impact on the individual. Examples of chronic disease management include the treatment of hypertension, diabetes, osteoporosis
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Overview of practice management in child and adolescent psychiatry.
Schreter, Robert K
2010-01-01
The manager of a psychiatric practice must create and direct a clinical delivery system, design and oversee the administrative services necessary to support the system, and guide the business operations that contribute to its success. Regardless of the size of the practice, the psychiatrist administrator must handle seven core administrative responsibilities and oversee individual functions and capabilities within each domain. These responsibilities include practice development, clinical services management, medical office operations, clinical management, information management, business management, and risk management. This article provides a roadmap for creating and sustaining successful clinical and administrative endeavors. It can also be used by existing practices as an audit instrument to provide a snapshot of current capabilities so that strengths as well as opportunities for continued growth can be identified.